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1.  Prevalence of clinical findings at examinations of young Swedish warmblood riding horses 
Soundness of an individual horse is important for animal welfare and owner economy. However, knowledge of health status in normal horse populations is limited due to lack of systematic health recordings. The aim of the investigation was to study the prevalence of veterinary clinical findings in 4-5-year-old Swedish warmblood riding horses, and their influence on overall health scores, where associations to future longevity has been indicated.
The prevalence of clinical findings in 8,281 horses examined during 1983–2005 was studied according to a standardised protocol and related to overall health scores in linear statistical models. Effects of sex, age, examination event and changes over time were included. In total, 49% of the horses had clinical findings of medical health (MED), 42% in hooves (HOOF) and 74% of palpatory orthopaedic health (PALP). However, only 6%, 3% and 24% had moderate or severe findings, of MED, HOOF and PALP, respectively. Flexion test reactions were reported in 21% of the horses (5% moderate/severe), heavily influencing the overall score (H2). One fifth of these horses also had findings of unprovoked lameness while 83% had PALP findings (44% with moderate/severe findings). Acute clinical signs, i.e. heat or soreness, had a large influence on the H2 score but were rare, whereas more common clinical findings had smaller effects on overall health. Large variations in recorded health results were observed among events. A decrease in findings has occurred since 1983, in particular for PALP findings.
Results of occurrence and relevance of evaluated clinical findings could be used for advice on preventive actions to keep horses sound, and possibly for benchmarking, and genetic evaluation of health traits. The distinct effect of event on recorded clinical findings emphasises that further harmonisation of veterinary examinations are desirable.
PMCID: PMC3764978  PMID: 23597257
Medical health; Orthopaedic health; Flexion test; Hoof; Clinical signs
2.  Genetic analysis of clinical findings at health examinations of young Swedish warmblood riding horses 
Soundness is important for welfare and utility of the riding horse. Musculoskeletal disorders are the most common causes of interruption in training and of culling. Despite great importance, heritability of a majority of health traits in horses has previously not been estimated. The objective was to perform genetic analyses of medical and orthopaedic health traits in young riding horses, including estimates of heritability and genetic correlations between health traits, and to reveal possibilities for genetic evaluation of stallions for progeny health.
The heritability of health traits was estimated using records from 8,238 Swedish warmblood riding horses examined as 4–5 year olds at the Riding Horse Quality Test in 1983–2005. The analyses were performed using multi-trait linear mixed animal models. The heritabilities of palpatory orthopaedic health (PALP), including effusion, swelling, heat, soreness and stiffness/atrophy, and hoof examination results (HOOF), of hoof shape and hoof wall quality, were 0.12 and 0.10, respectively. The genetic variation in these traits resulted in distinct health differences between progeny groups of stallions. The highest heritability among clinical signs of PALP was found for synovial effusions at 0.14. For systemic locations, joint related findings had the highest heritability; 0.13. The heritabilities of medical health and locomotion examination results were low, 0.02 and 0.04, respectively. A genetic improvement of health status has occurred over time but accounts only partly for the decrease in clinical findings of health during the studied period.
The genetic variation found in PALP and HOOF implies distinct differences between progeny groups. Thus, there are possibilities for improvement of these traits in the population through selection. The weak and non-significant correlation between PALP and HOOF suggests that both traits need to be selected for in practical breeding to improve both traits. Some genetic improvements over time have already been achieved, possibly due to regular stallion health inspections and an indirect selection for lifetime performance. For further improvements stallion breeding values for health may be introduced, based on RHQT examinations, complementary to present breeding values for performance.
PMCID: PMC3606462  PMID: 23510509
Medical health; Orthopaedic health; Flexion test; Hoof; Clinical signs; Heritability; Genetic correlation
4.  Integrating databases for research on health and performance in small animals and horses in the Nordic countries 
Acta Veterinaria Scandinavica  2011;53(Suppl 1):S4.
In a world of limited resources, using existing databases in research is a potentially cost-effective way to increase knowledge, given that correct and meaningful results are gained.
