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Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.
To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.
The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.
This work applies stereometric parameters and fractal theory to characterize the structural complexity of the 3D surface roughness of Anacardium occidentale L. leaf using atomic force microscopy (AFM) measurements. Surface roughness was studied by AFM in tapping mode, in air, on square areas of 6,400 and 10,000 μm2. The stereometric analyses using MountainsMap Premium and WSXM software provided detailed information on the 3D surface topography of the samples. These data showed that the morphology of the abaxial and adaxial side of the cashew leaf is different, which was also observed in relation to their microtextures. Fractal analysis showed that the adaxial and abaxial sides have strong microtexture homogeneity, but the adaxial side presented higher surface entropy. These results show that image processing associated with fractal theory can be an indispensable tool for identifying plant species by their leaves because this species has singularities on each side of the leaf.
The purpose of this study is to identify factors associated with diagnostic stability of Bipolar Mood Disorder (BMD) with statistical and clinical interest.
Retrospective cohort study, in which the medical records of 916 individuals admitted to Coimbra University Hospital, between 1989 and 2008 with first diagnostic of BMD, were analysed for the following characteristics: age, gender, occupation, educational level, age at first diagnostic, number and types of hospital admissions, presence of suicide attempts, pharmacological treatments, time between first diagnostic and the new one (Schizophrenia, Delusional Disorder or Dementia), type of cognitive impairment, assessment examinations (TC-CE and EEG) and presence of co-morbidities.
The analysed sample was divided in two groups: one that kept the first diagnostic (BMD) and another that later received a different diagnostic.
Diagnostic criteria according to International Classification of Diseases- 10th edition.
4,7% of the total sample received a different diagnostic in a posterior assessment: 41,9% Schizophrenia, 4,7% Delusional Disorder and 53,5% Dementia. The factors were analyzed with traditional statistical methods and Mann-Whitney's test. The authors found five main factors with statistical significance between the two groups, namely, age, age at first diagnostic, total number of admissions and number of admissions for maniac episodes, and educational level.
The aim of the study was achieved. In clinical practice the reported characteristics must receive a special attention in patient's assessment, in order to verify the diagnostic stability and eventual evolution to another diagnostic.
Chronically stressed adult male Balb C mice were submitted to the tail suspension test. Chronic immobilization stress (6 h/d for 14 consecutive days) induced a significant reduction in immobility time when compared to non-stressed controls. Pretreatment with LY 53857, a serotonin 5HT2 antagonist, and IPS 339, a selective beta-2 adrenoceptor blocker, reversed immobility time to the levels of non-stressed controls. Chronic administration of corticosterone (100 mg/kg for 7 d) did not modify immobility time as compared to saline treated controls. It is suggested that both serotonergic and adrenergic pathways in the brain may participate in the stress-induced changes occurring in the tail suspension test response and that corticosterone does not appear to play a role in this process.
“Revolving Door Syndrome” is usually defined as a cyclical pattern of short-term readmissions to the psychiatric units of health care centers, by young adults with chronic psychiatric disorders. Concerning the actual politics in health care sistems, with sucessive budget cuts and reduction of full-time hospital beds, the authors' aim has been to identify the patients that enter into a vicious circle of being admitted to hospital, discharged, and admitted again, as well as the underlying psychosocial reasons.
The purpose of this study was to identify factors associated with short-term readmissions to psychiatric acute care services, with statistical significance, and clinical interest, within a portuguese sample.
Material and methods
Retrospective cohort study, in which the medical records of patients admitted to Coimbra University Hospitals two or more times (with short-term readmissions) between January and December of 2009, were analysed for socio-demographic characteristics, psychiatric diagnostic, presence of comorbidities, number of hospital admissions within that year, psychofarmacological treatments and presence of social and familiar support.
Results and conclusions
The authors found that lack of social and familiar support is a strong predictor for “Revolving Door Syndrome”, as well as the presence of a chronic psychiatric disorder.
