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Generation of steady streaming vortices is usually accomplished by mechanically vibrating bodies, as occurs in several microfluidic applications for mixing, as well as for transport and handling of microparticles. Here, we propose the generation of streaming from the harmonic electromagnetic forcing of a free-moving circular magnet held afloat on a shallow electrolytic layer, and show that the sense of rotation of steady vortices is the opposite to that of the classical streaming flow. Reverse streaming is attributed to the coupling between the fluid and the free-moving body. Analytical solutions offer a physical rationale for the observed flow dynamics, while numerical simulation reproduces the experimental observations satisfactorily.
Anaphylactic reactions can lead to life-threatening situations. Therefore, a rapid diagnosis and therapy are indicated. Various guidelines recommend immediate treatment with intramuscular adrenaline in severe anaphylaxis. Based on study data from different countries, it has been shown that therapy of anaphylaxis is often not carried out according to existing guidelines.
Study Objective:
The aim of the study was an analysis of the emergency treatment and outcome of anaphylaxis in children and adults according to its severity. Focus was placed on the recommended first-line therapy with adrenaline in cases of severe reactions. Further demographic data, triggers, symptoms, and hospitalization rates of anaphylaxis were analyzed.
Methods:
Data from Emergency Medical Services from Dresden/Germany in cases of anaphylaxis from the start of 2012 through the end of 2016 were retrospectively analyzed. The data of the air rescue were not considered. The severity of the anaphylaxis, the therapy, the further monitoring, and the outcome were analyzed.
Results:
A total of 1,131 adults and 223 children with anaphylactic reactions (Grade I-IV) were analyzed. Overall, 591 adults and 102 children showed a severe anaphylaxis. The most common trigger for severe anaphylactic reactions was food in children (61%) and medication in adults (33%). Seven percent of adults and eight percent of children with Grade II or higher anaphylactic reactions received adrenaline. There is a significant correlation between adrenaline therapy and improved condition/outcome in adults and children. Sixty-six percent of adults and 83% of children with severe anaphylaxis were hospitalized. Twenty-one percent of the adults and 13% of the children did not receive further medical observation despite a severe reaction.
Conclusion:
The guideline-compliant first-line therapy with adrenaline was not carried out in the majority of the cases analyzed. However, the study shows that treatment with adrenaline for anaphylaxis leads to a significant improvement in the patients’ condition.
The European Clozapine Task Force is a group of psychiatrists and pharmacologists practicing in 18 countries under European Medicines Agency (EMA) regulation, who are deeply concerned about the underuse of clozapine in European countries. Although clozapine is the most effective antipsychotic for people with treatment-resistant schizophrenia, a large proportion of them do not have access to this treatment. Concerns about clozapine-induced agranulocytosis and stringent blood monitoring rules are major barriers to clozapine prescribing and use. There is a growing body of evidence that the incidence of clozapine-induced agranulocytosis is very low after the first year of treatment. Maintaining lifelong monthly blood monitoring after this period contributes to unjustified discontinuation of clozapine. We leverage recent and replicated evidence on the long-term safety of clozapine to call for the revision and updating of the EMA’s blood monitoring rules, thus aiming to overcome this major barrier to clozapine prescribing and use. We believe the time has come for relaxing the rules without increasing the risks for people using clozapine in Europe.
This paper describes four methodological proposals for rescuing from oblivion and highlighting women writers in Graeco-Roman Antiquity. In workshops employing a variety of active methodologies, students become acquainted with Greek writers like Sappho, Diotima of Mantinea and Aspasia, and their Roman counterparts, including Sulpicia and Agrippina the Younger, while also becoming aware of the authorship of these women writers and their lack of visibility. The proposals take the shape of activities aimed at fostering a vocation for science among baccalaureate students in Spain but can also be easily adapted to secondary and even higher education in other educational contexts.
Researchers generally do an excellent job tracking the scientific impacts of their scholarship in ways that are relevant for academia (e.g., publications, grants) but too often neglect to focus on broader impacts on population health and equity. The National Cancer Institute’s Implementation Science Centers in Cancer Control (ISC3) includes 7 P50 Centers that are interested in broad measures of impact. We provide an overview of the approach underway within the ISC3 consortium to identify health and social impacts.
