We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
More than 50% of patients with dementia visit the emergency department (ED) each year. Patients with dementia experience frequently unrelieved symptoms that can benefit from palliative care. Response to palliative care needs in the ED can be quite challenging and access to palliative care is generally scarce. The aim of this scoping review is to assess ED use and responsiveness to palliative care needs of patients with dementia in their last year of life.
Methods
A scoping literature review following the Joanna Briggs Institute methodology. Electronic search of the literature was undertaken in Medline (PubMed), Web of Science, Scopus, Scielo, and APA PsycInfo, last updated on 19 February 2024.
Results
Twenty-four studies were identified and confirmed that patients with dementia frequently resort to the ED near the end of life, frequently more than once in their last year of life. Eight studies directly addressed palliative care needs, suggesting significant rates of palliative care needs among patients with dementia and in comparison, to other oncological or non-oncological conditions. Infections and neuropsychiatric symptoms were the main reasons of admission to the ED. Access to palliative care was confirmed to be low.
Significance of results
This scoping review indicates that patients with dementia frequently resource to the ED in their last year of life with unmet palliative care needs. Although scarce access to palliative care and the existence of important barriers in the ED, palliative care intervention in this setting can be seen as an opportunity to attend palliative care needs and referral to palliative care services.
Avian Plasmodium parasites can be pathogenic to their vertebrate hosts. Although cases of anaemia are frequently reported in parasitized birds, the potential damage caused by the parasite during the exoerythrocytic reproduction phase remains poorly investigated. Here, we report 2 individuals of red-legged seriemas (Cariama cristata) infected with 2 different lineages of Plasmodium huffi, one of them exhibiting potential malarial-compatible tissue lesions in the spleen, liver, brain and lungs, alongside molecular confirmation of parasite presence in the spleen. Previously classified as specific to birds from the order Piciformes, this parasite has shown different associated lineages amplified across diverse host orders in South America (Anseriformes, Charadriiformes, Columbiformes, Galliformes, Pelecaniformes and Passeriformes). Those infections, however, were defined as abortive due to the absence of gametocytes visualized in blood smear slides. Herein, we confirm P. huffi as a generalist parasite based on the first morphological characterization in the peripheral blood of a bird outside the Piciformes order. This is also the first morphological and molecular description of a Plasmodium species in Cariamiformes. In addition to the morphological analyses, we have also proposed a novel phylogenetic hypothesis based on the partial cytb gene and the near-complete mitochondrial genome of this parasite. Our findings support that the division of the genus Plasmodium into subgenera is not monophyletic, as P. (Huffia) huffi and its associated lineages cluster more closely with Plasmodium (Haemamoeba) gallinaceum than with Plasmodium (Huffia) elongatum.
Psychiatric disorders are complex and multifaceted conditions that profoundly impact various aspects of an individual’s life. Although the neurobiology of these disorders is not fully understood, extensive research suggests intricate interactions between genetic factors, changes in brain structure, disruptions in neurotransmitter pathways, as well as environmental influence.
In the case of psychotic disorders, such as schizophrenia, strong genetic components have been identified as a key feature in the development of psychosis. Moreover, alterations in dopamine function and structural brain changes that result in volume loss seem to be pervasive in people affected by these disorders. Meanwhile, mood disorders, including major depressive disorder and bipolar disorder, are characterized by disruptions in neurotransmitter systems responsible for mood regulation, such as serotonin, norepinephrine, and dopamine. Anxiety and personality disorders also exhibit neurotransmitter dysfunction and neuroanatomical changes, in addition to showing a genetic overlap with mood and psychotic disorders.
Understanding the underlying mechanisms in the pathophysiology of these conditions is of paramount importance and involves integrating findings from various research areas, including at the molecular and cellular levels. This brief overview aims to highlight some of the important developments in our current understanding of psychiatric disorders. Future research should aim to incorporate a comprehensive approach to further unravel the complexity of these disorders and pave the way for targeted therapeutic strategies and effective treatments to improve the lives of individuals afflicted by them.
