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There has been considerable research on postnatal depression (PND), in comparison to antenatal depression (AND). We aimed to study the Prevalence of AND, testing the following hypotheses:
a. Depressed pregnant women will have more negative life events than non depressed women.
b. Depressed women will have less social support than non-depressed women.
Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.
342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.
This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.
Rehabilitation should help the mentally ill persons to strength their potentials and reduce the deficits in order to live successfully in community. First Croatian Outpatient Rehabilitation Center is organized in Psychiatric Hospital Vrapce. Its goal is to improve the quality of life in patients with psychotic disorders through a holistic rehabilitation program. The Rehabilitation Centre offers program provided by Multi-disciplinary team. Team evaluates each patient on individual bases and develops a realistic treatment/rehabilitation plan. The key of treatment is combination of case management and group treatment. Rehabilitation program includes a supportive individual therapy, provided by the coordinator and different group therapy (psychoeducation, anti-stigma program, family education, healthy life styles, social skill training, stress cooping and vocational training) and creative groups.
40 patients were evaluated in program in our Center according to frequency of visits and rehospitalisation. Also we followed up the family involvement, the number and types of groups which patients attend and contacts with case manager. The obtained data will be compared with BPRS score and the Satisfactory scale results.
It was evident that patients, who regularly contact their case managers, attend to more than one group and have family support, have the treatment better results on Satisfactory scale and BPRS score.
Community Rehabilitation Center offers highly individualized program which combines case management and group therapy in order to help patients with psychotic disorders to recover and live with higher quality standards in community and its long lasting benefits are expected in future.
Since April 2004, Government policy in England upholds that clinicians should send copies of their clinical letters to their patients. However, some argue that patients already have the right to access their records under the Data Protection Act, 1998. Others suggest it wiser not to provide a letter in certain circumstances. Little evidence is available examining the factors that impact on and underlie patients’ views in relation to this.
To inform professionals about patients’ views on receiving clinical letters.
To establish the proportion and characteristics of patients who would like to receive clinical letters and to elicit underlying reasons for decisions.
Subjects were randomly sampled from an outpatient clinic and data collected using an 11-item questionnaire, between October 2010 and July 2013.
The majority (60%) of patients wished to receive their clinical letter. Most (62%) favoured wanting to know about treatment primarily. Of those who did not wish to have a copy, greatest concerns were of loss in the post and ‘unnecessary paperwork’ (each 11%). This group of patients were characteristically male, aged 61-80, of asian ethnicity, unmarried and unemployed. Patients with a diagnosis of adult personality and behaviour (ICD-10 F60-69) were most likely to opt to receive their clinical letter.
Although the majority preferred to receive clinical letters, reasons for preferences varied widely. With an increasing drive towards greater transparency in the health service, approaches to enhancing patient involvement will need to be flexible to the individual to enable truly meaningful patient participation.
There has been a continued debate in the last decade about the possible role of polyunsaturated fatty acids especially omega-3 fatty acids in attention deficit hyperactivity disorder (ADHD) either as a causative factor - on deficiency - or as a treatment.
To compare omega-3 fatty acids status in children with ADHD to normal children and to study the efficacy of high dose supplementations of fatty acids on symptoms of ADHD.
Subjects & methods:
40 children diagnosed with ADHD combined type and another 40 normally developing as a control group. All patients were subjected to Mini International Neuropsychiatric Interview for Children, IQ assessment,.Conners' Parent Rating Scale-Revised long version (CPRS-R-L), Vigil continuous performance test. The patients were prescribed omega-3 fatty acid supplement daily dose of 900 mg EPA and 600 mg DHA for 3 months. After end of the 3 months these children were assessed again using the Conners' parent rating scale-revised and Vigil continuous performance test.
Significantly lower levels of EPA and DHA in ADHD group compared to normal control inverse correlation between DHA on one side and Conner's ADHD index; inattentive subtest and total DSMIV indexed on the other side Conners’ ADHD index subscale there was a statistically significant improvement following the treatment.
Low levels of omega 3 may contribute to the symptoms of ADHD. Supplementing omega 3 in the treatment of ADHD could be a useful add on tratment specially in cases demonstrating low serum levels.
The cutaneous polymorphic eruption of pregnancy (PEP) is presented by skin lesions usually in the third trimester of gestation and about 13% of women also suffer from perinatal depression.
To determine the frequency of pruritic urticarial papules of gestation with and without perinatal depression.
To assess the maternal causes for polymorphic eruption of pregnancy (PEP) in patients with and without perinatal depression.