Methods:
ISC3 adapted and applied the Translational Science Benefits Model (TSBM) to identify the impact on the discipline of D&I science and to consider dissemination and implementation (D&I) impacts in the four original TSBM domains: (1) clinical; (2) community; (3) economic; and (4) policy. To collect data from all Centers, we: (1) co-developed a set of detailed impact indicators with examples; (2) created a data collection template; and (3) summarized the impact data from each center.
Results:
Based on data from 48 ISC3 pilot studies, cores, or consortium activities, we identified 84 distinct benefits. The most common impacts were shown for implementation science (43%), community (28%), and clinical (18%). Frequent audiences included primary care providers, public health practitioners, and community partners. ISC3 members highlighted the need for product feedback, and storytelling assistance to advance impact.
Conclusions:
The ISC3 consortium is using a participatory approach to successfully apply the TSBM, thus seeking to maximize the real-world impacts of D&I science. The D&I field needs to prioritize ways to more fully document and communicate societal impacts.
Diagnostic stability is a controversial issue in first episode psychosis (FEP) due to heterogenous symptoms and unclear affective symptoms. Differencing affective and non-affective psychoses is important as treatment strategies are different. Initial affective symptomatology has low specificity for predicting the subsequent diagnosis of affective psychosis. Sex has proven to be relevant for clinical and functional outcomes but it remains unclear how sex may contribute to diagnosis switch of FEP.
Objectives
To determine the role of sex in diagnostic stability in a sample of FEP after 1-year follow-up.
Methods
Diagnoses of FEP patients from Hospital del Mar of Barcelona were assessed at baseline and 1 year after. Univariate analyses was perfomed for all diagnoses and dichotomic variable (affective/non-affective). Logistic regression model was perfomed to know which variables predict diagnosis switch.
Results
256 patients were enrolled. No differences were found at baseline between completers and non-completers (Table 1). No significant differences between men and women at baseline diagnosis were found, neither all diagnoses (p=0.274) nor the dichotomic variable affective/non-affective (p=0.829) (Table 2AB). Significant differences were found at 1-year follow-up between men and women, for all diagnoses (p=0.043) and the dichotomic variable (p=0.039). Sex was the only variable that predicted diagnosis switch (Figure 1), PANSS, CDSS, YMRS, GAF and cannabis did not.Table 1.
Baseline characteristics of participants
Completers (n=188)
Non-completers (n=68)
p
Women (n, %)
71 (37.8)
30 (44.1)
0.111
Age (M, IQR)
24 (20-28)
22 (20-28)
0.899
Cannabis use (M, IQR)
5.5 (0-18)
7 (0-21)
0.231
DUP (M, IQR)
45 (12.5-130)
36 (11.25-115.75)
0.213
PANSS (m, sd)
44.55 (10.17)
40.93 (10.42)
0.761
CDSS (M, IQR)
2 (0-7)
3 (0-5.5)
0.199
YMRS (m, sd)
19 (9.64)
17.6 (9.15)
0.845
GAF (M, IQR)
30 (25-50)
30 (25-35)
0.114
TABLE 2A and 2B.
Diagnosis comparison (n, %)
Baseline
1-year follow-up
Men
Women
Total
Men
Women
Total
Psychosis NOS
69 (59)
39 (54.9)
108 (57.4)
28 (23.9)
10 (14.1)
38 (20.2)
Schizophreniform disorder
22 (18.8)
16 (22.5)
38 (20.2)
14 (12
9 (12.7)
23 (12.2)
Induced psychosis
4 (3.4)
0 (0)
4 (2.1)
15 (12.8)
4 (5.6)
19 (10.1)
Affective psychosis
17 (14.5)
9 (12.7)
26 (13.8)
24 (20.5)
25 (35.2)
49 (26.1)
Schizophrenia
0 (0)
0 (0)
1 (0.4)
30 (25.6)
14 (19.7)
44 (23.4)
Brief psychotic disorder
5 (4.3)
7 (9.9)
12 (6.4)
6 (5.1)
8 (11.3)
14 (7.4)
Baseline
1-year follow-up
Men
Women
Total
Men
Women
Total
Affective psychosis
17 (14.5)
9 (12.7)
26 (13.8)
24 (20.5)
25 (35.2)
49 (26.1)
Non-affective psychosis
100 (85.5)
62 (87.3)
162 (86.2)
93 (79.5)
46 (64.8)
139 (73.9)
Image:
Conclusions
Sex has proven to be the main predictor of switching initial diagnosis of FEP.
