The association of Curcuma and Scutellaria plant extracts improves laying hen thermal tolerance and egg oxidative stability and quality under heat stress conditions

Chronic exposure to high ambient temperatures is detrimental to laying hen performance and egg quality. Plant secondary metabolites may alleviate effects, partly due to their antioxidant activities. Herein, we investigated the effects of dietary supplementation with a phytonutrient solution (PHYTO) consisting of a plant extract combination of Scutellaria baicalensis and Curcuma longa on young layers (25–32 wk of age) raised under naturally elevated temperature conditions. Four hundred, 24-wk-old Lohmann hens were allocated in 50 cages and, after a week of adaptation, were offered a diet either containing 2 g/kg of PHYTO or not, for 8 wk. Hen BW was measured at the beginning and end of the trial, and egg production and feed intake were recorded weekly. At week 32, four eggs per cage were collected to determine egg quality characteristics as well as the rate of lipid and albumen oxidation in fresh eggs. At the end of the trial, two hens per cage were blood sampled for assessment of biochemical markers, one of which was euthanized for histopathological evaluation of the liver and intestine and assessment of intestinal histomorphometry. The herbal mixture supplementation significantly increased egg production rate at weeks 28 and 29 and for the overall production period, and feed efficiency at weeks 26–29. In addition, the degree of liver necrosis and microvascular thrombosis was lower (P < 0.05) whereas intestinal villosity was greater in duodenal and jejunal segments (P < 0.05) in the PHYTO compared to the control group. Supplementation also reduced (P < 0.05) blood concentrations of corticosterone, alanine aminotransferase activity, and TBARS, and a reduction in catalase activity was observed. Egg quality characteristics were not affected, except for eggshell thickness, egg diameter, and eggshell breaking strength that were superior in the PHYTO group (P < 0.05). PHYTO supplementation significantly improved egg lipid oxidation status of fresh eggs. In conclusion, supplementation with PHYTO improved laying hen productivity and egg quality, which was associated with an improvement in laying hen thermotolerance.

Starving for nutrients: anorexia during infection with parasites in broilers is affected by diet composition

In 2 experiments, we investigated whether diet composition plays a role in pathogen-induced anorexia, the voluntary reduction in ADFI during infection in broilers. We hypothesized that either energy or CP dietary content could influence the extent of anorexia in Ross 308 broilers and infection outcomes with Eimeria maxima. From d 13 of age, half of the birds were infected, and half were uninfected. ADFI was measured daily, and BW every 3 d until d 29. Oocyst excretion was measured daily from d 17 to 23. The impact of parasitism on the small intestine was assessed on d 19 and 25. In Experiment 1, 336 birds were offered diets progressively diluted with lignocellulose, starting from a diet with 3,105 (kcal ME/kg) and 20% CP. There was a significant interaction between infection and diet on ADFI during the acute stage of infection (d 17 to 21): for control birds diet dilution decreased ADFI and consequently reduced energy and CP intake. For infected birds, diet dilution increased ADFI, leading to the same energy and CP intake across diets. Oocyst excretion and villi length to crypt depth ratio (VCR) were constant across infected treatments. In Experiment 2, 432 birds were offered diets with constant ME (3,105 kcal/kg), but different CP contents (24, 20, 26, and 12%). Infection significantly reduced ADFI. Although there was no interaction between infection and diet on ADFI, there was an interaction on CP intake during the acute stage of infection. Infected birds on the 20% CP diet achieved the same CP intake as uninfected birds. There were no differences in the VCR and ADG of the infected birds on 24, 20 and 16% CP treatments, but birds on 12% had the lowest ADG and excreted more oocysts. We suggest that during infection, birds target a nutrient resource intake, which appears to be beneficial for infection outcomes, while at the same time they avoid excess protein intake. We conclude that different mechanisms regulate ADFI in infected and uninfected birds.

What are the limits to feed intake of broilers on bulky feeds?

