Applied Animal Behaviour Science 175 (2016) 50–55 Contents lists available at ScienceDirect Applied Animal Behaviour Science journal homepage: www.elsevier.com/locate/applanim Management and design of hospital pens relative to behavior of the compromised dairy cow: A questionnaire survey of Iowa dairy farms Katrine K. Fogsgaard a , Mette S. Herskin a , Patrick J. Gorden b , Leo L. Timms b,c , Jan K. Shearer b , Suzanne T. Millman b,d,∗ a Department of Animal Science, Aarhus University, Foulum, Tjele, Denmark Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA c Department of Animal Science, Iowa State University, Ames, IA, USA d Department of Biomedical Science, Iowa State University, Ames, IA, USA b a r t i c l e i n f o Article history: Received 6 August 2014 Received in revised form 22 November 2015 Accepted 6 January 2016 Available online 22 January 2016 Keywords: Animal welfare Dairy cattle Hospital pens Sickness behavior a b s t r a c t Compromised dairy cows, such as those suffering from illness or injury, are likely to have different behavioral priorities and needs compared to healthy cows. Although hospital pens are typically required in animal welfare standards and assessment programs, there is surprisingly little information on best practices for housing and management of compromised cows. The purpose of this study was to provide descriptive information about management and husbandry practices of compromised cows on dairy farms in Iowa. A questionnaire-based survey was designed to examine demographic information, design and management of hospital pens, as well as decisions concerning humane endpoints when euthanasia is considered. The survey was sent to 300 Iowa dairy farmers including organic, large (>500 cows) and ordinary (≤500 cows) dairy farms, with overall response rate of 41%. Eighty-two percent of respondents had the possibility to house a sick or injured cow away from her normal pen. Hospital areas typically involved pen housing (89% of farms), and bedded pack was the most common flooring used (88%). Compromised cows were frequently housed in the same enclosure as fresh cows (45%), calving cows (36%), close up cows that are soon to calve (35%), dry cows (15%), or other cattle (8%), including heifers, calves and bulls. Half of the farms had standard management protocols for non-ambulatory cows. Calving difficulties, injury, milk fever, lameness and displaced abomasum were the most frequently cited conditions for moving cows into hospital pens. The present data can be used to formulate hypotheses and design experiments in order to examine relationships between the behavior of compromised cows under different management strategies. Research is needed to formulate recommendations for effective design and management of special needs areas and hospital pens, notably with respect to social groupings and behavioral needs of ill and injured cows. © 2016 Elsevier B.V. All rights reserved. 1. Introduction Compromised cows include individuals that are injured or ill. Within modern dairy farming, production diseases such as claw lesions (Huxley, 2013) and mastitis (Bradley, 2002) are considered major welfare problems (Broom, 2006). Despite decades of research into the welfare of dairy cows, questions about the behavior and welfare of compromised animals are only recently topics of scientific investigation (European Food Safety Authority, 2009; ∗ Corresponding author at: Lloyd Veterinary Medical Center #2201, 1600 South 16th Street, Ames, IA 50011, USA. Fax: +1 515 294 1072. E-mail address: smillman@iastate.edu (S.T. Millman). http://dx.doi.org/10.1016/j.applanim.2016.01.016 0168-1591/© 2016 Elsevier B.V. All rights reserved. Jensen et al., 2015; Weary et al., 2009). It has been suggested that these dairy cows may have different behavioral priorities and needs than healthy herdmates (Millman, 2008, 2013). In general, housing and management protocols for dairy cows are designed for healthy animals, whereas challenges affecting compromised cows might be exacerbated by inadequacies in the home pen, such as during competition for feed and access to lying space (Millman, 2007). Typically, compromised cows are cared for in the home pen or pasture, in special needs areas and more recently, in designated hospital pens or infirmaries. Hospital pens are specifically designed and equipped to facilitate management of compromised cows (Smith et al., 2001), including inspection and treatment (Cook and Nordlund, 2004). Although hospital pens are commonly required in animal care guidelines, there are few recommendations about K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55 how hospital pens should be designed or managed (e.g., NFACC, 2009; FASS, 2010; Humane Farm Animal Care, 2014). When managing sick or injured dairy cows, caregivers have to consider the severity of the disease, disease or injury prognosis and biosecurity. However, there has been little research to inform evidence-based best practices for design and location of hospital pens within dairy facilities, social groupings during treatment and recovery stages, records for evaluating and tracking animal responses to treatment, and humane endpoints to aid euthanasia decision making. The aim of this study was to provide descriptive information on design and use of hospital pens for compromised cows as a subcategory of “special needs” dairy cows, with the goal of identifying areas where further research by applied ethologists and animal welfare scientists is warranted. 