Psychotic disorders are strongly linked to a higher risk of mandatory hospitalization, often affecting men more, though some studies report the opposite. Recent investigations also show a higher rate of involuntary admissions in younger individuals. Knowledge in this area is still limited despite extensive research.
Objectives
Analyze whether there is an association between sex and age with involuntary admissions of individuals with psychotic disorders.
Methods
Retrospectively, 254 people with psychotic disorders admitted between 2018-2023 to the adult psychiatric inpatient unit at Hospital Universitari Germans Trias i Pujol were selected, collecting their nature of admission, sex, age, and discharge diagnosis. Comparisons between voluntary and involuntary admissions, with respect to sex and age variables, were conducted using independent sample t-tests, Mann-Whitney U tests, Fisher’s exact test, and chi-square tests. A logistic regression model was used to identify variables significantly associated with mandatory admission.
Results
In both the male and female groups, there were no statistically significant differences in terms of the mean age at admission (p = 0.162) or the nature of admission (p = 0.586) (Table 1). When analyzing the voluntary nature of admission based on age and sex, statistically significant differences were only found in the female group (p = 0.01), resulting in a 9.18 year age difference among those admitted voluntarily (Table 2). The model that best predicted the probability of involuntary admission in individuals with psychotic disorders included the sex variable (OR = 4.88) and the interaction between sex and age (OR = 0.97) (Table 3).Table 1:
Differences between sex regarding voluntariness of patients with psychotic disorders.
Male
Female
p value
N (%)
122 (48%)
132 (52%)
Age, m (SD)
38.39 (16.64)
44.15 (18.44)
0.162
Admissions, N (%)
Voluntary
38 (31.1%)
37 (28.0%)
0.586
Involuntary
84 (68.9%)
95 (72.0%)
Table 2:
Analysis of voluntariness by sex and age.
Age, m (SD)
Voluntary
Involuntary
p value
Male
37.45 (16.38)
38.81 (16.84)
0.677
Female
50.76 (18.19)
41.58 (17.98)
0.01*
Total
44.01 (18.44)
40.28 (17.46)
0.127
Table 3:
Predictors of involuntariness in psychotic patients: Logistic regression model (ENTER METHOD).
Predictor
-2log likelihood
Nagelkerke R2
x2 (df*)
OR* (95% CI*)
p value
301.22
0.039
0.03 (1)
Age
1.01 (0.98; 1.03)
0.674
Sex
4.88 (1.15; 20.72)
0.032*
Age x Sex Interaction
0.97 (0.94; 0.99)
0.046*
Conclusions
Young women with psychotic disorders face a higher risk of involuntary admissions, emphasizing the need for gender-specific strategies to improve care of these patients.
Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.
Objectives
To evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.
Methods
Clomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.
Results
The dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.
The pre and post results are summarized in tables 1 and 2.Table 1.
Hamilton Depresion Rating Scale (0-52)
Basal
Post 10-week treatment
21
4
Dimensional Y-BOCS (0-15)
Basal
Post 10-week treatment
Aggressive-related obsessions and compulsions
10
2
Religious-related obsessions and compulsions
5
1
Symmetry and order
7
1
Pollution and cleaning
0
0
Collecting and accumulation
2
0
Miscellaneous
10
3
Conclusions
Vortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.
This chapter traces a select anthological archive to examine how Chicana/Latina lesbian feminist editors and writers of the late twentieth century—through collective efforts to write their lesbian feminisms into existence—made significant contributions to U.S. lesbian feminist literature and thought. Chicana/Latina lesbian feminist writers have been important contributors to the formation of multiple U.S. literary movements, including U.S. lesbian feminist literature, especially through the editing of anthologies. This chapter considers how an archive of Chicana/Latina lesbian feminist willfulness has been instrumental in constituting and anthologizing lesbian and women of color feminisms.
