Psychiatry Commons^™

Support For Family Members Who Are Caregivers To Relatives With Acquired Brain Injury, Janet Walker, Lourens Schlebusch, Bernhard Gaede

Journal of Mind and Medical Sciences

Objectives. Family members caring for a patient with acquired brain injury (ABI) are coping with inordinate levels of stress partially due to their lack of understanding of the neuropsychological effects of acquired brain injury in the patient. The objective of this research is to show that as the caregivers’ stress levels increase, there is an increase in suicidal ideation. This highlights the causal relationship between unhealthy stress and reduced psychological well-being in these caregivers. In addition, qualitative research evidence regarding the caregivers’ views of their main sources of stress are presented. Methods. The participants were a random sample of 80 …

Linking The Brain And Bone Through Fat, Elisabeta Malinici, Anca Sirbu, Miruna Popa, Simona Fica

Journal of Mind and Medical Sciences

Over the past years, bone and adipose tissue have gained interest from researchers in the light of their secretory profiles, being able to produce active molecules, with the final effect of regulating energy homeostasis. Both adipocytes and osteoblasts originate in the pluripotent mesenchymal stem cell and this common origin has been proposed as the core of the fat-bone relationship. The central nervous system might be the third player in this association, capable of integrating signals. Numerous adipose tissue secreted factors that influence energy homeostasis and bone have been described: leptin, adiponectin, lipocalin 2, and inflammatory cytokines (e.g. IL-1, IL-6 and …

Carbamazepine-Induced Dress Syndrome: A Case Report, Andrada Luciana Lazar, Olga Hilda Orășan, Corina Baican, Nicolae Voicu Rednic, Adela Sitar-Tăut, Bogdan Man, Vasile Negrean, Nicolae Rednic, Angela Cozma

Journal of Mind and Medical Sciences

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, idiosyncratic, acute adverse drug reaction. Fever, morbilliform cutaneous eruption, and eosinophilia are essential features for the diagnosis of this syndrome, along with significant multisystem involvement, hepatitis being the most common, followed by nephritis. The pathogenesis of DRESS syndrome is not yet fully understood. Several hypotheses have been proposed which support the involvement of an intricate interplay of multiple factors. We report a clinical case of DRESS syndrome with renal injury, induced by carbamazepine, in a patient with alcohol abstinence syndrome. In order to define the case, the …

When Myocardial Infarction Is Choosing Young Victims, Cristina Nedelcu, Mihaela Ionescu, Paris Ionescu, Vitalie Morosanu, Gabriel Smarandache, Dumitru Cristinel Badiu, Florentina Gherghiceanu, Vlad Denis Constantin, Emanuele Maria Merlo, Daniel Niţă

Journal of Mind and Medical Sciences

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a “burnout …

Covid-19 Outbreak Impact On Plastic Surgery Residents From Romania, Cristina N. Marina, Daniela E. Gheoca-Mutu, Laura Răducu, Adelaida Avino, Lăcrămioara A. Brîndușe, Corina M. Stefan, Razvan V. Scaunasu, Cristian R. Jecan

Journal of Mind and Medical Sciences

The COVID-19 outbreak triggered a global crisis with long-term effects on people’s daily lives. It has altered surgical practice and education and imposed major changes in healthcare systems and resources. In order to analyze the impact the COVID-19 pandemic has had on Romanian Plastic Surgery residents, we carried out an anonymous questionnaire through Google forms. Survey items addressed aspects such as how the pandemic has affected their surgical practice, their exposure to the virus, and the protective measures that have been implemented to minimize risk. Among other results, our study found that nearly 1 in 5 respondents had contact with …

The Quality Of Sexual Life After Vaginal Surgical Interventions, Maria Pană, Romina-Marina Sima, Oana-Denisa Bălălău, Anca-Daniela Stănescu, Liana Pleş, Mircea-Octavian Poenaru

