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The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.
Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.
The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
The incidence of depressive symptoms among adolescents has been increasing in the last years and several risk factors have been associated with depression which has become a major public health issue.
Assess the prevalence and determinants of depression in a Portuguese sample of adolescents.
A cross-sectional study was designed with a sample of 447 adolescents aged 12 to 19 years old, attending a public school in S tao, Portugal. A self-administered questionnaire with questions about socio-economic status, risk behaviours and sleep disorders was answered by adolescents. Depressive symptoms were assessed by the Portuguese validated version of the Beck Depression Inventory, and the cut-off point for depression was 13 points. We considered the following global scores: 0-13:minimal depression; 14-19:mild depression; 20-28:moderate depression; and 29-63:severe depression. Prevalence was expressed in proportions and compared by the Chi-square test.
The prevalence of depressive symptoms was 13.2%. According to the severity of depressive symptomatology, the prevalence of minimum, slight and moderate depressive symptoms was 57.4%, 5.4% and 2.3%, respectively. Depression was associated with insomnia (yes, OR=7.9 95%CI=3.1-19.9), residence area (urban, OR=1.4 95%CI=1.1-2.1), father’s educational level (<9yrs, OR=3.4 95%CI=1.1-10.2), alcohol consumption (OR=1.6 95%CI=1.1-2.2), coffee consumption (OR=1.4 95%CI=1.0-1.9) and smoking habits (OR=1.5 95%CI=1.2-1.8).
Adolescents who develop depression are also likely to develop insomnia. Depressive symptoms are associated with sociodemographic variables and addictive habits. Mental health promotion should be considered in school programmes in order to decrease the risk of depression and associated diseases.
When cognitive decline (CD) is present, attention is one of the impaired mental functions. CD is also associated with anxious/depressive symptoms and with some demographic variables, particularly, age.
Investigate the associations between selective attention (Stroop Test: Stroop_Word, Stroop_Color, Difference between Stroop_Word and Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color and Difference between Stroop Ratio_Word and Stroop Ratio_ Color) and CD (Montreal Cognitive Assessment/MoCA) in institutionalized elders; explore the predictive value of Stroop variables for CD, controlling anxious/depressive symptoms and sociodemographic variables.
140 institutionalized elders (mean age, M = 78.4, SD = 7.48, range = 60-97) voluntarily answered to sociodemographic questions, the MoCA, the Geriatric Anxiety Inventory/GAI, the Geriatric Depression Scale/GDS and Stroop test.
73 elders (52, 1%) had CD. Dichotomized MoCA was associated with Stroop_Word, Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color, GDS and the sociodemographic variable schooling × profession. Age and education were not tested, since MoCA was stratified according to those variables. GDS, Stroop Ratio_Word and Stroop Ratio_Color showed to predict CD.
There was an association between Stroop_Word, Stroop_Color, Stroop Ratio_Word and Stroop Ratio_Color and CD, confirming that selective attention is smaller when the elderly reveal CD. GDS and CD were, also, associated. However, there was no association between MoCA dichotomized and differences between the correct answers (Stroop_Word and Stroop_Color) and Ratios (Stroop Ratio_Word and Stroop Ratio_Color). Selective attention and depressive symptoms predicted CD. It would be important to intervene through cognitive rehabilitation with the elders to improve their attention.
Aging is a very heterogeneous and dissimilar process, full of asymmetries. There is evidence that socio-economic differences determine disadvantages and inequalities in old ages. Older people face particular inequalities in healthiness especially with more complex and vulnerable long-term conditions, being more likely to need support from social care services.
To evaluate the quality of life (well-being) related to the health of the elderly according to socio-economic indicators.
Cross-sectional quantitative study was performed. A total of 316 elderly people (M = 74.78; SD = 9.78 years of age) was interviewed with the Portuguese version of the EQ-5D-3L scale for health-related quality of life.
