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PubMedDate not supplied

[Rehabilitation and the pathology of dementia].

To recognize the influence of the social and physical environment on demential pathology has methodological and therapeutical implications. Since the beginning of the seventies, many works have demonstrated that senile deterioration is not a continuous nor insurmountable process. There is no ineluctable evolution, independent of environment. The different therapeutical strategies can be analysed in terms of behavior modification through an action upon the physical and social determinants of the environment. The authors present two complementary methods of revalidation: an individualised reeducation of necessary behaviors for a social autonomy (toilet, dressing, continence) and a program of physical and psychic activation, to maintain or reestablish social skills (management of the institutional environment, physical mobilisation, ergotherapy and sociotherapy). These methods are relevant to the functional analysis and behavior modification. They are in concordance with the goals of the contemporary gerontology.

Activities of Daily Living↗
PubMed2001

[Evidence-based medicine and applying new therapies in general practice: wish and reality].

In the last years some important therapies were introduced in the treatment of rheumatoid arthritis (RA), which represent a significant clinical advance. This concerns the introduction of TNF blockade with etanercept and inflixmab, the combination of DMARDs, leflunomide and the COX-2-specific inhibitors. In the year 2000 the restrictive social law in Germany, the collective and individual budgets for medicaments, did prevent a broader use of the very expensive therapy with TNF blockade. A rising number of international healthcare studies shows a profound potential for saving costs by improving the functional capacity (HAQ) in patients with RA. The biologicals and leflunomide have this potential. To realise the potential of reducing healthcare costs by an optimal therapy of RA some modification of the restrictive social law is necessary as well as the introduction of disease-management programs.

Antirheumatic Agents↗
PubMed2004

[Hormone therapy of ageing: myths and realities].

Is well being in the elderly be improved by hormone replacement therapy which compensate deficits accounting for generalized weakness, poor endurance, loss of muscle strength, impaired mobility and balance and decreased cognitive functions? Hormone replacement therapy of menopause has favorable effects on bone loss and decreased cognitive functions but also on several unpleasant symptoms--vasomotor instability, skin atrophy, mucosal dryness, anxiety and fatigue--but at the prize of increased incidence of cancer and cardiovascular morbidity. Decreased testosterone levels in elderly men are associated with increased fatigability, decreased muscle strength and bone mass and increased risks of accelerated atheromatosis. Testosterone substitution seems to be helpful but with side effects, particularly development of prostate cancer. Aging also affects adrenal function. The consequences of decreased DHEA production are still matter of debate. DHEA administration in elderly women seems to be associated with favorable effects on physical and psychological well being. Somatopause is characterized by a progressive decrease of growth hormone production starting as soon as the third decade. Growth hormone therapy has favorable effects on lean body mass, skin atrophy as well on body fat reduction. However, numerous side effects and the theoretical increased risk of cancer limit the use of growth hormone therapy in the elderly.

Adrenal Glands↗
PubMed1989

The reality of an integrative sex therapy.

Although sex therapy from its inception has been acknowledged to be an integrative modality, little attention has focused on integrating various systemic approaches into sex therapy; yet the majority of sex therapists are probably familiar with these approaches. This article attempts to convey the reality of a newer sex therapy that integrates systemic thinking. Through a detailed case analysis and explication of the conceptual framework, it demonstrates the utility of several systemic strategies in treating sexual dysfunction; accounts for which techniques were and were not effective; and acknowledges the significance of the therapeutic relationship and of ethical and value issues that are present in all therapy.

Adult↗
PubMed2006

Cognitive rehabilitation in Alzheimer's Disease.

Non-pharmacological treatment in Alzheimer's Disease has gained great attention in recent years. The limited efficacy of drug therapy and the plasticity of human central nervous system are the two main reasons that explain this growing interest in rehabilitation. Different approaches have been developed. Here we discuss the efficacy of non-pharmacological therapy in the frame of two main approaches: Multistrategy Approaches (Reality Orientation, Reminiscence Therapy and Validation Therapy) and Cognitive Methods.

Aged↗
PubMed2005

Antiretroviral therapy in resource-poor countries: illusions and realities.

The prospects for antiretroviral therapy in resource-poor settings have changed recently and considerably with the availability of generic drugs, the drastic price reduction of brand-name drugs, and the simplification of treatment. However, such cost reductions, although allowing the implementation of large-scale donor programs, have yet to render treatment accessible and possible in the general population. Successfully providing HIV treatment in high-prevalence/high-caseload countries may require that we redefine the problem as a public health mass therapy program rather than a multiplication of clinical situations. The public health goal cannot simply be the reduction of morbidity and mortality for those treated but must be the reduction in morbidity and mortality for the many, that is, at a population level.

Anti-Retroviral Agents↗
PubMed2003

Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial.

BACKGROUND: A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials. AIMS: To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life. METHOD: A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures. RESULTS: One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group. CONCLUSION: The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.

Aged↗