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J. Dairy Sci. 85992–1001 American Dairy Science Association, 2002. Farmers ’ Choice of M

J. Dairy Sci. 85992–1001  American Dairy Science Association, 2002. Farmers ’ Choice of M
J. Dairy Sci. 85992–1001  American Dairy Science Association, 2002. Farmers ’ Choice of M

J.Dairy Sci.85:992–1001

American Dairy Science Association,2002.

Farmers’Choice of Medical Treatment of Mastitis in Danish Dairy Herds Based on Qualitative Research Interviews

M.Vaarst,*B.Paarup-Laursen,?H.Houe,?C.Fossing,*and H.J.Andersen ||

*Department of Animal Health and Welfare,

Danish Institute of Agricultural Sciences,P.O.Box 50,DK-8830Tjele ?Department of Ethnography and Social Anthropology,

Moesgaard,A

?rhus University,DK-8200A ?rhus ?Research Centre for the Management of Animal Production and Health,Danish Institute of Agricultural Sciences,P.O.Box 50,DK-8830Tjele

||Danish Dairy Board,Frederiks Alle

′22,DK-8000A ?rhus C ABSTRACT

A qualitative research study was conducted to de-scribe and analyze farmers’perspectives on their own

choices regarding decisions to have cows treated for mastitis.Through qualitative research interviews of 16Danish dairy farmers,four levels of the decision-mak-ing process used by farmers to decide whether or not to treat a cow with antibiotics were identi?ed.Those levels were:1)symptom level (seriousness of the masti-tis case),2)cow level (to the extent a cow ful?lled goals of the farmer and the herd),3)herd level (the situation of the herd,e.g.,in relation to milk quota),and 4)level of alternatives (whether the farmer regards such practices as blinding of teats or homoeopathy as serious alternatives to antibiotic treatment).All four levels could be recognized in all herds,but with differing weights and relative importance across herds.Direc-tions of different possibilities within each level also varied among farmers.By identifying those four levels,a model for understanding the farmers’choices is pro-vided.This provides background for dialogue with each farmer about choices in the context of each speci?c herd.It also provides insight into implications of mastitis treatments for effective treatment versus issues of anti-biotic resistance when discussing choices on a more general https://www.wendangku.net/doc/ad105234.html,munication and understanding be-tween farmers and their veterinarians and cattle-ori-ented advisors is essential.Farmers were shown to be coherent in their choices of treatment,but their deci-sions often seemed to differ from normal veterinary recommendations.Such differences have to be under-stood and implemented into effective decisions for the whole farm.

Received March 30,2001.Accepted October 19,2001.

Corresponding author:M.Vaarst;e-mail:Mette.Vaarst@agrsci.dk.

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(Key words:mastitis treatment,clinical mastitis,med-ical treatment,decision-making)

INTRODUCTION

Mastitis is the disease complex that prompts most of the medical treatments in Danish dairy cows (Aarestrup,2000).The whole issue of medical treat-ment for production animals raises discussions among farmers and other professionals related to dairy produc-tion about treatment thresholds.This discussion con-tains both ethical questions (e.g.,when is it responsible and/or regarded as necessary to treat a diseased ani-mal?)and “technical”questions about possible conse-quences of using or not using antibiotics in disease treatments.In Denmark,only veterinarians are al-lowed to administer the ?rst treatment of dairy cows with antibiotics.This practice in?uences the way in which a farmer handles a diseased animal.

The question about development of antibiotic resis-tance has caused major concern during the past years.In theory,antimicrobial resistance should not occur,if drug labels are followed,but in practice it is shown to form an increasing problem (Aarestrup,2000).There have been attempts made to give guidelines for a more “rational use of antibiotics”,to minimize the risk of antibiotic resistance (Ekman et al.,1994b;Pedersen et al.1999;Aarestrup,2000).Several governmental and research initiatives indicate a wish and a will to opti-mize treatments in a way that decreases the risk of antibiotic resistance,and—at the same time—improves the prognosis as much as possible.

Because only veterinarians are allowed to initiate antibiotic treatment of dairy cows in Denmark,the ?rst treatment is always carried out and chosen by the veter-inarian.A discussion about clinical diagnosis,choice of type,dose,application,and course of antibiotic treat-ment necessarily involves the veterinarian (Ekman et al.,1994a).But,the initial call for the veterinarian is

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solely dependent on the farmer.Attempts to set up systematic criteria and plans for treatment seem to fail for reasons that are not immediately understood by the health professionals connected to the dairy herd.The perspective of the farmer remains silent and not de-scribed,probably because it is complex,context-related,and contains nonquanti?able elements.Seen from out-side,farmer perspectives may seem inconsistent,non-transparent,and at times irrational.

The decision to treat a diseased cow is a very im-portant part of the herd management.Udder health (e.g.,de?ned by mastitis occurrence and SCC)is very often shown to vary among herds that have the same housing system and breed and look alike in their physi-cal framework.In such cases,the individual herd man-agement is often claimed to explain the majority of this variation in udder health results (Hutton et al,1990;Barkema,1998;Barkema et al.,1999a,1999b).In each herd,experience is gradually built up in collaboration between farmer and veterinarian,and both contribute to this common experience with their backgrounds and former experiences.

