The influence of floor type before and after 10 weeks of age on osteochondrosis in growing gilts

Osteochondrosis (OC) is a degenerative joint condition developing in a short time frame in young growing gilts that may cause lameness at an older age, affecting welfare and leading to premature culling of breeding sows. Causes of OC are multifactorial including both genetic and environmental factors. Floor type has been suggested to affect OC prevalence and effects might be age dependent during the rearing period. The aim of this study was to investigate possible age-dependent effects of floor type, conventional concrete partially slatted versus wood shavings as deep bedding, on OC prevalence in gilts (Dutch Large White × Dutch Landrace) at slaughter (24 wk of age; 106.5 [14.7 SD] kg of BW). At weaning (4 wk of age; 6.9 [1.3 SD] kg of BW), 212 gilts were subjected to 1 of 4 flooring regimens. Gilts were either subjected to a conventional floor from weaning until slaughter (CC), wood shavings as bedding from weaning until slaughter (WW), a conventional floor from weaning until 10 wk of age after which gilts were switched to wood shavings as bedding (CW), or wood shavings as bedding from weaning until 10 wk of age after which gilts were switched to a conventional floor (WC). After slaughter the elbow, hock, and knee joints were macroscopically examined for OC and scored on a 5 point scale where 0 indicates no OC and 4 indicates the severest form of OC. There was no significant difference (P > 0.4) between treatments on the overall OC prevalence for any joint assessed or at the animal level (all joints combined). At the animal level, however, gilts had greater odds to have OC scores 3 and 4 in the CW treatment (odds ratios [OR] = 2.3; P = 0.05), WC treatment (OR = 2.6; P = 0.02), and WW treatment (OR = 3.7; P < 0.001) compared with gilts in the CC treatment. The results indicate that there are no age-dependent effects of floor types on overall OC prevalence. However, wood shavings as bedding seems to increase the odds for severe OC and might affect animal welfare in the long term

Day hospital Mentalization-based treatment versus intensive outpatient Mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial

BACKGROUND: Borderline personality disorder (BPD) is associated with a high socioeconomic burden. Although a number of evidence-based treatments for BPD are currently available, they are not widely disseminated; furthermore, there is a need for more research concerning their efficacy and cost-effectiveness. Such knowledge promises to lead to more efficient use of resources, which will facilitate the effective dissemination of these costly treatments. This study focuses on the efficacy and cost-effectiveness of Mentalization-Based Treatment (MBT), a manualized treatment for patients with BPD. Studies to date have either investigated MBT in a day hospitalization setting (MBT-DH) or MBT offered in an intensive outpatient setting (MBT-IOP). No trial has compared the efficacy and cost-effectiveness of these MBT programmes. As both interventions differ considerably in terms of intensity of treatment, and thus potentially in terms of efficacy and cost-effectiveness, there is a need for comparative trials. This study therefore sets out to investigate the efficacy and cost-effectiveness of MBT-DH versus MBT-IOP in patients with BPD. A secondary aim is to investigate the association between baseline measures and outcome, which might improve treatment selection and thus optimize efficacy and cost-effectiveness. METHODS/DESIGN: A multicentre randomized controlled trial comparing MBT-DH versus MBT-IOP in severe BPD patients. Patients are screened for BPD using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and are assessed before randomization, at the start of treatment and 6, 12, 18, 24, 30 and 36 months after the start of treatment. Patients who refuse to participate will be offered care as usual in the same treatment centre. The primary outcome measure is symptom severity as measured by the Brief Symptom Inventory. Secondary outcome measures include parasuicidal behaviour, depression, substance use, social, interpersonal, and personality functioning, attachment, mentalizing capacities, and quality of life. All analyses will be conducted based on the intention-to-treat principle. Cost-effectiveness will be calculated based on costs per quality-adjusted life-year. DISCUSSION: This multisite randomized trial will provide data to refine criteria for treatment selection for severe BPD patients and promises to optimize (cost-)effectiveness of the treatment of BPD patients. TRIAL REGISTRATION: NTR2292 . Registered 16 April 2010.status: publishe

Day hospital mentalization-based treatment versus specialist treatment as usual in patients with borderline personality disorder: Randomized controlled trial

BACKGROUND: Day hospital mentalization-based treatment (MBT-DH) is a promising treatment for borderline personality disorder (BPD) but its evidence base is still limited. This multi-site randomized trial compared the efficacy of MBT-DH delivered by a newly set-up service v. specialist treatment as usual (S-TAU) tailored to the individual needs of patients, and offered by a well-established treatment service. METHODS: Two mental healthcare institutes in The Netherlands participated in the study. Patients who met DSM-IV criteria for BPD and had a score of ⩾20 on the borderline personality disorder severity index (BPDSI) were randomly allocated to MBT-DH (N = 54) or S-TAU (N = 41). The primary outcome variable was the total score on the BPDSI. Secondary outcome variables included symptom severity, quality of life, and interpersonal functioning. Data were collected at baseline and every 6 months until 18-month follow-up, and were analyzed using multilevel analyses based on intention-to-treat principles. RESULTS: Both treatments were associated with significant improvements in all outcome variables. MBT-DH was not superior to S-TAU on any outcome variable. MBT-DH was associated with higher acceptability in BPD patients compared v. S-TAU, reflected in significantly higher early drop-out rates in S-TAU (34%) v. MBT-DH (9%). CONCLUSIONS: MBT-DH delivered by a newly set-up service is as effective as specialist TAU in The Netherlands in the treatment of BPD at 18-month follow-up. Further research is needed to investigate treatment outcomes in the longer term and the cost-effectiveness of these treatments.status: publishe