The Ethiopian core collection of the USDA-Agriculture Research Service, National Plant Germplasm System (NPGS) includes 376 accessions and a genomic characterization that revealed 151,210 single nucleotide polymorphisms. This collection, however, lacks phenotypic characterization for several important agriculture traits. A total of 330 accessions from this NPGS Ethiopian core set were evaluated for grain mould resistance response across four tropical environments. Most of the accessions in the NPGS Ethiopian collection showed susceptibility to grain mould based on the low emergence rate and high seed deterioration observed in the seeds. The population structure of the collection was not related to grain mould resistance response suggesting this germplasm originated in regions with low disease pressure. The analysis identified two accessions with high emergence (PI 457867 and PI 454221) and three (PI 455036, PI 455213 and PI 330821) with low seed degradation. Genome-wide association analysis found genomic regions in chromosome 1, 3 and 8 associated with the observed grain mould resistance variation. Candidate gene analysis within these three loci identified diseases resistance genes involved in pathogen recognition and signalling cascades of the plant immunity system. These five NPGS Ethiopian accessions are candidates for use in a pre-breeding germplasm programme to develop improved germplasm with grain mould resistance.
Functional diversity indices have been used to differentiate the relative contribution of stochastic and deterministic processes that modulate the assemblage of communities; however, knowledge regarding the relative contribution of assemblage mechanisms in forest communities is scarce. We analysed the assembly mechanisms driving forest assemblages along a topographic gradient at two spatial scales (1000 m2 and 3000 m2) for three different forest types from subtropical mountain forests (pine-oak, mixed pine-broadleaf and broadleaf forest) in western Mexico, using null models of multi-trait indices. The forest structure differed along the topographic gradient. Upper slopes were dominated by Pinus douglasiana with an importance value index (IVI) of 0.8, while 10 and 13 tree species were required in the middle and lower slopes, respectively, to reach the same IVI. The results support the idea that the subtropical montane forest of western Mexico is a mosaic of communities, when analysed at a scale of 1000 m2 the forest assembly was mainly explained by stochastic processes, while analysis at the scale of 3000 m2 showed that functional convergence of species were the main mechanisms of the assemblage of the pine-oak forest communities due to an abiotic stressful environment.
A common design of a high-level radioactive waste (HLW) disposal system consists of the waste canisters emplaced in tunnels or shafts, with the space between the heat-emitting canisters and the surrounding rock filled with a bentonite-based material. Understanding the behavior of this barrier, in particular the effect of prolonged heating on its properties, is important to assess the barrier’s long-term performance. The objective of the present study was to add to this understanding and to supply experimental data about the state of bentonite hydrated and heated for a long period of time. To that end, a 50 cm long column of Wyoming-type bentonite pellets was heated at its base at 140 °C (simulating the waste canister) while a synthetic sodium-chloride-rich groundwater including sulfate, calcium, and magnesium was supplied through its upper surface for almost 10 y. At the end of the experiment the upper half of the column was saturated, but in the lower half the water content decreased sharply toward the heater, where it was close to 0%. No relevant mineralogical changes occurred, and the main component of the bentonite continued to be a predominantly sodium montmorillonite with no structural changes with respect to the initial one. In the area where the temperatures were >60°C and the material very dry, however, the smectite was not able to completely develop the 1-layer hydrate after 48 h of stabilization at RH 55%, although its expandability was fully recovered when the smectite was hydrated with liquid water. The ions solubilized as a result of the water-content increase were transported toward the heater and concentrated in two distinct areas: sodium and calcium chlorides closer to the heater than calcium and sodium sulfates. At the heater contact, the bentonite microstructure was of dense packets with carbon and Na-S-coated cavities. Precipitation of calcite and calcium sulfates and possibly dissolution of silica minerals also took place close to the heater.
