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How to improve clinical practice on involuntary hospital admissions of psychiatric patients: Suggestions from the EUNOMIA study
- A. Fiorillo, C. De Rosa, V. Del Vecchio, L. Jurjanz, K. Schnall, G. Onchev, S. Alexiev, J. Raboch, L. Kalisova, A. Mastrogianni, E. Georgiadou, Z. Solomon, A. Dembinskas, V. Raskauskas, P. Nawka, A. Nawka, A. Kiejna, T. Hadrys, F. Torres-Gonzales, F. Mayoral, A. Björkdahl, L. Kjellin, S. Priebe, M. Maj, T. Kallert
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- Journal:
- European Psychiatry / Volume 26 / Issue 4 / May 2011
- Published online by Cambridge University Press:
- 16 April 2020, pp. 201-207
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Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.
Evaluation of soil intake by growing Creole young bulls in common grazing systems in humid tropical conditions
- S. Jurjanz, C. Collas, M. L. Lastel, X. Godard, H. Archimède, G. Rychen, M. Mahieu, C. Feidt
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Soil is the main matrix which contributes to the transfer of environmental pollutants to animals and consequently into the food chain. In the French West Indies, chlordecone, a very persistent organochlorine pesticide, has been widely used on banana growing areas and this process has resulted in a long-term pollution of the corresponding soils. Domestic outside-reared herbivores are exposed to involuntary soil intake, and tethered grazing commonly used in West Indian systems can potentially favour their exposure to chlordecone. Thus, it appears necessary to quantify to what extent grazing conditions will influence soil intake. This experiment consisted of a cross-over design with two daily herbage allowance (DHA) grazed alternatively. Six young Creole bulls were distributed into two groups (G1 and G2) according to their BW. The animals were individually tethered and grazed on a restrictive (RES) or non-restrictive (NRES) levels of DHA during two successive 10-days periods. Each bull progressed on a new circular area every day. The two contrasting levels of DHA (P<0.001) were obtained via a different daily grazing surface area (RES: 20 m2/animal, NRES: 31 m2/animal; P<0.01) offered to the animals by the modulation of the length of the tethering chain (RES: 1.9 m, NRES: 2.6 m). These differences in offered grazing areas resulted in DHA of 71 and 128 g DM/kg BW0.75, respectively for RES and NRES treatments. As expected, the animals grazing on the reduced area realized a lower daily dry matter intake (DMI) (RES: 1.12 kg/100 kg BW, NRES: 1.83 kg/100 kg BW; P<0.05) and present a lower organic matter digestibility (RES: 0.67, NRES: 0.73; P<0.01) than NRES ones, due in part to the shorter post-grazing sward surface height (RES: 3.3 cm, NRES: 5.2 cm; P<0.01) of their grazing circles. Soil intake was estimated on an individual level based on the ratio of the marker titanium in soil, herbage and faeces. Grazing closer to the ground, animals on RES treatment ingested a significantly higher proportion of soil in their total DMI (RES: 9.3%, NRES: 4.4%; P<0.01). The amount of ingested soil in the diet was not significantly different between the two treatments (RES: 98 g/100 kg BW, NRES: 78 g/100 kg BW; P>0.05) due to the lower DMI of RES compared with NRES treatment.
Soil intake of lactating dairy cows in intensive strip grazing systems
- S. Jurjanz, C. Feidt, L. A. Pérez-Prieto, H. M. N. Ribeiro Filho, G. Rychen, R. Delagarde
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Involuntary soil intake by cows on pasture can be a potential route of entry for pollutants into the food chain. Therefore, it appears necessary to know and quantify factors affecting soil intake in order to ensure the food safety in outside rearing systems. Thus, soil intake was determined in two Latin square trials with 24 and 12 lactating dairy cows. In Trial 1, the effect of pasture allowance (20 v. 35 kg dry matter (DM) above ground level/cow daily) was studied for two sward types (pure perennial ryegrass v. mixed perennial ryegrass–white clover) in spring. In Trial 2, the effect of pasture allowance (40 v. 65 kg DM above ground level/cow daily) was studied at two supplementation levels (0 or 8 kg DM of a maize silage-based supplement) in autumn. Soil intake was determined by the method based on acid-insoluble ash used as an internal marker. The daily dry soil intake ranged, between treatments, from 0.17 to 0.83 kg per cow in Trial 1 and from 0.15 to 0.85 kg per cow in Trial 2, reaching up to 1.3 kg during some periods. In both trials, soil intake increased with decreasing pasture allowance, by 0.46 and 0.15 kg in Trials 1 and 2, respectively. In Trial 1, this pasture allowance effect was greater on mixed swards than on pure ryegrass swards (0.66 v. 0.26 kg reduction of daily soil intake between medium and low pasture allowance, respectively). In Trial 2, the pasture allowance effect was similar at both supplementation levels. In Trial 2, supplemented cows ate much less soil than unsupplemented cows (0.20 v. 0.75 kg/day, respectively). Differences in soil intake between trials and treatments can be related to grazing conditions, particularly pre-grazing and post-grazing sward height, determining at least in part the time spent grazing close to the ground. A post-grazing sward height lower than 50 mm can be considered as a critical threshold. Finally, a dietary supplement and a low grazing pressure, that is, high pasture allowance increasing post-grazing sward height, would efficiently limit the risk for high level of soil intake, especially when grazing conditions are difficult. Pre-grazing and post-grazing sward heights, as well as faecal crude ash concentration appear to be simple and practical tools for evaluating the risk for critical soil intake in grazing dairy cows.