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Patient-reported outcomes (PROs) are increasingly collected in clinical trials and real-world studies as they provide valuable information on the impact of a treatment from the patient’s perspective. Studies in Parkinson’s disease psychosis (PDP) have focused on hallucination and delusions, however individuals with PDP also face functional limitations associated with worsening psychosis. Assessing activities of daily living (ADLs) and functioning of PDP patients can help inform PDP treatment. The International Parkinson and Movement Disorder Society has recommended the use of the Functional Status Questionnaire (FSQ) which has been infrequently utilized. Prior results were reported from a Phase 4 open-label study examining the impact of pimavanserin on ADLs and functioning in patients with PDP which utilized a modified version of the FSQ (mFSQ) as the primary outcome measure. In this analysis, we provide additional data on the patient-reported mFSQ within specific domains and correlation to the Schwab & England ADL scale.
Methods
Eligible patients entered a 16-week single-arm, open-label study of once-daily oral pimvanserin (34mg). The 6 domain FSQ was modified to assess 5 domains by removing the work/performance domain since this was not applicable to the patients in this study. The mean change from baseline to week 16 was evaluated in mFSQ domains (Basic ADL, Intermediate ADL, Psychological Function, Quality of Interaction, Social Activity). In addition, correlation between Schwab & England ADL scale and observed mFSQ value across post-Baseline visits were evaluated.
Results
A total of 29 patients were enrolled in the study, mean age (70.2 years), 62% males. The MMRM LSM (SE) for mSFQ from baseline to Week 16 were the following within each domain: Basic ADL (n=22), 8.1 (2.41), p=0.0031; Intermediate ADL (n=21), 7.0 (3.00), p=0.0286; Psychological Function (n=22), 13.3 (1.94), p <.0001; Quality of Interaction (n=22), 12.3(2.07), p <.0001; and Social Activity (n=18), 25.8 (7.52), p=0.0026. All mFSQ domains were showing improvement at 16 weeks from baseline; however, the largest change was seen in Social Activity. The correlation of mFSQ and the Schwab & England ADL scales resulted in a correlation coefficient of r=0.6 (p <.0001) for patient total score and r=0.5 (p<.0001) for caregiver total score. There was a consistent trend among both scales which was demonstrating improvement among patients and caregivers.
Conclusions
This was the first open-label clinical trial to utilize the mFSQ in patients with PDP. In this small, proof-of-concept study, treatment with pimavanserin was associated with improvement across all mFSQ domains; most improvement was seen in social activity. Additionally, the mFSQ was significantly correlated with the Schwab & England ADL, thus this appears to be a promising scale deserving of further evaluation and use in clinical studies as well as in the clinic to complement other assessments.
The aim of the research reported in this Research Communication was to apply the 5-point body condition scoring (BCS) system to dairy buffaloes and subjectively validate it by assessing the intra- and inter-assessor agreement. For this purpose, the BCS system developed for dairy cows was applied to buffaloes. A total of 230 Nili Ravi buffaloes of varying parity, lactation stages and pregnancy status were enrolled from the Buffalo Research Institute, Pattoki, Pakistan. Four observers independently assigned BCS values to each enrolled buffalo in two phases, as follows: (1) during phase I, the assessors were trained for BCS assessment using a BCS chart developed by Elanco Animal Health Ltd.; and (2) during phase II, the assessors were trained using live buffaloes for BCS assessment. Kappa statistics (kw) were used to determine the intra- and inter-assessor agreement. The results revealed that the exact overall inter- and intra-assessor agreement was moderate (kw = 0.48–0.55) and increased to substantial levels after training on live animals (kw = 0.63–0.87). Furthermore, the intra- and inter-assessor exact agreement was higher (kw = 0.57–0.58) for buffaloes tied to the mangers compared to the buffaloes standing in the loafing area (kw = 0.50). The inter-assessor agreements within 0.25 and 0.5 points were almost perfect (kw = 0.97–1.0). The current results suggested that the 5-point BCS system (using a scale from 1 to 5 with 0.25 increments) had substantial agreement for assessment and repeatability when applied to buffaloes.
Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.
The smoking rate among Malaysian aboriginal people is double the rate of other Malaysians. Smoking is a major cause of morbidity and mortality in aboriginal people but smoking cessation among this population is very low. At present, pharmacotherapy for smoking cessation is not subsidised in the health services.
Objective and aim
The study aimed to explore potential reasons for the underutilisation of drug therapy for smoking cessation among aboriginal and non-aboriginal smokers.