Nordic examples of the use of secondary small animal and equine databases include studies based on data from tumour registries, breeding registries, young horse quality contest results, competition data, insurance databases, clinic data, prescription data and hunting ability tests. In spite of this extensive use of secondary databases, integration between databases is less common. The aim of this presentation is to briefly review key papers that exemplify different ways of utilizing data from multiple sources, to highlight the benefits and limitations of the approaches, to discuss key issues/challenges that must be addressed when integrating data and to suggest future directions. Data from pedigree databases have been individually merged with competition data and young horse quality contest data, and true integration has also been done with canine insurance data and with equine clinical data. Data have also been merged on postal code level; i.e. insurance data were merged to a digitized map of Sweden and additional meteorological information added. In addition to all the data quality and validity issues inherent in the use of a single database, additional obstacles arise when combining information from several databases. Loss of individuals due to incorrect or mismatched identifying information can be considerable. If there are any possible biases affecting whether or not individuals can be properly linked, misinformation may result in a further reduction in power. Issues of confidentiality may be more difficult to address across multiple databases. For example, human identity information must be protected, but may be required to ensure valid merging of data. There is a great potential to better address complex issues of health and disease in companion animals and horses by integrating information across existing databases. The challenges outlined in this article should not preclude the ongoing pursuit of this approach.
PMCID: PMC3194123  PMID: 21999438
5.  Orthopaedic health status of horses from 8 riding schools - a pilot study 
Orthopaedic injury is the most common reason for lameness and wastage in sport and leisure horses. Studies on racehorses have shown differences in injury risk between trainers and training strategies. The aim was to study between riding school variation in orthopaedic health status by clinical examination and horses age, and control for change of examiner, in schools with previous high (n = 4) and low (n = 4) insurance utilisation.
Horses (n = 99) at 8 riding schools were examined for conformation, movement in all gaits, standing flexion tests and palpation by two veterinary surgeons (in some schools only one). Indexes of findings were created for total health, movements, limbs, conformation and back palpation.
Logistic regression analyses showed that findings increased with age (walk, trot, canter, conformation left hind limb, palpation fore limbs, hooves and flexion tests) or decreased with age (conformation right fore limb). Significant differences in findings were found between riding schools and examiner for seven and eight criteria each (partly overlapping). Increasing indexes were significantly associated with one examiner (total health, movements, back palpation), increasing age (total health, movements) or more time at the school (limbs). The back palpation index was highest at 5 < 8 years since acquisition.
The age distribution differed markedly between riding schools and age affected several types of findings. This, combined with the two opposite groups of insurance use, shows that schools with low insurance utilisation had previously been able to "avoid" using the insurance, maybe even on similar types of cases if these were more promptly/differently handled indicating differential coverage of disease data in the insurance database. The examiner effect was clearly demonstrated. For some findings, the amount of clinical observations differed by school, even when examiner and age was adjusted for. Most findings were of minor importance, including slight movement irregularities. Orthopaedic status varies between riding schools. We hypothesize that this is associated with management factors that warrant further study.
PMCID: PMC2939618  PMID: 20727185
6.  Validation of computerized diagnostic information in a clinical database from a national equine clinic network 
Computerized diagnostic information offers potential for epidemiological research; however data accuracy must be addressed. The principal aim of this study was to evaluate the completeness and correctness of diagnostic information in a computerized equine clinical database compared to corresponding hand written veterinary clinical records, used as gold standard, and to assess factors related to correctness. Further, the aim was to investigate completeness (epidemiologic sensitivity), correctness (positive predictive value), specificity and prevalence for diagnoses for four body systems and correctness for affected limb information for four joint diseases.
A random sample of 450 visits over the year 2002 (nvisits = 49,591) was taken from 18 nation wide clinics headed under one company. Computerized information for the visits selected and copies of the corresponding veterinary clinical records were retrieved. Completeness and correctness were determined using semi-subjective criteria. Logistic regression was used to examine factors associated with correctness for diagnosis.
Three hundred and ninety six visits had veterinary clinical notes that were retrievable. The overall completeness and correctness were 91% and 92%, respectively; both values considered high. Descriptive analyses showed significantly higher degree of correctness for first visits compared to follow up visits and for cases with a diagnostic code recorded in the veterinary records compared to those with no code noted. The correctness was similar regardless of usage category (leisure/sport horse, racing trotter and racing thoroughbred) or gender.
For the four body systems selected (joints, skin and hooves, respiratory, skeletal) the completeness varied between 71% (respiration) and 91% (joints) and the correctness ranged from 87% (skin and hooves) to 96% (respiration), whereas the specificity was >95% for all systems. Logistic regression showed that correctness was associated with type of visit, whether an explicit diagnostic code was present in the veterinary clinical record, and body system. Correctness for information on affected limb was 95% and varied with joint.
Based on the overall high level of correctness and completeness the database was considered useful for research purposes. For the body systems investigated the highest level of completeness and correctness was seen for joints and respiration, respectively.
PMCID: PMC2801496  PMID: 20003256
7.  Insurance data for research in companion animals: benefits and limitations 
The primary aim of this article is to review the use of animal health insurance data in the scientific literature, especially in regard to morbidity or mortality in companion animals and horses. Methods and results were compared among studies on similar health conditions from different nations and years. A further objective was to critically evaluate benefits and limitations of such databases, to suggest ways to maximize their utility and to discuss the future use of animal insurance data for research purposes. Examples of studies on morbidity, mortality and survival estimates in dogs and horses, as well as neoplasia in dogs, are discussed.
