Udder health, conceptual construct, and uses of the term: A systematic review from 1962 to 2019.

Background and Aim: Udder health management is essential for the further development of milk production systems and public health. This process depends on the generation of knowledge regarding control, prevention, and promotion of health. In scientific literature, it is impossible to find a synthesis of the categories that would allow comprehension of the complex phenomenon udder health. Different research approaches have allowed this polysemic concept, described by some researchers as multifactorial and by philosophical perspectives as a social phenomenon, to be further studied. Thus, the objective of this systematic review was to systematize the conceptual categories of udder health and the use of the term in the original articles published in the scientific literature from the period 1962 to 2019. Materials and Methods: A systematic review with a broad approach was designed by applying the phases of identification, screening, selection, and inclusion criteria described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guide. An exhaustive search of original articles by specificity was carried out in the Science Direct, PubMed, Scielo, LILACS, and Google Scholar databases. The investigation was carried out on November 22, 2019. According to the inclusion criteria established, articles needed to be original studies, to be publications on bovine livestock, written in English, Spanish and Portuguese. Furthermore, the articles considered needed to tackle the term udder health so that its conceptual categorization could be extracted. Google Scholar patents and citations and articles removed from databases or not available were excluded from the study and those that, based on the reading of the complete text, considered the farming of animal species other than bovine. A qualitative synthesis of the year of publication, continent, approach, type of study, and conceptual category of udder health was carried out by calculating frequencies (Statistical Package for the Social Sciences version 24). Results: In total, 165 articles were included in the study. Eight conceptual categories, consolidated over time, were systematized, showing that udder health is not a static problem, and that science has been responding through the generation of new knowledge around conceptual categories as different udder health problems emerge. Conclusion: Culture and politics were two categories, related to all the others, that stood out in the results. These two categories were of great interest in countries advanced in milk production and in the implementation of udder health policies, which acknowledge the producer and other actors of the production chain as fundamental political actors for policies, decision-making processes, and public health care to be effective. The lack of synonyms for the term udder health (e.g., mastitis) may have led to the exclusion of important articles in each category. However, the constriction to the term udder health was intentional and aimed at constructing the concept. Udder health is hereby understood as a health-disease process, different from the term mastitis, which from its semantic origin, refers only to the disease process. According to this study, the concept can be understood through the categories of traditional epidemiology based on risk factors and disease; microbiology; genetics, resistance, and immunity; animal welfare; nutrition; organic production; culture; and politics.