2. Materials and methods The protocol for this study was approved by the federally mandated Institutional Review Board for use of human subjects at Iowa State University. 51 details of housing design, such as type of bedding, and management decisions for special needs areas and hospital pens. 2.3. Distribution of the questionnaires and follow-up The questionnaires were mailed to the farmers on January 19, 2010, with a postage-paid return envelope and an invitation letter for informed consent as well as explanation of the confidentiality agreement. A second copy of the questionnaire was mailed to 218 non-respondents on February 9, 2010. Follow-up phone calls were made to participants who had not returned surveys as of February 22, when telephone contact information was available, and participants were encouraged to submit their completed questionnaires. The Survey and Behavioral Research Service group at Iowa State University was responsible for administration and management of the questionnaires, and follow-up telephone calls. 2.4. Analysis of data Data were manually transcribed from the paper surveys into an Excel spreadsheet, and proportions were calculated manually. 2.1. Selection of dairy farms for participation 3. Results Iowa dairy farmers were invited to participate in the study in January 2010. The list of participants was drawn from a database of 1600 Iowa dairy farmers provided by the Iowa Department of Agriculture and Land Stewardship Dairy Bureau (2009) and a database of farmers with United States Department of Agriculture organic certification as identified by two certifying bodies (Iowa Department of Agriculture and Land Stewardship, and a commercial organic milk processing company, 2009). From these databases, three mutually exclusive groups of farms were compiled for a total of 300 invited participants, representing organic dairy farms (n = 83), large dairy farms (>500 cows; n = 50) and ordinary dairy farms (neither organic nor large farms; n = 167). The types of farms were selected in order to achieve data representing the most common types of farms in Iowa. Due to differences in sample populations, all organic farms and large farms in the databases were enrolled in the study, whereas ordinary farms were randomly selected from the remaining database with consideration to regional representation of the 99 counties in Iowa. 2.2. Questionnaire We constructed a questionnaire, consisting of 51 questions, focusing on design and availability of special needs areas and hospital pens, as well as the management of compromised cows, assisted by the Survey and Behavioral Research Service team at Iowa State University (ISU). As a component of the questionnaire development, the researchers visited four Iowa dairy farms to observe the special needs facilities and hospital pens, and to interview farm managers and veterinarians about common practices and challenges facing the dairy industry. Prior to distribution, the questionnaire was beta-tested by a convenience sample of ISU veterinarians, animal scientists and applied ethologists with expertise in dairy production, and revised for clarity and terminology. Within the questionnaire, an initial section focused on demographics of the dairy farm, including herd size and parity, marketing stream (organic or non-organic), housing system (tie stall, free stall, stanchion or pasture) and number of employees. Questions were asked specifically relating to the most recent sick, injured or lame lactating cow that was treated, regardless of outcome, as well as questions related to on-farm euthanasia. For farms with the possibility to move compromised dairy cows from the home pen to a special needs area or hospital pen, respondents were asked to complete a second part of the questionnaire, including questions on the Of the 300 questionnaires mailed out, six were returned by the postal service as undeliverable (1 large farm and 5 ordinary farms). A further 20 questionnaires were returned with explanation that the respondent was no longer farming dairy cattle (3 organic and 17 ordinary farms). Of the remaining 274 questionnaires delivered, 114 were returned by farmers who were actively engaged in dairy farming in Iowa, two farmers chose not to participate (1 organic and 1 ordinary farm), and partial or complete data was provided for 112 Iowa dairy farms for a response rate of 41% of the delivered questionnaires (40 organic, 20 large and 52 ordinary farms). The types of housing used on these farms included free stall housing (62% of farms), tie stalls (20% of farms) and stanchion stalls (13% of farms). Other types of housing (e.g., bedded packs) were reported on 3% of farms, and more than one type of housing was reported on 5% of farms. Pasture access was provided on 53% of farms, and was identified as the sole housing on 9% of farms. Of the 112 farmers responding to the questionnaire, 82% (n = 92) had “facilities to house a sick or injured dairy cow away from her normal pen or stall”. Of the 20 farmers without access to hospital pens, 60% described how they managed compromised cows in the comments section of the questionnaire. Three farmers housed sick or injured cows in tie stalls, whereas 7 farmers described locations where cows could receive individual treatment (such as the milking parlour) and made provisions for compromised cows within their home pens. Two farmers indicated that they had not experienced compromised cows to date. Among the 92 farmers with the possibility to move a compromised cow away from the home pen, sick or injured cows were reported to be held in the same enclosure as fresh cows (45%), calving cows (36%), close up cows (35%), dry cows (15%), or other cattle, including heifers, calves and bulls (8%). Conversely, tailored housing and management practices were provided on some farms, with access to a designated hospital area provided on 66 of these farms (72%), and designated lameness areas provided on 45 farms (49%). Few farmers, only 19% of the full cohort of 112 respondents, provided special rations for sick or injured cows. Respondents were asked to score pre-determined “reasons for moving a lactating cow to a special needs area/hospital pen” on a 1–5 point Likert scale (1 = not important, 5 = very important). Table 1 lists the reasons according to those identified as most important to least important. Cow-related factors (cow wellbeing and cow comfort) were identified as particularly important. 52 K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55 Table 1 The distribution of the pre-formulated goals underlying decision to move a dairy cow into a special needs area or hospital pen on Iowa dairy farm with aforementioned facilities (n = 92). Goal 1Not important 2 3 4 5Very important No response Cow well-being Cow comfort More frequent observation of cow Ease of handling Milk withdrawl Reduce disease transmission 2% 8% 5% 5% 36% 17% 2% 5% 2% 4% 5% 23% 11% 13% 12% 16% 13% 16% 21% 21% 29% 35% 13% 16% 59% 49% 45% 33% 27% 21% 5% 4% 7% 7% 5% 7% Table 2 The distribution of housing design and management of the hospital area on Iowa dairy farms. The data are presented as the percentage of respondents that reported using the following resources, and included only farms reported to have a designated hospital area for ill and injured cows (n = 66). Resources Options Proportion Type of enclosuresa Pen or box stall Free stall Stanchion Tie stall Other Bedded pack Concrete Dirt Rubber Partially slatted concrete Mattress Straw Sand Sawdust Other (corn stalks) Compost No bedding 89% 14% 11% 2% 2% 88% 23% 12% 3% 2% 0% 65% 15% 14% 11% 0% 0% Flooringb Beddingc a More than one type of enclosure may be present in the hospital area. Some enclosures may be used for restraint and treatment, rather than housing. b More than one type of flooring may be present in the hospital area. c More than one type of bedding may be present in the hospital area. A standard management procedure for non-ambulatory cows was reported for 52% of farms; 41% did not have a procedure and 7% did not provide a response to this question. Possibility to milk cows in the special needs or hospital area was provided on 32% of farms. Of the remainder, the distance between the special needs/hospital area and the “milking facility where special needs cows are normally milked” was less than 15.2 m (50 ft) on 51% of the farms, and less than 305 m (1000 ft) on 89% of the farms. Data regarding the design of the hospital pens such as types of enclosures, flooring, and type of bedding are presented in Table 2. Respondents were asked to evaluate 13 different preformulated diagnoses and report the likelihood they would “move cows with [these] conditions to [a] special needs area/hospital pen”. Table 3 lists the diagnoses according to the likelihood for moving cows to a special needs area or hospital pen for farmers that had facilities to do so. Among the most commonly reported reasons for moving a cow to a special needs area or hospital pen were calving difficulties, normal calving, milk fever and displaced abomasum. When reporting data for the most recently treated sick, lame or injured dairy cow, farmers were asked to specifically describe the reason for treatment. There was potential for overlap between some of these conditions; for example, a cow reported with a leg injury was presumably also lame. We categorized these cases according to the primary reason provided by the farmer, which was “injury” in the example above. For the 92 farms with special needs or hospital pen facilities, the most common