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Chronic physical illnesses in patients with schizophrenia spectrum disorders are independently associated with higher rates of psychiatric rehospitalization; a cross-sectional study in Croatia
- I. Filipcic, I. Simunovic Filipcic, E. Ivezic, K. Matic, N. Tunjic Vukadinovic, S. Vuk Pisk, D. Bodor, Z. Bajic, M. Jakovljevic, N. Sartorius
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- Journal:
- European Psychiatry / Volume 43 / June 2017
- Published online by Cambridge University Press:
- 23 March 2020, pp. 73-80
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Background:
Increased physical morbidity in patients with schizophrenia spectrum disorders (SSDs) is well documented. However, much less is known about the association between somatic comorbidities and psychosis treatment outcomes.
Subjects and methods:This cross-sectional study, nested within the larger frame of a prospective cohort study, was done in 2016 at Psychiatric Hospital Sveti Ivan, Zagreb, Croatia. Data were collected on a consecutive sample of 301 patients diagnosed with schizophrenia spectrum disorders who achieved a stable therapeutic dosage. Key outcome was the number of psychiatric rehospitalizations since diagnosis of the primary psychiatric illness. Predictors were number of physical and psychiatric comorbidities. By robust regression, we controlled different clinical, sociodemographic, and lifestyle confounding factors.
Results:The number of chronic somatic comorbidities was statistically significantly associated with a larger number of psychiatric rehospitalizations, even after the adjustment for number of psychiatric comorbidities and large number of other clinical, sociodemographic, and lifestyle variables.
Conclusions:Chronic somatic comorbidities are associated with higher rates of psychiatric rehospitalization independently of psychiatric comorbidities and other clinical, sociodemographic, and lifestyle factors. Therefore, to treat psychosis effectively, it may be necessary to treat chronic somatic comorbidities promptly and adequately. Chronic somatic comorbidities should be considered equally important as the SSD, and should be brought to the forefront of psychiatric treatment and research with the SSD as one entity. The integrative approach should be the imperative in clinical practice.
GERD is associated with the outcome of MDD treatment
- K. Matić, I. Šimunović Filipčić, Ž. Bajić, I. Filipčić
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S478
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Introduction
Gastroesophageal reflux disease (GERD) is more prevalent among patients with major depressive disorder (MDD) than in general population, and vice versa. Bidirectional association of GERD and MDD is well documented. Although protective effect for gastric symptoms has been indicated for several antidepressants like trazodone, citalopram, fluoxetine, mirtazapine or fluvoxamine, these findings are sometimes contradictory. Similar may be claimed for antidepressive effect of some proton pump inhibitors. We decided to examine the association of GERD with the long-term efficacy of MDD treatment.
ObjectiveTo examine the association of GERD and efficacy of MDD treatment.
MethodsThis nested cross-sectional study was done during 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 1008 psychiatric patients. Key outcome was the number of psychiatric rehospitalizations since the first diagnosis of MDD. Predictor was patient-self-declared diagnosis of GERD. Covariates controlled by multivariate analysis of covariance were sex, age, duration of MDD in years, education, marital status, number of household members, work status, clinical global impression scale–severity of MDD at diagnosis, treatment with tricyclic antidepressants (TCA), selective serotonin reuptake inhbitors (SSRI), serotonin-norephinephrine reuptake inhibitors (SNRI), noradrenergic and specific serotonergic (NaSSA) and antipsychotics.
ResultsMDD patients with GERD had significantly larger number of psychiatric rehospitalizations (mean = 5.4 (SD 6.82)) than MDD patients with no GERD (mean = 3.1 (SD 4.45)). After adjustment for all covariates, GERD significantly moderated the efficacy of treatment of MDD (P = 0.048; η2 = 0.05) (Figure 1).