The view that genetic selection for carcass yield has limited the size of the gastrointestinal tract (GIT) of modern broilers has sparked concerns that their capacity to cope with energy dilution or bulk is also limited. We investigated the capacity of male Ross 308 broilers to deal with increasing levels of bulk and aimed to identify a feed bulk dimension responsible for limiting feed intake (FI). About 528 day-old broilers were allocated to 48 pens and offered a common starter feed until day 8, and 1 of 7 feeds from day 8 to 36 of age: a basal control (B), which was diluted to 3 levels (15, 30, or 45%) with either oat hulls (OH) or sugar beet pulp (SBP). Feed intake was measured daily and birds were dissected for GIT measurements at day 15, 22, and 36. Feed intake increased in birds offered OH15 (135 g/d), OH30 (140 g/d), and SBP15 (138 g/d) compared with birds offered the B feed (106 g/d; SEM 2.4). By increasing FI, birds were able to compensate for the lower energy content of their feeds. The greatest increase in FI was seen on OH30: its energy content (2,273 kcal/kg) was 26% lower than the B feed (3,081 kcal/kg). There was evidence of adaptation on the bulky feeds, as during the last week only birds on SBP45 were limited in FI and performance. The relative weights of the GIT were greater in the SBP than OH series, suggesting that the former needed to accommodate a higher bulk intake. For the OH series the increase in the relative GIT weights was confined to the gizzard and small intestine; whereas for the SBP series, the increase was extended to proventriculus and large intestine. Because only SBP45 was limiting FI, we were unable to identify a bulk dimension to be used to predict FI. Our data reject the suggestion that modern broilers have a reduced ability to cope with reductions in feed energy content.

Interactions between dietary calcium and phosphorus level, and vitamin D source on bone mineralization, performance, and intestinal morphology of coccidia-infected broilers1

Coccidiosis penalizes calcium (Ca), phosphorus (P), and fat-soluble vitamin status, as well as bone mineralization in broiler chickens. We hypothesized that dietary vitamin D (VitD) supplementation in the form of 25-hydroxycholecalciferol (OHD), compared to cholecalciferol (D3), would improve bone mineralization in broilers receiving marginally deficient Ca/P diets, with more pronounced effects during malabsorptive coccidiosis. In a 2 VitD source × 2 Ca/P levels × 2 levels of infection factorial experiment (n = 6 pens per treatment, 6 birds/pen), Ross 308 broilers were assigned to an Aviagen-specified diet supplemented with 4,000 IU/kg of either OHD or D3 between days 11 and 24 of age. The diet contained adequate (A; 8.7:4.4 g/kg) or marginally deficient (M; 6.1:3.1 g/kg) total Ca and available (av)P levels. At day 12 of age, birds were inoculated with water (C) or 7,000 Eimeria maxima oocysts (I). Pen performance was measured over 12 days post-infection (pi). One bird per pen was assessed for parameters of bone mineralization and intestinal histomorphometric features (day 6 and 12 pi), as well as E. maxima replication and gross lesions of the small intestine (day 6 pi). There was no interaction between infection status and Ca/avP level on bone mineralization. Bone breaking strength (BS), ash weight (AW), and ash percentage (AP) were highest in broilers fed the OHD-supplemented A diets irrespective of infection status. Eimeria maxima infection impaired (P < 0.05) ADG and FCR pi; Ca and P status at day 6 pi; OHD status, BS, AW, and AP at day 12 pi; and intestinal morphology at day 6 and 12 pi. A- compared to M-fed broilers had higher BS, AW, and AP at day 6 pi, and AW at day 12 pi. VitD source affected only OHD status, being higher (P < 0.001) for OHD- than D3-fed broilers at day 6 and 12 pi. In conclusion, offering OHD and adequate levels of Ca and P improved bone mineralization, with no effect on performance. Dietary D3 and OHD supplemented at 4,000 IU/kg had similar effects on coccidiosis-infected and uninfected broilers, which led to the rejection of our hypothesis.

