1. Web-based cohort studies The CARE about laminitis initiative Danica (Dee) Pollard PhD student

2. Outline  Equine laminitis  Web-based cohort studies  CARE about laminitis project

3. Associated processes 2. Systemic inflammation/ gastrointestinal disease  Carbohydrate overload  Colic  Bacterial toxins  Metritis/retained placenta 3. Mechanical overload/concussion  Severe lameness in one leg  Concussion  Equine Cushing’s Syndrome  Equine Metabolic Syndrome (EMS)  Obesity  Insulin resistance (IR)  Breed type 1. Underlying endocrine (hormonal) disorders Lamellae stretch and elongate Lamellae separate

4. Clinical signs Prominent digital pulse & heat Changes in stance & gait Image WHW Lameness Changes in foot anatomy Image Dr J. Ireland Image Dr S. Collins Abnormal hoof growth Image Dr J. Ireland

5. Equine laminitis Epidemiology investigates disease at a population level (how often disease occurs and why?) What proportion of horses & ponies are affected by laminitis? Which factors contribute to laminitis developing/not developing? Can we change these factors to reduce the risk of laminitis (are they modifiable)?

6. Web-based cohort studies  Determine proportion of animals that develop disease (disease frequency) Study cohort e.g. British horses & ponies Start End

7. Frequency of laminitis in Britain Reported estimates cover large range, difficult to estimate “true” frequency of disease Estimate of 23.5% in a population of rescue animals on East Anglian Farm (2010) Estimate of 0.5% in a sample of veterinary- attended population (2013)

8. Web-based cohort studies  Determine proportion of animals that develop disease (disease frequency)  Do proportions differ between animals exposed to certain (risk) factors? Study cohort e.g. British horses & ponies Start End

9. Risk factors Sore after shoeing or trimming Box rest Rapid weight gain Decreasing height New access to grass Season - winter & summer vs. spring and hours of sunshine Increasing time since last worming Previous laminitis history Existing endocrine disorder Feeding of supplements Transport Increased risk Decreased risk Sex – mares vs. geldings

10. Web-based cohort studies  Relatively new to animal health research  Automation  Visual & audio aids  Control what respondents view  Quicker return  More economic for larger cohorts  However…  Should still have plan B for when technology not accessible/compatible  Still maintain personal touch where possible

11. Web-based cohort studies  Reach much greater  Use of social media for free advertising & sharing  Data collection platform (website)  Create secure log in area for members  Used for regular updates  Educational material  Help with recruitment & retention of study members

12. CARE about laminitis 1. Estimate frequency of owner-reported laminitis 3. Develop evidence-based management strategies for the control and prevention of laminitis 2. Further investigate associations between modifiable risk factors and laminitis

13. CARE about laminitis website www.careaboutlaminitis.org.uk 1.Register & submit baseline questionnaire 2.Return monthly to update questionnaire 3.Monitor weight & condition using online weight tracker 4.Submit a Laminitis Reporting Form in event of laminitis

14. CARE about Laminitis > 3000 horses & ponies Aug 2014 Aug 2015Aug 2016

15. CARE about Laminitis > 3000 horses & ponies Aug 2014 Aug 2015Aug 2016

16. CARE about Laminitis > 3000 horses & ponies Aug 2014 Aug 2015Aug 2016 Laminitis case – which factors contributed to laminitis occurring? No laminitis – which factors contributed to laminitis NOT occurring?

17. CARE about Laminitis Vital to collect information from both animals that will and will not develop laminitis - owners of all horses and ponies, irrespective of their animal’s history of laminitis, are encouraged to participate

18. CARE about Laminitis Current member stats Member count: 400 Horse & pony count: 570

19. CARE about Laminitis Dee Pollard at Animal Health Trust danica.pollard@aht.org.uk 01638 751000 (Ext: 1506)