The interaction between income and the type of residential follow-up (alone vs. accompanied) was not statistically significant [F (2.310) = .910, P < .407; Ƞp2 = .006]. Differences in health status index were statistically significant for income [F (2.310) = 5.518, P < .004; Ƞp2 = .034]. Post-hoc comparisons indicated that the mean score for those with insufficient income for their expenses (M = .39, SD = .27) was significantly different from those with income reaching their expenses (M = .50, SD = .25) as well as those with income covering their expenses sufficiently (M = .60, SD = .21). The main effect for the type of follow-up (alone vs. accompanied) did not reach statistical significance [F (2.310) = .224, P < .636, Ƞp2 = .672].
Income has an impact on health-related quality of life. Health in aging as a social phenomenon is not neutral to economic differences and is exposed to these structural disadvantages.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Obsessive-compulsive disorder (OCD) is a severe mental illness that causes significant stress in children and adolescents. It is possible to infer three distinct etiologies – neurobiology, environment and dysfunctional interpretative patterns. Certain characteristics are attributable to OCD with onset in childhood or adolescence as higher prevalence in males, increased frequency of isolated compulsions (more cleaning, repeating and checking), higher rate of aggressive obsessions and more common accumulation behaviors. There are several psychiatric comorbidities associated with OCD like anxiety disorder and major depression. The first-line treatment in OCD is the association of a selective serotonin reuptake inhibitor (SSRI) and individual psychotherapy.
The authors reviewed the clinical records of patients diagnosed with OCD observed in a child and adolescence psychiatry liaison consultation between April and September 2015, inclusive, aiming to characterize the sample, to describe the typical clinical picture and to evaluate the existence of physical and/or psychiatric comorbidities, comparing the results with those expected in literature.
The typical patient profile found was a 12-year-old male, living with relatives, with no neonatal complications, with stable home environment, without family psychiatric history, with associated medical comorbidities, with age of onset symptoms at 10.5 years-old, with only an obsession (contamination), with only a compulsion (cleaning or checking), with psychiatric comorbidities, treated with SSRI and without psychologyaccompaniment.
There are some limitations that must be taken into account because the sample was taken from a liaison psychiatry consultation, but in general terms, the results were similar to those described in the literature.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The relative contribution of imported vs. locally acquired infections to urban malaria burden remains largely unexplored in Latin America, the most urbanised region in the developing world. Here we use a simple molecular epidemiology framework to examine the transmission dynamics of Plasmodium vivax in Mâncio Lima, the Amazonian municipality with the highest malaria incidence rate in Brazil. We prospectively genotyped 177 P. vivax infections diagnosed in urban residents between June 2014 and July 2015 and showed that local parasites are structured into several lineages of closely related microsatellite haplotypes, with the largest genetic cluster comprising 32% of all infections. These findings are very unlikely under the hypothesis of multiple independent imports of parasite strains from the rural surroundings. Instead, the presence of an endemic near-clonal parasite lineage circulating over 13 consecutive months is consistent with a local P. vivax transmission chain in the town, with major implications for malaria elimination efforts in this and similar urban environments across the Amazon.
Intercoronary communications are a very rare congenital coronary artery anomalies. We report a case of a man who underwent elective coronary angiography that showed a bidirectional direct intercoronary communication between right coronary and left circumflex arteries.
Both transposition of the great arteries (TGA) previously submitted to a Senning/Mustard procedure and congenitally corrected TGA (cc-TGA) have the systemic circulation supported by the morphological right ventricle, thereby rendering these patients to heart failure events risk. The aim of this study was to evaluate cardiopulmonary exercise test parameters for stratifying the risk of heart failure events in TGA patients.
Retrospective evaluation of adult TGA patients with systemic circulation supported by the morphological right ventricle submitted to cardiopulmonary exercise test in a tertiary centre. Patients were followed up for at least 1 year for the primary endpoint of cardiac death or heart failure hospitalisation. Several cardiopulmonary exercise test parameters were analysed as potential predictors of the combined endpoint and their predictive power were compared (area under the curve).
Cardiopulmonary exercise test was performed in 44 TGA patients (8 cc-TGA), with a mean age of 35.1 ± 8.4 years. The primary endpoint was reached by 10 (22.7%) patients, with a mean follow-up of 36.7 ± 26.8 months. Heart rate at anaerobic threshold had the highest area under the curve value (0.864), followed by peak oxygen consumption (pVO2) (0.838). Heart rate at anaerobic threshold ≤95 bpm and pVO2 ≤20 ml/kg/min had a sensitivity of 87.5 and 80.0% and a specificity of 82.4 and 76.5%, respectively, for the primary outcome.