Effects of reducing growth rate via diet dilution on bone mineralization, performance and carcass yield of coccidia-infected broilers

Coccidiosis and rapid growth rate (GR) compromise bone mineralization in modern broilers. We tested the hypothesis that reducing GR via diet dilution during peak bone development will improve bone mineralization in both infected and uninfected broilers. A total of 384 male Ross 308 chicks were allocated to a basal grower diet (3,107 kcal/kg ME and 19.4% CP) diluted with 0, 5, 10, or 15% lignocellulose (n = 12 pens/treatment, 8 birds/pen) at day 10 of age. Prior to this, birds in each group received half the intended diet-dilution levels (day 8 to 10 of age) and a common starter diet (day 1 to 7 of age). At day 13 of age (day 0 post-infection, pi), birds were orally inoculated with either 7,000 sporulated Eimeria maxima oocysts (I) or water (C), forming a 4 diet-dilution level × 2 infection status factorial experiment. Performance was measured over 12 days pi and scaled to BW at infection (day 0 pi) to account for a priori BW differences. At day 12 pi (day 25 of age), 1 bird/pen (a total of 6 birds/treatment) was sampled to assess tibia and femur mineralization relative to BW, and carcass yield. There was no interaction (P > 0.05) between infection status and diet-dilution level on ADFI/BW measured over day 1 to 12 pi, or on any bone variable. ADG/BW pi decreased (P < 0.01) with diet dilution amongst C birds, but was statistically similar (P > 0.05) amongst I birds. I compared to C birds had reduced breast meat (P < 0.05) and eviscerated carcass yield (P < 0.01), femur (P < 0.05) and tibia (P < 0.01) breaking strength (BS), and femur ash weight (AW) (P < 0.05). Diet dilution did not affect carcass yield, but improved femur BS (P < 0.001), and tended to improve (P < 0.1) femur and tibia AW. Overall, diet dilution significantly affected femur, more than tibia, variables: relative BS, robusticity index, and ash percentage. Reducing GR affected broiler long bone mineralization to a similar degree in the presence or absence of coccidiosis.

Differential immune response to Eimeria maxima infection in fast- and slow-growing broiler genotypes

Very little has been reported comparing resistance to coccidiosis in fast or slow growing broilers, the latter of which are becoming more prevalent in the broiler industry. We examined mRNA expression in the intestines of fast and slow growing broilers following Eimeria infection. We show that by day 13 post-infection (d pi) with 2500 or 7000 oocysts of Eimeria maxima, slower-growing (Ranger Classic) broilers significantly (P < 0.01) upregulated expression of proinflammatory cyclooxygenase genes (LTB4DH, PTSG1 and PTSG2) above that detected in fast growing (Ross 308) broilers. Expression of CD8α mRNA was downregulated in Ross 308 at day 6d pi with either 2500 or 7000 oocysts of E maxima (P < 0.05), compared to uninfected controls, but was not differentially expressed in Ranger Classic. CD4 genes were not differentially expressed in either chicken line infected with either infectious oocyst dose at d6 pi, compared to uninfected controls. However, at d13 pi, CD4 expression was significantly upregulated in both chicken lines infected with either infectious oocyst dose, compared to uninfected controls (P < 0.05) but this was significantly greater in Ranger Classic broilers compared to Ross 308 (P < 0.05). At d13 pi, expression of CD3 chains (required for T lymphocyte activation) was significantly increased in Ranger Classic compared to Ross 308, infected with either oocyst dose (P < 0.05-0.01). Expression of IL-2 and IL-15 mRNA, required for T lymphocyte proliferation was also significantly upregulated, or maintained longer, in Ranger Classic broilers compared to Ross 308. These differences in immune response to E maxima corresponded with a reduction in E maxima genome detected in the intestines of Ranger Classic compared to Ross 308.