Methods
A cross-sectional study was conducted among aboriginal and non-aboriginal smokers in the state of Selangor between March 2010-August 2010. Participants were asked to complete a questionnaire on demographics, smoking behaviour, physician counselling on smoking cessation and perceptions about drug therapy for smoking cessation.
Results
The overall response rate was 85% (250 Aboriginal smokers and 105 non-aboriginal smokers). Majority of smokers reported smoking cessation or reduction in the previous 6 months (Aboriginal 62% vs non-aboriginal 68%). Aboriginal participants were less likely to seek physician services (p = 0.001) and less willing to use nicotine replacement therapy (p = 0.01) or varenicline (p = 0.001). Among all smokers, having to buy the medication and price of the medication was the most important factor associated with less willingness to use the drugs but advice from physician was associated with willingness to use the drugs.
Conclusions
Regardless of ethnic origin, smokers were interested to quit smoking, but cost of medication may explain their lower uptake of drug therapy. Malaysian policy makers should consider making the drugs for smoking cessation freely available in the Malaysian health services.
The poster will address the important issue of how we can use opportunities in teaching our medical students how to take a wider view of psychiatry and learn to ‘think outside the box’ thus broadening their vision, enabling them to challenge presently held concepts, while at the same time learning the basic tenets of our profession.
Clearly, this is done by involving our students in clinical research based and audit based activities. However not all schools or teachers are comfortable with doing this, while the medical curriculum is broad, and there is a risk that students ‘only study for exams’.
Research based activities, including simple things such as using basic it skills to do a literature search for a review article or carrying out a useful clinical audit, using a unit held database, are however things which students can easily do, and these can lead to publishable case reports, posters, or ever articles in peer reviewed journals.
The poster will illustrate how we developed research activities with students at Cambridge University Clinical School. It shall discuss the advantages, difficulties, and indeed enjoyment of carrying out such activities.
This study surveyed Malaysian aborigine people to determine the prevalence of alcohol abuse dependence, psychiatric morbidity and psychosocial correlates among Malaysians aborigines. Studies among minority group in developed nations repeatedly showed severe drinking problems (Lomnitz, 1976; Gordon, 1978; Karno et al, 1987; Yamamoto et al, 1993).
Household survey with informed consent taken. Selected household were chosen and orang asli (aborigines) age 18 above were interviewed in Kuala Betis areas. Alcohol screening used AUDIT questionnaires and Psychiatric morbidity measured by MINI. Odds ratio was used as measures of the association for the variables. The data analysis was done using SPSS version. 276 orang asli were interviewed during the study. Majority are within age group of 18-29 years of age (37%) with the mean age 36.51 years old. The M: F (50.7% and 49.3%). Senoi ethnic group is the majority (97.8%). 28% has no formal education and 58% received primary school education.
Majority are married (82.2%). Half of them are employed and more than half received less than RM 500 monthly (USD 150). Types of alcohol use mainly beer and whisky. 90.24% have AUDIT score less than 7.
Multivariate analysis showed only those employed are significantly associated with alcohol problems, Odds ratio= 0.089, 95% CI (0.033-0.246), P< 0.001.
Prevalence of alcohol use among orang asli is comparable with general population. Employed people may have more money to buy alcoholic beverages. Orang asli probably need more attention on awareness program and further interventions.
The aim of this study is to investigate the “Hospital Service providers” perception, attitude and actual practice in managing schizophrenia in Malaysia.
Method:
In this study, it was designed as a mixed -methods study. in the first phase, quantitative surveys have been implemented among 42 service providers. in the second phase, the descriptive qualitative study method was also used.
Result:
The questionnaires designed to gather the data relating to the respondent satisfied in managing Schizophrenia in Malaysia. Thirty five (or 83.3%) of the respondents are satisfied with the current Schizophrenic overall management, but twenty one (or 50.1%) of the respondents does not satisfy with current psychosocial interventions available in Malaysia. The qualitative found that, the psychiatrists responded that they are satisfied with current use of atypical antipsychotic in the hospitals but they are concerned with the lack of community services particularly in the university hospitals. The medical officers and general practitioners responded that they received many patients who were brought by their families to see them in outpatient clinic. However, many doctors failed to diagnose the disorder as they have a lack of training in diagnosing mental illness diseases. This is mainly due to misperception about mental illness particularly in rural areas among the Malay population.