Journal of Mind and Medical Sciences

Introduction. The malfunction of the supporting pelvic system generates signs and symptoms that require various procedures. The aim of our study was to evaluate whether vaginal surgical interventions for genital prolapse or urinary incontinence have an impact on patients’ sexual quality of life. Materials and methods. We studied 40 eligible women who underwent vaginal surgical procedures in Saint John Hospital, Bucharest. Patients completed a questionnaire 6 months after the intervention. Results. Patients who underwent vaginal surgery for prolapse were 50-64 years of age. The most frequent vaginal surgical intervention was vaginal hysterectomy (32.5%), followed by anterior and …

Work Place Impact On Mental Wellbeing Of Frontline Doctors, Vishnupriya Veeraraghavan, Krishnan Srinivasan

Journal of Mind and Medical Sciences

Background. Coronavirus Disease 2019 (COVID-19, also known as 2019-nCoV), a cluster of acute respiratory illness with unknown causes, has occurred in India since January 2020. Over the past several months, the entire world is struggling to cope with and contain the virus spread. Several studies showed that mental health problems could occur in both healthcare workers and SARS survivors during the SARS epidemic. Considering the geographical variation, dense population, multi-strata health care structure, and rising COVID cases in South India, we have a reason to speculate that the burden on the frontline doctors is high and their psychological condition …

Indicators Of Psychological Distress And Body Image Disorders In Female Patients With Breast Cancer, Helena Van Oers, Lourens Schlebusch

Journal of Mind and Medical Sciences

Breast cancer patients are vulnerable to elevated stress related to receiving the diagnosis, unfamiliar and invasive treatment, and coping with the side-effects of treatment, which may find various forms of expression. Another common feature of this patient population is body image dysphoria. Both the disease and treatment lead to impairments in physical appearance and general bodily functioning. This study aimed to explore the differential manifestations of stress and the nature of body image dysphoria within a sample of female breast cancer patients (n=80), compared to female patients with other sites of disease (n=80) in order to examine differences in the …

Assessing Test Anxiety And Resilience Among Greek Adolescents During Covid-19 Pandemic, Sofia Sakka, Vasiliki Aliki Nikopoulou, Eleni Bonti, Paraskevi Tatsiopoulou, Panayiota Karamouzi, Aikaterini Giazkoulidou, Virginia Tsipropoulou, Eleni Parlapani, Vasiliki Holeva, Ioannis Diakogiannis

Journal of Mind and Medical Sciences

The aim of the present study was to explore the impact of school year’s extension due to the coronavirus pandemic (COVID-19) by addressing test anxiety and by studying the coping strategies adolescents used to overcome it. For the majority of the adolescents the final exams can be a powerful source of stress, since the entrance examinations are required for admission into higher education and further reflect the transition to adulthood. The sample consisted of 67 High School students and the data collection was conducted online due to the imposed measures by the Greek government. Results showed normal or average levels …

Consciousness Level Determination Of Red Meat Consumption Of Pregnant Women, Giresun/Turkey Province, Duygu Balpetek Külcü, Özge Cağcağ Yolcu

Journal of Mind and Medical Sciences

In this study, meat consumption and the nutritional status of pregnant women living in Giresun province of Turkey were investigated. The study was carried out at Giresun University, the Maternity and Pediatrics Training and Research Hospital between February-March 2019. The study group consisted of 218 pregnant women aged 18 to 49 years, who benefited from polyclinic services and agreed to participate in the survey. A questionnaire consisting of 12 questions was used, and the findings were evaluated using SPSS to generate descriptive statistics and t-tests or ANOVAs. The majority of participants stated that red meat is beneficial during pregnancy (71.1%) …

Impact Of Rational And Experiential Thinking Styles On Interpersonal Conflict Resolution Among Young Adults, Ayesha Rafique, Hania Habib, Fariha Abdul Rehman, Shabnam Arshi