ConclusionTo treat MDD effectively we should treat GERD as well.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Early solid additional feeding of suckling rabbits from 3 to 15 days of age
- L. Kacsala, Zs. Szendrő, Zs. Gerencsér, I. Radnai, M. Kovács, R. Kasza, I. Nagy, M. Odermatt, T. Atkári, Zs. Matics
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Studies have shown that nutrient requirement of suckling kits is not satisfied, but they can be fed a double quantity of milk (double nursing) resulting in improved BW and weight gain. The aim of our trials was to give additional solid feed during the early suckling period (3 to 15 days of age) when rabbit kits drink exclusively milk. Two experiments were conducted with animals from Pannon Rabbit Breeding Program. In experiment 1 (n=77 does, 734 kits) the does received commercial feed (C) or C pellet supplemented with 0.2 g powdered thyme/kg (CT). Within both dietary groups of the does three groups of litters were formed: no additional solid creep feeding (N); soya bean-based pellet (S); S pellet with 1% added powdered thyme (ST). In group S and ST, cylinder-shaped solid pellets were made. At the beginning (3 days of age) two pieces of pellets were placed daily into the nestbox after nursing. Later on it was increased to six pellets till 15 days of age. The kits consumed the additional solid feed (S and ST), however, it did not affect the BW, weight gain or survival. In experiment 2 (n=30 does, 240 kits) all does consumed commercial feed. The additional feed for kits was based on commercial piglet feed. Three groups were formed: the litters in control group were fed no additional solid feed (K), kits were fed additionally with pellets (8 mm of diameter) based on piglet feed powder, pellet adhesive and water (PI), and extra glycerin powder was added to the mixture of piglet feed powder and water (PG). The experiment lasted from the age of 3 days till 21 days. At the beginning six pellets were placed on the nest material. Later on the amount was gradually increased to 24 pellets till age of 15 days. The kits consumed the pellets. The BW of PI group differed from group PG at age of 5, 9, 12 and 21 days by +7.3%, +6.5%, +5.9%, +4.8%, respectively (P<0.05) and from group K at age of 12 days by +5.9% (P< 0.05). The differences were more expressed at age of 16 and 19 days in favour of group PI (from K by +7.1%, +6.9% and from PG by +5.9%, +5 8%, respectively, P<0.01) and at 21 days of age (from K by +6.2%, P<0.01). To find appropriate composition of creep feed for kits further studies are needed.
Performance and welfare of rabbit does in various caging systems
- A. Mikó, Zs. Matics, Zs. Gerencsér, M. Odermatt, I. Radnai, I. Nagy, K. Szendrő, Zs. Szendrő
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The objective of the study was to compare production and welfare of rabbit does and their kits housed in various types of cages. Female rabbits were randomly allocated to four groups with the following cage types: CN: common wire-mesh flat-deck cage, without footrest; CF: cage similar to the CN but with plastic footrest; ECWP: enlarged cage with wire-mesh platform; and ECPP: extra enlarged cage with plastic-mesh platform. All does were inseminated on the same day, 11 days after kindlings. Reproductive performance was evaluated during the first five consecutive kindlings. Severity of sore hocks was scored at each insemination. Location preference of the does and the platform usage of their kits were evaluated. Kindling rate, litter size (total born, born alive, alive at 21 and 35 days) and kit mortality were not significantly influenced by the cage types. The litter weight at 21 days was higher in ECWP and ECPP cages than in the CF group (3516, 3576 and 3291 g, respectively; P<0.001), and at 35 days the difference was only significant between the groups ECPP and CF (8712 and 8060 g, respectively, P<0.05). At 21 and 35 days of age, the kits were heavier in large (ECWP and ECPP) than in conventional cages (CF and CN) (P<0.001). At the fifth insemination, the percentage of rabbits with sore hocks’ score of 1 to 2 (0=intact foot pads; 1=no hairs, callus formed, <2.5 cm; 2=no hairs, callus formed, >2.5 cm) and 3 to 4 (3=callus opened, cracks present; 4=wounds) were 58%, 60%, 78% and 48%, and 0%, 5%, 0% and 48% in groups ECPP, ECWP, CF and CN, respectively. Higher number of daily nest visits was observed for CF does than for ECWP does (12.5 v. 5.9; P<0.05). The frequency of multiple nursing events (>2/day) was higher in the CF group than in the ECWP group (12.1 v. 3.2%; P<0.01). Within large cages, the does were observed on the platform more frequently in the ECPP cages compared with the ECWP cages (56.9% v. 31.7%; P<0.001). Similarly, 2.7% and 0.2% of kits at 21 days of age, and 33.2% and 5.2% of kits at 28 days of age, were found on the platforms of ECPP and ECWP cages, respectively. In conclusion, cages larger than the conventional ones improved kits’ weaning weight, plastic footrests and plastic-mesh platforms in conventional and/or large cages reduced sore hocks’ problems, plastic-mesh platforms were more used by both does and kits compared with the wire-mesh platforms.
