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As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study’s intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.
Despite the high level of standardization of the intracytoplasmic sperm injection (ICSI) technique, there are some aspects that deserve special attention and should still be improved. The major drawback of the technique is its invasiveness, as during cytoplasmic aspiration different structures of the oocyte may be lost or damaged. This is partly because the microtools used in ICSI were not specially designed for assisted reproduction but for other medical–biological disciplines. In view of the above caveats, the aim of the study was to compare the results of ICSI with the traditional oocyte-holding pipette and the oocyte-holding pipette without aspiration (PiWA). In total, 155 patients and 1037 oocytes were included in the study. In each ICSI cycle, half of the oocytes were microinjected using a traditional holding pipette and the other half using a PiWA. In result, the PiWA technique produced a significant increase in the fertilization rate: 88.12% (95%CI: 84.62–90.92%); holding pipette: 73.33% (95%CI: 68.72–77.49%). Also, it produced a significant decrease in the embryo degeneration rate compared with the traditional holding pipette [PiWA: 2.07% (95%CI: 1.11–3.8%); holding pipette: 4.51% (95%CI: 3.06–6.59%)]. Pregnancy rate depended on the holding technique used, both in single embryo transfers (n = 59; χ2 = 4.608; P-value = 0.032) and double embryo transfers (n = 156; χ2 = 4.344; P-value = 0.037); with PiWA presenting a significantly higher pregnancy rate than the traditional holding technique. Based on current evidence and the present results, improvements should focus on decreasing the invasiveness of the microinjection itself by minimizing or avoiding aspiration and cytoplasmic disorganization, as is successfully achieved with PiWA.
Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.
The disease burden due to non-specific, functional, and somatoform disorders is high. An unknown part of these medically unexplained symptoms belongs to factitious disorders. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder.
Objectives
The aim is to highlight, on the one hand, the differences between somatoform disorder and factitious disorder and, on the other hand, the potential impact of misdiagnosis in medical expertise regarding eligibility for a disability income.
Methods
A case report of Ms A. a 42-year-old Caucasian woman. She worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Subsequently, she developed total blindness, accompanied by distress in a crucial emotional context. A diagnosis of factitious disorder was retained by an expert psychiatrist, with severe consequences for her, such as disability income suspension and family conflict. We evaluated Ms. A. in our multidisciplinary medical expertise service for a disability income review.
Results
The patient reported a total absence of light perception in both eyes (subjective), not confirmed by objective ocular examination and spécific neuro-ophthalmological examination.
Psychiatric examination revealed that Ms. A. had been sexually assaulted at age of 7 and sexually abused for a year by her teacher at age of 14. Regarding the identity of the first abuser, she describes that she “can’t see his face” and that the multiple sexual assaults during her teenage years took place in the classroom after school, with the teacher “pulling down the window shades so it was totally dark.” She explains that, defensively, to avoid thoughts related to the traumatic experience, she was heavily invested in her studies. But, at the age of 30, after separation with her first boyfriend, diffuse pain and progressively total blindness appeared.
We concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance.
Conclusions
Blindness not explained by a physiologic process may accompany trauma and psychological distress, with the search for the link between the onset of symptoms and significant unconscious psychic conflicts being crucial in the psychiatric investigation. A new diagnosis of dissociative neurological symptom disorder with visual disturbance (6B60.0) is included in the ICD-11. It is characterized by visual symptoms such as blindness, tunnel vision, diplopia, visual distortions, or hallucinations that are not consistent with a recognized disease of the nervous system, other mental, behavioral, or neurodevelopmental disorders. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.
Methoprene, a juvenile hormone analog, is used to accelerate sexual maturation in males of species of economic importance in support to the sterile insect technique (SIT). In the SIT, mass-reared sterile males are released into the field and need to survive until they reach sexual maturation, find a wild female, mate with her and then induce female sexual refractoriness, so she will not remate with a wild counterpart. The use of methoprene shortens the time between release and copulation. However, in South American fruit flies, Anastrepha fraterculus, the ability of methoprene-treated males to inhibit female remating has been shown to be lower than wild males, when methoprene was applied by pupal immersion or topical application. Here we evaluated the possibility of incorporating methoprene into the male diet at different doses and the ability of those males to inhibit female remating, as well as the effect of methoprene on male reproductive organ size, due to the possible correlation between male accessory gland size and their content, and the role of male accessory gland proteins in female inhibition. We found that A. fraterculus males fed with methoprene in the adult protein diet at doses as high as 1% were less likely to inhibit female remating, however, at all other lower doses males had the same ability as untreated males to inhibit female remating. Males fed with methoprene had bigger male accessory glands and testes compared to methoprene-deprived males. We demonstrate that the incorporation of methoprene in adult male diets is possible in this species and potentially useful as a post-teneral, pre-release supplement at doses as low as 0.01%. Even at higher doses, the percentage of females remating after 48 h from the first copulation is sufficiently low in this species so as not compromise the efficiency of the SIT.