Heart rate at anaerobic threshold ≤95 bpm had the highest predictive power of all cardiopulmonary exercise test parameters analysed for heart failure events in TGA patients with systemic circulation supported by the morphological right ventricle.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
The bovine whey consists of more than 200 different types of proteins, of which β-lactoglobulin, α-lactalbumin, serum albumin, immunoglobulins and lactoferrin predominate. However, their concentrations are not stable due to the existence of protein dynamics during a transition from colostrum secretion to mature milk. To evaluate the dynamics of whey proteins of Jersey cows during a colostral phase and first month of lactation and an influence of the number of lactations, 268 milk samples from 135 Jersey cows were selected through a clinical evaluation. Whey was obtained by rennet coagulation of the mammary secretion. The concentration of total proteins was determined by the biuret method and their fractions were identified by 12% dodecyl sulfate-polyacrylamide gel electrophoresis (12% SDS-PAGE). Maximum concentrations of all protein fractions were observed in the first 12 h of lactation, reducing over the course of the study. Modification of the protein predominance was also observed. The transition from colostrum secretion to milk occurred between 24 and 72 h postpartum. There was an influence of the number of lactations on the dynamics of whey proteins, indicating that multiparous cows had better immunological and nutritional quality when compared to primiparous cows.
The use of cactus cladodes in animal feed is well-established in semi-arid areas. The cactus Nopalea cochenillifera (L.) Salm-Dyck cladodes (Nopalea) have high acceptability amongst dairy cows and are resistant to carmine cochineal insects (Dactylopius opuntiae Cockerell), a problem in semi-arid regions, but in regions of prolonged drought, it has lower productivity compared with the cactus Opuntia stricta (Haw.) Haw cladodes (Opuntia), which is also resistant to the insect. The objective of the current study was to evaluate the intake and content of digestible material of dry matter (DM) and its components, feeding behaviour, microbial protein synthesis, nitrogen balance, blood parameters, performance and milk composition of Holstein cows fed a control diet, containing either Nopalea or Opuntia associated with different concentrate levels (225, 275, 325 and 375 g/kg). Ten cows with an initial average milk production of 20 ± 2.1 kg/day were distributed into a double 5 × 5 Latin square design. Diets containing 775 g roughage/kg and 225 g concentrate/kg promoted similar responses to the analysed variables regardless of the cactus cladode used, except for digestibility of neutral detergent fibre. Diets containing higher proportions of concentrate (325 and 375 g/kg) promoted greater DM intake and 3.5% fat-corrected milk yield. The diet containing Opuntia at 775:225 g/kg roughage:concentrate proportion is as effective as the control diet for Holstein cows producing 20 kg of milk/day. To promote greater milk production, higher proportions of concentrate should be added to diets using Opuntia.
Excitable temperament disrupts physiological events required for reproductive development in cattle, but no research has investigated the impacts of temperament on growth and puberty attainment in Bos indicus females. Hence, this experiment evaluated the effects of temperament on growth, plasma cortisol concentrations and puberty attainment in B. indicus heifers. A total of 170 Nelore heifers, weaned 4 months before the beginning of this experiment (days 0 to 91), were managed in two groups of 82 and 88 heifers each (mean ± SE; initial BW=238±2 kg, initial age=369±1 days across groups). Heifer temperament was evaluated via exit velocity on day 0. Individual exit score was calculated within each group by dividing exit velocity into quintiles and assigning heifers with a score from 1 to 5 (1=slowest; 5=fastest heifer). Heifers were classified according to exit score as adequate (ADQ, n=96; exit score⩽3) or excitable temperament (EXC, n=74; exit score>3). Heifer BW, body condition score (BCS) and blood samples were obtained on days 0, 31, 60 and 91. Heifer exit velocity and score were recorded again on days 31, 60 and 91. Ovarian transrectal ultrasonography was performed on days 0 and 10, 31 and 41, 60 and 70, 81 and 91 for puberty evaluation. Heifer was declared pubertal at the first 10-day interval in which a corpus luteum was detected. Exit velocity and exit score obtained on day 0 were correlated (r⩾0.64, P<0.01) with evaluations on days 31, 60 and 91. During the experiment, ADQ had greater (P<0.01) mean BCS and BW gain, and less (P<0.01) mean plasma cortisol concentration compared with EXC heifers. Temperament × time interactions were detected (P<0.01) for exit velocity and exit score, which were always greater (P<0.01) in EXC v. ADQ heifers. A temperament × time interaction was also detected (P=0.03) for puberty attainment, which was delayed in EXC v. ADQ heifers. At the end of the experiment, a greater (P<0.01) proportion of ADQ were pubertal compared with EXC heifers. In summary, B. indicus heifers classified as EXC had reduced growth, increased plasma cortisol concentrations and hindered puberty attainment compared to ADQ heifers. Moreover, exit velocity may serve as temperament selection criteria to optimize development of B. indicus replacement heifers.