Comparison of performance and welfare of single-caged and group-housed rabbit does
- Zs. Szendrő, A. Mikó, M. Odermatt, Zs. Gerencsér, I. Radnai, B. Dezséry, É. Garai, I. Nagy, K. Szendrő, Zs. Matics
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Although rabbit does are generally single housed on rabbit farms worldwide, it has been suggested by some specialists and recommendation of organic rabbit production systems that group housing of does is more comfortable and similar to the living conditions of the European wild rabbits. The aim of this experiment was to compare production of single-caged (S) and group-housed does (G). The S does were housed in commercial rabbit cages (floor area 0.32 m2 and 0.3 m high). In treatment G, four does and one buck were housed in four pens measuring 7.7 m2 (half of the floor was deep litter and the other half was plastic slat), with four nest boxes in each pen (n = 16). In treatment S, approximately half of the does (n = 18) were inseminated 2 days after kindling (S-33), whereas in the remaining does (n = 16) AI was done 11 days after kindling (S-42). A single-batch system (all of the does in the group were inseminated on the same day) was used in both S treatments. Kindling rates were 77.6%, 85.2% and 45.6% in treatments S-33, S-42 and G, respectively (P < 0.05). During the experiment, the percentage of does that kindled 0, 1, 2, 3, 4 and 5 times were 17%, 25%, 17%, 25%, 17% and 0% (G); 0%, 0%, 0%, 8%, 69% and 23% (S-33); and 0%, 0%, 17%, 58% and 25% (S-42, in this treatment does had a maximum of four kindlings). There were no significant differences among treatments for litter size. In treatments S-33, S-42 and G, suckling mortality was 14.0%, 15.2% and 38.5%, respectively (P < 0.001); survival of does was 71%, 81% and 50% (P = 0.084); and faecal corticosterone concentrations were 61, 54 and 175 nmol/g (P < 0.001). The high mortality of kits was associated with stress and aggressive behaviour of does, including scratching, biting or killing the kits, which resulted in the high rates of mortality and culling, as well as shorter lifespan of does. Because of high stress, increased mortality and morbidity, and low productivity, group housing of rabbit does resulted in poorer animal welfare and increased production costs, and therefore is not recommended.
Effect of different weaning ages (21, 28 or 35 days) on production, growth and certain parameters of the digestive tract in rabbits
- M. Kovács, A. Bónai, Zs. Szendrő, G. Milisits, H. Lukács, J. Szabó-Fodor, G. Tornyos, Zs. Matics, F. Kovács, P. Horn
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The effect of different weaning ages, that is, 21 (G21), 28 (G28) or 35 (G35) days, on growth and certain parameters of the digestive tract was examined in rabbits to assess the risk of early weaning attributable to the less-developed digestive system. On days 35 and 42, G35 rabbits had 10% to 14% and 10% higher BW, respectively (P < 0.05), than those weaned at days 21 and 28. In the 4th week of life, early weaned animals had 75% higher feed intake than G28 and G35 rabbits (P < 0.05). The relative weight of the liver increased by 62% between 21 and 28 days of age, and thereafter it decreased by 76% between 35 and 42 days of age (P < 0.05), with G21 rabbits having 29% higher weight compared with G35 animals on day 35 (P < 0.05). The relative weight of the whole gastrointestinal (GI) tract increased by 49% and 22% after weaning in G21 and G28 rabbits, respectively (P < 0.05). On day 28, the relative weight of the GI tract was 19% higher in G21 than in G28 rabbits, whereas on day 35 G21 and G28 animals had a 12% heavier GI tract compared with G35 rabbits (P < 0.05). Age influenced the ratio of stomach, small intestine and caecum within the GI tract; however, no effect of different weaning age was demonstrated. The pH value of the stomach and caecum decreased from 5.7 to 1.6 and from 7.1 to 6.3, respectively, whereas that of the small intestine increased from 6.8 to 8.4 (P < 0.05); the differences between groups were not statistically significant. Strictly anaerobic culturable bacteria were present in the caecum in high amounts (108), already at 14 days of age; no significant difference attributable to weaning age was demonstrable. The concentration of total volatile fatty acids (tVFA) was higher in G21 than in G28 and G35 throughout the experimental period (P < 0.05). The proportion of acetic and butyric acid within tVFA increased, whereas that of propionic acid decreased, resulting in a C3 : C4 ratio decreasing with age. Early weaning (G21) resulted in higher butyric acid and lower propionic acid proportions on day 28 (P < 0.05). No interaction between age and treatment was found, except in relative weight of the GI tract and caecal content. In conclusion, early weaning did not cause considerable changes in the digestive physiological parameters measured, but it resulted in 10% lower growth in rabbits.