We conclude that insurance data can and should be used for research purposes in companion animals and horses. Insurance data have been successfully used, e.g. to quantify certain features that may have been hitherto assumed, but unmeasured. Validation of insurance databases is necessary if they are to be used in research. This must include the description of the insured population and an evaluation of the extent to which it represents the source population. Data content and accuracy must be determined over time, including the accuracy/consistency of diagnostic information. Readers must be cautioned as to limitations of the databases and, as always, critically appraise findings and synthesize information with other research. Similar findings from different study designs provide stronger evidence than a sole report. Insurance data can highlight common, expensive and severe conditions that may not be evident from teaching hospital case loads but may be significant burdens on the health of a population.
PMCID: PMC2777155  PMID: 19874612
8.  Herd and cow characteristics affecting the odds of veterinary treatment for disease – a multilevel analysis 
Research has indicated that a number of different factors affect whether an animal receives treatment or not when diseased. The aim of this paper was to evaluate if herd or individual animal characteristics influence whether cattle receives veterinary treatment for disease, and thereby also introduce misclassification in the disease recording system.
The data consisted mainly of disease events reported by farmers during 2004. We modelled odds of receiving veterinary treatment when diseased, using two-level logistic regression models for cows and young animals (calves and heifers), respectively. Model parameters were estimated using three procedures, because these procedures have been shown, under some conditions, to produce biased estimates for multi-level models with binary outcomes.
Cows located in herds mainly consisting of Swedish Holstein cows had higher odds for veterinary treatment than cows in herds mainly consisting of Swedish Red cows. Cows with a disease event early in lactation had higher odds for treatment than when the event occurred later in lactation. There were also higher odds for veterinary treatment of events for cows in January and April than in July and October. The odds for veterinary treatment of events in young animals were higher if the farmer appeared to be good at keeping records. Having a disease event at the same date as another animal increased the odds for veterinary treatment for all events in young animals, and for lameness, metabolic, udder and other disorders, but not for peripartum disorders, in cows. There were also differences in the odds for veterinary treatment between disease complexes, both for cows and young animals.
The random effect of herd was significant in both models and accounted for 40–44% of the variation in the cow model and 30–46% in the young animal model.
We conclude that cow and herd characteristics influence the odds for veterinary treatment and that this might bias the results from studies using data from the cattle disease database based on veterinary practice records.
PMCID: PMC2736961  PMID: 19698112
9.  Evaluation of dog owners' perceptions concerning radiation therapy 
External radiation therapy (RT) has been available for small animals in Sweden since 2006. This study was designed to obtain information on owner experiences and perceptions related to RT of cancer in their dogs. Another survey was used to determine the attitudes about use of RT in a group of Swedish veterinarians. Their responses were analyzed and compared to their level of knowledge of oncology and RT.
Owners of all dogs (n = 23) who had undergone RT for malignancy at Jönköping Small Animal Hospital between March 2006 to September 2007 were interviewed. A questionnaire was given to a selected group of veterinarians.
All 23 owners responded. All owners thought that their dog did well during RT and most that their dog was also fine during the following phase when acute RT-related skin reactions occur and heal. Three owners stated that their dog had pain that negatively impacted quality of life because of radiation dermatitis. Five owners reported that RT positively impacted quality of life of the dog during the first weeks after RT because palliation was achieved. The owners were not disturbed by the efforts required of them. All but one owner (22 of 23) stated that they would make the same decision about RT again if a similar situation occurred. The most important factor for this decision was the chance to delay occurrence of tumour-related discomfort. The chance for cure was of less importance but still essential, followed by expected side effects. Time commitments, travel, number of treatments required and financial cost; all had low impact. The veterinarian survey showed that less background knowledge of small animal oncology/RT was associated with more negative expectations of RT for small animals.
The results show that for these owners, RT was a worthwhile treatment modality and that the discomfort for the dog was manageable and acceptable relative to the benefits. Improved continuing education about small animal RT in Sweden will likely result in increased evidence-based and positive treatment recommendations concerning RT by veterinarians.
PMCID: PMC2687441  PMID: 19402904
10.  Radiographic parameters for diagnosing sand colic in horses 
Ingestion of sand can cause colic, diarrhoea and weight loss in horses, but these signs are unspecific and can have many other causes. The amount of sand that induces disease may vary between individuals. To avoid over-diagnosing, it is important to determine the amount of sand that can be found in horses without clinical signs of gastrointestinal disease. The aim of this study was to use previously suggested parameters for establishing a radiographic diagnosis of sand colic, and compare these findings between a sand colic group and a control group.
