Thanks very much. Thank you very much for inviting us to talk to this meeting. I'm here to represent Bristol Veterinary School, particularly Emily Blackwell, who's sorry that she can't join you.

She did tell me that this is a really great meeting to go to, and I can see why. It's been a fascinating day, my first visit, and. Emily is part of the Bristol Vet School Animal Welfare behaviour Group.

Some of you may know her from some of her TV performances where she talks about cat and dog behaviour. This is an MSC project that was funded by the fund for Nicholas Wales, who's our dermatology nurse at Bristol Veterinary School. And she was working with Natalie Barnard at the time and myself in the clinic.

My job at Langford is partly doing dermatology, but I also do a few other things such as livestock pathology as well. Natalie came up with a proposal that we don't know. Much about factors for causing pruritus in cats.

Cats are a little bit of a challenge, and we put in an application to the fund. We're very pleased that they gave us some funding. Natalie's now moved on to work for CVS in a referral clinic based in Bristol.

For short, we came up with a very short title called PUE which is Pris unrelated to ect parasites in Cats, and that was the focus of the study. By way of background, some of you will be aware that if you're in general practise that cats can suffer from a variety of skin diseases. Cats are somewhat of a mystery to many of us as to what causes their skin disease.

We often assume. Fleas are a major factor and therefore once we've attempted to rule out the role of fleas, we're then left with what might be other allergens and so people then start to explore the role of food sometimes called food allergy or cutaneous food. Allergic reactions or they might be allergic to things in their environment and you might notice that I've avoided using the term atopic dermatitis here, which is commonly used in the context of dogs because in cats we don't really know what they're allergic to.

So if they don't get better with flea control, if they don't get better with a diet trial, then we infer perhaps that they might be allergic to other elements possibly in their environment. Now it's interesting we started the day talking about surgical interventions and various interventions with animals and do we do too much with our cases with our patients and cats have kind of given us a hard task here because they're actually quite difficult to. They're quite difficult to investigate.

So for example, most British cats usually don't live indoors exclusively, so they're allowed outdoors and who knows where they go, who knows where they can get food items. So doing a proper diet trial with a cat is an enormous challenge. If they hunt, we don't know if they're allergic to the food that they hunt and eat.

And then if we want to give them a special diet, there's lots of what kind of food you might want to feed them, and then once you've decided what you want to feed them, they're not going to eat it. So cats are notoriously difficult to work with and we are limited compared to dogs with what we can treat them with. A potic cat is an unhappy cat.

We want to improve its welfare, so we're going to give it a variety of medications. So the first challenge we have is that cats say to you, I'm not going to take that. I'm not going to take those pills.

I'm not going to take that liquid. Dogs relatively are quite stupid. They will take all the medications under the sun.

So and there's a plethora of products out there from lots of different pharmaceutical companies to treat dogs, but we can't always use them in cats, partly because we don't have the evidence, we don't have safety studies, but partly because cats simply won't take them. Now in canine veterinary dermatology we use a lot of topical products. We're increasingly having to do that because of safety issues, because of resistance problems with infection.

Cats probably don't get a lot of bacterial infections or yeast infections, but using topical products in cats is very, very difficult because they've got two things. They've got a very, very thick, dense hairy coat, and they've got the second most important thing perhaps in their life is this amazing structure thing called the tongue. And they're going to lick everything off and in fact it's the tongue that does a lot of the damage to the skin and to the hair coat, so managing cats is challenging.

And we know that. Because people often infer that, OK, we've got flea control in place, we're thinking about diet, we're thinking about treating them symptomatically. What role does stress play?

Are these cats distressed in some manner? Is this important? And it's fair to say that having worked in clinical work for many, many years, we see lots of itchy dogs.

We see quite a lot of itchy cats, but I think it's fair to say that cats actually can be really, really challenging, and in my years of doing this sort of work, it's probably the case sadly that we've had more cats put down, euthanized. Interesting decision, perhaps, because the owner can't cope. With the cat's quality of life.

In human dermatology, studies have been done to try and establish indices as methods to calculate the quality of life of the human patient, and in recent years, various colleagues in the veterinary dermatology community have tried to use some of those principles in veterinary dermatology to explore the impact of skin disease in cats and dogs, and increasingly also the impact of these diseases on the owner. Because the owner has got to medicate the animal, bathe the animal, feed the special food, put the flea control on, and try and manage the case, and it's often the situation that we say in clinic that it's not just the financial cost to the owner that. The issue, it's the physical logistical issues involved and also sometimes the enormous emotional involvement that's involved and as soon as owners begin to lose the motivation, their commitment, compliance drops off and then things start to unravel.

So it's perhaps compelling to say, OK, if stress is a factor, is this another possible management tool that will help us to be able to manage cats more successfully? So that was the focus of our study, could we begin to unpick the role of stress? So in order to do this, a case control study approach was given, a questionnaire study was adopted.

This is a little bit similar to what we're currently using. Some of you may be aware of the Bristol Cat study, which is where owners fill in. Long detailed questionnaires.

This particular study I'm talking about here was based on a study done a few years ago by colleagues at Bristol Vet School where we have a particular interest in cats, which was looking at lower urinary tract disease and cystitis. The criteria for eligibility for entry into the study was that the cats had to have a diagnosis of allergic skin disease by the veterinarian, that they'd and or they'd had at least 6 months of flea treatment. And they'd had 6 months of skin disease and where possible we would make sure that they'd actually followed the licence data sheet for when they were using flea control.