Cases and controls were matched on the grounds of maternal weight gain in gestation, hormonal changes, deficit in iron and zinc, dysregulation of hypothalamic pituitary axis, pre-maturity, pre-eclampsia, pre-term labour. Univariate and multivariate analysis, adjusting for important demographic factors and comorbodities was conducted to assess the relationship of PEP with and without perinatal depression in reduced and full models of ANOVA in regression analysis. (Reduced model Y = β0 + β1X1 + … and the full model Y = β0 + β1X1 + β2X2 + β3X3 + β4X4 + β5X5 + β6X6 + …)
Polymorphic eruption of pregnancy with perinatal depression was statistically significant in maternal weight gain in gestation [odds ratio (OR) 1.20; 95% (CI): 1.15–1.30], hormonal changes [(OR) 2.78; 95% (CI): 2.52–2.82], deficit in iron and zinc [(OR) 2.18; 95% (CI): 2.04–2.38], dysregulation of hypothalamic pituitary axis [(OR) 1.37; 95% (CI): 1.18–1.49] and was not statistically significant in pre-maturity, pre-eclampsia and pre-term labour in cases and controls.
Pruritic urticarial papules and plaques of gestation are commonly associated in patients with perinatal derpession.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Even though the association between dermatological conditions in pregnancy with psychiatric findings is vital for patient management, studies on these issues are limited.
To determine the frequency and nature of dermatological problems in pregnant women having primary psychiatric illness.
To establish an association between cutaneous manifestations in pregnancy with the hypothesis that psychiatric illness also has a role in pregnancy.
This was a case control study and non probability convenient sampling was used on 50 pregnant patients with cutaneous manifestations along with psychiatric illness and 50 age matched non pregnant patients free from dermatological conditions and psychiatric illness. The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) Criteria was used to diagnose psychiatric illness and for skin manifestations patients underwent a physical examination of skin.
Pregnant patients with depressive disorders were associated with atopic eruption of pregnancy [odds ratio (OR) 1.19; 95% (CI): 1.13–1.49], pruritic urticarial papules [(OR) 2.89; 95% (CI): 2.55–2.97], plaques of pregnancy [(OR) 2.14; 95% (CI): 2.01–2.39], prurigo of pregnancy [(OR) 1.33; 95% (CI): 1.17–1.45], intrahepatic cholestasis of pregnancy [(OR) 2.45; 95% (CI): 2.29–2.67], pemphigoid gestationis [(OR) 1.57; 95% (CI): 1.50–1.68], impetigo herpetiformis [(OR) 1.83; 95% (CI): 1.65–2.24], and pruritic folliculitis of pregnancy [(OR) 2.34; 95% (CI): 2.20–3.62], psoriasis [(OR) 1.75; 95% (CI): 1.64–2.37], melasma [(OR) 1.88; 95% (CI): 1.63–2.49], intrahepatic cholestasis [(OR) 2.77; 95% (CI): 2.14–3.48].
The results of the study support the hypothesis, that there is an association between psychiatric and skin diseases in pregnancy.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The symptoms and behavior of children with ADHD impose demands and difficulties on part of their caring parents, which may cause the latter group to suffer psychological stress.
The study of the suffering and symptomatic expression of psychological stress in parents of children with ADHD.
To study type and severity of symptoms in children with ADHD and the effect of that on the stress response of their parents.
Thirty-seven children with ADHD diagnosed clinically and with Conner's Test were studied using Child Behavior Chick List (CBCL). Available parents for each child were interviewed and studied with Symptom Chick List 90 Revised (SCL90R). Two control groups were used for both ADHD children and their parents.
The mean age of the children with ADHD was 7.1 ± 1.6, they were 22 males and 15 females. Parents of these children scored highly on total and subscales of SCL90R, they were significantly higher than their control group on total and some of these subscales including somatization, interpersonal, depression, paranoid ideation and hostility domains. Depression and paranoid ideation of ADHD children parents were positively and significantly correlated with most of the sub-items of Conner's test of their children. In addition, somatization, depression and hostility of parents were positively and significantly correlated with most of the sub-items of CBCL of their ADHD children.
The symptoms, behavior and severity of illness of children with ADHD have a great impact on their parents’ psychological state of suffering and stress.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Epilepsy is a common neurological condition that shows a marked genetic predisposition. The advent of next-generation sequencing (NGS) has transformed clinical genetic testing by allowing the rapid screen for causative variants in multiple genes. There are currently no NGS-based multigene panel diagnostic tests available for epilepsy as a licensed clinical diagnostic test in Ontario, Canada. Eligible patient samples are sent out of country for testing by commercial laboratories, which incurs significant cost to the public healthcare system.
An expert Working Group of medical geneticists, pediatric neurologists/epileptologists, biochemical geneticists, and clinical molecular geneticists from Ontario was formed by the Laboratories and Genetics Branch of the Ontario Ministry of Health and Long-Term Care to develop a programmatic approach to implementing epilepsy panel testing as a provincial service.