Maximizers attempt to find the best solution in decision-making, while satisficers feel comfortable with a good enough solution. Recent results pointed out some critical aspects of this decision-making approach and some concerns about its measurement and dimensional structure. In addition to the analysis of these aspects, we tested the possible mediational role of regret in this psychological process. The Maximization Inventory (MI; satisficing, decision difficulty, and alternative search), regret, and Satisfaction with Life Scale (SWLS) were translated and adapted to Spanish in order to answer these issues with a Chilean sample. Validity and reliability analysis of the MI reports that only two dimensions of the MI have enough dimensional support (decision difficulty, alternative search). The tested structural model shows good fit of partial mediation effect of regret between decision difficulty and SWLS. At the same time, alternative search has a positive relation with SWLS. These results suggest that Regret becomes crucial for prescribing behavior to decision makers.
Priapism is an abnormally prolonged erection, painful and irreducible, unrelated to sexual stimulation. Around 25-40% of cases are iatrogenic, especially associated with pharmacological treatments, of which antipsychotics (first and second generation) account for 50%.
Objectives
The aim is to discuss a clinical case to provide further evidence.
Methods
The patient was a 37-year-old man with a diagnosis of schizophrenia who was admitted for clinical decompensation. He had stopped antipsychotic treatment three months earlier due to side effects. He reported previous episodes of priapism associated with Risperidone, Aripiprazole, Olanzapine, and Paliperidone. At admission, he was administered Asenapine 20mg with development of priapism. Treatment was stopped. The urologists performed a lavage of the corpora cavernosa and administered adrenaline. In the absence of effectiveness, surgical intervention was successfully performed. Given the psychopathological improvement, he was discharged without antipsychotic treatment and close follow-up.
Results
He presented a new admission one month later. Amisulpride was prescribed up to 800mg/day with good evolution and no adverse effects.
Conclusions
Antipsychotic-induced priapism appears to be related to the blockade of alpha-1 adrenergic receptors in the corpora cavernosa. There is a positive correlation between the affinity for the receptor and the propensity to cause priapism. The dose and duration of the medication do not appear to be correlated. Other risk factors are a history of previous episodes, restarting medication after noncompliance, use of concomitant substances or medications that cause priapism. Our choice of amisulpride was based on the fact that it has no affinity for alpha-1 adrenergic receptors.
A partir del análisis de la configuración de los paisajes arqueológicos en el bosque montano de las yungas tucumanas, entre 400 aC y 1500 dC, se discuten los cambios y continuidades en la práctica y las condiciones en las cuales estos se reprodujeron. Como resultado de las investigaciones arqueológicas llevadas a cabo en Anfama desde el año 2014, se identificaron 14 asentamientos residenciales de distinta escala, los cuales fueron mapeados, sondeados, fechados y, algunos de ellos, excavados. El análisis cronológico, realizado en base a contextos materiales y a 15 dataciones radiocarbónicas, permite proponer cuatro bloques temporales que se diferencian en las modalidades de construir y habitar los espacios domésticos y en la utilización de materias primas a través de determinadas tecnologías. Se discute cómo las trazas materiales de la práctica social traslapan a dicha segmentación cronométrica, de la misma manera en que eventos constructivos, habitacionales y depositacionales se superponen en determinados lugares. Finalmente, se reconocen tendencias de larga duración que giran en torno a la dispersión poblacional como atributo que define a los paisajes y a las lógicas sociales que se sostuvieron en el área de estudio por casi dos milenios.