The Children Eating Attitudes Test (ChEAT; Maloney et al. 1988) is a well-established 26-item scale designed to measure a wide range of problematic eating attitudes and behaviours among children and adolescents.
To analyse ChEAT reliability and validity in a Portuguese adolescent girls sample.
565 high-school girls (mean age 15.76 ± 1.571; mean BMI 20.42 ± 2.745) answered the Portuguese versions of ChEAT and of the Contour Drawing Figure Rating Scale (CDFRS; Thompson & Gray, 1995). to study the temporal stability 124 girls answered the ChEAT again after approximately six weeks.
Cronbach's alpha was of .76. the test-retest Pearson correlation was of 0.61. A four factors structure (explained variance=44.06%) was selected: Factor (F) 1 Fear of Getting Fat, F2 Restrictive and Purging Behaviours, F3 Food Preoccupation, F4 Social Pressure to Eat. the body satisfaction as assessed through CDFRS was negatively correlated with the total ChEAT (-.35), F1 (-.47) and F2 (-.23) (all p > .001); and positively correlated with F4 (.26, p < .001). Significant mean differences (all p < .01) were found between the three CDFRS groups (Group -1 Want to be thinner; Group 0 Satisfied; Group 1 Want to be fatter) in all eating behaviour dimension scores, except for F3; total ChEAT, F1 and F2 mean scores between groups significantly decreased through the body satisfaction groups -1, 0 and 1 and significantly increased for F4.
The Portuguese ChEAT psychometric characteristics are good. Factorial structure is in accordance with the original. It could be very useful to clinical and epidemiological purposes.
The Children's Depression Inventory (CDI) is a 27-item, symptom-oriented scale for youths aged 7-17. In Portugal some psychometric parameters has never been analyzed before.
To analyse the reliability and construct and concurrent validity of the CDI in a Portuguese adolescents sample.
969 adolescents (59.34% girls), aged 15.80 ± 1.51, answered the Portuguese versions of the CDI and of the Rosemberg Self Esteem Scale (SE). To study the temporal stability, 204 (58.74% girls) respondents answered the questionnaires again after approximately 5 weeks.
CDI mean scores were difference between genders [Girls=10.84 ± 6.025 vs. Boys: 8.90 ± 6.477, p < .001]. The Cronbach's alpha (α) was .85 for the total sample, .83 for the Girls, and .87 for the Boys. Pearson correlations between the test and the re-test was r = .81 for the total sample, r = .78 for the Girls sub-sample and r = .83 for the Boys sub-sample. Based on factorial and parallel analysis, a 4-factors structure was selected for the total sample (variance explained, VE = 38.93%), the Girls (VE = 36.92%) and the Boys (VE = 41.98%). The items content were similar in the total sample and by gender, but the order of the factors was different. The four factors were: “Depression and Negative Self Esteem”, “Ineffectiveness and Somatic Symptoms”, “Anhedonia”, “Interpersonal Problems”. The SE and CDI total scores were negative and statistically (p < .001) correlated in the total sample (r = -.67), in Girls (r = -.69) and in Boys (r = -.63).
The Portuguese CDI has good reliability and validity, showing to be an adequate instrument for measuring depressive symptoms in Portuguese adolescents.
For many years, psychiatric services were characterized by high rates of institutionalization and a strong focus on biological treatment. At present, aside from psychiatric hospitals, there are community mental health services introducing modern, community-based, and user-oriented services.
Taking this into consideration, the main aim of this poster is to provide an overview of a community mental health service of Lisbon's Psychiatric Hospitalar Centre (E.T.C. -Espaço Terapêutico Comunitário) for severe mental disorders, highlighting its complexities and challenges.
This poster also highlights the importance of recovery which requires symptom remission along with reduce interpersonal and social deficits and improved social adaptation and general life.
For this purpose, the authors portray a community mental health service and describe the results of the Personal and Social Performance Scale (PSP), a validated scale for the Portuguese population, useful in the evaluation of personal and social functioning of patients, which allows a better understanding and evaluation of therapeutic strategies implemented during the intervention.