Our study aim was to identify high-risk areas of neonatal mortality associated with bacterial sepsis in the state of São Paulo, Southeast Brazil. We used a population-based study applying retrospective spatial scan statistics with data extracted from birth certificates linked to death certificates. All live births from mothers residing in São Paulo State from 2004 to 2020 were included. Spatial analysis using the Poisson model was adopted to scan high-rate clusters of neonatal mortality associated with bacterial sepsis (WHO-ICD10 A32.7, A40, A41, P36, P37.2 in any line of the death certificate). We found a prevalence of neonatal death associated with bacterial sepsis of 2.3/1000 live births. Clusters of high neonatal mortality associated with bacterial sepsis were identified mainly in the southeast region of the state, with four of them appearing as cluster areas for all birth weight categories (<1500 g, 1500 to <2500 g and ≥ 2500 g). The spatial analysis according to the birth weight showed some overlapping in the detected clusters, suggesting shared risk factors that need to be explored. Our study highlights the ongoing challenge of neonatal sepsis in the most developed state of a middle-income country and the importance of employing statistical techniques, including spatial methods, for enhancing surveillance and intervention strategies.
Haemonchus contortus is one of the most pathogenic gastrointestinal parasites that infect small ruminants. The indiscriminate use of anthelmintics (i.e., benzimidazole class, BZ) to control infections has led to the reduction of drug efficacy in H. contortus populations worldwide. Resistance to BZ is associated with high frequencies of single nucleotide polymorphisms at F200Y, F167Y, and E198A positions of the β-tubulin isotype 1 gene. This study aimed to determine the frequency of single nucleotide polymorphisms associated with BZ resistance in H. contortus from 18 farms (545 sheep and 124 goats) in Paraná, Southern Brazil. Health management practices were identified as risk factors from individual farms. Genomic DNA was extracted from 20,000 larvae/farm and used in quantitative polymerase chain reaction assays for the three mutations. We ran a correlation analysis between flock health and quantitative polymerase chain reaction data. H. contortus was the most prevalent parasite in 67% (12/18) of the farms. Resistant allele frequencies were detected for F200Y (var. 46.4 to 72.0%) and F167Y (var. 15.7 to 23.8%). Only (100.0%) susceptible alleles were detected for the E198A. High treatment frequency (15/18), visual weight estimations for anthelmintic dose (15/18), no integration with other farm practices (14/18), treatment of all animals (14/18), and no quarantine period for newly acquired animals (10/18) were considered the most critical risk factors associated with BZ resistance. This is the first systematic prevalence study linking management practices on smallholder farms and the molecular data of BZ resistance of H. contortus in Southern Brazil.
Randomised controlled trials are the ‘gold standard’ approach in nutrition research to show a causal relationship between a dietary intervention and clinically relevant outcomes at the population level. Here we review why different study designs are needed to establish the efficacy of dietary interventions at the individual level and to better account for relevant factors that can also influence the outcomes. Over the past decade, precision nutrition approaches have been developed as a new way to measure the effectiveness of dietary interventions at the individual and population level. Precision nutrition aims to determine the individual factors that are associated with differences in responses to dietary interventions. This is complex, typically needing studies with a large number of participants and using advanced statistical approaches and machine-learning algorithms to identify predictors that can explain why individuals do or do not respond to consuming specific foods, meals or diets, for a given outcome. N-of-1 study designs, which are new to nutrition science, offer a robust alternative approach to assess how an intervention and everyday behaviours affect individual health outcomes. They utilise repeated measures within individuals, rather than baseline and end measures in a larger number of participants, to provide the statistical power required to determine an individual’s responsiveness to an intervention. The adoption of new study designs and modelling approaches, particularly the N-of-1 approach, to examine responses to interventions within individuals, will help to further the understanding of the relationships between diet and health within individuals more effectively and accurately.