Conclusion:
The study concluded that more community awareness program needs to be done which emphasis on mental illness to reduce the duration of untreated illness and ensure active roles of family members in supervision of treatment.
Malaysia is the tenth largest alcohol consumer in the world. Yet, there was limited data avaoilable about alcohol prevalence among Malaysian population at the moment. Apart from general population, the data on the usage of alcohol among the natives especially “Orang Asli” in central peninsular Malaysia are almost none. Orang asli are observed to use alcohol heavily as part of their cultural practices and end up with more complications e.g. intoxications, dependence syndrome and violence behavior.
Objectives
We investigate the prevalence of alcohol use among the aborigines and their psychosocial correlates related to alcohol use.
Methods
This is a household survey involving 200 participants, age 18 and above with written consent using sytematic sampling from the aborigine village area of Gombak Batu 11. We exclude those subjects who refused consent and those in the withdrawal or intoxication state during the interview. The Instruments use include Alcohol, Smoking and Substance Involvement Screening Tool linked with Brief-Intervention(ASSIST-BI) questionnaires and MINI neuropsychiatric inventory(MINI). We also conduct the focus group discussion for details interview on their belief,knowledge and practice regarding alcohol drinking habit,.Outcomes measures are analysed using SPSS version 16.
Results
We expect that the prevalence of alcohol and substance use among Malaysian aborigines are higher as compare to general population in Malaysia.
Conclusions
The aborigines in Malaysia pobably in need for specific awareness promotion and outreach treatment program that tailor to their unique way of life.
Motor Vehicle Accidents(MVA) are the main attendees of accident emergency unit in UMMC. Assessment by doctor found that some ot them used alcohol/substance prior to MVA event. They also found to have abnormal sleep pattern and “emotional problems” that contribute to MVA and injuries. Yet, limited study available in Malaysia that explore the relationship between sleep disorders, substance use, psychiatric morbidity and MVA events.
Objectives
To investigate the prevalence and associations of sleep disoders, substance use and psychiatric comorbidity among attendees in accident emergency unit, UMMC.
Methods
This is a cross-sectional hospital based study that examine all MVA attendees age 18 and above with written consent in accident emergency unit UMMC from 30 September to 30 November 2011. We exclude those patients with Glasgow Coma Sale(GCS) less than 10, intoxication and refused consent. We measure sleep disorders using Epsworth Sleep Scale(ESS), Psychiatric morbidity using Hospital Anxiety Depresion Scale(HADS) and substance use with Drug abuse screening tool(DAST). We also do rapid urine test kits for opiates, canabis, amphetamine type stimulants(ATS) and benzodiazepines. Chi square test will be analyses for the variable asssociations using SPSS 16.
Results
We expect that the prevalence of sleep disorders, subsatnce use and other psychiaric comorbidity are higher among MVA attendees. There are some association in between those factors that contributes to the MVA events.
Conclusions
MVA attendees probably need further assesment as routine e.g. sleep study, psychiatric morbidity and drug screening in order to better manage them and prevent further MVA in the future.
Pharmacological treatments targeting the neuroendocrine stress response may hold special promise in secondary prevention of posttraumatic stress disorder (PTSD). However, findings from clinical trials have been inconsistent and the efficacy of specific drugs, their temporal window of efficacy, effective doses and the characteristics of likely treatment responders remain unclear.
Method
Using an experimental human model of distressing involuntary memory formation, we compare the effects of two drugs that have theoretical or empirical support as secondary preventive agents in PTSD. Eighty-eight healthy women (average age: 23.5 years) received oral propranolol (80 mg), hydrocortisone (30 mg), or matched placebo immediately after viewing a ‘trauma film’. They then completed daily, time-stamped intrusion diaries for 1 week, at the end of which, voluntary memory was tested.
Results
While neither drug affected voluntary memory for the trauma narrative, propranolol treatment was associated with 42% fewer, and hydrocortisone with 55% fewer intrusions across the week, relative to placebo. Additionally, propranolol reduced general trauma-like symptoms, and post-drug cortisol levels were negatively correlated with intrusion frequency in the hydrocortisone group.
Conclusions
Overall, this study shows substantial reductions in intrusive memories and preserved voluntary narrative-declarative memory following either propranolol or hydrocortisone in an experimental model of psychological trauma. As such, despite some inconsistencies in clinical trials, our findings support continued investigation of propranolol and hydrocortisone as secondary preventive agents for re-experiencing symptoms of PTSD. The findings also suggest that it is critical for future research to identify the conditions governing the preventive efficacy of these drugs in PTSD.