The farmers’own version of the story is needed.This information without doubt will provide the debate about antibiotic use with valuable inputs,because the farmer is the one who decides what to do in every case of disease among the animals in the herd.The farmer’s treatment criteria must be regarded as even more im-portant when concern for antibiotic resistance gives the concept of “rational treatment”a new meaning.Goals for low SCC,improved udder health,and animal wel-fare have been major arguments for relatively low treat-ment criteria.Now,the risk of antibiotic resistance cre-ates arguments for a more critical treatment policy,and for an evaluation of the treatment strategies in a broader perspective.

The present study was conducted to bring the farm-ers’perspectives of disease handling and treatment into the discussion about mastitis incidence,and interpreta-tion of treatment data.The aim of this study was to identify and elucidate farmers’perspectives of disease handling.The use of semistructured qualitative re-search interviews makes it possible to make the choices of the farmer explicit.The results of this investigation will be discussed with respect to the situation in which risk for antibiotic resistance is a valid argument for a more critical and restrictive antibiotic treatment policy.

MATERIALS AND METHODS

The Setting:Danish Dairy Farming and Antibiotic Treatment Policy

Danish dairy farming is in?uenced by the develop-ment towards fewer and bigger dairy herds.In 1990,

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the average size of a dairy herd was 35.9cows per year;it was 65.7cows per year in 2000.The number of herds has been reduced from approximately 21,000to approx-imately 9800in the same 10-yr period.Due to a general increase in milk yield,approximately the same amount of milk (4.8million kg as regulated by EU-quota)is produced,even though the number of cows has declined from 753,000to 644,000from 1990to 2000.More and more loose housing systems are built,and TMR feeding,milk quota system,and premium classi?cation for low SCC count in the milk delivered to the dairy industry have been introduced.The most common breed is Hol-stein Friesian.Danish veterinarians work in private practice,mostly in small groups of three to four veteri-narians.During the past few years,bigger practices—with 10to 12veterinarians—have been developed,with some of them very often having specialized on some area (e.g.,ruminants,swine,companion animals,acu-puncture).The treatment policy in veterinary practice has been more restricted since June 15,1995,when new regulations (Anonymous,1995)were initiated.An-tibiotics can not be used for preventive purpose;in prac-tice medical drying can only be provided to cows with veri?ed bacteriological infection.The ?rst treatment of a dairy cow can only be carried out by a veterinarian.For each treatment,a recording form is ?lled out,and antibiotic residues in the milk found by routine tests result in a substantial ?ne.Consequently,antibiotic residues are rarely found in the milk.Farmers can ad-minister medicine for subsequent treatments,provided they have signed a health advisory service contract with their veterinarian.This contract includes monthly health advisory visits by the veterinarian,who are paid by the farmer at approximately 100to 120US $/https://www.wendangku.net/doc/ad105234.html,anic farmers have not accepted the right of farmers to administer subsequent treatments,and more restric-tions on antibiotic treatments are imposed in organic herds.

Selection of Herds

Sixteen dairy herds (15conventional and 1organic)were chosen among herds participating in a project run by the Danish Dairy Board (Andersen et al.,2000).This group of herds was originally chosen to participate in a parallel study,focusing on clinical examination of udders after milking.It was a convenience sample,in which all herds were geographically close to each other,and where cows could be secured for clinical examina-tion.Herd veterinarians were not involved in the selec-tion,and the 16farmers had different levels of collabo-ration with their respective veterinarians.A total of eight different veterinarians provided service to the 16herds.Herd characteristics are listed in Table 1.

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Table1.Herd characteristics of the study herds.

Milk yield averages,%

kg/d3Cows/mo

No.%Treated with Breed(≥milking Calculated mastitis chronic Herd85%of cows per Housing1st2nd3rd bulk milk cases per elevated

ID cows)1year https://www.wendangku.net/doc/ad105234.html,ct.SCC month SCC4

1HF51Tied24.831.429.8320 4.920.2

2HF56Tied26.929.030.0478 4.224.6

3HF66DL...25.329.1452 5.526.8

4HF74Tied22.725.725.92099.0 4.1

5Jersey72Tied21.426.426.3354 4.17.2

6HF74Tied27.629.931.6199 2.4 6.3

7HF/RDM95LHSF26.331.035.6144 5.4 3.4

8HF113Tied25.431.530.23539.217.1

9HF102LHSF27.529.927.9226 3.37.7

10HF70Tied24.629.334.72787.512.4

11HF57Tied23.224.125.9331 5.017.4

12HF190LHSF26.330.232.2353 3.9 4.7

13HF63Tied23.127.229.6253 6.110.1

14RDM51Tied25.528.632.2196 2.2 5.1

15HF131LHSF22.426.228.0215 3.1 5.4

16HF119LHSF19.022.723.5418 2.816.0

Average585...22.825.326.0309 5.014.0

1HF=Holstein Friesian,RDM=Red Danish Milking Breed.