Glycine-rich proteins (GRPs) are arbitrarily defined as those containing 20% or more glycine residues and constitute a superfamily divided into subfamilies based on their structure and/or function. GRPs have been identified in a diverse array of organisms and have been shown to possess a number of distinctive biological characteristics, including nucleic acid binding, adhesive glue-like properties, antimicrobial activity, involvement in the stress response and in the formation of cuticle components. In ticks, their expression has been described and studied mainly in the salivary glands, and their primary function is usually associated with cement formation and/or structure. Conversely, several GRPs are present in all tick developmental stages, and the expression of many GRP genes is modulated by physiological processes and immune challenges, such as feeding and pathogen infection. Considering that some tick GRPs appear to play essential roles in the tick life cycle, they have been evaluated as immune targets, with a focus on their potential application in vaccine development. This review highlights the roles that tick GRPs may perform beyond the formation and maintenance of the cement scaffold, including structural characterization, locations and functional relevance, hypothetical functions, and their potential use in anti-tick vaccine development.
This chapter studies the effect of Rede de Vizinhos (RdV or “Neighbor Network”) community policing program in Santa Catarina, Brazil, which aims to improve public safety and trust between citizens and police by facilitating real-time information about crime and public safety through dedicated WhatsApp instant messages groups with the participation of a police officer. We randomly allocated neighborhoods that would see the policy implemented into treatment and control groups, with the former being exposed to an information campaign through which we publicized induction meetings using Facebook. Despite reaching roughly 10 percent of Santa Catarina’s population, our study does not find a differential participation rate in the RdV campaign regions. Further, we don’t find evidence of increased perceptions over the police or improvements over criminal rates in treated neighborhoods. Our results suggest that despite their promise, (technology-enabled) community policing programs may fail to deliver substantial impacts given saturation dynamics and diminishing marginal returns – our baseline surveys indicated that 52 percent of respondents had heard already about the RdV program with 13.1 percent actively participating.
This study hypothesized that the signal grass (Urochloa decumbens [Stapf] R. Webster) modifies its structural and productive characteristics under a silvopasture system with legume trees. The treatments were composed of (i) signal grass in monoculture and (ii) a silvopasture system intercropping signal grass + Mimosa caesalpiniifolia Benth. a legume tree, over two consecutive years. The experiment was set in a completely randomized block design with three replications. Grazing was carried out by cattle with an average body weight (BW) of 186 ± 26 kg. The type of system had no significant effect on the structural and productive characteristics of signal grass. In the first grazing season, the greatest canopy height (54 cm) and total forage mass (6473 kg DM/ha) occurred in the dry period. The leaf:stem ratio was greater in the rainy season. Forage accumulation (515 kg DM/ha/28 days) and forage accumulation rate (18 kg DM/ha/day) were greater in the rainy season. Higher total forage production (4583 kg DM/ha) occurred in the first grazing season. The silvopasture with double rows spaced 25 m apart and with a tree density of 600 plants/ha did not compromise the structural and productivity characteristics of the signal grass pasture. The legume M. caesalpiniifolia has the potential for use as an arboreal component in silvopasture systems with signal grass.
Sex differences in lifespan have been labelled as one of the most robust features in biology. In human populations, women live consistently longer than men, a pattern that encompasses most mammalian species. However, when expanding both the taxonomic scope beyond mammals and the range of mortality metrics the female survival advantage over males is no longer the rule. Moreover, current evidence suggests that sex differences in actuarial ageing parameters (i.e. age at the onset of ageing and rate of ageing) are far from consistent across the tree of life. This chapter first reviews current knowledge of sex differences in mortality patterns across animals and appraises how these diverse patterns can be explained by the current evolutionary framework. It then emphasizes the relevance of going beyond the differences in mortality patterns by exploring how natural and sexual selection have shaped age- and sex-specific changes in reproductive performance and body mass across the tree of life, and by identifying some possible biological pathways modulating ageing in a sex-specific way. Finally, it highlights how evolutionary theories can be relevant to understand the widespread differences in causes of death between sexes, offering a complementary approach to gain a comprehensive understanding of the evolution of sex differences in health and ageing, with likely biomedical implications.
