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Schizoaffective disorder is a psychotic disorder of controversial nosological entity. Affective symptomatology and psychotic features of varying intensity coexist simultaneously in him throughout evolution. The lack of consensus on the existence of this entity determines its diagnostic delay and the absence of specific treatment guidelines.
To review the diagnostic criteria for schizoaffective disorder and the published scientific evidence on the efficacy and safety of the different therapeutic options available. To analyze the efficacy of a multidisciplinary treatment plan implemented in an intensive follow-up program, presenting the evolution of a clinical case.
To review the psychiatric history and psychopathological evolution of a patient diagnosed with schizoaffective disorder from the beginning of an intensive follow-up program in a day center to the present. Review the existing scientific evidence on the usefulness of the treatments used in this nosological entity.
This is a longitudinal and retrospective study of a clinical case in which the areas for improvement are analyzed before implementing a multidisciplinary therapeutic program and the favorable results obtained today. Currently, the patient is euthymic and attenuated and chronic positive and negative symptoms persist that do not interfere with his functionality.
From the implementation of an individualized, personalized and multidisciplinary maintenance treatment plan, an overall improvement in psychopathological stability and functional recovery is observed. Among the psychopharmacological options in this patient, Paliperidone Long Acting Injection (PLAI) stands out for its long-term efficacy and safety.
People with borderline personality disorder are at higher risk of repeating suicidal behavior. At the same time, numerous publications have demonstrated the relationship between cocaine dependence and suicide attempts of repetition.
Review the relationship between cocaine addiction, borderline personality disorder and repeated suicide attempts. Present through a clinical case the effectiveness of a comprehensive and multidisciplinary therapeutic plan with different mental health devices.
To review the psychopathological evolution of a patient with a diagnosis of borderline personality disorder; dependence to the cocaine; Harmful alcohol consumption and suicidal behavior from the beginning of follow-up in mental health services to the present. Review the existing scientific evidence on the relationship between cocaine addiction and repeated suicide attempts. Analyze the eficacy of the different treatments available.
This is a longitudinal and retrospective study of the psychiatric history and evolution of a clinical case since the implementation of an individualized therapeutic program and the favorable results obtained. Intensive outpatient follow-up was carried out for high suicide risk and hospitalization in a psychiatric hospitalization unit, day care centre and therapeutic community.
At present, the patient remains in abstinence with remission of suicidal ideation. The literature has shown the usefulness of intensive mental health follow-up programs to achieve remission of suicidal ideation and maintain abstinence from illegal substances.
Strategies for pandemic preparedness and response are urgently needed for all settings. We describe our experience using inverted classroom methodology (ICM) for COVID-19 pandemic preparedness in a small hospital with limited infection prevention staff. ICM for pandemic preparedness was feasible and contributed to an increase in COVID-19 knowledge and comfort.
The personality disorders are defined according to the DSM-5 like “an enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's cultures. These patterns develop in adolescence and the beginning of adulthood, and are associated with significant distress or disability”. The personality disorders can be a risk factor for different processes of the psychiatric pathology like suicide. The personality disorders are classified in 3 groups according to the DSM-5:
– cluster A (strange subjects): paranoid, schizoid and schizotypal;
– cluster B (immature subjects): antisocial, bordeline, histrionic and narcissistic;
– cluster C (frightened subjects): avoidant, dependent and obsessive-compulsive.
To describe the influence of personality disorders in suicide attempts.
Exhibition of clinical cases.
In this case report, we exhibit three clinical cases of suicide attempts which correspond to a type of personality disorder belonging to each of the three big groups of the DSM-5 classification, specifically the paranoid disorder of the cluster A, the disorder borderline of cluster B and the obsessive compulsive of cluster C.
The personality disorders have a clear relation with the suicide attempts, increasing this influence in some of them, especially the borderline personality disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.
To estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.
Transversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).
Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.
Twenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).
The high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.
Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Our pilot study evaluated the feasibility, effectiveness, and implementation of a group-based lifestyle-integrated functional exercise (Mi-LiFE) program for older adults in an interprofessional primary care practice. A physical therapist taught participants how to integrate strength and balance activities into daily routines during one individual and four group sessions, and two follow-up phone calls. Feasibility outcomes were recruitment, adherence, and retention over 6 months. Physical activity (PA) (accelerometer, International Physical Activity Questionnaire [IPAQ]), Short Physical Performance Battery (SPPB), and health-related quality of life (EuroQol Five-Dimensional Questionnaire with 3 Levels [EQ5D-3L]) were evaluated at baseline and 6 months. Of the 123 eligible individuals, 39 per cent participated and 61 per cent were not interested or unreachable. Forty-eight participants (mean ± standard deviation [SD] age = 81 ± 5 years; body mass index [BMI] = 28 ± 5 kg/m2; 60% women; moderate-to-vigorous PA = 49 ± 87 minutes/week) enrolled. Four participants withdrew prior to intervention. Thirty-two participants (67%) were retained at follow-up. Daily diary-documented adherence was 50 per cent at 6 months, and 77 per cent attended more than four sessions. No statistically significant changes in moderate-to-vigorous PA and SPPB outcomes were observed; yet self-reported strength and balance PA and quality of life significantly improved at follow-up. The Mi-LiFE program is feasible with acceptable recruitment and attendance rates alongside modifications to address retention and adherence challenges. These findings inform the feasibility of future pragmatic exercise programs in primary care for older adults.
We aimed to assess the maternal and family determinants of four anthropometric typologies at the household level in Colombia for the years 2000, 2005 and 2010.
We classified children <5 years old according to height-for-age Z-score (<−2) and BMI-for-age Z-score (>2) to assess stunting and overweight/obesity, respectively; mothers were categorized according to BMI to assess underweight (<18·5 kg/m2) and overweight/obesity (≥25·0 kg/m2). At the household level, we established four final anthropometric typologies: normal, underweight, overweight and dual-burden households. Separate polytomous logistic regression models for each of the surveyed years were developed to examine several maternal and familial determinants of the different anthropometric typologies.
National and sub-regional (urban and rural) representative samples from Colombia, South America.
Drawing on data from three waves of Colombia’s Demographic and Health Survey/Encuesta Nacional de Salud (DHS/ENDS), we examined individual and household information from mothers (18–49 years) and their children (birth–5 years).
Higher parity was associated with an increased likelihood of overweight and dual burden. Higher levels of maternal education were correlated with lower prevalence of overweight, underweight and dual burden of malnutrition in all data collection waves. In 2010, participation in nutrition programmes for children <5 years, being an indigenous household, food purchase decisions by the mother and food security classification were also associated with the four anthropometric typologies.
Results suggest that maternal and family correlates of certain anthropometric typologies at the household level may be used to better frame policies aimed at improving social conditions and nutrition outcomes.
Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents’ stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.
This research aimed at assessing the effects of a ceiling fan ventilation system on health, feeding, social behaviour and growth response of finishing young bulls fattened indoors during a mild summer season. A total of 69 Charolais young bulls were housed in six pens without any mechanical ventilation system (Control) and in six pens equipped with ceiling fans. The experimental period lasted 98 days from June until mid-September 2014. Four experimental days were considered in order to assess the effect of the ventilation system under two different microclimatic conditions: 2 alert days at monthly interval with temperature humidity index (THI) between 75 and 78, and 2 normal days with THI⩽74. Health and behaviour of the bulls were evaluated through 8-h observation sessions starting after morning feed delivery. The study was carried out during a rather cool summer with a climate average THI of 68.9 and 4 days with average THI>75. Despite these mild climate conditions, ceiling fans lowered litter moisture and acted as a preventive measure for bulls’ dirtiness (odd ratio=47.9; 95% CI 19.6 to 117.4). The risk of abnormal breathing was increased for Control bulls (odd ratio=40.7; 95% CI 5.4 to 304.2). When exposed to alert THI conditions, respiration rate and panting scores increased and rumination duration dropped in Control bulls compared with bulls provided with a ceiling fan. During observations under alert THI, bulls spent less time eating, more time being inactive and consumed more water compared with normal THI conditions. Bulls’ daily dry matter intake measured during the observation sessions decreased on alert compared with normal THI days (P<0.001) due to a drop of intake during the daylight hours. Ceiling fan treatment had no effect on bulls’ growth performance or water consumption but these results most likely depended on the mild climate conditions. Ceiling fans proved to mitigate some of the negative effects of heat stress on bulls’ behaviour (rumination, lying down and drinking water) and respiration rate, however. The lack of a significant improvement of bulls’ growth response should not discourage beef farmers from using ceiling fans in indoor systems, considering the likely increase in frequency and intensity of heat waves in the planet’s temperate areas induced by global warming.