reasons for treating a cow included lameness (27%), mastitis (18%), injury (9%), calving difficulties (8%), displaced abomasum (7%) and milk fever (7%). The percentage of these cows that were housed in a special needs or hospital pen during part or all of the treatment period were 71% Table 3 The distribution of the pre-formulated diagnoses underlying the decision to move a dairy cow into a special needs area or hospital pen on Iowa farms with aforementioned facilities (n = 92). Condition Calving difficultiesa Normal calving Displaced abomasum Milk fever Injury Ketosis Retained placenta Lamenessb Open woundsc Mastitis Metritis Respiratory diseases Diarrhea Proportion of farmers Yes, always Sometimes No, never No response 51% 41% 40% 40% 30% 21% 19% 14% 14% 13% 11% 10% 5% 34% 24% 35% 42% 53% 35% 26% 64% 46% 46% 35% 46% 44% 10% 28% 15% 13% 7% 34% 46% 17% 29% 35% 35% 35% 46% 5% 7% 8% 4% 10% 11% 10% 4% 11% 4% 15% 8% 5% a Included cows that were non-ambulatory as a result of calving difficulties, such as paralysis. b Included cows identified as non-ambulatory unless a specific reason was provided for the cow being down. c Some injuries may have also been associated with open wounds, but was not included unless specified in the description provided by the farmer. for calving difficulties, 63% for injury, 52% for lameness, 50% for displaced abomasum, 50% for milk fever and 35% for mastitis. On 64% of the farms, the most recently treated cow recovered. The recovered cow was moved directly to her home pen on 31% of the farms, was placed in a fresh cow pen for a few days and then returned to the home pen on 26% of farms, was moved into a recovery group where she remained for some or all of her lactation on 10% of the farms, was placed in a pen with cows in the same stage of lactation on 10% of the farms and placed in any available pen on 5% of farms. For cows, that did not recover following treatment in the special needs area or hospital pen, 26% were culled from the herd, 41% were euthanized on farm and 30% died. Of the 11 euthanized cows, 73% were euthanized by the owner or manager and the remainder were euthanized by a veterinarian. 4. Discussion Farmers and veterinarians take care of food producing animals with the aim to keep them healthy, productive and to avoid suffering. Although preventive care and identification of risk factors are active areas of research, today only scant guidance on the design and management of hospital pens exist. This report is among the first to provide descriptive information on design and availability of hospital pens and the management of compromised cows within the dairy industry, using a subset of Iowa dairy farms as a study population. More than 80% farmers had the opportunity to move compromised cows from the home pen, and of these, 70% had access to designated hospital pens. A diversity of approaches for managing the needs of compromised cows was reported. K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55 In general, the high prevalence of pen housing in designated hospital pen areas, together with bedded pack flooring, likely provides comfortable spaces and traction to facilitate resting behavior. A small number of respondents used tie stalls or stanchions for the compromised cows, which are associated with restricted lunging space for postural transitions (Krohn and Munksgaard, 1993). In hospital pens, flooring as well as type and level of bedding may be of even greater importance for the cows than in the home environment. Proudfoot et al. (2014b) kept cows on deep straw bedding in the days after calving, and found that dairy cows with metritis, mastitis or pneumonia tended to lie more than a healthy control group. These results are in line with reports of sickness behavior from other animal species (Hart, 1988). When an animal becomes ill with an infectious disease, the immune system initiates strategic behavioral changes in order to facilitate conservation of energy (Dantzer, 2001). Thus, it may be important for the welfare and recovery of compromised dairy cows that they are able to express their motivation to lie down. However, reports from Siivonen et al. (2011) and Fogsgaard et al. (2012, 2015) showed decreased lying behavior in cows with mastitis during the period of clinical illness. In those studies, the animals were kept on relatively hard flooring (rubber mattresses and sawdust) and the authors speculated whether the reduced lying time may be a reflection of the combination of the sore udder and the lack of softness of the flooring. Similarly, Jensen et al. (2015) and Bak (2015) reported that lame cows showed a clear preference for lying on the sand compared to the rubber floor. At present, it is not known whether the recovery or welfare of compromised dairy cows can be affected by the choices of flooring and/or bedding in hospital pens. These results, combined with recent information about bovine sickness behavior and its link to animal welfare (Fogsgaard, 2015; Proudfoot et al., 2014a), calls