Salivary molecules, as glycine-rich proteins (GRPs), are essential to tick attachment and feeding on the host and are suggested to be involved in the host's immune system evasion, therefore representing natural candidates in the search for protective vaccine antigens. This work shows the molecular characterization of a GRP from Rhipicephalus microplus (RmGRP). The cDNA and putative amino acid sequences were analysed, as well as the transcription level in tick tissues/developmental stages, showing the highest levels of gene expression in 1-day-old larvae and salivary glands of fully engorged females. RmGRP gene silencing resulted in a lower hatching rate of larvae from treated females. In addition, recombinant RmGRP (rRmGRP) was recognized by sera from naturally and experimentally infested bovines, displaying considerable differences among the individuals tested. rRmGRP was recognized by anti-saliva and anti-salivary glands sera, while anti-rRmGRP serum recognized RmGRP in saliva and salivary glands, indicating its secretion into the host. The data collected indicate that RmGRP may present roles other than in the tick–host relationship, especially in embryo development. In addition, the high expression in adult females, antigenicity and presence of shared characteristics with other tick protective GRPs turns RmGRP a potential candidate to compose an anti-tick vaccine cocktail.
The aims of the present work were to test the effect of tamoxifen administered topically and the therapeutic efficacy of tamoxifen and pentavalent antimonial combinations in an experimental model of cutaneous leishmaniasis. BALB/c mice infected with a luciferase expressing line of Leishmania amazonensis were treated with topical tamoxifen in two different formulations (ethanol or oil-free cream) as monotherapy or in co-administration with pentavalent antimonial. Treatment efficacy was evaluated by lesion size and parasite burden, quantified through luminescence, at the end of treatment and 4 weeks later. Topical tamoxifen, formulated in ethanol or as a cream, was shown to be effective. The interaction between tamoxifen and pentavalent antimonial was additive in vitro. Treatment with combined schemes containing tamoxifen and pentavalent antimonial was effective in reducing lesion size and parasite burden. Co-administration of tamoxifen and pentavalent antimonial was superior to monotherapy with antimonial.
