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This article assesses the nutritional status of Indigenous women from 14 to 49 years of age in Brazil.
Sample size was calculated for each region considering a prevalence of 50 % for all disease outcomes, a relative error of 5 % and a CI of 95 %. In the initial data analysis, the prevalence of excess weight and obesity was calculated according to independent variables. Multivariate multilevel hierarchical analyses were conducted based on a theoretical model of two ranked blocks.
The 2010 Indigenous population in Brazil was 896 000, with approximately 300 Indigenous ethnic groups, making Brazil one of the most ethnically diverse countries in the Americas and the world.
Of the total target sample of 6722 women evaluated by the National Survey, thirty did not participate, 939 were not eligible for analyses due to pregnancy or unknown pregnancy status, and thirty-nine were excluded due to missing anthropometric data.
The evaluation of nutritional status was completed for 5714 non-pregnant women (99·3 % of eligible participants for this outcome). High prevalence rates were encountered for both excess weight (46·2 %) and obesity (15·8 %) among the sampled women. In the multivariate analyses, higher socioeconomic indicators, market-integrated living conditions and less reliance on local food production, as well as increased age and parity were associated with excess weight and obesity.
Results point to distinct patterns of associations between socioeconomic indicators and the occurrence of excess weight and obesity among Indigenous women, which have potentially significant implications from a public policy perspective for Indigenous peoples in Brazil.
Microencapsulation of functioning cells for transplantation therapies is particularly promising, but the cells must retain their proper physiology and viability after being encapsulated. K-562 cells are multipotential and exhibit erythroid, megakaryocytic, or granulocytic properties that can be exploited by using an array of physiologically differentiating factors. The potential for cell differentiation makes it attractive the use of K-562 cells as functional model to the assessment of the effects of encapsulation on cell viability and physiology. Thus, alginate and hybrid alginate matrices were produced by extrusion technique for K-562 cell encapsulation. The produced systems were composed of bare alginate (1–3 wt%) and alginate in combination with chitosan or silica. The resulting materials were characterized by dynamic laser scattering, zeta potential measurements, small-angle X-ray scattering, and Fourier transform infrared spectroscopy. To assess viability, the encapsulated cells were subjected to the Trypan blue exclusion technique and NAD(P)H-dependent oxidoreductase (MTT) assays; hemin-induced erythroid differentiation capacity was also evaluated. The encapsulated alginate-based systems were shown to be monomodal and bimodal, depending on the nature of the capsule, with mean sizes in the range between 414 and 4.129 nm. Encapsulated cells exhibited viability ratios compatible with their use for prolonged cell cultures. Erythroid differentiation occurred in the range between 39 and 44%. The present results allow the consideration of the viability of therapeutic cells encapsulated in both bare alginate and in hybrid matrices.
To study the role of skin color as a distinct social component of racial/ethnic cultural identity in the context of Brazilian higher education students.
From an existing database holding information on 1,306 students at a Brazilian public university, economic, academic and demographic differences relating to skin color were explored, as well as their experiences of discrimination and stereotypes held by Black and Brown minority groups of students. As they share many features, they were analyzed together, regarding quantitative variables, and compared to the White majority group. Blacks and Browns were compared to one another when there was any quantitatively significant difference between them and for their responses to open-ended questions about racial/ethnic identity, experiences of racism and discrimination.
Both Blacks and Browns share social markers of disadvantages in Brazilian society, which is accentuated in university populations. Black students show the worst social-economic status. Blacks also have a more established involvement with ethnic traditions and they report more experiences of discrimination than the Brown group of students.
Different factors influence the individual's cultural identity, which, in turn, leads to the development of particular perceptions, thoughts and attitudes. Blacks and Browns in Brazilian society share, besides African origins, similar indexes of social markers and both are socially disadvantaged, when compared to the White population. Nevertheless, they are not similar in other respects. This study found that self-declared Black students usually have a more developed sense of ethnicity and participation in themes related to Afro culture.
To describe the socio-demographic and clinical characteristics, complications and therapeutic response of patients treated with ECT in the Psychiatric Unit of the General Hospital from University of Campinas-Brazil (1993-2007).
All medical records of the patients who underwent ECT were reviewed and compiled for subsequent statistical analysis by SPSS program.