Concrete is a composite material, composed of cement, sand, gravel and water, reinforced with steel bars or mesh. It is used for the construction of infrastructure assets such as airports, dams, ports, bridges and road ways. Polymer concrete is a relative new material containing a thermosetting resin (instead of water) displaying improved mechanical strength, low permeability, greater corrosion resistance and higher durability. It is employed for new construction and old concrete reparation in the chemical, food, fertilizer, mine and civil industries. Polymer concrete pipe specimens, reinforced with glass-fibers were prepared and exposed in a salt spray (fog) chamber, operating with a NaCl solution, following ASTM standard B-117-11. The deterioration effects were assessed by testing the physical and mechanical properties, before and after the exposure in the spray chamber, in accordance with standard ASTM D3039-2013. Corrosion resistance was evaluated applying ASTM standard C876-2013. The result of this work are presented, illustrated and discussed.
Microalgal blooms are a natural part of the seasonal cycle of photosynthetic organisms in marine ecosystems. They are key components of the structure and dynamics of the oceans and thus sustain the benefits that humans obtain from these aquatic environments. However, some microalgal blooms can cause harm to humans and other organisms. These harmful algal blooms (HABs) have direct impacts on human health and negative influences on human wellbeing, mainly through their consequences to coastal ecosystem services (fisheries, tourism and recreation) and other marine organisms and environments. HABs are natural phenomena, but these events can be favoured by anthropogenic pressures in coastal areas. Global warming and associated changes in the oceans could affect HAB occurrences and toxicity as well, although forecasting the possible trends is still speculative and requires intensive multidisciplinary research. At the beginning of the 21st century, with expanding human populations, particularly in coastal and developing countries, mitigating HABs impacts on human health and wellbeing is becoming a more pressing public health need. The available tools to address this global challenge include maintaining intensive, multidisciplinary and collaborative scientific research, and strengthening the coordination with stakeholders, policymakers and the general public. Here we provide an overview of different aspects of the HABs phenomena, an important element of the intrinsic links between oceans and human health and wellbeing.
This study described prescribing trends before and after implementing a provincial strategy aimed at improving osteoporosis and fracture prevention in Ontario long-term care (LTC) homes. Data were obtained from a pharmacy provider for 10 LTC homes in 2007 and 166 homes in 2012. We used weighted, multiple linear regression analyses to examine facility-level changes in vitamin D, calcium, and osteoporosis medication prescribing rates between 2007 and 2012. After five years, the estimated increase in vitamin D, calcium, and osteoporosis medication prescribing rates, respectively, was 38.2 per cent (95% confidence interval [CI]: 29.0, 47.3; p < .001), 4.0 per cent (95% CI: –3.9, 12.0; p = .318), and 0.2 per cent (95% CI: –3.3, 3.7; p = .91). Although the study could not assess causality, findings suggest that wide-scale knowledge translation activities successfully improved vitamin D prescribing rates, although ongoing efforts are needed to target homes with low uptake.
To determine the prevalence of women of childbearing age with schizophrenia and bipolar disorder exposed to antipsychotic (AP) drugs and mood stabilizers (MS) in Lombardy, a European region of 10 million inhabitants and 1 752 285 women of childbearing age.
The data concerning psychiatric care, drug treatments and pregnancy outcomes were retrieved from local administrative databases during a 12-month census period.
During a 12-month census period, 2893 women of childbearing age with schizophrenia (74.8% of all women of childbearing age with schizophrenia) and 918 with bipolar disorder (80.1% of all women of childbearing age with bipolar disorder) were exposed to AP drugs or MS, yielding a prevalence of exposure for women with schizophrenia of 1.65 (95% confidence interval (CI) 1.59–1.71) per 1000 female inhabitants, and for women with bipolar disorder of 0.52 (95% CI 0.49–0.55) per 1000 female inhabitants. Persistent exposure to potentially teratogenic medications accounted for one in every 1000 women of childbearing age. Of the 57 pregnancies in women with schizophrenia, normal delivery was recorded in 23 (40%) cases; of the 26 pregnancies in women with bipolar disorder, normal delivery was recorded in 10 (38%) cases.
In women of childbearing age with severe mental disorders, exposure to psychotropic drugs is substantial, which suggests that the issue of reproductive health is epidemiologically relevant and a major public health concern.