Sows in mid parity are best foster mothers for the pre- and post-weaning performance of both light and heavy piglets1

To improve the performance of lightweight piglets during suckling, producers are advised to create uniform litters using young sows. However, fostering piglets to primiparous sows may confer penalties due to their lower milk yield and milk immunoglobulin concentrations compared with multiparous sows. The objective was to determine the effect of foster sow parity (primiparous (F), second (S), and mid parity (M: parity 3 to 5)) on the performance from birth to day 68 of piglets born light (L: ≤1.25 kg) or heavy (H: 1.50-2.00 kg) and on creep feed consumption. Piglets (n = 507) considered L or H were cross-fostered, creating litters of 13 similar-sized piglets/litter and were randomly fostered to one of the foster parities. All litters were offered creep feed with a green dye to discern between consumers and nonconsumers, and the medication administered was recorded. Medication administrated pre- and postweaning did not differ (P > 0.05) across the different experimental groups. A significantly (P ≤ 0.025) lower number of H piglets were removed as a result of preweaning weight loss from F and S, rather than M litters. The interaction between birth weight and foster parity only affected piglet BW at day 10 (P = 0.020); foster parity did not influence BW of L piglets, but influenced that of H piglets. H piglets in F and M litters (3.82 and 3.80 kg) were significantly lighter (P ≤ 0.013) than H piglets in S litters (4.15 kg). As expected, L piglets performed worse pre- and postweaning than H piglets; they were 4.50 kg lighter at day 68. Foster parity significantly affected BW: F piglets were weaned lighter (P = 0.004) than S and M piglets (7.52 vs. 8.02 kg). Postweaning (day 68) however, F piglets achieved similar BW as S piglets (29.7 vs. 29.9 kg), whereas M piglets performed best (31.2 kg, P ≤ 0.079). Significantly fewer (almost none) of the L than the H piglets consumed creep feed (P < 0.001); significantly (P = 0.007) more F and M piglets were considered consumers than S piglets. The results suggest that irrespectively of birth weight, piglets tend to perform better when in M litters, being weaned heavy and having a high creep feed intake; however, more piglets are removed from such litters preweaning. Although S litters were weaned heavy, they were unable to maintain this BW advantage postweaning, due to their low creep feed intake and F litters remained small throughout. Long-term performance monitoring to slaughter is recommended.

A reassessment of the vitamin D requirements of modern broiler genotypes

We hypothesized that performance and bone mineralization of 2 broiler lines will benefit from increasing vitamin D (vitD) supplementation above current commercial levels and by partial substitution of D3 by 25-OH-D3. Male Ross 308 and 708 chicks (n = 576), were offered diets with low (LD; 1,000), medium (MD; 4,000) or high levels of D3 (HD; 7,000 IU/kg), and medium levels of vitD where the majority of D3 was substituted by 25-OH-D3 (25MD; 1,000 D3+3,000 25-OH-D3 IU/kg). Performance was measured at the end of starter (day 10), grower (day 24), and finisher periods (day 38). Three birds per pen were dissected at the end of each period to assess tibia and femur ash percentage (%), ash weight, bone breaking strength (BBS), and serum levels of 25-OH-D3. Remaining birds were gait scored (GS) at day 37 of age. Genotype and diet did not interact for any trait, whilst performance was not affected by diet. Ross 708 had lower body weight (P < 0.005), higher feed conversion ratio over the grower period (P < 0.05), similar levels of 25-OH-D3, but higher GS (P < 0.05) than Ross 308. Serum 25-OH-D3 levels were affected by diet at the end of the starter and grower periods (P < 0.05), being lowest for LD and highest for 25MD. Diet affected GS (P < 0.01), being higher in LD than 25MD. Femur ash % was higher at the end of the starter and grower periods for 25MD than LD and for both HD and 25MD than LD (P < 0.05). Femur and tibia ash weight were higher for 25MD in comparison to LD birds (P < 0.05) at the end of the grower period. Femur and tibia BBS were higher (P < 0.05) for 25MD in comparison to LD at the end of the grower and finisher periods, respectively. Overall, effects of vitD supply were more pronounced for femur than for tibia mineralization. Results do not suggest supplementation of vitD above current maximum levels and support partial substitution by 25-OH-D3.