With the purpose of broadening knowledge on the evolution of life history strategies and behaviour of fruit flies within the tribe Carpomyini, the natural history and mating behaviour of the poorly known species Rhagoletotrypeta pastranai Aczél, are described for the first time. Larvae of R. pastranai were recovered from infested Celtis tala Gillies ex Planch and Celtis iguanaea (Jacq.) Sarg. during a 2-month fruiting period. Adults emerged from the recovered pupae after an average of 144.9 ± 3.9 days for females and 143.2 ± 3.38 days for males, suggesting that most individuals became dormant. Results of a variable winter length study suggested that environmental factors other than winter length may regulate dormancy/diapause duration in this subtropical species. Under laboratory conditions, R. pastranai adults lived an average of 51.13 ± 3.06 days in case of females and 48.08 ± 3.76 days in case of males, and required 5–15 days to reach sexual maturity. Behavioural observations under confinement revealed scarce sexual activity but sufficed to determine that, as in other members of the tribe Carpomyini, R. pastranai exhibits a male resource defence mating system. We discuss our findings emphasizing the importance of documenting the natural history and behaviour of unknown species of family Tephritidae and additionally, we highlight the necessity of future research to understand factors regulating dormancy/diapause and the evolution of life history strategies and sexual behaviour of subtropical species.
The Mediterranean fruit fly Ceratitis capitata is a globally invasive pest, often controlled with the sterile insect technique (SIT). For the SIT, mass-rearing of the target insect followed by irradiation are imperatives. Sterile males are often less able to inhibit female remating and transfer less number of sperm, and even irradiation could affect male reproductive organs, with consequences for their ability to inhibit female remating. On the other hand, male age could affect their ability to modulate female response after mating. Here, we evaluated the quality of the genetic sexing strain Vienna-8-tsl mass-reared in Bioplanta San Juan, Argentina, under laboratory conditions, with regard to: (i) the ability of sterile males irradiated at 100 or 140 Gy to inhibit female remating, in the same day and at 24 h of first copulation; (ii) the ability of 3, 4 or 5 day-old sterile males to inhibit female remating at 24 h of first copulation, and (iii) the effect of a reduction in irradiation doses on the number of sperm stored by females and reproductive organ size in virgin males. Sterile males were better able than wild males to inhibit female remating in the same day of first copulation and as able as wild males 1 day after first copulation. Male age did not affect their ability to inhibit female receptivity. Number of sperm stored by females, testes size and ectodermal accessory glands size were not affected by male identity, while sterile 100 Gy males had larger mesodermal accessory glands than control lab males. A reduction in irradiation dose does not impact any variable measured, except for percentage of sperm-depleted females: females mated with sterile 100 Gy males had lower probabilities to store sperm. The results showed here are very encouraging for tsl Vienna 8 strain reared in Argentina and are discussed in comparison with previous studies in C. capitata female remating with dissimilar results.
It has become increasingly clear over the last few years that the most effective treatments for patients with Borderline Personality Disorder (BPD) is a combined psychological and pharmacological approach, aiming to improve the symptoms, feelings and behaviours that are so distressing and damaging to their lives. On this poster we try to show our daily therapeutic practice with these patients through a complete review of the BPD patient's medical records available in our outpatients psychiatric clinic.
Method
Systematic review of all BPD patients medical records, treated in our clinic with a particular reference to pharmacological, psychotherapeutic or both approaches stating the type of intervention in each case.
Results
We found a mostly mixed approach to treating BPD patients in our clinic as clinical guidelines and other literature recommends. Being critical of our practice, we have observed a prolonged use of medication despite evidence suggesting a sometimes limited benefit for acute and chronic symptoms.
Although psychotherapeutic interventions are widely used in our Clinic, it is doubtful that the most accepted psychotherapies mentioned earlier are the ones implemented (Kernberg, Linehan….)
Conclusion
The evidence from the literature and prescribing guidelines, suggests that some of the main approaches to treating BPD patients are specific psychotherapies. However, without belittling the benefit of these psychotherapies, we found that the use of psychopharmacological treatments helps too with alleviating acute and more chronic symptoms; maybe improving the likelihood of psychotherapeutic engagement.
Borderline Personality disorder is a well recognised syndrome. These patients show a clear emotional unstability, lack of control impulse, unpredictible auto and heteroaggresive behaviour, poor interpersonal realitionships and self image as well as brief psychotic episodes.The unspecific symtomatology and diagnostic difficulty derived from different nosographic frames makes their diagnosis and treatment a challenge. Through the analysis of their medical records we aim to know the age they sought specialized help, the symptomatology at first consultation, the treatment given and the outcome after years of therapy.
Methodology
Systematic review of all BPD patient's medical records treated in our Unit with a particular reference to age and symptoms at the start of treatment and at present. Medical records from the Childhood and Adolescence Psychiatric Unit were also reviewed to determine the most prominent symptoms at that time.