Journal of Mind and Medical Sciences

This research aimed to find the relationship between thinking styles (rational or experiential) and interpersonal conflict resolution (ICR) in young adults. A sample of 99 females and 103 males, age range 18 to 40 years, was selected via convenient and snow-ball sampling. Thinking styles were assessed using Rational-Experiential Inventory-40, and ICR was measured using Conflict Resolution Questionnaire. Regression analysis was used to predict ICR based on thinking style covariates and several relevant demographic covariates, including gender and family birth order. Rational thinking style (RTS) was most prevalent among young adults and was the strongest predictor of ICR. In addition, gender …

Compassion And Suppression In Caregivers: Twin Masks Of Tragedy And Joy Of Caring, Emanuele Maria Merlo, Sean M. Mcnabney, Fabio Frisone, Federica Sicari, Mihai Paunica, Catalina Motofei, Salvatore Settineri

Journal of Mind and Medical Sciences

Background: Compassionate caregiving is a critical skill for workers among the helping professions, but the degree of empathy required by caregivers can place high demands on their mental and emotional resources. While many professionals employ successful coping strategies to mitigate these stressors, others experience compassion fatigue or burnout from emotional exhaustion. The objective of this research was to evaluate the relationships between caregivers’ demographic/career variables, compassion satisfaction, compassion fatigue, and psychodynamic defense mechanisms such as suppression, repressive function, regression in the service of the Ego, and rationalization. Methods: Participants were 250 caregivers with 178 (71,2%) women and 72 men (28,8%) …

Underactive Bladder - An Underestimated Entity, Spinu Arsenie Dan, Ovidiu Gabriel Bratu, Dragos Radu Marcu, Adina Elena Stanciu, Florentina Gherghiceanu, Florentina Ionita-Radu, Simona Bungau, Ana Maria Alexandra Stanescu, Dan Mischianu

Journal of Mind and Medical Sciences

Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis depends on urodynamic findings, and symptoms are usually rare and intricated with the symptoms of other urinary pathology.

Matherials and methods. This review examines the current literature on underactive bladder regarding pathology, definition, diagnosis, current guidelines, and any further potential medical developments.

Conclusions. Underactive bladder is a poorly understood pathologic condition. Only since 2002 has there been any consensus regarding the definition. The diagnosis relies only on urodynamics; clinical diagnosis is a challenge even for a consultant; and treatment does …

The Role Of Biotransformation Processes In Mediating Interactions Between Psychotropic Drugs And Natural Products, Nicolae Bacinschi, Ina Pogonea, Lilia Podgurschi, Maria Mihalachi-Anghel, Emil Ștefănescu, Bogdan Socea, Marin Chianu

Journal of Mind and Medical Sciences

Many patients are not aware that natural products such as fruit juices or plant infusions can cause significant interactions with several drugs, some of which can be dangerous, especially when the medical treatment is for neurological or psychiatric disorders. Among the most predisposed for interacting with drugs are citric juices, particularly grapefruit and plant infusions, especially St John`s wort (Hypericum perforatum). Understanding the mechanism and the frequency of this type of interaction helps to avoid it. The goal of this research was to identify and summarize the most relevant reports on interactions between psychotropic drugs and natural beverages, in order …

Lars-Like Symptoms In The General Population May Suggest The Significance Of Postoperative Functional Problems And Emotional Implications Of Rectal Surgery, Tudor-Cristian Frunza, Sorinel Lunca, Iustina Baciu, Iulia Axinia, Cezar V. Mocanu, Andreea Crudu, Narcis Bujor, Lucia F. Livenschi, Claudiu A. Nicolaiev, Andreea Hulubencu, Anca Diaconu, Emilia Valasciu, Ioana Jalobceastai, Malina Tibirna, Mihail G. Dimofte