156 patients were studied. Ages ranged from 13 to 78 years-old, with a mean of 39.9±17.8 years-old [95% CI: 37.2-42.8 years]. There were 64 (41%) men and 92 (59%) women. The main diagnostic categories of the patients submitted to ECT were: schizophrenia (33.9%), depression without psychotic symptoms (30.8%), depression with psychotic symptoms (39.1%), bipolar disorder (18.6%) and schizoaffective disorder (3.2%). Complications occurred during the procedure in 98 cases (62.8%), immediately after the application in 85 cases (54.5%) and three days after the last session in 33 cases (21.2%).
The response to ECT was: good response in 132 (84.6%) patients, unchanged psychiatric symptoms in 14 (9%) patients and worsening in 3 (1.9%). The mean time of permanence inside the Psychiatric Unit was 57.5±38.2 days [95% CI: 51.4-63.2 days].
Complications during the procedure
Ineffective session after three applications
Complications immediately after the proce
Complications at least three days after t
The diagnostic categories for which ECT therapy corresponded to those described in the literature. Data suggest that the incidence of complications was moderate and the response to treatment was positive in most cases, reinforcing the importance of this therapeutic method for the treatment of patients with severe mental illness.
To evaluate the diagnostic and therapeutic applications of playrooms implemented in care services of children's health, while waiting for a consultation appointment.
A playroom was developed in a child psychiatry outpatient service in a University Hospital, where spontaneous approaches, without educational or psycho-specific directing, were conducted by members of a multidisciplinary team of this service. The children had their attitudes and behaviors observed by these professionals during the playful waiting time in the playroom. Therefore, all observations have been used in subsequent discussions with the professional directly responsible for the child's care, in order to enrich and supplement the case's supervision.
In spite of the spread of the playrooms, there are few studies about them, their objectives and key aspects for their creation and maintenance. It not only adds new elements to those given by family, teachers and patients, but also allows a free observation of the latent unspoken aspects that emerge during play and complement or even change the caregiver first impressions.
The experience of a playroom implemented in a child psychiatry outpatient service in a University Hospital agrees with the studies that indicate that through playful-creative activities children can make discoveries their own way, develop relationships and elaborate affective aspects of their psychic space. Rescue strategies in spontaneous play are essential elements for the children's integral development, creativity, learning and socialization. Above all, playrooms also have a therapeutic and diagnostic role in children's care.
To access the Intelligence Wechsler Scale for Children (WISC-III) as an auxiliary resource in the diagnosis of patients with suspected mental retardation.
Thirty patients were evaluated in a university psychiatric service for children and adolescents, consulted during 2008. Those patients underwent a psychiatric evaluation and, after, subsequently the WISC III scale was administered. Patients were classified, according to their intellectual coefficients, as with or without a mental retardation score, following ICD-10 criteria. The results were transferred to a SPSS (Statistical Package for Social Sciences) spreadsheet and then analyzed in its socio-demographic and clinic variables.
Of the thirty patients, 18 (60%) were children and 12 (40%) adolescents; 22 (73,33%) were male and 8 (26,67%) female. Furthermore, the sample revealed that 20 (68,97%) patients had had an axis I diagnosis. For the participants, 7 (23,3%) had an IQ below the cutoff of 70, consistent with the mental retardation diagnosis, and agreeing with the psychiatric evaluation. The other 23 (76,7%) patients had an IQ within the normal range. From those considered intellectually deficient, 5 (71,43%) had a score for mild and 2 (28,57%) for moderate mental retardation.
This study showed that clinical diagnosis of mental retardation is difficult, especially for mild cases, when the characteristics are not very clear. The error probability is increased if an instrument such as WISC III is not administered. Therefore, WISC III is an important instrument in the diagnostic process for mental retardation, in many instances changing a first clinic impression.
To exemplify the role and relationship of Consultation Liaison Psychiatry with other areas of knowledge involved in the health-disease process, intending to propose solutions, under a biopsychosocial perspective, to clinical (care delivery) or institutional (service-related) problems.
The review of a patient record who represents an instance of this need for integration of approaches is reported.