The chemical and structural properties of Mg smectites in the Vicálvaro sepiolite deposit have been studied in detail. The characterization was performed on different size-fractions of selected smectitic samples (5−2 µm; 2−1 µm; 1−0.5 µm; <0.5 µm and <0.1 µm). The chemical compositions of individual particles (5−1 µm) and of bulk undifferentiated fine fractions (1−<0.1 µm) were determined by energy dispersive spectroscopy-scanning electron microscopy and interpreted with the aid of X-ray diffraction (XRD) and infrared spectroscopy (IR) methods. The XRD and IR data demonstrate that all of the Mg smectite materials studied are mainly composed of a complex mixture of stevensite, saponite and mica-type minerals. Although the presence or absence of saponite cannot be confirmed absolutely, stevensite is a significant component of these Mg smectites. This is proven by the calculated layer charge reduction after the Hofmann-Klemen effect. The results are in close agreement with the suggested mechanism of topotactic overgrowth of stevensite on pre-existing phyllosilicate templates. This characterizes clay diagenesis in saline-lake systems.
Dengue, chikungunya, and Zika are arboviruses that cause 390 million infections annually. Risk factors for hospitalization are poorly understood. Communities affected by these diseases have an escalating prevalence of allergies and obesity, which are linked to immune dysfunction. We assessed the association of allergies or body mass with hospitalization for an arbovirus infection. From 2014 to 2017, we recruited participants with a clinical diagnosis of arbovirus infection. Arbovirus infections were laboratory-confirmed and allergies were self-reported. Mid-upper arm circumference (MUAC), weight, and height were measured. We used two logistic regression models to assess the relationships between hospitalization and allergies and between hospitalization and body mass (MUAC for participants <20 years old and body mass index (BMI) for adults ≥20 years old). Models were stratified by age group and adjusted for confounders. For allergies, 41 of 265 were hospitalized. There was no association between allergies and hospitalization. For body mass, 34 of 251 were hospitalized. There was a 43% decrease in hospitalization odds for each additional centimetre MUAC among children (aOR 0.566, 95% CI 0.252–1.019) and a 12% decrease in hospitalization odds for each additional BMI unit among adults (aOR 0.877, 95% CI 0.752–0.998). Our work encourages the exploration of the underlying mechanisms.
While partisanship in American politics has been historically tied to racial identity and racial attitudes, most studies of Latino partisanship do not incorporate these factors into understanding their partisan attachments. I argue that the concepts of race, color, and mestizaje as they are understood within Latino communities in the United States can influence political attitudes and partisanship among Latinos themselves. Using six consecutive Cooperative Election Study (formerly Cooperative Congressional Election Study) surveys I examine how self-identification as white, racial resentment, and color-blind attitudes influence Latino partisanship. I find that white racial identity has a small but significant positive association with Republican partisanship among Latinos, and a negative association with Democratic partisanship. Additionally, negative racial attitudes among Latinos are strongly related to identification as Republican, even when controlling for ideology and other factors like immigrant generation and religion. These results have important implications for understanding current and future Latino voting patterns.
This article contributes to the literature analysing the role of public banks in crises. Taking the case of Spain, it analyses the behaviour of the public bank (ICO) between 1971 and 2015, specifically during two crises: the crisis of the 1970s, when Spain was an economically backward country coming out of a dictatorship; and that of 2008–13, by which time it had integrated into the international economy. Public credit underwent sweeping privatization in 1991, which translated into major downsizing. From then on, a gradual process of modernization began, mainly characterized by institutional changes in governance and access to resources. Our results indicate that public and private credit behave differently during recessions. Private credit always remains closely synchronized with the business cycle, but public credit less so.
To meet the UK's greenhouse gas (GHG) emissions targets, the Climate Change Committee (CCC) recommended to reduce current meat and dairy intake by 20% by 2030. In this study, we modelled the impact of potential dietary changes on GHG emissions and water use with the selected scenarios based on the trend of food purchase and meat and dairy reduction policy. We show that implementing fiscal measures and facilitating innovations in production of meat alternatives would accelerate existing positive trends, help the UK reach the CCC 2030 target of 20% meat and dairy reduction and increase fruit and vegetable intake.