Journal of Mind and Medical Sciences

Background & Aim. Sphincter-saving rectal surgery is prone to cause changes in bowel function associated with Low Anterior Resection Syndrome (LARS). Our aim was to assess LARS-like symptoms within a population of 50-80-year old in order to understand the functional disturbances and emotional impact of LARS. Materials and methods: We used a questionnaire to evaluate LARS with the following categories of symptoms: flatulence control, anal incontinence, frequency, clustering and urgency of the stools, and the psycho-emotional impact created by the presence of these symptoms. We calculated the severity of LARS on 343 responders. Results. The average age of the responders …

Review Of The Effects Of Anesthetic Agents Used As Premedication For Patients Undergoing Electroconvulsive Therapy With Diagnoses Of Bipolar Disorder Or Major Depression On Convulsion, Recovery Period, And Hemodynamic Parameters, Volkan Ozen, Mehmet Emin Orhan

Journal of Mind and Medical Sciences

Objective: The aim of this study was to examine the effects of anesthetic agents used as premedication in patients undergoing electroconvulsive therapy (ECT) for diagnoses of bipolar disorder or major depression in terms of convulsion, recovery period, and hemodynamic parameters. Materials and Method: This retrospective study was carried out by screening the anesthesia forms of patients in a psychiatry clinic in Turkey. Results: Researchers reviewed 104 patient files, of which 39 fit the inclusion criteria. 26 patients were given premedication; 13 patients were not given premedication. The study found a significant difference between the group to which dexmedetomidine was given …

Experimental Pharmacological Research Regarding The Antidepressant Effect Of Associating Doxepin And Selegiline In Normal Mice, Cornel Chiriță, Emil Ștefănescu, Cristina E. Zbârcea, Horațiu Mireșan, Simona Negreș, Diana C. Nuță, Carmen Limban, Rucsandra E. Dănciulescu Miulescu, Cristina D. Marineci

Journal of Mind and Medical Sciences

The severity and complexity of depression can vary widely among individuals, thus making single drug therapy ineffective in some cases. Taking this fact into account and using a mouse model, we set on investigating the possibility of obtaining a synergism of action between a classical tricyclic antidepressant that inhibits noradrenalin and serotonin reuptake (doxepin), and a modern antidepressant that inhibits type-B monoamine oxidase (selegiline). We measured the antidepressant effect using the forced swimming test and the tail suspension test. We determined motor activity using the Activity Cage test. Our results have shown that the antidepressant effect intensifies significantly in the …

The Effects Of Stimulants On Eating Patterns In Children And Adolescents With Attention Deficit Hyperactivity Disorder, Serkan Turan, Aynur Pekcanlar Akay

Journal of Mind and Medical Sciences

Objectives. This study aims to evaluate the effects of methylphenidate (MPH) on eating patterns and body mass index (BMI) in children with attention deficit/hyperactivity disorder (ADHD). The secondary aim of this study is the comparison between weight and eating behavior of children with ADHD undergoing an MPH treatment, and of children without ADHD. Methods. One hundred fourty three children and adolescents who diagnosed with ADHD were enrolled, and the effects of MPH on the eating patterns and BMI were evaluated. All participants completed a number of tests to analyze eating patterns and clinical psychopathological profiles. Results. Children and adolescents with …

The Burden Of Clostridium Difficile Infection In Patients With Liver Cirrhosis, Despina Moraru, Andrada Dumitru, Sergiu I. Micu, Marilena Musat, Gabriel Preda, Popoiag R. Emanuela

Journal of Mind and Medical Sciences

Clostridium Difficile Infection (CDI) has registered a dramatically increasing incidence in the general population over the past decades. Nowadays, Clostridium Difficile is the leading cause of hospital-acquired diarrhea in Europe and North America. Liver cirrhosis is the final stage of any chronic liver disease (CLD). The most common causes are chronic hepatitis C or B and viral co-infections, alcohol misuse, and nonalcoholic fatty liver disease (NAFLD). CLD and cirrhosis are listed among the ten leading causes of death in the US. Cirrhosis due to any etiology disrupts the homeostatic role of the liver in the body. Cirrhosis-associated immune dysfunction (CAID) …