The Working Group made several recommendations for testing to support the clinical delivery of care in Ontario. First, an extension of community healthcare outcomes-based program should be incorporated to inform and educate ordering providers when requesting and interpreting a genetic panel test. Second, any gene panel testing must be “evidence-based” and takes into account varied clinical indications to reduce the chance of uncertain and secondary results. Finally, an ongoing evaluative process was recommended to ensure continued test improvement for the future.
This epilepsy panel testing implementation plan will be a model for genetic care directed toward a specific set of conditions in the province and serve as a prototype for genetic testing for other genetically heterogeneous diseases.
The purpose of this study was to investigate the 10-year impact of Hurricane Katrina on the incidence of acute myocardial infarction (AMI) along with contributing risk factors and any alteration in chronobiology of AMI.
A single-center, retrospective, comparison study of AMI incidence was performed at Tulane University Health Sciences Center from 2 years before Hurricane Katrina to 10 years after Hurricane Katrina. A 6-year, pre-Katrina and 10-year, post-Katrina cohort were also compared according to pre-specified demographic, clinical, and chronobiological data.
AMI incidence increased from 0.7% (150/21,079) to 2.8% (2,341/84,751) post-Katrina (P<0.001). The post-Katrina cohort had higher rates of coronary artery disease (36.4% vs. 47.9%, P=0.01), diabetes mellitus (31.3% vs. 39.9%, P=0.04), hyperlipidemia (45.4% vs. 59.3%, P=0.005), smoking (34.4% vs. 53.8%, P<0.001), drug abuse (10.2% vs. 15.4%, P=0.02), psychiatric illness (6.7% vs. 14.9%, P<0.001), medication non-adherence (7.3% vs. 15.3%, P<0.001), and lack of employment (7.2% vs. 16.4%, P<0.001). The post-Katrina group had increased rates of AMI during nights (29.8% vs. 47.8%, P<0.001) and weekends (16.1% vs. 29.1%, P<0.001).
Even 10 years after the storm, Hurricane Katrina continues to be associated with increased incidence of AMI, higher prevalence of traditional cardiovascular and psychosocial risk factors, and an altered chronobiology of AMI toward nights and weekends. (Disaster Med Public Health Preparedness. 2019;13:217–222)
Service utilisation by refugee families may be affected by the mismatch between Western individualistic service delivery approaches and the target communities’ more collectivist cultural patterns and practices. In addition to access barriers, utilisation of early childhood services by refugees can also be impacted upon by distrust of services, health and settlement issues, stigma, unfamiliarity with early childhood programmes, and fear of child protection and other legal systems. This low service utilisation sits in conflict with the need for early interventions for very young children, who are in the peak period of brain development. This article explores the implementation of a model to address these issues in early childhood work with refugee families and communities, with the intent to increase service uptake. Some strategies to address potential barriers will be described in the context of a community engagement model that includes consultation, relationship building, collaborative flexible service design and delivery, partnerships in community capacity building and cross-referral. Flexible, culturally appropriate interventions can enhance strengths based, non-pathologising and development-focused approach. A community engagement approach will, nevertheless, present challenges for service providers who must be willing to adapt their practices. Services and funding bodies need to recognise that this process is lengthy and resource intensive, but will ultimately lead to better service delivery and uptake, potentially leading to improvements in health, development and relational outcomes, for children and families from refugee backgrounds.
Monitoring of nesting beaches is often the only feasible and low-cost approach for assessing sea turtle populations. We investigated spatio-temporal patterns of sea turtle nesting activity monitored over 17 successive years in the Lamu archipelago, Kenya. Community-based patrols were conducted on 26 stretches of beach clustered in five major locations. A total of 2,021 nests were recorded: 1,971 (97.5%) green turtle Chelonia mydas nests, 31 (1.5%) hawksbill Eretmochelys imbricata nests, 8 (0.4%) olive ridley Lepidochelys olivacea nests and 11 (0.5%) unidentified nests. Nesting occurred year-round, increasing during March–July, when 74% of nests were recorded. A stable trend in mean annual nesting densities was observed in all locations. Mean clutch sizes were 117.7 ± SE 1 eggs (range 20–189) for green turtles, 103 ± SE 6 eggs (range 37–150) for hawksbill turtles, and 103 ± SE 6 eggs (range 80–133) for olive ridley turtles. Curved carapace length for green turtles was 65–125 cm, and mean annual incubation duration was 55.5 ± SE 0.05 days. The mean incubation duration for green turtle nests differed significantly between months and seasons but not locations. The hatching success (pooled data) was 81.3% (n = 1,841) and was higher for in situ nests (81.0 ± SE 1.5%) compared to relocated nests (77.8 ± SE 1.4%). The results highlight the important contribution of community-based monitoring in Kenya to sustaining the sea turtle populations of the Western Indian Ocean region.