Technical Summary
We used 2001–2019 data from the Family Food module of the Living Costs and Food Survey (LCF), an annual UK survey of about 5,000 representative households recording quantities of all food and drink purchases, to model four 2030 dietary scenarios: Business as usual (BAU); two fiscal policy scenarios (‘fiscal 10%’ and ‘fiscal 20%’), combining either a 10% meat and dairy tax and a 10% fruit and vegetable subsidy, or a 20% tax and 20% subsidy on the same foods; and an ‘innovation scenario’ substituting traditionally-produced meat and dairy with plant-based analogues and animal proteins produced in laboratories. Compared to 2019 levels, we forecasted reductions in the range of 5–30% for meat and 8–32% for dairy across scenarios. Meat reductions could be up to 21.5% (fiscal20%) and 30.4% (innovation). For all scenarios we forecasted an increase in fruit and vegetables intake in the range of 3–13.5%; with the fiscal 20% scenario showing highest increases (13.5%). GHG emissions and water use reductions were highest for the innovation scenario (−19.8%, −16.2%) followed by fiscal 20% (−15.8%, −9.2%) fiscal 10% (−12.1%, 5.9%) and BAU (−8.3%, −2.6%) scenarios. Compared to average households, low-income households had similar patterns of change, but both past and predicted purchase of meat, fruit and vegetables and environmental footprints were lower.
Social Media Summary
Meat and dairy-reduction policies would help meet net zero targets and improve population health in the UK.
The hawksbill sea turtle Eretmochelys imbricata is categorized as Critically Endangered on the IUCN Red List and its population has declined by over 80% in the last century. The Eastern Pacific population is one of the most threatened hawksbill populations globally. Western Mexico is the northern distribution limit for hawksbill sea turtles in the Eastern Pacific and recent research indicates that the Mexican Pacific portion of the population is a separate management unit because of the restricted movements of these turtles. Here we use the most complete database of sighting records in the north-west Pacific of Mexico to identify sites where hawksbill turtles are present. We also develop a conservation index to determine the conservation status of hawksbill turtle sites. Our results demonstrate the importance of this region for juveniles and the relevance of rocky reefs and mangrove estuaries as habitats for hawksbill turtles. We identified 52 sites with records of hawksbill turtles. Most of these sites (71%) are not protected; however, sites with high conservation value included islands and coastal sites along the Baja California peninsula that are established as marine protected areas. Reefs and mangrove estuaries relevant for hawksbill turtles are probably also significant fish nursery areas that are important for local fishing communities, creating opportunities for conservation strategies that combine science, local engagement and policy to benefit both local fishing communities and hawksbill sea turtle conservation.
Conversion disorder (a term that describes what was previously called hysteria) refers to motor or sensory symptoms, or both, that resemble a neurological disease, but that do not originate from or cannot be explained by a known physical disease.
Objectives
To find reliable tools that can guide the difficult diagnosis of conversion disorder.
Methods
Bibliographic review
Results
The exact prevalence of the disorder is unknown. It is estimated that approximately 5% of referrals to neurology are for this disorder. Approximately one third of patients referred to the neurologist have symptoms that cannot be explained by an organic disease. Involuntary movements are the most common motor manifestations of the conversive syndrome, being tremor one of the most frequent manifestations. The first differential diagnosis of conversion disorder is neurological disease. It is currently not necessary for the diagnosis to assess whether or not the symptoms are produced intentionally, as the assessment of conscious intentionality is unreliable. The neurological examination is the fundamental tool for the diagnostic approach, being even more enlightening than the complementary tests. Hoover’s sign, Babinski’s combined leg flexion, plantar flexion of the ankle, tremor and its distraction and synchronisation manoeuvres, as well as the clinical differences between epileptic seizures and non-epileptic seizures of psychogenic origin, are some of the reliable tools for a correct diagnosis.
Conclusions
The diagnosis of the disease should be one of exclusion. There must be clinical data showing clear evidence of incompatibility with a neurological disease and conversion symptoms do not correspond to known physiological mechanisms and anatomical pathways.