Findings may suggest that these community structures may exert a great influence on social functioning of severely ill patients and that the recovery of people with chronic mental illness requires integrated support services. Therefore, the integration of health and social services is an essential element for the psychosocial rehabilitation and the administration of brief assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes
Perfectionism is a personality traitcharacterized by a person's striving for flawlessness and setting excessivelyhigh performance standards, accompanied by overly critical self-evaluations andconcerns regarding others' evaluations. This trait has been associated with abroad range of psychopathological conditions, starting in adolescence. In this context, prevention of its effects must start early, and the efficacyof reducing perfectionist levels in adolescents must be empirically investigated.
Toanalyse, for the first time, if one session to cope with perfectionism has theeffect of reducing the levels of this trait after two and six months later. Method:868 adolescents (610 girls),aged 15.73±1.571 years, from two secondary schools in Coimbra, Portugal, answered the Portuguese validated version of the Child and AdolescentPerfectionism Scale (CAPS). Two groups were formed: intervention group receivedone skill session oriented to reduce perfectionism (N=615); control group withoutintervention (N=253). Both groupsanswered CAPS again after two/T1 and six/T2 months.
No significant differences betweengenders were found in Total CAPS, Self Oriented Perfectionism/SOP and SelfPrescribed Perfectionism/SPP. At T1 significant mean reductions were observedin SOP at the intervention group (T0= 39.58±8.554 vs. T1: 38.44±8.676 t= 3.498,p=.001) but not at the control group (T0= 40.48±8.998 vs. T1: 39.34±7.753 t=1.894, p=.061). No differences significant differences were found in Total CAPSand SPP. At T2, SOP reduction remained in the intervention group (T1=38.44±8.676 vs. T2: 38.67±8.375 t= -.640, p=.020).
Adolescents are sensitive to short interventionsaiming to reduce perfectionism.
The term “revolving door” describes a subpopulation of chronically mentally ill patients frequently readmitted to psychiatric units. Policy of deinstitutionalization in mental health services during the past decades has highlighted the theme. Literature review indicates that patients at higher risk for revolving-door phenomenon are more likely to be younger, single males, with a diagnosis of a psychotic illness and high number of previous admissions. Patients with poor support networks, lower levels of education and challenging social environments are likely to remain well for shorter periods. Non-adherence to prescribed medications contributes significantly to relapse rates. the most consistently identified predictor is the number of previous hospitalizations.
Authors pretend to identify patients with a high number of admissions to Coimbra University Hospitals (CUH), analyze their clinical and socio-demographic characteristics, causes of readmission and social network, and give examples.
Retrospective cohort study, in which the medical records of individuals admitted to CUH during the last year were analyzed to identify those with the highest frequency of inpatient admissions (at least more than two within 18 months).
Results and conclusions:
Our preliminary results are consistent with those from the literature, regarding the clinical and social characteristics of patients with revolving-door phenomenon, however the most severe cases are found between female patients.
Considering the social burden and the pressure on inpatient services caused by revolving door patients, it is important to understand the factors that may contribute to this phenomenon to develop interventions that could reduce the prevalence of recidivism.
Depression, irritability and fibromyalgia have been linked to obstructive sleep apnea (OSA) which in turn presents with decreased slow wave sleep, the sleep phase responsible for cerebral recovery and consolidation of sleep.
Pregabalin increases slow wave sleep and sleep efficiency; while simultaneously combining mood stabilizing properties, being a theoretical therapeutic option for the psychiatric complications of OSA.
Case report of a patient with full remission of a major recurrent depressive disorder and resistant insomnia after treatment with Pregabalin; bibliographic search using PubMed/MedLine database with the following keywords: mood disorder; personality disorder; obstructive sleep apnea; pregabalin.