Use of different areas of pen by growing rabbits depending on the elevated platforms’ floor-type
- Zs. Szendrő, Zs. Matics, M. Odermatt, Zs. Gerencsér, I. Nagy, K. Szendrő, A. Dalle Zotte
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The addition of platforms to rabbit cages increases their accessible area and provides rabbits greater freedom and mobility. Different types of platforms enable rabbits to situate themselves where they are most comfortable. The objective of this experiment was to analyse preference of growing rabbits between different areas of the pen depending on the elevated platforms’ floor-type. Pens with a basic area of 0.84 m2 were equipped with platforms of 0.42 m2. Three types of flooring of the elevated platforms were used as treatments: deep-litter floor and an open wire-net floor (Experiment 1), and a deep-litter floor and a wire-net floor with a manure tray beneath it (Experiment 2). Growing rabbits (n = 168; 42 per treatment) between the ages of 5 and 11 weeks were studied, based on 24 h video recordings from infra-red cameras (one recording per week) applying scan sampling method with a frequency of 30 min. When the platform was deep-litter, significantly (P < 0.001) more rabbits used the area under the platform (53.7% and 54.3% in Experiments 1 and 2, respectively) than stayed on the platform (16.7% and 7.6%). In treatments of wire-net platform with and without tray beneath the platform also significantly (P < 0.001) more rabbits stayed under the platform (43.7% and 34.7%, respectively) than on the platform (19.5% and 29.9%, respectively). The differences from the expected 33.3% staying on the platform or under the platform were significant at least at the level of P < 0.05. The results show that the wire-net platform with the manure tray provides the optimal environment as it leads to the rabbits spreading themselves more evenly in the pen (i.e. the platform expands available floor area) without the risk of soiling from above, and without adverse effects on heat dissipation, and with the possibility of seeking cover when desired.
Subsequent effect of subacute T-2 toxicosis on spermatozoa, seminal plasma and testosterone production in rabbits
- M. Kovács, G. Tornyos, Zs. Matics, L. Kametler, V. Rajli, Zs. Bodnár, M. Kulcsár, Gy. Huszenicza, Zs. Keresztes, S. Cseh
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Pannon White (n = 12) male rabbits (weight: 4050 to 4500 g, age: 9 months) received 2 ml of a suspension containing purified T-2 toxin by gavage for 3 days. The daily toxin intake was 4 mg/animal (0.78 to 0.99 mg/kg body weight (BW)). Control animals (n = 12) received toxin-free suspension for 3 days. Since a feed-refusal effect was observed on the second day after T-2 administration, a group of bucks (n = 10) were kept as controls (no toxin treatment) but on a restricted feeding schedule, that is, the same amount of feed was provided to them as was consumed by the exposed animals. On day 51 of the experiment (i.e. 48 days after the 3-day toxin treatment), semen was collected, and pH, concentration, motility and morphology of the spermatozoa, as well as concentration of citric acid, zinc and fructose in the seminal plasma, were measured. After gonadotropin-releasing hormone (GnRH) analogue treatment, the testosterone level was examined. One day of T-2 toxin treatment dramatically decreased voluntary feed intake (by 27% compared to control, P < 0.05) and remained lower (P < 0.05) during the first 2 weeks after the withdrawal of the toxin. BW of the contaminated rabbits decreased by 88% on days 17 and 29 compared to controls (P < 0.05). No effect of toxin treatment was detected on pH and quantity of the semen or concentration of spermatozoa. The ratio of spermatozoa showing progressive forward motility decreased from 65% to 53% in the semen samples of toxin-treated animals compared to controls (P > 0.05). The ratio of spermatozoa with abnormal morphology increased (P < 0.05) in the ejaculates collected from the toxin-treated animals. T-2 toxin applied in high doses decreased the concentration of citric acid in seminal plasma (P < 0.05). No effect of T-2 toxin on the concentrations of the other seminal plasma parameters (fructose and zinc) was observed. T-2 toxin decreased the basic testosterone level by 45% compared to control (P < 0.01) and resulted in lower (P < 0.05) GnRH-induced testosterone concentration. Feed restriction, that is, less nutrient intake, resulted in more morphologically abnormal spermatozoa in the semen, but it did not cause significant loss in BW, motility of the spermatozoa, composition of the seminal plasma or testosterone concentration – its effect needs further examination.