Once small always small? To what extent morphometric characteristics and post-weaning starter regime affect pig lifetime growth performance

Background

The aim of this study was to determine the effect of piglet morphometric characteristics and starter regime on postnatal growth. Some piglets born light are able to grow faster than others, and identifying which piglets are more at risk to remain light and at which stages of growth is essential. A nutrient enriched starter regime may allow lightweight pigs to improve their post-weaning growth. A total 1487 newly born piglets from 137 litters originating from 8 consecutive farrowing batches were followed from birth (BiW) to weaning (WW, d28) and finishing (d99). At birth morphometric measurements were taken, including body mass index (BMI), ponderal index (PI) and BiW:cranial circumferences (BiW:CC). At weaning pigs were randomly allocated to one of two experimental regimes: either a nutrient enriched regime with a 20% higher essential amino acids (EAA): energy ratio (HIGH) or a standard regime (CTRL). Piglets were retrospectively allocated to 4 different weight classes (C) using percentiles at birth, weaning and finishing, with C1 representing the lightest and C4 the heaviest class. A series of novel statistical models were used to determine which factors were able to predict performance.

Results

For BiW C1 piglets, BMI (P = 0.003) and BiW relative to birth litter (P = 0.026) were positively associated with pre-weaning performance, whereas BiW:CC (P = 0.011) and WW (P = 0.001) were positively associated with post-weaning growth. Post-weaning the best predictors of piglets weaned light (WW C1) were PI (P = 0.037), BiW:CC (P < 0.001) and WW (P < 0.001). Starter regime did not influence (P > 0.05) post-weaning performance.

Conclusion

Our results show that not all light pigs are the same and that their performance is under the influence of body shape rather than BiW. Therefore, pig producers should discriminate between light pigs based on birth characteristics to improve the effectiveness of intervention strategies at the different stages of growth. Irrespective of weight class piglets did not benefit from the EAA enriched regime applied.

Electronic supplementary material

The online version of this article (10.1186/s40813-018-0098-1) contains supplementary material, which is available to authorized users.

Does selection for growth rate in broilers affect their resistance and tolerance to Eimeria maxima?

Chickens exhibit varied responses to infection with Eimeria parasites. We hypothesise that broilers selected for increased growth rate will show lower resistance and tolerance to a coccidian challenge. 288 chickens of fast (F) or slow (S) growing lines were inoculated with 0 (control), 2500 (low-dose), or 7000 (high-dose) sporulated E. maxima oocysts at 13 days of age in two consecutive rounds. Gain and Intake were measured daily and their values relative to BW at the point of infection were calculated over the pre-patent (days 1-4 post-infection), acute (d5-8 pi), and recovery (d9-12 pi) phases of infection to assess the impact of infection. Levels of plasma carotenoids, vitamins E and A, long bone mineralisation, caecal microbiota diversity indices, and histological measurements were assessed at the acute (d6 pi) and recovery stage (d13 pi). In addition, we measured the levels of nitric oxide metabolites and the number of parasite genome copies in the jejunumat d6pi. In absolute terms F birds grew 1.42 times faster than S birds when not infected. Infection significantly reduced relative daily gain and intake (P < 0.001), with the effects being most pronounced during the acute phase (P < 0.001). Levels of all metabolites were significantly decreased, apart from NO which increased (P < 0.001) in response to infection on d6pi, and were accompanied by changes in histomorphometric features and the presence of E. maxima genome copies in infected birds, which persisted to d13pi. Furthermore, infection reduced tibia and femur mineralisation, which also persisted to d13pi. Reductions in measured variables were mostly independent of dose size, as was the level of parasite replication. The impact of infection was similar for S and F-line birds for all measured parameters, and there were no significant interactions between line x dose size on any of these parameters. In conclusion, our results suggest that line differences in productive performance do not influence host responses to coccidiosis when offered nutrient adequate diets.