We report and discuss the case of a 63-year-old woman with a history of major recurrent depressive disorder, histrionic personality disorder and chronic resistant insomnia. The patient presented with chronic widespread pain, nonspecific somatic complaints, depressive mood and chronic resistant insomnia. After several unsuccessful treatment trials with Venlafaxine, benzodiazepines and Zolpidem; the patient presented slight relief of depressive mood with Trazodone (150mg/day). Complete resolution of all disorders was obtained following adjunctive therapy with Pregabalin (50mg/day). Polysomnography revealed severe supine apnea hypopnea index (32.1), sleep architecture fragmentation, global efficiency of 57%; with an increased slow wave sleep of 33%.
The patient was referred to sleep apnea consultation and remains asymptomatic.
Our case suggest that Pregabalin may be useful in the treatment of several psychiatric conditions secondary to OSA. Literature revision suggests theoretical mechanisms that could explain the underlying mechanisms of this therapeutic effect such as increased slow wave sleep.
One third of all patients that comitted suicide attended Mental Health Services in the year that preceded their suicide (1/5 in the previous month) and 50-70% of all specialists and 40-50% of Psychiatry residents experience at least one case during their clinical practice. In fact, 97% of all therapists assume a patient's suicide as their strongest fear. All available studies describe a patient's suicide as an emotional, often traumatic, experience for the therapist. Our study aimed to assess and describe the impact of a patient suicide in their therapist in a sample of portuguese psychiatrists, both specialists and residents, focusing in their emotional responses. An annonimous questionnaire was emailed to all psychiatrist working in the Centre of Portugal (area of Coimbra). Included questions regarding socio-demographic information of the therapist, years of practice, sociodemographic data regarding the patient and context of suicidal behaviour, and ten different emotional responses assessing both its intensity and duration. Deadline for accepting replies is 30th November 2013. We hope to finish analysing all data by the end of January 2013 and be ready to present by February 2013.
(Hypo)mania is a known consequence of antidepressants in type I, type II and type III bipolar disorder. This conceptualization often induces the generalized belief that only the introduction of the antidepressant induces the mood switch.
Report the occurence of an understudied therapeutic event with unknown mechanism and associations. Promote clinical attention and further investigation.
Case report of a patient who developed a hypomanic switch upon venlafaxine discontinuation; bibliographic search using PubMed/MedLine database with the following keywords: bipolar; mania; hypomania; venlafaxine; antidepressant; discontinuation.
We report and discuss the case of a 48-year-old woman with previous history of a recurrent depression. The patient was successfully treated with Venlafaxine (300mg/day), Pregabalin (300mg/day) and Clonazepam (0.5mg/day) completing the acute and continuation phases of the treatment. She was then discharged with the indication to maintain treatment for her maintenance phase. After a couple of months the patient initiated slow Venlafaxine discontinuation after which she developed a clinical picture characterized by talkativeness, persistently elevated mood, increased goal-directed activity and unreasonable expenses lasting for an unspecified number of weeks and subsequent severe depressive episode without psychotic symptoms. The patient was again referred to our consultation and medicated with Venlafaxine (300mg/day) and Valproic acid (1000mg/day) remaining depressed and treatment resistant to this day.
Studies show that antidepressant-withdrawal (hypo)mania is a known but rarely reported leading to its unawareness an consequent unknown true incidence. Two hypothetical models may explain this clinical entity: Withdrawal-induced cholinergic overdrive; and Noradrenergic hyperactivity.
N-acetylcystein (NAC), a precursor to the amino acid cysteine, has been emerging as an interesting add-on treatment in several psychiatric conditions and especially in Obsessive Compulsive Disorder (OCD). These results may be linked to its metabolic profile: antioxidant properties through glutathione production; anti-inflammatory properties; and modulation of the glutamatergic and dopaminergic systems of neurotransmission.
Review the potential therapeutic effects of NAC in psychiatry, with main focus on syndromes of the obsessive-impulsive spectrum with report of a clinical case.
Case report of a patient with OCD and Hoarding disorder, with complete clinical remission after treatment with NAC; bibliographic search using PubMed/MedLine database with the following keywords: n-acetylcysteine; OCD; hoarding.