Abdominal radiographs were obtained in 30 horses with a complaint unrelated to the gastrointestinal tract. In addition, archived abdominal radiographs of 37 clinical cases diagnosed with sand impaction were investigated. The size of the mineral opacity indicative of sand in the abdomen was measured and graded according to a previously published protocol based on height and length. Location, homogeneity, opacity and number of sand accumulations were also recorded.
Twenty out of 30 control horses (66%) had one or more sand accumulations. In the present study; height, length and homogeneity of the accumulations were useful parameters for establishing a diagnosis of sand colic. Radiographically defined intestinal sand accumulation grades of up to 2 was a common finding in horses with no clinical signs from the gastrointestinal tract whereas most of the clinical cases had much larger grades, indicating larger sand accumulations.
Further work to establish a reliable grading system for intestinal sand content is warranted, but a previously proposed grading system based on measurements of height and length may be an alternative for easy assessment of sand accumulations in the meantime. The present study indicates that a grade 1 – 2 sand accumulation in the intestine is a frequent finding in horses. When working up a case with clinical signs from the gastrointestinal tract, one or more accumulations of this grade should not be considered the cause until other possibilities have been ruled out.
PMCID: PMC2467425  PMID: 18554381
11.  Sebaceous adenitis in Swedish dogs, a retrospective study of 104 cases 
Sebaceous adenitis (SA) is an uncommon, immune mediated skin disease in dogs. The aim was to retrospectively investigate SA in dogs in Sweden with respect to breed, sex and age distribution. A second aim was to retrospectively compare clinical signs in dogs with generalized SA and to estimate the survival after diagnosis in the English springer spaniel, standard poodle and the akita.
In total 34 Swedish veterinarians contributed with 104 clinically and histologically verified SA cases. Breed, gender and age at diagnosis were registered for each case. The degree of clinical signs at time for diagnosis and at follow-up and information about treatments, concurrent diseases and euthanasia were recorded for the springer spaniels, standard poodles and akitas using a standardized questionnaire.
A total of 104 cases of SA were included; most cases were recorded for the springer spaniel (n = 25), standard poodle (n = 21) and the akita (n = 10). These three breeds, together with the lhasa apso and the chow-chow, were the most common when national registry data from the Swedish Board of Agriculture and Swedish Kennel Club were considered. The mean age at diagnosis was 4.8 years. The proportion of males was 61%. When the springer spaniels, standard poodles and the akitas with generalized signs were compared (n = 51), the spaniels showed significantly more severe clinical signs than the poodles at diagnosis regarding alopecia, seborrhoea, pyoderma and the overall severity of clinical signs. At follow-up, the degree of clinical signs for otitis externa and pyoderma differed significantly between the breeds. The estimated median survival time was 42 months.
In dogs where data regarding survival was available at the end of the study (n = 44), SA was reported to be the reason for euthanasia in 14 dogs, whereof 7 within 24 months after diagnosis.
The result of this study implicates that the English springer spaniel is a breed predisposed to SA and that it has more severe clinical signs than the standard poodle. A large proportion of the dogs (spaniel, poodle and akita) investigated regarding survival were reported to have been euthanized to great extent due to the disease.
PMCID: PMC2412885  PMID: 18501018
12.  Canine atopic dermatitis: validation of recorded diagnosis against practice records in 335 insured Swedish dogs 
A cross-sectional study of insured Swedish dogs with a recorded diagnosis of canine atopic dermatitis (CAD) was performed. In order to validate the correctness of this specific diagnosis in the insurance database, medical records were requested by mail from the attending veterinarians. All dogs with a reimbursed claim for the disease during 2002 were included in the original study sample (n = 373). Medical records were available for 335 individuals (response rate: 89.8%). By scrutinizing the submitted records it was determined that all dogs had been treated for dermatologic disease, and that 327 (97.6%) could be considered to have some allergic skin disease. However, as information regarding dietary trial testing was missing in many dogs the number that were truly atopic could not be determined. The clinical presentation and nature of test diet for dogs with or without response to dietary trial testing was compared for a subset of 109 individuals that had undergone such testing. The only significant difference between these two groups was that the proportion of dogs with reported gastrointestinal signs was higher in the group that subsequently responded to a diet trial. In conclusion, the agreement between the recorded diagnosis in the insurance database and the clinical manifestations recorded in the submitted medical records was considered acceptable. The concern was raised that many attending veterinarians did not exclude cutaneous adverse food reactions before making the diagnosis of CAD.
PMCID: PMC1553461  PMID: 16987404

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