The case of a patient who presented an unusual pathophysiological manifestation of Behçet's Syndrome (pseudo tumor neurological inflammation) and also developed psychiatric manic symptoms after the pharmacological treatment with corticosteroids is described. Despite both the remission of mental and behavioral symptoms with psychopharmacological treatment of short duration, her clinical outcome made it necessary to reintroduce corticotherapy, with recrudescence of psychiatric manifestations and the need for maintenance treatment to assure its management.
Besides illustrating a rare clinical condition, the described report exemplifies the benefits of joint and planned actions between psychiatrists and other professionals involved in integral assistance to inpatients at hospital wards.
To analyze the use of Clozapine in six children and adolescents with Serious Conduct Disorder, whose symptoms had been refractory to other pharmacology treatment. Scalar analysis is supplied for the more important psychopathology aspects and the changes with therapeutic one.
Six patients diagnosed with Serious Conduct Disorder are described who had begun the use of Clozapine. They had been widely studied and received application of standardized instruments of infantile psychiatry (CBCL - Child Behavior Check List) before and after the use of this medication.
The patients had mainly significant improvement in relation to the level of aggressiveness and social behavior.
Although ample studies on the use of this medication in children and adolescents do not yet exist, more precisely for cases of Serious Conduct Disorder, the preliminary results are very positive and indicate that Clozapine could be an important tool in the handling of the aggressiveness in those refractory patients with Serious Conduct Disorder.
To analyze the clinical and demographic profile of psychiatric interconsultations in a pediatric ward of a Brazilian university hospital in 2008.
Review and statistical analysis, using SPSS, of the medical records of the 31 children/adolescents admitted to the Hospital from the University of Campinas-Brazil who required psychiatric assessment.
1,072 children/adolescents were hospitalized, with a total of 1,933 admissions. Psychiatric consultation was requested for 31(16 girls and 15 boys), 4(12.9%) were hospitalized more than once in 2008. Ages: 2 months-18 years old (mean: 9.9 ± 4.5). 19(61.3%) were white, 5(16.1%) mixed and 3(9.7%) black. Mothers were responsible for the children/adolescents in 23(74.5%) cases. 2(6.5%) children attended kindergarten and 19(61.3%), primary school. The permanence time varied between 1-199 days (mean: 24 ± 38.1). 8(25.8%) patients had psychiatric diagnoses at admission and were taking psychotropic drugs. 26(83.9%) had a positive clinical pediatric history. In 25(80.6%) patients the psychiatry diagnosed at least one mental disorder (more than one in 15-48.4% patients). Depressive mood disorders were the most prevalent. Psychiatric pharmacotherapy was used for 20(64.5%) patients and 17(54.8%) continued taking medication after discharge. Only 1 patient did not need referral after discharge. 1 patient died 7 months after the assessment.
The experience of being ill can have great emotional significance for children/adolescents and their families. The presence of a psychiatrist on staff can help the pediatrician in dealing with these situations, influencing therapy and prognosis.
To illustrate, with a case report, the risk of suicide in general hospitals among inpatients with acute confusion or delirious states.
The review of a patient record who represents an instance of this risk is reported.
A Brazilian farmer, with incomplete elementary education, was admitted to the General Infirmary of Adults, from the Clinical Hospital of the State University of Campinas-Brazil (Unicamp), diagnosed with a hypothyroidism mixedematous myopathy, which led to the following clinical sequence: rhabdomyolysis, myoglobinuria and acute renal failure. An accidental iatrogenic levothyroxine poisoning precipitated or exacerbated the confusion in this previously weakened patient, leading to psychiatric symptoms of delirium. When a bed was brought to the corridor by nurses, he considered it an ambush. Anxious, wanting to flee, he pitched himself from the 6th floor (8 meters). The fall was partly contained by a protection net. Following the episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes.
Physicians should recognize confused states to identify and treat the underlying causes and to prevent the development of its complications. Besides clinical and psychiatric care for patients with confused and agitated states, several other measures are recommended when aiming to prevent suicide in a general hospital, such as: restriction of access to means of suicide (windows and hazardous balconies); placement of protective nets; training of the care team for early detection and intervention in any mental disorders; assessment of suicide risks before hospital discharge.
To determine the outcome of patients who underwent ECT in a Brazilian General Hospital between 1993 and 2007.
Telephone contact with all patients (or their relatives) who were submitted to ECT during psychiatric hospitalization in HC-Unicamp-Brazil. Data were compiled for statistical analysis at SPSS.