We report and discuss the case of a 44-year-old man with a diagnosis of Obsessive Compulsive Disorder with orderliness and contamination themes, coupled with Hoarding disorder. The patient experienced gradual though slight improvement with Paroxetine (60 mg/day) to which was subsequently added Risperidone (2 mg/day) with further slight improvement. In combination with the previously given pharmacological agents, NAC (1800 mg/day) was introduced with subsequent complete remission of all symptoms.
Studies suggest that NAC may be useful in the treatment of several psychiatric conditions. Our case report suggests direct relation between treatment with NAC and remission of obsessive and hoarding symptoms. Although encouraging, additional controlled research will be required to ascertain NAC clinical usefulness.
Nonsuicidal self-injury (NSSI) is defined as intentionally causing bodily harm to oneself without the intent to kill oneself. NSSI can be associated with a number of psychiatric disorders, including mental retardation, schizophrenia, borderline personality disorder, pervasive developmental disorders, stereotypic movement disorder, and Tourette's Disorder. In this paper we present the case of a 23-year old patient with Gilles de la Tourette's syndrome that exhibited severe compulsive self-mutilation and hostility leading to eye surgery following traumatic eye injury, as well as, familiar distress and social malfunctioning.
A review of the recent literature on NSSI different contexts and presentations, as well as, a case report, is presented. Our objective is to draw attention to less debated conditions related to NSSI, with particular focus on Tourette's syndrome and its potentially self-harming symptoms.
In adolescents, Socially Prescribed Perfectionism/SPP has been consistently associated with depression. Findings on Self-Oriented-Perfectionism/SOP and depression are equivocal. Self esteem/SE has been found to play a significant role between SPP and depression.
To analyse the relationship between perfectionism, SE and depression in a Portuguese adolescents sample.
963 adolescents (59.2% girls), aged 15.80 ± 1.510 answered the Portuguese versions of the Children Depression Inventory/CDI, Rosenberg Self-Esteem Scale and Child and Adolescent Perfectionism Scale.
CDI and SE mean scores were significantly different between genders (CDI-Girls:10.84 ± 6.025 vs. Boys:8.90 ± 6.477; SE- Girls:20.11 ± 4.953 vs. Boys:20.48 ± 4.856; p < .001). SOP was not significantly correlated with CDI and SE in both genders. In both genders SPP was positive correlated with CDI and negatively correlated with RSES (r = .20, p < .01). RSES was negative correlated with CDI (Girls, r = -.70; Boys, r = -.63; p < .01). Girls with high SPP (>M+1SD) had CDI total mean scores significantly higher than girls with low SPP ( < M-1SD) (12.61 ± 6.79 vs9.75 ± 5.24, p=.003). Gils and boys with high SE vs. low SE had significantly higher CDI total mean scores (Girls:18.49 ± 5.98 vs. 4.91 ± 3.05; Boys:17.02 ± 7.65 vs.5.80 ± 5.62; p < .001). Linear regression showed that the model composed by SPP and RSES explained 49.5% of the CDI variance in girls and 40.0% in boys (p < .001). In both genders, SPP and SE were significant CDI predictors (p < .05). The mediation analysis revealed that in the Girls sub-sample SE partially mediated the relationship between SPP and CDI (IC 95% .036-.126).
High SPP and low SE are associated with depression in adolescence.
International professional mobility is a reality, people have skills they can put in the global marketplace. The increasing migration of health professionals to wealthy countries is a phenomenon known as “brain drain”.
This work aims to present the push factors that pressure people to migrate from Portugal.
A cross-sectional survey was carried out with the psychiatric trainees in Portugal. A self-administered structured questionnaire was distributed to collect psychiatry trainees’ demographic and educational characteristics.
In Portugal, the majority of trainees have a Portuguese citizenship. Almost 2/3 did not have a short-mobility experience, and the majority never migrated to another country. Less than half consider staying in Portugal in the next years, and nearly 4/5 have considered leaving the country. Working conditions ranked first as the priority condition to be improved in psychiatry in Portugal, followed by financial conditions. In fact, an attractive job for psychiatry trainees in Portugal must have as the most important feature a pleasant work environment.