Alcoholic Liver Cirrhosis, More Than A Simple Hepatic Disease – A Brief Review Of The Risk Factors Associated With Alcohol Abuse, Sergiu I. Micu, Madalina E. Manea, Roxana Popoiag, Dragana Nikolic, Dumitru Andrada, Angelo M. Patti, Marilena Musat, Cristian Balalau, Anca Rogoveanu, Manfredi Rizzo, Anca Pantea Stoian

Journal of Mind and Medical Sciences

Liver cirrhosis is a significant public health problem, being an important cause of mortality and morbidity, responsible for approximately 1.8% of the total number of deaths in Europe. Chronic alcohol consumption is the most common cause of liver cirrhosis in developed countries. Europe has the highest level of alcohol consumption among all the global World Health Organisation (WHO) regions. In this paper, we briefly review major factors leading to excessive alcohol consumption in order to draw attention to the fact that alcoholic liver cirrhosis is more than a simple liver disease, and if those risk/causal factors can be prevented, the …

Insights Into The Pathogenesis Of Nicotine Addiction. Could A Salivary Biosensor Be Useful In Nicotine Replacement Therapy (Nrt)?, Anida-Maria Băbțan, Nausica B. Petrescu, Anca Ionel, Bianca A. Boșca, Willi A. Uriciuc, Claudia N. Feurdean, Codruța I. Mirică, Roxana Bordea, Viorel Miclăuș, Flavia Ruxanda, Adina D. Todea, Teodora G. Alexescu, Radu S. Câmpian, Aranka Ilea

Journal of Mind and Medical Sciences

Nicotine has gained the attention of the medical community due to its insidious addictive mechanisms which lead to chronic consumption. The multitude of compounds derived from tobacco smoke have local and systemic negative impacts, resulting in a large number of smoking-related pathologies. The present review offers insights into nicotine addiction physiopathology, as well as social and medical implications, with emphasis on its correlation with Advanced Glycation End Products (AGEs). Therapeutic strategies and new approaches to nicotine assessment and cessation treatment are discussed, noting that such strategies could take into account the possibility of slow and gradual nicotine release from a …

Postpartum Depression And Thyroid Dysfunction– Should Pregnant Women Be Screened For Thyroid Disorders?, Anca A. Simionescu, Erika Marin

Journal of Mind and Medical Sciences

The relationship between thyroid dysfunction and postpartum depression has been investigated for quite some time now, but no consensus has been reached regarding the need for screening for thyroid function during pregnancy. This paper aims to investigate whether thyroid hormone screening in pregnancy might contribute to the diagnosis of postpartum depression.

Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) - one of the most widely used measures in detecting postpartum depression and anxiety. Thyroid function was measured using the commonly recommended thyroid laboratory tests.

A structured questionnaire was given to 61 patients closely monitored during their pregnancy and …

The Risk Of Bleeding And Encephalopathy In Surgical Patients With Liver Cirrhosis, Petrișor Banu, Salvatore Settineri, Emanuele Maria Merlo, Maria Rosaria Anna Muscatello, Nicolae Bacalbașa, Carolina Negrei, Bianca Gălățeanu, Octav Ghinghină, Ioana Păunica, Cristian Bălălău

Journal of Mind and Medical Sciences

Liver cirrhosis is a disease with an increasing incidence. Surgical procedures in patients with cirrhosis are also increasing, due to a longer life expectancy in these patients and also to the improvement of therapeutic and diagnostic resources.