There were 53 successful telephone contacts (33.9% of 153 patients who underwent ECT). Losses were due to changes of telephones/addresses. No refuses occurred. The mean time between the procedure and the contact was 55.4 months (3-170). Twenty patients (37.3%) and 37 relatives (69.8%) were interviewed. Most were women (60.4% n=32), 4 were inpatients by the occasion of the call and 4 died. The mean age was 42.9±19.4. The assessments of current mental state by patients were: excellent in 5-9.4% cases, good in 12-22.6%, poor in 2-3.8%. The evaluation by family members was: excellent in 11-20.8% cases, good in 11-20.8%, poor in 7-13.2% and very poor in 5-9.4%. In 42 cases (79.2%) the patient was still under psychiatric treatment (taking psychotropic medication in 39-73.6%). In 28 cases (54%) there was need for new admission in a psychiatric inpatient ward. In 38 cases (74%) the patient reported knowing that he/she had undergone ECT, and only in 5 cases (9.4%) there was a lasting side effect of treatment reported, which was change in memory.
Data of the evolution of patients corroborate the importance of treatment with ECT for severe mental disorders, and also shows the low rate of long-term complications related to the procedure.
To review the literature on child sexual abuse with emphasis on psychosocial/psychodynamic aspects.
Systematic literature review from the articles indexed in Medline, PSYinfo, Pepsic, Lilacs and Scielo in the last ten years. Terms researched were: child sexual abuse, psychosocial, psychodynamic and psychoanalysis.
Child sexual abuse can have devastating consequences for the psychological functioning of children, possibly interfering with their proper process of development. It can contribute to violent behavior, acts of delinquency and mental disorders in adolescence and adulthood, as well as the development of comorbid post-traumatic stress and self-aggressive behaviors, risk behaviors and teenage pregnancy. Gravity of psychic consequences increase in relation to the frequency of abuse. Aspects of power, seduction and coercion are involved. Inequalities of age and gender are highlighted. Often practiced without the use of physical force, it may be difficult to be proven. A frequent abuser of familiarity with the child creates conditions that foster abuse. The revelation of the abuse may not occur, perpetuating the suffering and helplessness of the child. Sexually abused children may develop identification with the abuser and even become sexual offenders in adulthood. There are difficulties in the conceptual definition of abuse, the establishment of protocols for investigative and therapeutic management of cases and in predicting the immediate consequences along with the medium and long-term consequences.
Studies on the therapeutic practices used for the treatment of abused children and their families can help to construct therapeutic models, minimizing suffering in this terrible situation of violence.
To investigate socio-demographic and clinical trials of 19 sexually abused children.
Statistical analysis with SPSS of data on psychiatric and pediatric care of sexually abused children, aged 2-12 years old, treated at the Pediatric Service of University of Campinas-Brazil Clinical Hospital in 2007.
From a total of 19 children, 2 (10.5%) were boys and 17 (89.5%) girls. The average age group was 7.4 years. Eleven (57.9%) attended regular school, one (5.3%) attended special school, one (5.3%) pre-school and six (31.5%) did not attend any school. Regarding ethnicity, 11 (57.9%) children were white and eight (42.1%) non-white. The abuse was committed with physical threats in nine (47.4%) cases, without threats in two (10.5%). Eight children were unable to define physical threat. The abuse occurred only once in 10 (52.6%) cases and several times in nine (47.4%). Prior psychiatric treatment occurred in two (5.3%) children and psychological treatment in six (31.6%). Twelve (63.2%) children had never attended psychological or psychiatric consultations. Eleven (57.9%) children received a psychiatric diagnosis and referral for treatment. In 13 (68.4%) attendance was diagnosed in the Z-code of the International Classification of Diseases-10. Family and people close to children appear as abusers in 15 cases (78.9%).
Despite the small sample, this study supports the literature in which child sexual abuse appears as a phenomenon more frequent in girls, dysfunctional families, and practiced mainly by family members or close friends of children. The relationship with psychiatric disorders was also highlighted.
To discuss the paradigm of melancholy in hysteria.
case report of M., a 45 year-old woman, who is under psychotherapy and psychiatric treatment at the General Hospital of the University of Campinas (HC Unicamp).