We explored the allelopathic potential of kudzu as a function of its phenolics. Aqueous and methanol extracts of different kudzu organs (leaf, stem, root, and seed) were assayed for allelopathy with the use of lettuce and radish seeds. Both leaf and root extracts significantly inhibited all of the measured germination indices (total germination, speed of germination, and coefficient of the rate of germination) (all P < 0.01). When treated with leaf extract, the total germination of both species was ∼ 20% less than the control. Furthermore, the leaf extract significantly reduced the speed of germination to 38 and 53% that of the lettuce and radish controls, respectively. Lettuce and radish seeds soaked in leaf and root extracts for 24 h imbibed less water (∼ 30% for both species) than those soaked in distilled water (control), suggesting that a reduction of water imbibition might be one of the mechanisms of germination retardation. Stem and seed extracts affected neither the water uptake nor the germination indices of radish and lettuce seeds. Kudzu leaves and roots contain higher amounts of total phenolics (P = 0.001) and soluble phenolics (P = 0.005) than stems and seeds, consistent with the results of the germination bioassays. In agar plate bioassays, both litter and rhizosphere soil had phytotoxic effects on the radicle growth of radish (P = 0.003) and perennial ryegrass (P = 0.001) seedlings. Perennial ryegrass and cobbler's pegs seedlings grown on leaf and root leachate-amended soil gave ∼ 40% shorter roots and shoots and ∼ 50% less dry weight than those grown in leachate-free soil. Kudzu litter was incorporated and incubated in soil for 6 wk, at which point the soluble phenolics in the soil solution were at a level (> 150 ppm) considered to be allelopathic.
Shoe soles have been shown to transfer infectious microorganisms to floor and ground surfaces. However, the possible modes of transmission of infectious agents from floors or ground surfaces to human contact for infection have not been systematically reviewed. A systematic review was performed on articles indexed in medical databases (Medline, EMBASE, PubMed) using a pre-defined search strategy and MeSH terms (date of last search: 15 March 2016). Only primary research studies in English that investigated the transmission dynamics of infectious microorganisms from floor or ground surfaces to human infection were included. Extraction of articles was performed two independent reviewers using pre-defined data fields in an Excel sheet. Disagreements were resolved by consensus. Thirty studies met the inclusion criteria. Almost all hospital-associated microorganisms including methicillin-resistant Staphylococcus aureus, Clostridium difficile, and multidrug-resistant Gram-negative species were identified on floor or ground surfaces. Several modes of transmission dynamics, most commonly direct contact or aerosolization, were identified. In conclusion, interventions such as efficient cleaning of floor surfaces and vectors that transfer infectious organisms to floors such as shoe soles could be an effective infection control strategy to prevent human disease.
Experiment was conducted to evaluate the effect of weaning age on growth performance, feed intake, feed efficiency (FE) and blood metabolites in Nili-Ravi male buffalo (Bubalus bubalis) calves. Twenty-four male buffalo calves were assigned to one of the three treatment groups: continuous milk feeding (CMF), limited milk feeding (LMF) and early weaning (EW), and weaned off milk at 12, 10 and 8 weeks of age, respectively. For the first 3 days after birth, calves in all three treatments were fed colostrum, and were then moved to individual milk feeding at 10% of BW for the next 6 weeks. Thereafter, the provision of milk to the CMF group was gradually tapered to zero through week 12, using week 6 intakes as a base. The LMF calves were fed milk at 7.5%, 5.0%, 3.5%, and 1.5% of BW during weeks 7 to 10, respectively. Lastly, calves in the EW group were fed milk at 5.0% and 2.5% of BW at weeks 7 and 8, respectively. Calf starter (CS) feed was also provided ad libitum from weeks 2 to 12 and individual intakes were recorded on a daily basis. Blood samples were taken from weeks 6 to 12, on a weekly basis; whereas, the BW, heart girth, withers height and hip width were measured at the start of experiment and later on a weekly basis. Weight gain, average daily gain, and body measurements were the same across all three groups. Milk intake was lower (P < 0.05), whereas CS intake was greater (P < 0.05) in the EW calves compared with the other treatment groups. Dry matter intake was greater (P < 0.05) in the EW and LMF calves compared with the CMF calves. The FE was greater (P < 0.05) in the CMF calves compared with the LMF and EW treatment groups. Blood glucose concentration was similar among the treatments; however, blood urea nitrogen was greater (P < 0.05) in the EW calves compared with the CMF and LMF groups. Plasma concentration of non-esterified fatty acids was higher (P < 0.05) in the EW calves compared with the CMF calves. In light of these results, it is evident that buffalo calves can be successfully weaned as early as 8 weeks of age without negatively affecting their growth performance.