2LHSF=Loose housed systems with slatted?oor;beds with straw,‘deep litter’or sand,DL=Deep litter

system.

3Milk yield calculated only on basis of cows without chronically elevated SCC.

4Calculation of chronically elevated SCC on cow level,based on monthly samples(measuring milk yield,

composition and somatic cell counts).Observed minus expected values of log10(milk×SCC)adjusted for

breed and parity.

5Average of150herds participating in the whole Danish Dairy Board project‘The kongea?-project’(Andersen

et al.,2000).

Interviews

All farmers were interviewed in qualitative semi-structured research interviews from February to May, 2000.All interviews were performed by the same person (?rst author)and recorded on tape.Lengths of inter-views were between65and90min.The qualitative research interview is a research method with the aim of exploring and describing a spectrum of attitudes and experience within a certain?eld,rather than pres-enting a“representative sample of opinions”or quanti-fying opinions or experience among a group of people (Kvale,1996;Strauss and Corbin,1990,1996).The in-terviews are structured in a number of thematic ques-tions.The person being interviewed(the interviewee) is encouraged to speak and direct the course of the interview.The interviewer follows up on his/her ques-tions,explores self-contradictory statements,and asks for further examples.During the interview,the inter-viewer is continuously enquiring and evaluating the consistency and weight of the story told by the inter-viewee.The interviewer takes responsibility for not leaving the theme of the interview,but the thematic questions are weighted differently in the different inter-views,depending on the focus areas and experience of Journal of Dairy Science Vol.85,No.4,2002the interviewee.For example,if the thematic question is“communication with the veterinarian about treat-ments,”it is possible to discuss whether the farmer and veterinarian have made treatment plans on a herd level (and then discuss the content of these plans),or whether they discuss each treatment case separately.In the interviews presented in this article,the starting point was an investigation of the?ve most recent mastitis treatment cases and the?ve cows most recently culled from the herd.Much of the dialogue was therefore con-centrated on explaining the action of the farmer in spe-ci?c treatment situations.This discussion was a part of12themes or thematic questions(Table2),which were touched on in various degrees(depending on the focus of the farmer as just explained),asking about the attitude to alternative treatment methods,health advisory service,information material about mastitis and other topics.

Data Analysis

The interviews were transcribed in their full length. They were analyzed across interview persons in a so-called grounded theory analysis(Strauss and Corbin, 1990,1996).First,open coding was made by creating

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Table 2.Themes or thematic questions which were discussed during the interview with the farmers.1

Going through the ?ve most recent veterinary mastitis treatments,and the ?ve most recent cullings.Discussing the motivation,the course,the decision-making,and communication about each case.

2The history of this herd,and the motivation for building it up as it appears now.3Own experience of problem areas of the herd,and how they are solved.

4Milking routines:motivation and experience.

5Veterinarian:Attitude to and use of health advisory service,motivation.6Communication with the veterinarian about treatments.

7Communication with colleagues,consumers and others about disease treatment.8Which kind of information is included in decision-making and general orientation in this herd.

9Alternative treatment:how is it used here in this herd.Motivation for using/not using alternative treatment.

10The public debate of antibiotic resistance:attitude.11The goals of this herd,including breeding goals.

12

Expectations to future—own herd,farm,and Danish dairy production.

meaning condenses.That is,sequences of one state-ment or exchange of ideas were given a heading that summarized the content of this statement.After this,so-called axial coding was performed,where themes across interviews were identi?ed.A full model con-taining various levels of the decision with regard to a mastitis case was made.These levels were identi?ed in the grounded theory analysis and named disease level,cow level,herd level,and alternative level.During this process,a short visit to all herds was carried through to con?rm the understanding of the interview.At the end of the process,a farmers’group meeting was arranged to con?rm the understanding of the levels identi?ed in the treatment process,at which the farm-ers were asked whether they could recognize this inter-pretation of their daily choices.

RESULTS

Disease level:Acute symptoms of mastitis will always lead to antibiotic treatment.All farmers claimed that they always had ‘sick cows’treated by their veterinarian.The de?nition of ‘sick’varied very much from farmer to farmer,from changes in appear-ance of milk to a decrease of health.Through speci?c examples,the farmers described symptoms of mastitis that generally would lead to antibiotic treatment of any cow in the herd.Antibiotic treatment is per de?nition ‘veterinary treatment,’because only veterinarians are allowed to treat dairy cows with antibiotics.Those were mainly symptoms,which from a veterinary point of view would be described as ‘severe symptoms of masti-tis.’Those symptoms could be fever,watery milk,signs of pain,markedly swollen udder gland,reduced appe-tite,or other signs of general affection of the cow,and/or not coming to the milking parlor at milking time.Journal of Dairy Science Vol.85,No.4,2002

Some farmers had not experienced such ‘severe cases’for years,while other farmers regularly saw severe cases typical of coliform bacteria.