K. is a 45 year-old divorced mother and former teacher, who started psychotherapy and psychiatric treatment at HC Unicamp in 2007, two years after the death of her father.Since such loss,K. made several violent suicide attempts: she jumped from the balcony of her apartment, took an overdose of medications, and set fire to her body in front of the mirror, which caused permanent scars. During both the psychotherapy sessions and the psychiatric consultations, K. frequently expressed how her life had lost its meaning after the death of her father. She mentioned she was no longer able to love and had no reason to continue living. She also complained about her ex-husband, from whom she was divorced after being betrayed, and about her children, who did not give her, according to her point of view, enough attention and care.
The patient is inside a typical hysterical scene, a “spectacle” composed by dramatic acts against her life. However, it is undeniable her identification with the lost object, her father. By setting fire to her own body in front of the mirror, she shows a melancholic kind of satisfaction with the pain, caused by a massive and destructive narcissism turned against herself.
To describe the experience of group therapy with offender adolescents in an Institution for minor violators (“Fundação CASA”) and who have suffered from mental disorders related to psychoactive substance use.
“Fundação CASA” is an institution created to shelter minor offenders. In 2008 some were judicially referred for treatment to a University Hospital Psychoactive Substance Outpatients Service. An operative and informative group was formed, since they have not adapted to the already existing adult group. This group met weekly, aimed to prevent relapse and initially planned to last 6 meetings.
Soon there were 4 adolescents who had engaged with the group and requested to increase the number of sessions. Psychodynamic issues emerged during the sessions, which were well evaluated by all participants after 10 weeks, when the group had to be ended due to the completion of sentences of 3 participants. In 2009 only 3 of them were found. The first reported a relapse, but remains abstinent. The second started working as general assistant and remained abstinent. The third continued to consume crack and was arrested by the time he was 18.
This study showed the need for specific treatment for the group of juvenile offenders. Operative and informative groups create a communication space for drug users and other psychotic subjects. It permits group identification and allows the expression of mental suffering. Therefore this practice consists of a low complexity approach in an extremely vulnerable population, which is so prevalent in developing countries such as Brazil.
To analyze, for all the pediatric consultations in 2008 in the emergency ward of the Pediatric Hospital of the University of Campinas, the clinical and demographic profile of the consultations in which there was a possible psychiatric diagnosis.
Review of all forms of consultations for children enrolled in the unit during 2008, selecting those with the possibility of a psychiatric diagnosis.
Of 21,811 consultations in 2008, 95(0.43%) included psychiatric complaints - 60(63.2%) girls and 35(36.8%) boys, aged 1-13 years(9±0.4). 70(73.7%) were white, 18(18.9%) mixed and 7(7.4%) black. A psychiatric evaluation was called for in 39(41.0%) cases. In 35(36.8%) sexual abuse was suspected. Other forms of violence were reported in 8(8.4%) cases. There were 6(6.31%) suicide attempts, 10(10.5%) cases of extreme agitation, 14(14.7%) consultations for extreme anxiety/dissociative symptoms, 5(5.3%) for depressive symptoms and 4(4.2%) for a psychotic condition. Twenty(21.1%) children were already using psychotropic drugs at the time of evaluation and in 29(30.5%) evaluations there were subsequent psychiatric interventions, with drug prescriptions in 11(37.9%). Nine(9.5%) children had clinical/pediatric conditions.
Children may need psychiatric care in emergency situations for various conditions. Despite the small percentage among the total number of pediatric emergency consultations, psychiatric evaluation, when necessary, can be useful and have an impact on diagnostic and therapeutic procedures. The plight of these children can be intense, demanding prompt and effective action. A psychiatrist can provide assistance that may help the pediatrician in the management of severe pathological conditions that affect the mental lives of children.
Psychosocial representations about the manic episode may constitute personal difficulty factors in dealing with the disorder, to relate socially and compromise satisfactory adherence to clinical treatments. It was elected to recall the experiences of manic episode due to its social and individual stigma.
To discuss the meanings of life experiences regarding manic episodes as reported by outpatients with bipolar affective disorder in remission.
Research methodology from the Humanities employed to health settings, using clinical-qualitative method, with the technique of semi-directed interview with open-ended questions. The sample was closed by the criterion of theoretical saturation of information. Eight interviews were conducted in a university psychiatric clinic. Data were treated through the qualitative content analysis, with free-floating readings of the corpus - the set of the transcribed interviews - in order to categorization in core's discussion.