Effect of nursing by two does on the performance of sucking and growing rabbits
- Zs. Szendrö, T. Gyarmati, L. Maertens, E. Biró-Németh, I. Radnai, G. Milisits, Zs. Matics
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- Journal:
- Animal Science / Volume 74 / Issue 1 / February 2002
- Published online by Cambridge University Press:
- 18 August 2016, pp. 117-125
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- February 2002
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Five hundred and eighty-four Pannon White kits of 73 newborn litters were submitted to one of five treatments. Control litters (SS) were nursed once a day for 35 days post partum (traditional method of nursing). DD litters were raised by two does and the kits were nursed both in the morning and in the evening until day 35 post partum. DS litters were nursed twice a day for 23 days, and then once a day until weaning at 35 days. Part of the DS litters were nursed at 08:00 and 20:00 h (i.e. every 12 h, DS12), the rest were nursed at 08:00 and at 16:00 h (DS8). Kits of the fifth treatment (D0) were nursed twice a day until day 23, and then immediately weaned.
Rabbit kits that were nursed twice a day (DD, DS12, DS8, D0) consumed on average 1·89 more milk compared with SS individuals until day 23 (overall treatment effect P < 0·001). The 21-day body weight of these young was 1·7 times greater than that of the SS kits (overall P < 0·001). D0 rabbits were weaned early and their growth curve showed a slight break at this point. However, they compensated for this lag by the end of the fattening period. SS rabbits and DD ones were respectively the first and the last to start consuming solid food. The food consumption of DS rabbits was similar to that of DD until day 23 and from then until day 35 it was not significantly different from that of SS. After having been weaned on day 23, D0 kits consumed only very small quantities of pellets for 2 days. Afterwards their food intake increased abruptly. Rabbits that were nursed twice a day (DD, DS12, DS8 and D0) consumed more food as compared with the SS individuals throughout the total period of fattening (157 v. 137 g/day; P < 0·05). The weight at 10 weeks of age was 2·49 v. 2·88 kg (overall P < 0·001), respectively for SS and doublenursed (DD, DS, D0) rabbits. Nursing twice a day did not affect dressing proportion but the proportion of the carcass in the front part of the body decreased slightly (318 v. 323 g/kg; P < 0·05) while that in intermediate part increased (321 v. 307 g/kg; P < 0·05). Nevertheless, rabbits that were nursed twice a day had more (P < 0·05) perirenal + scapular fat and produced heavier livers. Total fat content of the empty body, however, was not significantly higher, with the one exception of the DD rabbits which had higher levels than any other group. The results of our experiment show clearly that the growth potential of rabbit kits is strongly limited by the milk availability during the first weeks post partum.
The Judge and the Conflict Rule Reflections on Psychological Aspects of the Approach to the Conflict Rule
- Ž. Matić
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- Journal:
- Netherlands International Law Review / Volume 39 / Issue S1 / October 1992
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- 21 May 2009, pp. 227-230
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- October 1992
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The above quotation from Batiffol appears in the part of his book where the xenophobic approach to the legal position of a foreigner in ancient Greece is debated. Although centuries have passed since those times, that attitude is still deeply ingrained in human nature. The field of law had not escaped it either. In spite of the fact that no judge would be willing to admit it, it still influences many of them, at least unconsciously, albeit that they are honest, decent and learned persons. Only those of them who have been for a considerable time immersed in problems of the application of foreign law have been able, to a greater or lesser degree, to eliminate it. In this short essay I shall discuss briefly, without in any way attempting to be exhaustive, some of the aspects of the problem. The idea is simply to draw attention to an issue which is usually avoided in legal writing.