Cow level:‘Mild mastitis’leads to a complex treatment situation involving cow characteris-tics.When confronted with a cow with less severe symp-toms—e.g.,a cow with slightly abnormal milk or a slightly swollen udder gland,or (in some herds)high SCC—the treatment decision was based to lesser extent on observed symptoms.Individual SCC at the cow level were conducted by means of direct measurement every month at a central laboratory.The farmers collect milk from all four quarters during milking (directly from the milking machine).The milk samples are marked with the cow’s identity number,and all samples are collected after milking by a milk control assistant.Single cow characteristics in?uenced the choice of treatment to a large extent.These characteristics included ‘historical’as well as currently present characteristics,such as milk yield,former cases of mastitis (in the same or other glands),SCC pattern,and parity/age.Many different points of view were presented in this discussion,all of them with the main theme that it was not the actual symptoms of the cow that were in focus.Heifers or ?rst-lactation cows in early lactation were almost always mentioned as a group of animals that were treated im-mediately even in a case of very mild symptoms.Cows in early lactation were usually treated when showing symptoms of mastitis in order to ‘save their lactations.’Other cows were treated in accordance with priorities chosen within each herd.High milk yield,udder qual-ity,favorable reproduction status,and cows with a good temper were mentioned among cows that were listed on the ‘high priority list’speci?c for each herd.In gen-eral,cows that the farmer wanted to keep in the herd were treated even with a very low disease threshold.

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These cows could be treated two or more times during the same lactation,if the farmer thought it necessary. On the other hand,‘less desirable cows’—e.g.,cows con-sidered of less value?were treated less consistently and in some cases reevaluated just before the end of lacta-tion to determine whether a dry-cow therapy would be worth trying.‘Nondesirable cows’were not treated in cases of mild symptoms of mastitis,unless other rea-sons—on herd level,which will be presented in the following—were valid in each speci?c case.In some cases,the veterinarian cultured milk samples.In most cases when milk samples were taken,cows were treated on that day and then the veterinarian changed medicine on the second day if indicated by the results of the milk culture[either because of antibiotic resistance or because of misjudgement of bacterial infection(gram-positive vs.gram-negative)].In general,the farmer did not let culturing of milk samples in?uence the treat-ment decision as such.Instead,culturing milk samples solely in?uenced the veterinarian’s choice of medicine. Herd level:The situation of the herd guides the general treatment level.An important factor in the farmers’decision process in single cases as well as gen-eral treatment strategy was the actual herd situation. Among major elements of importance mentioned were the number of heifers that could replace culled cows(in cases where culling was seen as a relevant alternative to antibiotic treatment),the bulk milk SCC goal,and ful?lling this goal and the status of the milk quota.In some herds,the presence of these factors could lead to ‘treatment booms,’in which a number of cows with high SCC,or cows showing the slightest sign of milk changes were treated for a period of time to regulate the entire herd situation.Other priorities could also in?uence the treatment pattern.Some farmers claimed that they never wanted to milk more than two cows separately per milking.If more cows had mastitis,one or more with‘mild mastitis’or‘elevated SCC’had to wait for some days before they were treated.In some herds, monthly health advisory service visits by the veterinar-ian were combined with an increased number of treat-ments at a certain time,where a number of cows were treated because they had shown signs of mastitis during the previous month.

The level of alternatives:An example given in drying glands as an alternative.Blinding one teat (drying a single gland without medication but only by avoiding milking this single gland)is seen by some farmers as a possible alternative to antibiotic treatment in cases of chronically high SCC and/or repeated treat-ments of a recurrent mastitis.‘Blind teats’or‘dry glands’are often interpreted as a sign of bad udder health.The action of blinding one teat seemed to form two distinct groups of farmers.One group regarded this Journal of Dairy Science Vol.85,No.4,2002as a true alternative to repeated treatments of the same cow,and viewed it as a major control measure(control of SCC and reduction of treatment).The other group of farmers was willing to carry out repeated treatments to avoid cows with blind teats in their herd.Through the interviews,it became clear that those apparently ‘irrational’repeated treatments were performed be-cause the farmers associated‘cows with a blind teat’with‘bad farmer management.’Cows with a blind teat were viewed as a mirror of‘bad stockpersonship.’In this way,the idea of blinding teats actually could be seen as strongly related to what could be named‘farm-ers’pride.’Farmers who did blind teats mentioned eco-nomic rationality as the major reason.Farmers indi-cated that in their experience,cows with only three milking glands had almost as high milk yield as‘normal cows,’and in some cases the gland became normal—with a normal SCC—after the following calving.Fur-thermore,it took too much work,concentration,and time to continue working with one troublesome udder gland.

Perception of good stockpersonship as control of the situation:An argument for repeated treat-ments.Through the interviews it also became obvious that some farmers made a direct connection between ‘complete control of the health situation’and‘good stockpersonship.’The mirror of complete control could be low SCC on herd level,stability with regard to milk yield and composition(content of fat,protein,and urea), or other things.These farmers regularly used the word ‘control,’and they expressed the search for control as their main cause for repeated treatments.Blinding teats—as described above—was both described as‘con-trol measure’and‘a sign of loss of control.’