for further research into the design of hospital pens. There may be conditions where the relocation of compromised cows away from the home environment is not beneficial for them. As an example, Proudfoot et al. (2014a) showed that cows with mastitis, metritis, pneumonia, or some combination seek isolation during illness. However, lame cows did not seek isolation in another study (Jensen et al., 2015). Additionally, expression of sickness motivation is known to be context dependent, and may be disrupted in the face of stressors (Aubert, 1999). Today, effects of stressors on the expression of sickness behavior have not been examined in cattle. One-third of the respondents in the present study used their hospital pens for calving, fresh or dry cows (or a combination of these) as well as the sick or injured individuals. This practice is contrary to the recommendations by Cook and Nordlund (2004), because such “hospital pens” will be occupied by healthy transition cows or calving cows. Such mixing of ill and injured cows with healthy periparturient cows is of concern due to potential social stress, risk of transmission of infection and differing behavioral needs of convalescent and parturient cows. Agitation and restlessness associated with calving (Sepúlveda-Varas et al., 2013) are likely to pose increased risk of disturbance of convalescent behavior of the compromised animals, particularly where there is overstocking of pens. Further research is needed in order to establish effective management of the hospital pen in dairy production. We recommend the use of precise terminology (“hospital pens” versus “special needs pens” or “close up pens”) in order to emphasize the different function and care needed for the convalescent cow as well as periperturient animals. From our survey questions, we were unable to determine the proportion of compromised cows that were regrouped or socially isolated when moved into the special needs or hospital pen, or if regrouping occurred during the convalescent period. However, 51% of the newly recovered cows were introduced into a new social group. The effect of regrouping with unfamiliar animals has been 53 investigated in healthy cattle and leads to increased adrenocortical activation (Herskin et al., 2004), aggression (von Keyserlingk et al., 2008), reduced feed intake, reduced feeding time and reduced rumination activity (Schirmann et al., 2011), as well as decreased lying time (Munksgaard and Herskin, 2006). At present, the effects of regrouping compromised cows have received limited scientific attention. Isolation seeking behavior in dairy cows during illness (Proudfoot et al., 2014b) suggests that these animals are more sensitive to regrouping than healthy animals. Thus, relocation from the home environment (with or without isolation) may be beneficial. Based on the limited available knowledge concerning social motivation in sick or injured dairy cows, it is not possible to give evidence-based recommendations concerning the use of individual versus group hospital pens, or to advise an optimal stocking density in hospital pens. Results from healthy animals show that increased competition at the feed bunk leads to shorter feeding times and more aggressive interactions (DeVries et al., 2004), and that socially subordinate animals are displaced more frequently, particularly at high stocking densities (Huzzey et al., 2006). Considering increased motivation for social isolation (Proudfoot et al., 2014b) and decreased feeding motivation (Hohenbrink and Meinecke-Tillmann, 2012), compromised cows are most likely to benefit from hospital pens designs that provide reduced competition at the feed bunk. Many cows kept in hospital pens are lactating and need to be milked daily. In the present survey, approximately one third of the respondents had the opportunity to milk their compromised cows directly in the hospital pen, and an additional 51% of farms required cows to walk less than 15 m (50 ft) to the milking parlour. Depending on the specific pathological condition, the milking process may be a stressful event for compromised cows. Walking to the milking parlour and queuing to enter the parlour may be painful to the lame cow (Dyer et al., 2007). Furthermore, cows suffering from udder pathology may experience pain during the milking (Fogsgaard et al., 2015). Thus, opportunities to milk dairy cows close to or inside the hospital pen, combined with increased surveillance during milking, may be beneficial. Further research is needed to document possible consequences of the management of and facilities for milking of compromised animals When asked about conditions leading to the decision to move a cow from the home pen, the answers were highly variable. This is not surprising, given the diversity of causal factors for cow illness or injury, and the limited recommendations on hospital pen use. In the present dataset, the most prevalent conditions leading to the relocation of the cows from the home pen were calving