An alarming percentage of psychiatry trainees from Portugal intend to migrate. Impact on future career, financial conditions of doctors, job opportunities and better working conditions were some of the motivating factors behind the migration.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to themselves and to patients, yet they are often reluctant to seek help. Focusing on psychiatry, it is known that psychiatrists as a professional group are prone to stress burnout and suicide. Thus, it seems relevant and current to address on the burnout in this professional group.
To analyze the burnout levels and the existence of psychopathology in a Portugal psychiatry department.
Anonymous self-completion questionnaire, prepared by the Suicide Prevention Consultation (also using MBI-Maslach Burnout Inventory and QIS-Suicide Ideation Questionnaire) and distributed by e-mail and online submitted for all psychiatrists in the department.
Forty-two percent of psychiatrists responded, mostly women. Although the percentages of responses related to fatigue/amount of work are significant, there were not high levels of emotional exhaustion and depersonalisation, but before satisfactory levels of personal fulfilment.
High levels of “burnout” are associated with high scores of emotional exhaustion and depersonalisation, but also with low scores of personal fulfilment. Despite the preliminary results of this study, it is important to remember important prevention strategies. Further studies directed to psychiatry trainees seem important, as this represents an important risk group, where an early intervention can make a difference.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In vitro embryo production (IVEP) is a procedure that can promote genetic improvement in a short time frame. However, the success rates obtained with this biotechnology in water buffaloes are still inconsistent, and can be associated with the high concentration of lipids in the cytoplasm of oocytes and embryos. The objective of this study was to evaluate the effects of reduced concentration of fetal bovine serum (FBS) and/or use of l-carnitine during in vitro maturation (IVM) on the preimplantation development and lipid accumulation in bubaline embryos. In a first experiment, the lowest concentration of FBS in the IVM medium (0%, 2.5%, 5% or 10%) was determined, and the lowest concentration that maintained good embryo development rates was 5%. In a second experiment, the addition of 5 mM of l-carnitine into the maturation medium was evaluated. The blastocysts produced were submitted to lipid evaluation involving staining followed by observation using optical (Oil Red O) and confocal (BODIPY 493/503) microscopy. No difference was observed between the 5% and 10% FBS groups, which were superior to the 0% and 2.5% groups. Furthermore, the performance of the groups treated with 5% and 10% FBS was better than the groups supplemented with l-carnitine. There was no difference regarding embryo lipid accumulation. The results indicated that it is possible to reduce the FBS concentration to 5% in in vitro maturation medium for production of bubaline embryos, and supplementation with 5 mM l-carnitine does not increase embryo production.
The objective of this work was to evaluate the effect of protein reduction, with or without the supplementation of limiting amino acids, on the performance and carcass characteristics of meat quails from 22 to 42 days of age in a thermoneutral environment. A total of 324 European quails were randomly allocated into nine diets. The diets were formulated based on the recommended requirement (control) and were differentiated according to crude protein (CP) reduction levels into moderate reduction (10%) and severe reduction (20%). The diets were supplemented or not with limiting amino acids. The diets with severe and moderate protein reduction meeting the methionine + cystine, lysine and threonine requirements led to weight gain equivalent to that of the control quails. The diet with a moderate reduction in CP, with or without meeting the methionine + cystine requirement or meeting the methionine + cystine and lysine requirement, led to the greatest carcass yield and a greater leg weight and were similar to the control treatment. It is observed that supplementation with the crystalline sources of the amino acids is able to improve the performance of the quails, in addition, the attendance of methionine + cystine requirement important factor when the CP levels are reduced. In our studies, diets with 17.5% CP and supplemented with methionine + cystine, lysine and threonine meet the requirements of quails, thus generating a limiting amino acid requirement, so they are recommended for meat quails from 22 to 42 days old housed in thermoneutral environment.