Summary of the results:The decision of antibi-otic treatments on four levels.Through16interviews of farmers regarding their treatment decisions,a num-ber of factors on symptom,cow and herd level were identi?ed,elaborated,illustrated,and systematized to explain herd-speci?c decisions and patterns of treat-ment.The factors could be ranked in an order,which often were hierarchical.Severe mastitis symptoms had a high position in the hierarchy,meaning that cows with severe mastitis symptoms were treated irrespec-tive of their position in the herd or the general herd situation.In some cases,the levels were interactive with each other,so that factors on cow level,which normally would lead to avoidance of antibiotic treat-ment in mild mastitis cases,suddenly would lead to treatment under certain herd conditions.Such herd conditions could be a high bulk milk SCC level.The four levels are illustrated in Figure1.

Factors from these four levels could be recognized by all farmers.The importance of each factor was different

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Figure 1.The four levels of choice that were involved when making decisions in each mastitis case as experienced by the interviewed farmers.

in each herd,due to different priorities expressed by each farmer.

DISCUSSION

Qualitative research interviews used as a method to understand treatment decisions.The concept of qualitative research is by nature very differ-ent from the biological and biomedical research tradi-tion.The aim of the qualitative interview investigation is to describe,interpret,and understand the spectrum of experience and choices related to a given phenome-non (Kvale,1996;Strauss and Corbin,1990,1996)—in this case mastitis treatment in dairy herds.In this study,16farmers,who had widely different herd char-acteristics (Table 1)and who were chosen because they had cooperated in another study,participated.They were expected to represent a variety of strategies and opinions.We want to understand the choices of the Journal of Dairy Science Vol.85,No.4,2002

farmers—not just to know which treatments that have been made in a ‘representative sample of farmers,’but the context and logic connected to those treatments.All research processes—quantitative as well as qualita-tive—include a number of choices made by the research-ers (research design,statistical methods,sampling,etc.).In a qualitative research process,the researcher and the attitude,choices,and role taken by the re-searcher also in?uences the whole process (Malterud,1995).By carrying out,transcribing,and analyzing the interviews,the researcher himself/herself becomes a ‘research instrument,’and validity is consequently de-?ned differently for the whole research process [for de-tailed description,see Kvale (1996)and Denzin and Lincoln (2000)].

Lunde (1992)discusses the relevance of using quali-tative research methods to understand re?ections on disease and illness in human patients.She points to the fact that the discussion about disease and disease

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treatment is multi-dimensional,and that the patient’s as well as the health professional’s understanding of the patient’s reality interacts directly with the biological reality.This in?uences the way that both of them han-dle the situation.In the veterinary?eld,the same argu-ment seems valid as seen from the veterinarian’s and the farmer’s points of view.From the results of these interviews it became obvious how differently acute and chronic mastitis are handled by a relatively small num-ber of farmers who participated in this project.The importance of communication and understanding be-tween the farmers and health professionals(mainly the veterinarian)is underlined,because they are both involved in the treatment process on single animal as well as herd level.In this communication,more complex sets of arguments meet each other,so to speak.The farmer must take care of the rationality and harmony within the whole farm(including milk quota,culling cows,and choosing which heifers should stay in the herd).The veterinarian brings with him a professional knowledge,perspectives of animal welfare,and biomed-ical‘scienti?c’rationality on disease.Society—includ-ing the two groups just mentioned—expresses concern for increasing problems with antibiotic resistance. From this rationale an increased focus on the life-world of the farmer and the study of rationality behind farm-ers’actions seem justi?ed and highly relevant.

The four levels in a mastitis treatment decision. The symptom level was dominant in severe cases of acute,clinical mastitis,although‘severe’was de?ned differently among farmers.From an animal welfare point of view,it seems reasonable that action is taken to improve the situation in each individual cow irrespec-tive of individual cow characteristics.Severe clinical mastitis very often causes pain,and the prognosis for recovery is better when treated early.

Cow characteristics are involved to a high degree in cases of‘mild mastitis’(de?ned from high SCC to clini-cal mastitis without fever or very hard udder).The history of the cow is shown to have great in?uence on the prognosis and risk of developing mastitis(O¨st-era?s,1997).

The herd situation is an aspect that makes the treat-ment decision very context related,including a relation-ship to political and cultural structures(e.g.,milk quota,limits on cow numbers;economical choices that are beyond the scope of this article).On this level,farm-and society-related arguments seem stronger than vet-erinary-oriented arguments for or against medical treatment.The farmer is consequently the advocate of interests and priorities linked to this level.