In recent years, livestock producers have been supplementing animal diets with fish meal (FM) to produce value-added products for health conscious consumers. As components of FM have unique neuroendocrine–immunomodulatory properties, we hypothesize that livestock producers may be influencing the overall health of their animals by supplementing diets with FM. In this study, 40 pregnant ewes were supplemented with rumen protected (RP) soybean meal (SBM: control diet) or RP FM, commencing gestation day 100 (gd100), in order to evaluate the impact of FM supplementation on the innate and acquired immune response and neuroendocrine response of sheep during pregnancy and lactation. On gd135, half the ewes from each diet (n = 10 FM, n = 10 SBM) were challenged iv with lipopolysaccharide (LPS) to simulate a systemic bacterial infection and the febrile, respiratory and neuroendocrine responses were monitored over time; the other half (n = 10 FM, n = 10 SBM) of the ewes received a saline injection as control. On lactation day 20 (ld20), all ewes (n = 20 FM, n = 20 SBM) were sensitized with hen egg white lysozyme (HEWL) and the serum haptoglobin (Hp) response was measured over time. The cutaneous hypersensitivity response (CHR) to HEWL challenge was measured on ld30 (n = 20 FM, n = 20 SBM), and blood samples were collected over time to measure the primary and secondary immunoglobulin G (IgG) response to HEWL. There was an attenuated trend in the LPS-induced febrile response by the FM treatment when compared with the SBM treatment (P = 0.06), as was also true for the respiratory response (P = 0.07), but significant differences in neuroendocrine function (serum cortisol and plasma ACTH) were not observed between treatments. Basal Hp levels were significantly lower in the FM supplemented ewes when compared with the SBM supplemented ewes (P < 0.01), and the Hp response to HEWL sensitization differed significantly over time between treatments (P < 0.01). The CHR to HEWL was also significantly attenuated in the FM treatment compared with the SBM (P < 0.01); however, treatment differences in the primary and secondary IgG responses to HEWL were not observed. These results indicate that FM supplementation differentially affects the innate and acquired immune responses in pregnant and lactating sheep compared with a typical SBM diet of commercial flocks. The long-term implications of this immunomodulation warrant further investigation.
We report an interesting property of carbon dots: they emit light under charge injection. We synthesized carbon dots in diameter about 20 nm using wet chemistry methods. The photoluminescence quantum efficiency of the carbon dots dissolved in water was about 11%. We observed strong electrogenerated chemiluminescence (ECL) from the sample. This observation of ECL from carbon dots indicates that they could be a good candidate material for carbon-based electroluminescent devices.
Dermatitis is a common side effect of radiation therapy (RT) whereas squamous cell carcinoma (SCC) is not. Management must include treatment options outside of RT, especially when cases are limited by extreme fibrosis. Here, we present a case in which a patient developed multiple SCC, severe radiation fibrosis, and limited neck mobility. This situation of increased risk for intubation required interdisciplinary coordination for proper therapeutic intervention, namely Mohs micrographic surgery to manage cutaneous lesions.
Specific and non-specific esterases have been localized in sections and whole mounts of Avitellina lahorea, an intestinal parasite of sheep and goats. Non-specific esterases (NSE) were found in the sucker muscles, post-acetabular ganglia, nerve trunks, tegument, excretory canals, cirrus sac, vagina, uterus and the inner membrane of the embryophore. Acetylcholinesterase (AChE) was observed in all the above organs, including vas deferens and sperm ducts, but was absent from excretory canals and eggs. Tests with acetylthiocholine iodide (AThChI) revealed the nervous system, vas deferens, sperm ducts, uterus, cirrus sac and the vagina. The intensity of activity of AChE and AThChI was weak compared to NSE.
A comparative studs of the spectral, electrophoretic and isoelectric properties of the haemoglobins of three trematodes. Paramphistomum epiclitum. Gigantocotyle explanatum and Gastrothylax erumenifer was carried out. A high absorption in the beta band region indicates that trematode haemoglobins have high oxygen affinities. Electrophoretic mobilities of all trematode and their host haemoglobins were different. The isoelectric points of trematode haemoglobins were found to focus in the acidic range except that of G. crumenifer haemoglobin I. which focused at an alkaline pH.