We report on a wide-range Density Functional Theory (DFT) investigation of the g-C3N4 photocatalysis systems combined with metals/nonmetals, especially those available in plants and involved in the natural photosynthesis process, such as K, Mg, Mn, Mo, Fe, Co, Cr, S and B. It is found that doping increases the range at which light absorption occurs to significantly large regions of the visible spectrum. These findings suggested that the g-C3N4 can be a promising system for the photosynthesis process.
The early Miocene site of Wadi Moghra, Qattara Depression, Egypt, is important for interpreting anthracothere (Mammalia, Artiodactyla) evolution, because the Moghra sediments preserve a higher diversity of anthracotheres than any other pene-contemporaneous site. New specimens from Moghra are described and form the basis for the systematic revision of Moghra anthracotheres provided here. Among the important discoveries recently made at Moghra is the first complete skull of Sivameryx moneyi. Other new specimens described here include two new species of Afromeryx, and a new genus and species, all of which are unique to Moghra. A review of biogeographic information supports the conclusion that three of the Moghra anthracotheres (Brachyodus depereti, B. mogharensis, and Jaggermeryx naida, n. gen. n. sp.) are members of late surviving lineages with a long history in Africa, while three other species (Afromeryx grex, n. sp., A. palustris, n. sp., and Sivameryx moneyi) represent more recent immigrants from Eurasia.
The covalent functionalization of photosynthetic proteins with properly tailored organic molecular antennas represents a powerful approach to build a new generation of hybrid systems capable of exploiting solar energy. In this paper the strategy for the synthesis of the tailored aryleneethynylene organic fluorophore (AE) properly designed to act as light harvesting antenna is presented along with its successful bioconjugation to the photosynthetic reaction center RC from the bacterium Rhodobacter sphaeroides .
Ink-jet printing technique is used to prepare porous (ZnO)1−x(TiO2)x composite films on indium tin oxide-coated glass substrates. Dye-sensitized solar cells were fabricated using well-characterized printed films of thickness ∼20 and 30 μm, respectively. It is found that the photovoltaic performance of the cells is dependent on the film thickness and the concentrations of ZnO. The obtained results are compared with those of pure ZnO- and TiO2-based cells prepared by the same route to optimize the device efficiency. This study suggests that ink-jet printers promise an inexpensive and simple technology for manufacturing solar cell composite films.
National nutrition survey covering all geographical areas of the country.
Kuwaitis (n 1704) between 3 and 86 years of age.
Obesity was more prevalent among women than men (50 % and 70 % for females aged 19–50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9–13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78–100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre.
Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.
The purpose of the present study was to establish the prebiotic effect of a new xylo-oligosaccharide (XOS) and of an inulin-and-XOS mixture (INU–XOS) and to determine their effect on endotoxaemia (lipopolysaccharides (LPS)) and immune parameters. In this randomised, parallel, placebo-controlled, double-blind study, sixty healthy volunteers were randomly assigned to three groups, receiving either 5 g XOS, INU–XOS (3 g inulin +1 g XOS) or an equivalent weight of wheat maltodextrin (placebo) during 4 weeks. Faecal samples were collected to assess the effects of these products on microbiota, as well as SCFA composition, enzymatic activities and secretory IgA production. Circulating LPS was measured in plasma samples, and whole blood was incubated with LPS to measure cytokine expression. Consumption of XOS alone increased the faecal concentrations of Bifidobacterium and butyrate and activities of α-glucosidase and β-glucuronidase, while decreasing the concentrations of acetate and p-cresol. Consumption of XOS in combination with inulin did not decrease the concentrations of acetate and p-cresol, but increased in addition the faecal concentrations of total SCFA and propionate. Furthermore, consumption of XOS in combination with inulin decreased LPS concentrations in blood and attenuated LPS-induced increases in gene expression in IL-1β and LPS-induced decreases in gene expression in IL-13 in blood. In conclusion, consumption of XOS alone or in combination with inulin results in beneficial albeit different changes in the intestinal microbiome on a high-fat diet. In addition, consumption of XOS in combination with inulin attenuates the proinflammatory effects of a high-fat diet in the blood of healthy subjects.
This chapter presents a commentary on the lung-specific complications following transplantation and this should be used to drive the investigation plan and management. Shared care protocols with effective communication should be organized in patients who live at a distance from the transplant center to ensure that local follow-up includes monitoring of the lung function and imaging. Acute rejection can be identified on lung biopsies obtained via transbronchial biopsy (TBBx) at fiberoptic bronchoscopy. Many transplant centers perform regular bronchoscopy and TBBx in addition to spirometry in the first year to enable early diagnosis and treatment of asymptomatic rejection, with the aim of preserving graft function and protecting against bronchiolitis obliterans syndrome (BOS). Recently the importance of detecting early, subclinical BOS before irreversible fibroproliferative disease has become established has been recognized, and a new stage of BOS 0-p has been added.