The alternative for action in a case of mastitis is often left to the farmer to decide.The relevance of each alternative can be discussed,but if the farmer sees, Journal of Dairy Science Vol.85,No.4,2002e.g.,a herbal remedy as a true alternative,arguments such as lack of scienti?c proof will not be valid in his mind;he can make it work,and the choice is his.Like-wise,if the veterinarian sees culling as a true alterna-tive,but the farmer does not,there is still a basis for discussion.On the contrary,if the farmer has another plan for culling or adding new cows into the herd,he or she may not see culling as a true alternative to medical treatment.Again,the perspective of the farmer is illus-trated to be not only highly in?uential on treatment decisions,but also of a very complex character. Building up experience:Making a prognosis.An underlying process in decision-making is developing an ability to estimate prognoses well.The expectations to what will happen,if or if not a concrete action is taken, guide many decisions,and these expectations are based on former experience including both success and fail-ure.The outcome of treatment depends partly on the history and severity of the disease case.The physical and psychological environment may also be an im-portant factor in this discussion,because healing is dependent on whether recovery can take place under the given circumstances at all.Therefore,experience concerning treatment results is herd speci?c and conse-quently also dif?cult to generalize or to communicate among farms.

The concepts of disease and illness:Are they rele-vant in veterinary medicine?Clearly,decisions about treatment of an individual cow were made on a wider basis than the facts surrounding this cow,when seen from the farmer’s perspective.The herd situation seemed to guide the general treatment level,which also varied over time.

Kleinmann(1980)presented a concept of the con?ict and convergence between‘illness’—represented by the patient and describing the patient’s experience of‘being ill’versus‘disease.’‘Disease’is,in this terminology, understood as the professional de?nition of‘the condi-tion.’Disease is the clinical diagnosis,which is the pro-fessional label of what is wrong.In critical discussions about that model,which belongs to the clinical medical anthropology,the focus is claimed to be too narrow. Hahn(1984and1995)introduces the term sickness, where a society oriented aspect of the clinical disease and/or illness is represented.Doughterty and Tripp-Reimer(1985)discuss care taking in a situation of ill-ness,where the meeting between nursing and the pa-tient is discussed.In this veterinary context,the farmer represents the care-taker—the person,who‘nurses’the cow.It may be very relevant in veterinary medicine to discuss the society oriented sickness complex,but the model of disease and illness alone may provide a model for understanding a possible con?ict between the veteri-narian’s and the farmer’s understanding of and choice

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when confronted with a mastitis case.A mastitis case is not the farmer’s own personal experience of ‘being ill,”but it represents the life world of the farmer,containing complex interrelations and multiple areas of the whole farm situation that have to ?t in order to keep harmony.On the other side,a veterinarian stands with his or her ‘snapshot’of the present situation and a more narrow and focused concern about the single mastitis case,which is presented to him or her.Veterinarians may be expected to solve professional veterinary medical problems,which may be covered by the term ‘technical rationality,’critically discussed by Scho ¨n (1983):‘…pro-fessional activity consists in instrumental problem solv-ing made rigorous by the application of scienti?c theory and technique.’In other words,a professional person focuses on speci?c problems and has a ?eld over which he or she ‘claims mastery.’In human medical anthropol-ogy,the therapeutic process and the communication between patient and healer are explored (Chrisman and Johnson,1990;Csordas and Kleinman,1990).In the veterinary situation,this may relevantly be discussed in a similar way.

Referring to the four levels of the mastitis treatment decision,the symptom level and partly the cow level are involved in a more or less ‘pure disease evaluation.’Parts of the cow level,the herd level and the level of alternatives can be evaluated mainly from an illness point of https://www.wendangku.net/doc/ad105234.html,munication may be improved signi?-cantly if both the farmer and veterinarian are explicit and aware that their focus areas are basically different.Open communication,which is based on a common will to articulate and communicate about preferences,may improve the situation.A potential con?ict between the basically different viewpoints and interests will,how-ever,not be solved by communication alone.

The example of blinding teats:between farmers’pride and economic rationality.The question of blinding teats (either by cessation of milking or destroy-ing the quarter by cutting off the teats,or—in few cases—infusion with certain chemicals)seemed to di-vide the farmer group.A number of farmers apparently related the presence of three-teated cows in the herd to ‘bad management.’Avoiding blinded teats because of chronic mastitis may result in many antibiotic treat-ments,which are carried out to control a recurrent clinical mastitis.The image of blinded teats as a sign of ‘bad farmer’s management’also existed among farmers who did blind teats—they acknowledged that repeated treatments were expensive and did not offer a perma-nent solution of the chronic mastitis problem.

The discussion of blinding teats as a ‘rational action’and a proper way of handling mastitis,is not supported in literature.Edler and Grunert (1994)found in a study of 204teat amputations in milking cows that milk yield Journal of Dairy Science Vol.85,No.4,2002

decreases 5.5%during a lactation period after teat am-putation (which to a certain point can be compared to blinding a teat).Beaudeau et al.(2000)and Rajala-Schultz and Grohn (1999a,b)found a signi?cantly in-creased risk of culling in cows with teat injuries.In the light of farmers’choices in the present study,this ?nding can be strongly supported.A group of farmers would not accept such cows in their herd and would view them as ‘inef?cient cows,’which somehow mir-rored ‘mismanagement.’