In healthy older subjects, the glycaemic response to carbohydrate-containing meals is dependent on gastric emptying and intestinal absorption; when the latter is slowed, the magnitude of the rise in glucose is attenuated. The oligosaccharide α-cyclodextrin has been reported to diminish the glycaemic response to starch in young adults; this effect has been attributed to the inhibition of pancreatic amylase. We examined the effects of α-cyclodextrin on gastric emptying of, and the glycaemic and insulinaemic responses to, oral sucrose in healthy older subjects; as sucrose is hydrolysed by intestinal disaccharides, any effect(s) of α-cyclodextrin would not be attributable to amylase inhibition. A total of ten subjects (seven males and three females, age 68–76 years) were studied on 2 d. Gastric emptying, blood glucose and serum insulin were measured after ingestion of a 300 ml drink containing 100 g sucrose, labelled with 99mTc-sulphur colloid, with or without 10 g α-cyclodextrin. Gastric emptying was slowed slightly by α-cyclodextrin; this effect was evident between 135 and 195 min and was associated with a slight increase (P < 0·05) in distal stomach retention. After α-cyclodextrin, blood glucose was slightly less (P < 0·05) at 60 min, and serum insulin was less (P < 0·0005) at 90 and 120 min. There was no difference in the incremental areas under the curve (iAUC) for blood glucose, but there was a trend for the iAUC for serum insulin to be lower (P = 0·09) after α-cyclodextrin. We conclude that in a dose of 10 g, α-cyclodextrin has modest effects to slow gastric emptying of, and modify the glycaemic and insulinaemic responses to, oral sucrose, probably due to delayed intestinal carbohydrate absorption.
A 2200-yr long, high-resolution (∼5 yr) record of drought variability in northwest Montana is inferred from diatoms and δ18O values of bio-induced carbonate preserved in a varved lacustrine core from Foy Lake. A previously developed model of the diatom response to lake-level fluctuations is used to constrain estimates of paleolake levels derived from the diatom data. High-frequency (decadal) fluctuations in the de-trended δ18O record mirror variations in wet/dry cycles inferred from Banff tree-rings, demonstrating the sensitivity of the oxygen-isotope values to changes in regional moisture balance. Low frequency (multi-centennial) isotopic changes may be associated with shifts in the seasonal distribution of precipitation. From 200 B.C. to A.D. 800, both diatom and isotope records indicate that climate was dry and lake level low, with poor diatom preservation and high organic carbon: nitrogen ratios. Subsequently, lake level rose slightly, although the climate was drier and more stable than modern conditions. At A.D. 1200, lake level increased to approximately 6 m below present elevation, after which the lake fluctuated between this elevation and full stage, with particularly cool and/or wetter conditions after 1700. The hydrologic balance of the lake shifted abruptly at 1894 because of the establishment of a lumber mill at the lake's outlet. Spectral analysis of the δ18O data indicates that severe droughts occurred with multi-decadal (50 to 70 yr) frequency.
Performances and advantages of different high-resolution microscopy techniques are compared. These include Soft X-ray Contact Microscopy (SXCM), Atomic Force Microscopy (AFM), Focused Ion Beam (FIB) and Transmission Electron Microscopy (TEM). It is shown that they allow complementary approaches to imaging of biological objects. These techniques have been used to image the same type of cells (Saccharomyces cerevisiae) thus providing a common benchmark. In particular it is shown that the novel FIB technique allows easy target cell selection, fast operation, high resolution, 3D imaging and sample manipulation during imaging.
Soft X-ray contact microscopy (SXCM) experiments have been performed
using the Prague Asterix Iodine Laser System (PALS). Laser wavelength
and pulse duration were λ = 1.314 μm and τ (FWHM) = 450 ps,
respectively. Pulsed X rays were generated using teflon, gold, and
molybdenum targets with laser intensities I ≥
1014 W/cm2. Experiments have been performed
on the nematodes Caenorhabditis elegans. Images were recorded
on PMMA photo resists and analyzed using an atomic force microscope
operating in contact mode. Our preliminary results indicate the
suitability of the SXCM for multicellular specimens.
A cross-linked copolymer of vinylferrocene and dimethyl-acrylamide is generated inside the less dense microporous domains of a cross-linked polydimethylacrylamide matrix. I.S.E.C. and E.S.R. data reveal that the obtained composite is in fact an I.P.N.(Interpenetrating Polymer Network) material.