The impact of depression and cardiophobia on quality of life in patients with essential hypertension

Patients with chronic conditions like hypertension may experience many negative emotions which endorse the development of anxiety and depression symptomatology, thus they increase their risk for poor quality of life. Several studies have shown an association between symptoms of psychological distress and hypertension. In this study we aimed to quantify the link between depression, cardiophobia and quality of life in hypertensive patients. A cross-sectional design was employed. A sample of 197 hypertensive patients (89 men-108 women, mean age 53 years, SD=12 ranged 25-78) from a university outpatient hypertension clinic in Greece participated. Ninety-four (47.7%) of the participants suffered from essential grade I hypertension; 68 (34.5%) were grade II; 16 (8.1%) were categorized as grade III, while only 11 (5.6%) patients were recorded as normotensives with high normal values. The questionnaires included: (a) question for the recording of social-demographic characteristics and clinical features, (b) The Short Form (SF-36) Health Survey, (c) The Beck Depression Inventory -I, and (d) The Cardiac Anxiety Questionnaire. There were no significant differences between the two genders with exception of marital status (p=0.010), dyslipidemia (p=0.050), grade of hypertension (p=0.014), cardiac left ventricular hypertrophy (p=0.004), renal failure (p=0.043) and stroke (p=0.024). Lower levels of quality of life and higher levels of depression and cardiophobia were observed compared to the general population. There were no significant differences on psychological measures between the two sexes (p>0.05). Cardiophobia was positively related to depressive symptomatology (r=0.533, p=0.000) while negatively to both physical and mental health summary measures of SF-36 health survey (r=-0.467, p=0.000 r=-0.537, p=0.000 respectively). Multiple linear regression models found that for psychical health depression and cardiac anxiety, avoidance activities had an influence on levels of quality of life in hypertensive patients, after controlling for age and other socio-demographic variables and clinical characteristics (Beta=-0.133, p=0.007, Beta=-0.364 p=0.000 and Beta=-0.167 p=0.006, respectively). For mental component summary depression and cardiophobia, heart focused attention had also impact on mental health in hypertensives (Beta=-0.438, p=0.016, Beta=-0.564, p=0.000 and Beta=-0.223, p=0.037, respectively) after adjustments. Heart focused anxiety symptoms-as avoidance activities and/or attention and monitoring cardiac activity, are related to hypertensive patients' present deteriorated depressive symptoms and levels of quality of life. Both depressive symptomatology and heart focused anxiety may be a mechanism partly responsible for hypertensive patients' present impaired levels of quality of life.

Optimal lysine:DE ratio in growing pigs is independent of starch or fat as main energy source at two energy intake levels

In a 2 × 2 factorial arrangement, 28 growing boars (initial BW of 24.7 ± 1.5 kg) were used to examine the effects of energy source (high starch vs. high fat) and DE level (2.2 vs. 2.7 times the DE requirements for maintenance) on Lys requirements. Pigs were allotted to 1 of 4 dietary treatments. A within-animal Lys titration technique was used to assess the responses to changes in Lys to energy ratio. The amount of apparent ileal digestible Lys in the diet decreased stepwise from 1.74 to 0.5 g/MJ DE in 8 equidistant steps of 3 d each. From 48-h urinary nitrogen excretion, the optimal Lys to energy ratio was estimated for each pig using a linear-plateau model. Feces were collected quantitatively over 27 d to determine apparent total tract digestibility (ATTD) of nutrients. The DE to ADG ratio, but not DE intake and ADG, tended ( < 0.1) to be 4% lower in the high-starch group than in the high-fat group. The ATTD of energy and CP tended ( < 0.1) to be lower (0.8% and 0.9% units, respectively) at the high DE level. The ATTD of energy was 2.2% units greater ( < 0.001) for pigs fed the high-starch diet, but the ATTD of CP was not affected by ES. Estimates for the intercept (21.2% to 22.8%), slope (57.4 to 59.6), transition point (0.84 to 0.86 g Lys/MJ DE), and plateau (70.6% to 72.3%) of the linear-plateau Lys titration curves were not affected by the dietary treatments. In conclusion, ES does not affect Lys requirements in growing pigs regardless the level of DE intake.