The overall conclusion,based on these interviews,is that blinding teats was very much a question of farmers’choice—just like the choice of medical treatment.A case of chronic mastitis will always precede the choice of blinding teats—but chronic mastitis may not lead to blinded teats in all cases,nor repeated treatments.Some of these cows may be culled,or stay in the herd with high SCC.Consequently,chronic mastitis preva-lence in a herd is not necessarily associated proportion-ally with the presence of blinded teats among cows in the herd or with many treatments.From the results of these interviews it generally becomes clear that treat-ment level in a herd does not closely re?ect the incidence of mastitis at all.

Good stockpersonship de?ned as control with the situation:An argument for repeated treat-ments.To be a good farmer—a good stockperson—is a goal that cannot easily be transformed into any eco-nomic value,but it still means a lot to the person in-volved in the farm.Good stockpersonship was interpre-ted in various ways by different stockpersons,and it can be de?ned in speci?c ways within different farming cultures or groups of farmers.High milk yield is a crite-rion very often seen as decisive for being a good dairy farmer.Another criterion could be a high level of hy-giene,good animal well-being,good farm structure,or control of the health situation.The latter aspect is strongly related to the discussion about blinding one teat:Blinding one teat could even be de?ned as one way of controlling the situation by some farmers,be-cause they see the end product as low SCC combined with few veterinary treatments.Other farmers would see many three-teated cows in the herd as lack of con-trol,evaluated on basis of the clinical condition of the cows—which they regard as a nonappropriate way to reach the goal of low SCC.Repeated treatments may be justi?ed in this argumentation,and a way of reaching a combined goal of ‘low SCC’and ‘cows in a good clinical condition.’The local logic of such farmers has partly been supported by a general professional attitude that medical treatment of any mastitis case as bene?cial for food safety,animal well-being,and disease control.Presenting new knowledge about risks related to this policy—such as antibiotic resistance—may in?uence

VAARST ET AL. 1000

the whole attitude to and perception of good stockper-sonship.

Farmers’decisions about medical treatment seen in the light of health economic decision anal-yses.Earlier in the discussion,we pointed out that the farmer’s expectations to prognosis and various out-comes of different actions were built up on a continu-ously growing experience.Decision tree analyses are one way of describing various choices,and their possible consequences and the expected outcomes,primarily from an economic point of view(Dijkhuisen and Morris, 1997;Lescourret and Coulon,1994).Parts of the deci-sion on handling a mastitis case may possibly be de-scribed—and hence understood—by means of classical decision tree analyses.However,the full model of deci-sion making in relation to a single farmer’s local logic is too complex to model in a single branched decision tree analysis.The four levels presented and discussed interact with each other,and they are not hierarchi-cally ordered.

From a veterinary and animal welfare point of view, any disease case should be met with some kind of action to improve the situation.From a biomedical point of view,medical treatment is the most appropriate solu-tion to what is regarded as a bacterial infection,and other actions may be de?ned as risky.Dijkhuisen and Morris(1997)present and discuss various aspects of decision-making,primarily based on economical consid-erations.Some of the concepts could be applied in mod-els,where values other than economical are included. This approach could be relevant in relation to decisions about mastitis treatments,where goals and values of the farmer are included.Through Bayes’theorem,prob-abilities for outcomes of different actions can be calcu-lated on the basis of the conditions in the herds(e.g., whether the health condition is good,average,or bad, the criteria of which are not de?ned).Such analyses may be relevant in relation to the decisions made by farmers in relation to mastitis,when covering the?-nancial part of the decision.Alternative end products or goals could be included,such as probabilities for different SCC or calculations on the workload when choosing different solutions or the level of animal wel-fare—if measurable.Still,de?nitions of background in-formation of the herds,as well as the presumptions for such models,must be very well de?ned.As soon as complex human decisions are included,one should be aware that different arguments—and outcomes—in-cluded when taking the decision often belong to a multi-dimensional?eld in the farm,herd,and farmer.This ?eld may not be expressed through measures that can be weighted directly against each others,which is the case in common decision analyses.

Journal of Dairy Science Vol.85,No.4,2002

Future perspectives:The decision on antibiotic treatments on more levels.The convergence of‘veteri-nary rationality,’‘the daily rationality of the farmer,’and the risk of antibiotic resistance is a?eld that should be further explored and discussed seriously for disease treatment.One role of the veterinarian could be ambu-lance service,that is,the veterinarian comes to the herd and treats what he is asked to treat,given that he agrees with the treatment decision.The role of the vet-erinarian seems changed today,because health plans and health advisory service,where treatment criteria and treatment protocols can be elaborated in collabora-tion,makes the veterinarian an integrated part of the farmer’s decision network.In the light of this develop-ment,it is important that the veterinarian and other advisors make a substantial effort to understand and respect the farmer’s own perspective.The advisor should not only play the role as an educator who tells the farmer what is best as seen from a veterinary point of view.Otherwise,it may lead to miscommunication and no improvement of the herd health situation.Build-ing up a dialogue in a systematic way,where these four levels are included,and where the farmer explains his or her priorities,values,and choices,could show one way forward to a better understanding between the farmer and the advisors of the herd.This may lead to the development of more ef?cient herd and individual treatment program,which promotes improved udder health.