Those criteria strangely are quite simple you might think, but they actually made it quite a challenge to recruit cases. We initially worked on our own referral clinic population contacting owners of cats that we've seen over the years, and then we started to reach out to other colleagues, to other practitioners, veterinary practitioners, so some of you may be aware of a letter in the veterinary record where we were looking to recruit cases. We also had to recruit control cats, so Langford Bristol Vet School has quite a lot of referral clinics.

It also has a first opinion clinic, so that gave us access to a lot of colleagues and potentially a lot of cats. But what I found interesting is watching Nicola learn to grapple with GDPR. The regulations came in during this time, and it's quite interesting to see the extra hurdles we had to get owners permission to approach them.

It was also fascinating to see, because I'm not social media savvy at all, to see a young person grapple with social media and it's an amazingly powerful tool for reaching out to people and recruiting them. So I find that really quite compelling that usually when you set up a study, all the cases disappear, but on this occasion, Nicola was able to use various tools to recruit these cases. The questionnaire was quite lengthy, about 49 questions I think it was.

It would take the owners 20-30 minutes to go through, and it was going to collect a lot of different data, so the usual stuff, the age, the sex, the neuter status, and then quite a lot about the background of the home environment where the animal lived, whether there were dogs living in the house. Other cats in the house, things like the age profile of the people living in the house, factors that we might anticipate that would cause stresses for cats, such as were they showing signs of conflict, so there's various lists of signs that the cat might show which the owner could then tick and say, yeah, there's conflict over food or there's fights or lots of vocalisation going on. Whether the cat had been through any other stresses such as a concurrent illness or injuries and whether in fact they'd moved home or not.

Determining signs of stress is quite challenging, and I think what's come out of this study is that we need to understand more clearly what those signs might be. So those were listed in the questionnaires for the owner's benefit. We then use a variety of simple diagnostic statistical tests to try and unpick the data, so we're going to talk a bit about the unique variable analysis and a bit about the multivariable analysis as well.

So we were aiming for approximately 108 cats in the in the study, and Nicola managed to initially recruit 219, of which 111 were the control cats, which as usual, once you clean the data up, you realise that most of them are neutered, so there was a small number of intact cats, so those were removed from the data set, and then there were some animals where the questionnaire hadn't been completed properly. And there were some cats that hadn't had skin disease for 6 months and hadn't had the flea control done properly for at least 6 months. So this brought us down to a slightly smaller population of animals, 84 in the cases, and 98 control cats.

Overall, there are equal number of male and female cats. But in the Normal group, there were 57 males and 41 females. In the skin disease group there were 34 males and 50 females.

That proved to be an important finding as we go through. Nicolo used a variety of criteria to try and sort of fingerprint these cats. Where did they come from?

Were they rescued, were they strayed, were they living on a farm, have they been bred, that sort of thing, had they come from a breeder, and factors such as the number of cats in the house were established and These might range up to 10 in some situations, and most owners actually had 1 to 2 cats in both groups. When it comes to looking at the univariable analysis, we used a cut off of 0.2, so values less than 0.2 might be significant.

So those have been highlighted in blue in this column here. And so there are several factors here that we decided to look at in more detail. We have a couple of minutes.

Sorry, just a couple of minutes, right? And so these 6 areas were taken into further analysis and 2 On multivariable analysis came out as significant, with an odds ratio of 2.5 for sex and 2.3 for cats that showed signs of behavioural problems when they were in a multi-cat household.

The first thing I'm going to briefly talk about is the fact that female cats seem to be predisposed. This is an unexpected finding. We're not quite sure why this has occurred, whether this is overrepresentation.

Does it actually mean that female cats are predisposed? The study on the right, gender aspects, tells us that not much is known about gender predisposition. There's certainly more female cats than male cats described in the study by Hobi, which is the first large scale study of allergic cats where about 500 cats were assessed.

So that was an unexpected finding, and we can't explain that at the moment. Then the second finding was that cats in multi-cat households that showed signs of stress were more likely to have skin disease, and in these situations it's important to understand what signs they were actually showing. It's quite difficult for owners to know what is acute stress and chronic stress.

We assume that chronic stress is important. I've listed there some of the signs of acute stress which vets and owners might be aware of. Given the time, I need to focus on some of the chronic signs, so reduced appetite, reduced grooming and urination, feigned sleep.

These are all things we may need to take into consideration now when we're taking our histories, and for example, increased dependency on social withdrawal cats that try and slink away. So things that we might be able to do, and this is what the foundation would like us to try and help owners and vets know more about is how can we reduce stress. So we've got things such as giving cats routine, giving them plenty of access to resources, and one little.

Of fun that Emily's very keen to promote is the fact that always have more, one more than everything for all the cats that you've got in the house so that can help to reduce conflicts over food, play areas, going outdoors, over scratch posts and things like that. So just to finish up, this case control study showed that cats with allergic skin disease were more likely to be female, that cats that lived in multi-cat households where there were signs of stress, were more likely to have skin disease. And it behoves us perhaps to take this further forward and look at ways in which we might wish to put interventions in place to understand better what the conflicts in the house and then perhaps think about ways in which we can hopefully reduce the stress these cats might be suffering from.

So this has opened up some interesting questions which we didn't expect to find, and we are very grateful to the fund for their support and also for all the vets and all the owners that filled in all these questionnaires. I'll leave it there, sir. Thank you very much.