The challenge of American tegumentary leishmaniasis (ATL) continues in Brazil, presenting a persistent public health issue despite initiatives aimed at public outreach, vector control and health education. To gain a deeper understanding of this disease, a study was conducted in an endemic region located in the northern region of the state of Minas Gerais, Brazil. The study monitored 30 resident patients diagnosed with ATL, using serum samples from 6 healthy individuals as controls. The localized cutaneous form of the disease was found to be predominant, with lesions appearing on various parts of the body and the majority of the affected individuals being male. The study found significantly higher levels of IgG anti-α-Gal antibodies in ATL-infected patients compared to healthy individuals. Treatment of 19 patients with meglumine antimoniate resulted in limited improvement in symptoms for most. Nonetheless, the study found that 12 patients who completed treatment with epithelialization of the lesions showed a significant decrease in IgG anti-α-Gal antibodies, indicating potential applications of this antibody in the diagnosis and monitoring of the disease. The study also identified Leishmania species in 7 analysed patients, revealing 6 cases infected by Leishmania braziliensis and 1 by L. infantum, with a significant difference in the anti-α-Gal responses. The findings of the study emphasize the urgent need for the development of human vaccines and innovative treatment strategies adapted to the diversity of Leishmania species causing cutaneous leishmaniasis and individual patient responses to improve the clinical management of ATL in Brazil and similar endemic regions.
This study aimed to identify meal and snack patterns and assess their association with sleep timing in schoolchildren. This is a cross-sectional study carried out in 2018/2019 with 1333 schoolchildren aged 7–14 years from public and private schools in Florianópolis, Brazil. Previous-day dietary intake data for breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack were collected using a validated online questionnaire. Sleep timing was measured by the midpoint of sleep and classified as quartiles (very early, early, late and very late). Latent class analysis was performed to identify meal and snack patterns, and multinomial logistic regression was used to assess associations. Students with very late sleep timing were less likely to consume the ‘coffee with milk, bread and cheese’ breakfast pattern compared with very early group. Also, the former were more likely to consume the ‘mixed’ breakfast pattern (healthy and unhealthy foods) compared with very early students. The latter were more likely to eat the ‘Brazilian traditional, processed meat, egg and fish’ lunch pattern to the late students and less likely to consume the ‘pasta and cheese’ lunch pattern compared with the students with later sleep timing. Students with later sleep timing were more likely to eat ultra-processed food at mid-afternoon snacks compared with early group. The study findings suggest that morning preference appears to promote healthier breakfast, lunch and afternoon snack patterns, whereas later sleep timing may pose challenges in maintaining healthy patterns at these meals/snacks.
Several models of maternal undernutrition reveal impairment of testicular development and compromise spermatogenesis in male offspring. The expansion of the litter size model, valuable for studying the impact of undernutrition on early development, has not yet been used to evaluate the consequences of early undernutrition in the adult male reproductive system. For this purpose, pups were raised in either normal litter (ten pups/dam) or large litter (LL; sixteen pups/dam). On postnatal day 90, sexual behaviour was evaluated or blood, adipose and reproductive tissues were collected for biochemical, histological and morphological analysis. Adult LL animals were lighter and thinner than controls. They showed increased food intake, but decrease of retroperitoneal white adipose tissue weight, glycaemia after oral glucose overload and plasma concentration of cholesterol. Reproductive organ weights were not altered by undernutrition, but histopathological analysis revealed an increased number of abnormal seminiferous tubules and number of immature spermatids in the tubular lumen of LL animals. These animals also showed reduction in total spermatic reserve and daily sperm production in the testes. Undernutrition decreased the number of Sertoli cells, and testosterone production was increased in the LL group. Mitochondrial activity of spermatozoa remained unchanged between experimental groups, suggesting no significant impact on the energy-related processes associated with sperm function. All animals from both experimental groups were considered sexually competent, with no significant difference in the parameters of sexual behaviour. We conclude that neonatal undernutrition induces histological and physiological testicular changes, without altering sperm quality and sexual behaviour of animals.