difficulties, injuries, lameness, milk fever and displaced abomasum. These conditions are typically accompanied by standing and ambulation difficulties (Kahn and Line, 2006), and hence relocation to a hospital pen at disease onset may be strategic in order to avoid the risks of weakened and painful individuals becoming non-ambulatory in the home environment. Metritis and mastitis were among the conditions less likely to result in relocation of cows to hospital pens. For metritis, these low numbers may be surprising, since dairy farmers reported moderate pain scores for metritis (6 on a scale from 1 to 10) in a Scandinavian study (Thomsen et al., 2012). Furthermore, metritis is a costly disease, associated with decreased milk yield (Rajala and Grohn, 1998), increased risk of culling (Gröhn et al., 2003) and decreased reproductive performance (Melendez et al., 2004; Opsomer et al., 2000). Dairy cows suffering from metritis have been shown to eat less than healthy animals (Huzzey et al., 2007; Urton et al., 2005), thereby exposing themselves to slower recovery and increased risk of complications. Thus, dairy cows suffering from metritis may benefit from a stay in a hospital pen with a low level of competition, leading to a potential improvement in the production economy for the farmer. Similarly, mastitic dairy cows spend less time eating 54 K.K. Fogsgaard et al. / Applied Animal Behaviour Science 175 (2016) 50–55 and more time standing idle (Fogsgaard et al., 2012, 2015; Siivonen et al., 2011). Although these behavioral changes were not necessarily associated with competition or stocking density, relocation to a less competitive hospital pen may facilitate feed intake and improve recovery as well as animal welfare. However, no data exists regarding the associations between hospital pen use and production benefits for any diagnosis of illness or injury. In the present survey, after a stay in a hospital pen, recovered cows were most frequently moved directly to their home pens. In groups of cattle, social rank appears to be determined mainly by height, age and weight (Beilharz and Zeeb, 1982; Houpt, 2005). Consequently, in an established herd, the older cows tend to dominate (Houpt, 2005). Even though the exact temporal limits are not known, when a cow leaves her social group and returns within a short period of time, she will enter the same social status as before (Houpt, 2005). Thus, depending on the duration of the stay in the hospital pen, relocating recovered cows directly back to their home pen might not affect their social rank in the group. However, if sick cows change their social rank, their return to the home environment may represent unique social stressors during establishment of a new rank order. No information exists regarding effects of different management strategies for the return of recovered cows from hospital pens. One aspect of the management of compromised dairy cows which was not examined in the present questionnaire, and which has received limited scientific attention is the acceptable duration of the recovery period. Further research focusing on the recovery phase of prevalent bovine diseases is needed, including behavior and animal welfare parameters, in addition to production economy. Research findings could help inform decision making about humane endpoints as a component of the management of compromised dairy cows. 5. Conclusion Sickness behavior is an emerging area of research for applied ethologists, with particular relevance for the care of compromised cattle. This questionnaire survey is among the first to provide descriptive information on design and availability of hospital pens and the management of compromised cows within the dairy industry, using a subset of Iowa dairy farms as a study population. Cow well-being was considered either an important or very important reason for moving cows into hospital pens by 80% of respondents, and cow comfort was cited as important or very important by 70% of respondents. However, one-third of farmers reported housing ill and injured cows together with fresh, calving and close up cows. Research is needed to determine impacts of social grouping on expression of sickness behavior, particularly in regard to mixing compromised and periparturient cattle. Conflict of interest None. Acknowledgements The authors gratefully acknowledge the participation of the dairy farmers in Iowa, and the assistance provided by the Iowa State Dairy Association, dairy extension agents and organic certifying agents for networking and beta-testing our questionnaire. We are grateful to Kassi Miller, Becky Parsons, as well as Allison Andersen and Janice Larsen from the Iowa State University’s Survey and Behavioral Research Service, for technical support for the project. Dr. Annette O’Connor kindly provided helpful comments on an earlier draft. Thanks to Birthe Houbak and Eric L. Decker from Department of Animal Science, Aarhus University for the statistical support. 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