Patients whom experienced manic episodes use unique adaptive mechanisms to deal with their psychosocial experiences and emotions. The highlights were the recognized strategies of bargaining, denial, rationalization and escaping when facing the experienced problems.
The recognition of the management of patients’ experiences of mental disorder by the healthcare team can better harmonize the professional-patient relationship and develop strategies for greater adherence to the therapeutic and preventive measures for recurrence of the episodes.
Electrodermal activity has been considered as a potential source to identify subgroups of schizophrenics. However, the neural mechanisms that are the base of the electrodermal responsiveness in schizophrenia are not well-known. The present study aimed to determine if schizophrenic patients with different skin conductance levels (SCL) show differences in grey matter (GM) volume estimated through VBM. Thirty-four schizophrenic patients paired with healthy volunteers, matched according to sex, age, handedness, socio-economic status and years of education, were selected. All patients were using anti-psychotics, and were included only when their score in the BPRS was lower then “present in mild degree” in all the scale items, except for negative symptoms. The electrodermal activity was measured during five minutes at rest and in comfortable conditions. Three groups were obtained, according to the electrodermal level: control, schizophrenic with normal SCL and schizophrenic with low SCL. MRI was performed with a Siemens Magneton 1.5T imaging system. The optimized VBM protocol was implemented within MATLAB 7.0 (Mathworks Inc.) through Statistical Parametric Mapping 2. Compared to controls, schizophrenic patients presented abnormalities in regional GM volume in superior and medial frontal lobes, paracentral lobule, cingulate, transverse temporal, insula, precuneus and occipital lobe. Regarding the schizophrenia groups, it was observed that the low SCL group presented smaller regional GM density in the right superior frontal lobe and in the right anterior cingulated. Accordingly, these results suggest that these brain areas may be involved in the modulation of SCL in schizophrenia and could be altered in a subgroup of patients.
Minors Mental Disorders (MDM) is a term created to describe symptoms such as insomnia, fatigue, irritability, forgetfulness, difficulty concentrating, and somatic complaints.
This study aimed to estimate the prevalence of MDM in São Francisco do Conde (SFC), Bahia.
We conducted a cross-sectional study by randomly selecting 456 individuals aged over 18 years, registered at the Family Health Program of CFS. The data were collected through home visits in the period from October to December 2010. The subjects answered a questionnaire containing the “Self-Report Questionnaire” (SRQ-20), the demographics and lifestyles. The SRQ-20 is composed of 20 questions, four about physical symptoms and sixteen on psycho emotional symptoms. The answers are “yes” or “no” and attributed, respectively, values of “1” and “0”. The cutoff suggested for identifying DPM was seven or more positive responses. The project was approved by a Research Ethics Committee registered the CONEP.
The results showed a prevalence of 37.7% of MDM. Among males the prevalence was 17.6% and in females was 47.5%, this result was statistically significant.
The results showed a high prevalence of psychological distress in this population, especially among females. The results stimulate the continuity of the actions of health surveillance carried out in the city.
Children of patients with bipolar disorder are at increased risk of developing psychopathology and psychosocial difficulties.
To understand the emotional experiences of adult children of mothers with bipolar disorder.
Qualitative study, using in-depth semi-directed interviews with open-ended questions, sample closed by saturation information criteria, content analysis, discussion under psychodynamic concepts.
From interviewees’ reports, it can be seen that offspring's experiences emotional vulnerability, such as directions given by early exposure to self injurious behaviour, psychiatric hospitalizations, routine absences from home and consequent perception of helplessness, especially in periods of the mother's crisis. The findings suggest that for the children the insecurity to assume the precociously inverted responsibility regarding the need of care to mother seems to experience by them as an entrapment to the care of the mother, for the effort they make to keep them alive, with an emotional burden due to both impaired childhood and adolescent.
It was analyzed the assumption that the evolution of reactive psychological stages regarding the mother affected by a mental illness marked by bipolarity manifestations, alternating with phases of the normality of psychic manifestations, would follow the evolution of the oscillating psychological stages of his/her own mother, which minimizes often both the disease and the treatment during the phases of remission of manifestations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.