Sensitivity of periparturient breakdown of immunity to parasites to dietary protein source

Effects of increased MP supply on the degree of periparturient relaxation of immunity (PPRI) in sheep may be dependent on quality of supplied MP. Here we tested the hypothesis that additional MP supply from rations based on xylose-treated soybean meal would be more effective than from rations based on faba beans in reducing the degree of PPRI, as indicated by nematode egg excretion. Twenty-four multiple-bearing ewes were trickle infected with Teladorsagia circumcincta larvae from d -56 to d 31 relative to start of lactation (d 0). From d -26 onwards, ewes were fed at either 0.8 (LP) or at 1.2 times their respective calculated MP requirements using either xylose-treated soybean (HPS) or faba beans (HPB). Litter size was adjusted to 2 lambs at parturition. Feeding treatments did not affect nematode egg excretion, ewe BW or BCS during late pregnancy (P > 0.10), but HPS and HPB ewes had reduced plasma pepsinogen concentrations (P = 0.003). During lactation, HPS and HPB feeding increased ewe BW gain (P < 0.001) and BCS (P = 0.017), and reduced plasma pepsinogen concentrations (P = 0.008) to the same extent, compared with LP feeding. However, only HPS feeding increased litter weight gain (P = 0.017) and reduced nematode egg excretion (P = 0.015), which were both similar between HPB and LP (P > 0.10). The results support the view that extra MP supply from xylose-treated soybean based rations is more effective in reducing parasitism than MP from faba bean-based rations, suggesting that protein source and/or quality are important factors to consider for the nutritional control of parasitism.

Posttraumatic stress disorder and preparatory grief in advanced cancer

PURPOSE

The purpose of the current study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and its association with sociodemographic variables and preparatory grief in patients with advanced cancer.

METHODS

195 advanced cancer patients participated in the study. Out of them, 170 had PTSD and 25 had other anxiety disorders. The diagnoses were made in strict accordance with Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I)-Clinician version. Patients completed also the Preparatory Grief in Advanced Cancer Patients (PGAC) scale.

RESULTS

Patients with PTSD were younger (63.54 ± 12.07 years) than those without PTSD (70.36 ± 13.03 years, p=0.010). Patients with PTSD revealed more preparatory grief (37.69 ± 12.11) than those without PTSD (29.58 ± 14.04, p= 0.003). Multiple logistic regression analysis showed that preparatory grief (p=0.012), and metastatic disease (p=0.009) remained in the model whereas age showed a trend for independent significance (p=0.067).

CONCLUSION

In advanced cancer stages, younger patients, those with metastatic disease or patients with elevated scores on preparatory grief seemed to have a greater likelihood to develop PTSD. Thus, given the prevalence of PTSD in advanced cancer patients, health care professionals should be able to better recognize those who are at risk for or exhibit symptoms of this disorder so that appropriate treatment referrals can be made.

Consultation-Liaison psychiatric service delivery: results from a European study

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.

European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study

The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse. German psychosomatic C-L services saw virtually no such patients, although in other C-L services these patients constituted one-quarter to one-third of the patients referred. The second difference lays in the remaining group of referred patients. This group is best characterized by two dimensions. One describes the severity of psychopathology -- ranging from organic mental conditions to somatization. The other describes the clarity of the physical diagnosis -- ranging from patients referred by surgical wards to those referred by general medicine and neurology wards.

European Consultation-Liaison Psychiatric Services: the ECLW Collaborative Study

OBJECTIVE

To describe the patterns of organization of consultation-liaison (C-L) services in 11 European countries in relation to hospital characteristics and national approaches to C-L psychiatry.

METHOD

Cross-sectional survey.

RESULTS

Services can best be described in terms of their size and seniority of their staff and whether or not they are multidisciplinary. Single-discipline services are based upon the standard medical consultant model, whereas those with multidisciplinary teams work in a way that is comparable with community mental health teams. German psychosomatic C-L services belonged to either model. National differences were found.

CONCLUSION

This first international study provides empirical evidence for the wide variation in the organization of C-L services. In view of the increasing numbers of patients with psychiatric disorder who are being treated in general hospitals and the changing patterns of medical care there are important implications for clarification and improvement of the role of C-L services.

Dependence on zolpidem: a case report

We report the case of a patient with a history of zolpidem dependence. The patient, after a stressful life event, started using zolpidem. She rapidly developed tolerance and dependence, taking 50-100 mg, and sometimes up to 300 mg, of zolpidem daily. Also, our patient suffered episodes of altered consciousness, accompanied by visual hallucinations.