Digestive hemorrhage in the cirrhotic patient requires emergency medical intervention (intensive therapy, endoscopic or even surgical approaches), being at the same time a factor that precipitates episodes of encephalopathy, i.e. the conventional complication of cirrhosis. Hepatic encephalopathy represents one of the most severe clinical events of cirrhosis, being associated with high morbidity and mortality. The causes of hepatic encephalopathy are briefly presented in …

Quality Of Life In Romanian Patients With Schizophrenia Based On Gender, Type Of Schizophrenia, Therapeutic Approach, And Family History, Elena Alina Rosca, Ovidiu Eugen Alexinschi, Călin Brîncuș, Valentin Petre Matei, Ana Giurgiuca

Journal of Mind and Medical Sciences

The low quality of life of patients with schizophrenia has been extensively discussed and investigated. Various aspects from gender, socio-demographic profile, and/or type of neuroleptic treatment have been taken into account in describing this condition. The purpose of this study is to assess the perceived quality of life of Romanian patients suffering from schizophrenia and to correlate it with gender differences, type of schizophrenia, family history of psychiatric illness, and type of antipsychotic treatment. 143 patients diagnosed with schizophrenia according to DSM IV-TR and ICD 10 were included in the study. Social demographic data were documented and further assessment was …

Recurrent Vulvar Carcinoma: Complex Surgical Treatment Via Perineal Excision And Reconstruction With Musculocutaneous Flap, Dragoș Popa, Cosmin V. Obleagă, Ștefan Paitici, Stelian Ș. Mogoanta, Ionică D. Vîlcea, Pouya Pourgolafshan, Cristian Gheorghe, Manuela I. Vasile, Raluca Câmpeanu, Cecil S. Mirea

Journal of Mind and Medical Sciences

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion.

We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal …

The Mind-Body Problem; Three Equations And One Solution Represented By Immaterial-Material Data, Ion G. Motofei, David L. Rowland

Journal of Mind and Medical Sciences

Human life occurs within a complex bio-psycho-social milieu, a heterogeneous system that is integrated by multiple bidirectional interrelations existing between the abstract-intangible ideas and physical-chemical support of environment. The mind is thus placed between the abstract ideas/ concepts and neurobiological brain that is further connected to environment. In other words, the mind acts as an interface between the immaterial (abstract/ intangible) data and material (biological) support. The science is unable to conceives and explains an interaction between the immaterial and material domains (to understand nature of the mind), this question generating in literature the mind-body problem. We have published in …

Emergency Surgery On Mentally Impaired Patients: Standard In Consenting, Mihai Paduraru, Ahmed Saad, Krystian Pawelec

Journal of Mind and Medical Sciences

Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology) is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to …

Finasteride As A Model For Personalized Medicine, Ion G. Motofei, David L. Rowland, Ioana Păunică, Octavian C. Tănăsescu, Petrişor Banu, Stana Păunică

Journal of Mind and Medical Sciences

The side effects of Finasteride are currently a subject of controversy. Some studies report minor or acceptable adverse effects, which decrease after a variable period of time so that they do not necessitate terminating Finasteride administration. However, several clinical and neuro-endocrine studies show that some adverse effects persist indefinitely in the form of post-Finasteride syndrome, even after the drug cessation. This paper presents a possible explanation for these inconsistent findings. First, the study design of either informing or not informing patients prior therapy about possible adverse effects can influence the incidence and magnitude of reported adverse effects. Second, structural and …

End-Stage Head And Neck Cancer: Coping Mechanism, Bogdan Popescu, Oana Paun, Razvan V. Scăunaşu, Serban V.G. Berteşteanu

Journal of Mind and Medical Sciences

Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness …

Journal Of Mind And Medical Sciences: Translational And Integrative Mission, David L. Rowland, Ion G. Motofei

Journal of Mind and Medical Sciences

Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci.) established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports.

The journal adheres to the philosophy that high quality, original ideas and information should be readily accessible and freely shared within and amongst the scientific community. Accordingly, J Mind Med Sci. is an online, open access, non-for-profit journal which, because of individual/ private support, has levied no charges …