This article re-examines the race-populism nexus. It asks: Does populist political construction of the figure of “the people” necessarily involve processes of racial othering? We answer this question by revisiting three emblematic cases of populism. Each historical case illustrates a basic type of identity formation that can have an i) exclusionary, ii) ambivalent or iii) positive impact on racial justice. The first case is Thatcherism, whose “authoritarian populism” feeds on and reinforces anti-Black racial prejudice. The second is Peronism, which has an ambivalent relationship with race that promises to shed important new light on this classic case of populism. The third case is that of the American Populists, whose pioneering experiments in interracial politics remain an enduring illustration of populism’s progressive potential. In each case, we focus on a key document from that political regime/movement: the Conservative Manifesto of 1979, the Peronist Constitution of 1949, and the Omaha Platform of 1892. The article concludes that populism, as a logic of action, acts as a catalyst that intensifies whatever specific content is mobilised – racist and anti-racist content alike.
To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children.
Design:
Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3–4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6–23; 24–59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables.
Setting:
123 municipalities of the five Brazilian macro-regions.
Participants:
12 582 children aged 6–59 months.
Results:
The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <¼) had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were ‘dairy products’, ‘grains, roots, tubers, and plantains’ and ‘ultra-processed foods’.
Conclusion:
Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.
This spatial-scientometric study addresses research on Antarctic soils from 1958 to 2021. Through the review of 553 publications in the Web of Science and Scopus databases, geographical distribution, productivity, coauthorship and research topics were analysed. The results highlight the high productivity and interaction between researchers and institutions around the world, with a focus on microbiology, pollution, bioremediation, biogeochemistry and thermal and water monitoring of the soil and permafrost. This study provides insights into the importance of polar soils as global environmental indicators. The scientometric and spatial approach contributes to understanding the social and conceptual structure in this research area in addition to the development of the subject in time and space.
Antipsychotics are the primary class of drugs used to manage schizophrenia. These medications help control and reduce the severity of these symptoms, allowing individuals with schizophrenia to better function. On the other hand, rifampicin, used as treatment for tuberculosis, is a powerful inducer of several drug-metabolizing enzymes which have the potential to decrease the plasma levels of antipsychotics. Therefore, the presence of multiple pharmacokinetic interactions can alter how antipsychotics are metabolized, leading to a notable clinical impact when these medications are administered concurrently.
Objectives
The objective is to share valuable clinical experiences and insights to aid healthcare providers in making informed decisions when faced with the challenge of co-administering antipsychotics with rifampicin, ultimately ensuring the safety and efficacy of treatment for their patients.
Methods
It will be discussed a case of a 41-year-old woman with the diagnosis of schizophrenia under treatment with paliperidone palmitate and clozapine who had a sudden relapse after starting treatment for latent tuberculosis with rifampicin as a framework for a literature review based off Pubmed.
Results
The antituberculosis drug rifampicin induces drug-metabolizing enzymes in the liver, having the greatest effects on the expression of cytochrome P450 (CYP3A4) and therefore can lead to a decrease in the plasma levels of antipsychotic medications that also rely on these pathways for clearance. In this particular case, although specific data on clozapine and paliperidone concentrations were not reported, fluctuations in symptomatology following rifampicin introduction were probably explained by an inducing effect of this drug on their metabolism. So, when initiating rifampicin treatment and when discontinuing it, clinicians should carefully assess the dosages of any concomitant medications that may potentially interact with rifampicin. To ensure effective therapy during rifampicin treatment, it is crucial to monitor both the patient’s clinical response and their blood drug concentrations, making dosage adjustments as necessary.
Conclusions
This case report offers valuable guidance to clinicians on safely and effectively managing drug interactions between antipsychotic medications and rifampicin, ensuring the well-being of their patients during treatment. The co-administration of these medications lacks robust clinical evidence, and notably, there is insufficient data regarding its impact on plasma antipsychotic levels, a crucial factor in determining clinical effectiveness.