The results of this study indicate that the rationale of the farmer can be described in a relatively uniform way.The four levels described in this article are treated with various weights in different farms,but can still be described across farms.This opens a door to a more extensive understanding of the local logic of the farmer, which should be used directly in the daily communica-tion and decision making.

CONCLUSION

A systematic way of describing the decision-making in mastitis cases can be described from these results, involving four levels:mastitis symptoms,single-cow characteristics,the situation of the herd,and the farm-er’s perception of existing alternatives.Within each farm,these levels could be recognized and recon-structed,but each level and different factors within each level are given different priorities among farms. Farmers were shown not to be—as sometimes claimed—irrational in their choice of treatment,but they do not necessarily have the same kind of rational-ity as their practicing veterinarian.When a farmer is confronted with a newly introduced concern about anti-biotic resistance,his or her decisions and priorities may

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be forced or encouraged to be completely reorganized.Certain arguments are given for the concern of antimi-crobial resistance,such as the demonstrated occurrence of increased incidence of mastitis cases involving patho-gens with antimicrobial resistance (Aarestrup,2000).The concern both involves the fact that this leads to less ef?cient treatments and at the same time increases risk for humans via transfer of antibiotic resistance.These arguments have to be understood,and to be im-plemented into the framework of the whole farm,in which the farmer has his daily life,makes decisions,and takes action.

ACKNOWLEDGMENTS

Farmers are gratefully acknowledged for sharing their viewpoints and experience with me (?rst author)in such an honest and open-minded way.Colleagues from the research project ‘The in?uence of production facilities,management strategies,and medication pol-icy on health and antimicrobial resistance in dairy cat-tle herds’are gratefully acknowledged for their never-fading support to and interest in the whole process of interviewing and analyzing the interviews.

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调速器处于运行模式时,用该键可进入程序查看模式。在程序查看模式下,程序只能看,不能修改。 RUN(运行键):当机组准备就绪后,按RUN键发出一个透平运行或启动的指令给505E. STOP(停止键):一旦给予确认,触发透平控制停机(运行模式下)。通过服务模式设定(在“键选项”下)可以禁用STOP命令。 RESET(复位键):用于复位、消除运行模式下报警和停机。在停机后按该键,还能使调速器返回到(Controlling Parameter /Push Run or Prgm)状态. 0/NO:输入0/NO:回退出。 1/YES:输入1/YES或投入. 2/ACTR(执行器):输入2或显示执行器位置(运行模式下). 3/CONT(控制参数):输入3或显示当前的控制参数(运行模式下);按“向下翻页”键显示调速器的最后一次跳闸原因、条件存在图的优先权(steam map priority)\达到的最高转速、就地/远程状态(如果使用的话). 4/CAS(串级):输入4或显示串级控制信息(运行模式下). 5/RMT(远程):输入5或者显示远传转速给定控制信息(运行模式下). 6/LMTR(阀位限制器):输入6或者显示阀位限制器信息(运行模式下)。7/SPEED(转速):输入7或显示转速控制信息(运行模式下)。 8/AUX(辅助):输入8或显示辅助控制信息(运行模式下)。 9/KW(负荷):输入9或显示KW/负荷或第一级压力信息(运行模式下)。

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Installation and Operation Manual安装和操作手册 505 Digital Governor数字调速器for Steam Turbines蒸汽汽轮机with Single 单一or Split-Range部分范围Actuators调节器 Volume 1 Manual 85017V1B 第五章505运行操作 Run Mode Architecture运行模式体系结构 The 505 is designed愿意to be interfaced界面上with through通过a user-friendly用户界面友好的,用户容易掌握使用的service panel,维修面板 discrete and analog离散模拟input/outputs or Modbus communications.通讯Basic program基本程序 architecture体系结构is illustrated in Figure 以插图说明见5-1. When the control is powered up 加电and after the brief下达CPU self test自检测has been completed完成, the control displays a ready status就绪状态 (Controlling Parameter调节参数/Push Run or Program). The 505’s normal operating正常工作architecture is divided分成into two sections到两部分零件: the Run Mode and the Program Mode. The Program Mode is used to configure the 505 for the specific application专用应用程序and set all operating parameters工作参数(see Chapter 4). The Run Mode is simply仅仅the normal 正常 turbine operation mode工作操作方式and is used to view operating parameters and run the turbine. A Service Mode预检(服务)模式is also同样available可用to make制做additional另外附加的on-line adjustments调整机构 while the unit装置is running. See Volume 2 for information on the Service Mode. 505愿意从界面上通过用户的友好界面进行服务与维修。其基本程序体系结构为离散模拟输入/输出与Modbus通讯(插图说明见5-1)。当控制电源加电与CPU下达自检测完成后,控制面板显示ready status就绪状态(Controlling Parameter调节参数/Push Run or Program)。505正常工作体系结构分为两部分,即:the Run Mode and the Program Mode(设置全部的工作参数见第四章)。运行模式仅为正常工作操作方式与用户去浏览工作参数和启动汽轮机。预检(服务)模式同样可用需制做另外附加的调整机构,当装置运行时可以在服务模式上看见容积信息。

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