Results
We found that the vast majority of cases contacted the psychiatric services in their adolescence and early adulthood, probably in relation to demands of daily life at that age. The most relevant symptoms at onset of illness were depressive mood and anxiety. As time went on depressive symptoms were the main complaint. The clinical state remained fairly stable over time.
Conclusions
There is a clear early onset of symptoms, in particular, affective ones (depression and anxiety) being prominent in childhood and preadolescence. Also there is a stable psychopathology over time which keep the patients on long term follow ups. This medical demand seemed to diminish at their fifth decade.
In 1952, the American Psychiatric Association published the “Diagnostic and Statistical Manual of Mental Disorders”. Four revisions have come since then, adding new mental disorders, while others have been removed. The fifth edition is currently in progress.
Objective
Comparing the diagnosis given to patients admitted for the first time to an Acute Mental Health Unit, over a period of 10 years.
Method
Systematic review of first admission patients in our Unit in 2000 and 2010, comparing initial diagnosis.
Results
Of a total of 60 patients found in 2000 and 69 patients in 2010, we found these differences: firstly the increased number of admissions seen in 2010; secondly the initial diagnosis, being Schizophrenia the main diagnosis in 2000 and Bipolar Disorder the most prominent in 2010. There's also a larger prevalence of Psychotic episode secondary to drug abuse in 2010.
Conclusions
Since the introduction of DSM-criteria more than 30 years ago, the aim to validate the syndromes and finding of common etiologies have been difficult to reach. Despite many “proposed candidates”, no laboratory findings have proved to be specific to identify any of the syndromes of DSM. Epidemiological and clinical studies have shown high comorbidity amongst the disorders, discounting the hypothesis that the syndromes represent different etiologies. Besides, epidemiological data have brought the fact of high degree short-term diagnostic instability for many disorders.
In our study we’ve reached the conclusion that there appears to be a clear diagnostic variability during the last decade.
The functional deterioration is observed in the majority of the patients with schizophrenia and much importance is given in this diagnosis when a retrospective analysis is carried out on the history of this disease. The value scales have been an important key at the time of detecting deteriorating elements, being these very useful as a screening tool and hence a development control.
Objective
The objective is to demonstrate the good management of the use of the scales of which we have available and in this way can value the functionality of the psychotic patients as well as it's evolution.
Results
When choosing the medication, the degree of functionality measured by means of the use of the scales- confirmed a 65% an initial better response to the antipsychotics paliperidona, that in that not used drug, that initially showed an improvement of 40%.
Materials used and method employed
A retrospective study was carried out in the last year with the 82 patients of our CSM with schizophrenia diagnosis, all treated with antipsychotics.The Sample was divided into two groups of 41 patients, those of which besides the medication had been evaluated and followed by means of scales and the other in which they only took medication, with standard pursuit.
Conclusion
The ease of use of scales as well as its great utility should help to promote its routine use to be able to obtain an improvement of the function of the patient and, to optimize the long-term prognosis for patients.
Age and growth parameters were estimated for the deep-sea cardinalfish (Epigonus crassicaudus) from sagittal otoliths collected between 2012 and 2015 onboard commercial fishing vessels from the South-east Pacific off Chile between 33°04′S and 41°46′S. Von Bertalanffy growth parameters (VBGP) were estimated from assumed annual otolith growth zone counts. The verification of the first annulus of sagittal otoliths was determined by examining in detail daily micro-increments. These data helped inform the interpretation of the annual growth zones from transverse otolith sections. The von Bertalanffy growth model estimated to length-at-age data were asymptotic length (L∞) of 34.1 cm fork length (FL), a growth coefficient (k) of 0.1 cm/year and a t-zero (t0) of −0.85. The maximum ages observed were 67 and 65 years for female and male fish, respectively.