The number of horses in northern Spanish mountains has increased in recent decades, but little is known about their grazing behaviour, performance and potential for foal meat production. This research aimed to study the diet selection, liveweight (LW) changes and parasitic status of dry and lactating mares, and foals’ LW gains, grazing on heathlands with different botanical composition. The experimental design consisted of three vegetation types: dominated by heather (Ericaceae) species (H), dominated by gorse (Ulex gallii; G) and co-dominated by gorse and heath-grasses (G-G), with four replicates per treatment (12 paddocks of 1.2 ha). The study lasted three grazing seasons (2010–12). Each year, 24 crossbred mature mares (310±52 kg LW) were used, managing one lactating mare with her foal plus one non-lactating mare per paddock from May to late summer or early autumn. In the case of H paddocks, animals had to be removed before (late August to early September) because of apparent loss of body condition. Animals were periodically weighed. Mares’ diet composition was estimated using alkane markers, analysing the discrepancies in alkane concentrations between dietary plant components and faeces. Faecal samples were also analysed for gastrointestinal nematodes ova. Chemical composition of the main plant components (i.e. heather, gorse and grasses) revealed a low nutritive value, averaging 79, 115 and 113 g CP/kg dry matter (DM), respectively, that could restrict livestock performance. Mares initially selected gorse and grasses (0.47 and 0.40, respectively, in 2010), increasing heather consumption over time (from 0.13 in 2010 to 0.29 in 2012) as gorse availability decreased. The performance of both mares and foals was lower in H compared with G and G-G paddocks (−216 v. 347 g/day for mares, P<0.01; 278 v. 576 g/day for foals, P<0.05), whereas LW changes were more favourable in dry mares than in lactating ones (241 v. 78 g/day; P<0.05). Small strongyle (Cyathostominae) egg counts in mares’ faeces increased across the grazing season with no differences between treatments. These results indicate that grazing by horses on gorse- and grass-gorse-dominated shrublands could be sustainable at least during part of the year (4 to 6 months). However, heather-dominated heathlands are not able to meet the nutritional needs of horses even for a short time (2 to 4 months). Nevertheless, the low nutritive quality of these vegetation communities, especially in autumn, requires animal access to other pastures with a higher nutritive value, or supplementary feeding, to enhance foals’ growth and maintain sustainable grazing systems with productive herds.
The target article's call to end reliance on acceptability judgments is premature. First, it restricts syntactic inquiry to cases were a semantically equivalent alternative is available. Second, priming studies require groups of participants who are linguistically homogenous and whose grammar is known to the researcher. These requirements would eliminate two major research areas: syntactic competence in d/Deaf individuals, and language documentation. (We follow the convention of using deaf to describe hearing levels, Deaf to describe cultural identity, and d/Deaf to include both. Our own work has focused on Deaf signers, but the same concerns could apply to other deaf populations.)
Although the rat model of mammary tumors chemically induced by N-methyl-N-nitrosourea (MNU) has been frequently used by several research teams, there is a lack of ultrastructural studies in this field. The main aim of this work was to perform an ultrastructural characterization of MNU-induced mammary tumors in female rats. Some alterations previously reported in human mammary tumors, such as nucleus size and shape, accumulation of heterochromatin in the perinuclear region, and interdigitating cytoplasmic processes between cancer cells were also observed in MNU-induced mammary tumors. Although a low number of samples were analyzed by transmission electron microscopy in the present study, we consider that it may contribute to a better understanding of MNU-induced mammary carcinogenesis in a rat model. The ultrastructural characteristics of the two most frequently diagnosed mammary carcinomas described in the present work can be useful to differentiate them from other histological patterns. In addition, the loss of cytoplasm in neoplastic cells and formation of vacuoles were described.
Isolated oceanic islands may give rise not only to new and endemic species, but also to unique behaviours and species interactions. Multi-species fish interactions, such as cleaning, following, mob-feeding and others are understudied in these ecosystems. Here we present qualitative and quantitative observations on cleaning and mob-feeding reef fish associations at the isolated Ascension Island, South Atlantic Ocean. Cleaning interactions were dominated by juveniles of the facultative fish cleaners Bodianus insularis and Pomacanthus paru, with lesser contributions of Chaetodon sanctaehelenae, Thalassoma ascensionis and the cleaner shrimp Lysmata grabhami. Two types of feeding mobs were consistently identified: less mobile mobs led by the surgeonfish Acanthurus bahianus and A. coeruleus and the more mobile mobs led by the African sergeant Abudefduf hoefleri. This is the first record of A. hoefleri from outside of the Eastern Atlantic and also the first report of this species displaying mob-feeding behaviour. The principal follower of both mob types was the extremely abundant Melichthys niger, but the main aggressor differed: Stegastes lubbocki, a highly territorial herbivore, was the main aggressor of Acanthurus mobs; and Chromis multilineata a territorial fish while engaged in egg parental care, was the principal aggressor towards Abudefduf mobs. Our study enhances the scarce information on reef fish feeding associations at the isolated Ascension Island and at oceanic islands in the Atlantic in general.