Mycobacterium avium sp. avium (MAA), M. avium sp. hominissuis (MAH), and M. avium sp. paratuberculosis (MAP) are the main members of the M. avium complex (MAC) causing diseases in several hosts. The aim of this study was to describe the genetic diversity of MAC isolated from different hosts. Twenty-six MAH and 61 MAP isolates were recovered from humans and cattle, respectively. GenoType CM® and IS1311-PCR were used to identify Mycobacterium species. The IS901-PCR was used to differentiate between MAH and MAA, while IS900-PCR was used to identify MAP. Genotyping was performed using a mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) scheme (loci: 292, X3, 25, 47, 3, 7, 10, 32) and patterns (INMV) were assigned according to the MAC-INMV database (http://mac-inmv.tours.inra.fr/). Twenty-two (22/26, 84·6%) MAH isolates were genotyped and 16 were grouped into the following, INMV 92, INMV 121, INMV 97, INMV 103, INMV 50, and INMV 40. The loci X3 and 25 showed the largest diversity (D: 0·5844), and the global discriminatory index (Hunter and Gaston discriminatory index, HGDI) was 0·9300. MAP (100%) isolates were grouped into INMV 1, INMV 2, INMV 11, INMV 8, and INMV 5. The HGDI was 0·6984 and loci 292 and 7 had the largest D (0·6980 and 0·5050). MAH presented a higher D when compared with MAP. The MIRU-VNTR was a useful tool to describe the genetic diversity of both MAH and MAP as well as to identify six new MAH patterns that were conveniently reported to the MAC-INMV database. It was also demonstrated that, in the geographical region studied, human MAC cases were produced by MAH as there was no MAA found among the human clinical samples.
The combined U-series/electron spin resonance (ESR) dating method was applied to nine teeth from two Early Pleistocene archaeological sites located in the Orce area (Guadix-Baza Basin, Southern Spain): Fuente Nueva-3 (FN-3) and Barranco León (BL). The combination of biostratigraphy and magnetostratigraphy places both sites between the Olduvai and Jaramillo subchrons (1.78–1.07 Ma).
Our results highlight the difficulty of dating such old sites and point out the limits of the combined U-series/ESR dating method based on the US model. We identified several sources of uncertainties that may lead to inaccurate age estimates. Seven samples could not be dated because the dental tissues had (230Th/234U) activity ratios higher than equilibrium, indicating that uranium had probably leached from these tissues. It was however possible to calculate numerical estimates for two of the teeth, both from FN-3. One yielded a Middle Pleistocene age that seems to be strongly underestimated; the other provided an age of 1.19 ± 0.21 Ma, in agreement with data obtained from independent methods. The latter result gives encouragement that there are samples that can be used for routine dating of old sites.
Chorthippus vagans is a common species of Gomphocerinae (Orthoptera) on the Iberian Peninsula. It is endangered in Central Europe where information about its ecological requirements is available; however, aspects of its biology are almost unknown in Mediterranean ecosystems, where it is widespread and common. The focus of this study was to determine how C. vagans adjusts its biology to environmental features of this ecosystem and to interpret how it may be affected by the ecological changes related to the re-vegetation programme linked to the construction of the Breña dam (SW Spain). The research parameters included the autoecology, feeding response and some aspects of reproduction of this species in the Southern Iberian Peninsula. To determine the local distribution and phenology of C. vagans, monthly samplings were conducted (2007–2010) in 12 sampling plots. For the food selection tests, ten nymphs and ten adults were placed individually in insectaries under controlled conditions. Grasses (Lolium sp.) and shrubs (Cistus sp.) were supplied ad libitum in two types of tests, monospecific and mixed diet. The reproductive biology was analysed by both observations of anatomical structures (integument, bristles, tibial spines, tarsal claws and mandibles) and ovarian dissections of 29 females and in laboratory rearing experiments with 15 pairs of adults. The results indicate that C. vagans shows an extended activity period which peaks at the end of summer. It is a polyphagous grasshopper, although adults show a slight preference for grasses. In addition, it is a univoltine species with spring–summer breeding activity.
This study explored the relationship between 1) child sexual abuse (CSA), adolescent/adult sexual abuse (AASA), and both (CSA+AASA), and 2) the frequency of positive and negative sexual cognitions according to their content –intimate, exploratory, dominance, submission, and impersonal– in men and women. We also analyzed the severity of the sexual contact of individuals who had experienced AASA. We assessed a Spanish sample of 228 men and 333 women, aged between 18 and 50 years old. In the sample, 341 individuals reported having experienced some type of sexual victimization (victims group), while 220 individuals reported no victimization (non-victims group). Overall, sexual victims reported a higher frequency of positive sexual cognitions compared to non-victims, particularly when they had experienced CSA+AASA and the severity of the sexual contact was greater. Men and women who had experienced abuse reported a higher frequency of exploratory cognitions (p < .01). Male victims reported more cognitions of submission (p < .01), whereas female victims reported more cognitions of dominance (p < .05), which indicates lack of congruence with traditional gender roles. Finally, only intimate cognitions (p < .001) were experienced as negative by male victims. We discuss the relevance of the findings for therapeutic interventions with sexual abuse victims.