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[Pharmacotherapy of patients with dementia].

Dementing illnesses present among the most frequent and most consequential psychiatric disorders in old age. They thus constitute a particular challenge for science politics and society as a whole. Knowledge about multifactorial etiological and pathological factors is still rather limited. By way of stratified diagnostic procedures various dementia disorders can be differentiated rather reliably. Anti-dementia drugs can enhance cognitive performance and temporarily slow down the progress of the most frequently occurring dementias (Alzheimer-dementia, vascular dementia). In the treatment of behavioral symptoms in dementia newly developed psychopharmological agents are of particular relevance. They constitute an important element of a multi-modal therapeutic strategy.

Aged↗

Long-term maintenance following attainment of goal weight: a preliminary investigation.

The present study sought to determine whether the high relapse rates observed among subjects in fixed length behavioral-based weight loss programs would be lowered if subjects were allowed to continue in treatment until they had reached their desired weights. Five hundred seventeen (517) clients at a commercial weight-loss program were surveyed approximately 1 year posttreatment regarding their current weight status. Of the 267 subjects who responded to the mailed survey, it was found that 82% remained within 10% of their posttreatment weights at the time of the follow-up. Of particular interest was the fact that weight trends during the intervening year suggested subjects were actively and effectively calibrating their weight. It was concluded that the high relapse rates typical for this mode of treatment may be an artifact of premature treatment cessation and further investigation is indeed merited.

Adult↗

Antiaging methods and medicines for the memory.

The interaction of bedside and basic science has led to the identification ofa short list of pathological proteins as causal in Alzheimer's disease. AI3P has received the most attention, and work with animal models has reinforced the evidence that overproduction of ABP causes cognitive impairments. Animal models are now being used to discover and develop unique therapeutics directed at reversing the deleterious effects of ABP. These models strongly suggest that established Alzheimer's disease might be reversible, not just preventable. Animal models are also demonstrating that other peptides and proteins can enhance or impair cognitive function. These peptides and proteins add further to the list of possible therapeutic candidates. Approaches such as these, and not the commercial antiaging remedies that have no scientific basis, will eventually provide medicine for memory enhancement.

Aged↗

Effect of developmental status on the approach to physical examination.

A certain mystique surrounds pediatric clinicians, many of whom appear to have a magical touch with children. Admittedly, there are a few true masters of the art who invariably seem to bring calm to even the most frantic of patients. But for the most part, this magic can be learned by attending to the lessons provided by the study of normal child development. The science of knowing what to concentrate on, what to expect, and how to interpret findings, and the art of sequence, pace, and distraction are equally derived from on-going attention to the patient's stage of affective, cognitive, and physical development. When the stage-related approach is modified by individual circumstance (e.g., child's temperament, acuity of illness), the magic success can become a routine expectation for the vast majority of pediatric clinical encounters.

Adolescent↗

Nutrition education for care staff and possible effects on nutritional status in residents of sheltered accommodation.

OBJECTIVE: We investigated the nutritional, cognitive and functional status in residents of two service-flat (SF) complexes and the effects of a nutrition education programme for care staff. DESIGN: Controlled nonrandomised study. SETTING: Two SF complexes, that is community-assisted accommodation. SUBJECTS: Of 115 eligible SF residents, 80 subjects participated (age 83+/-7 y, 70% women). INTERVENTION: The nutritional status was assessed using body mass index (BMI, kg/m(2)), subjective global assessment (SGA), serum concentrations of albumin, insulin-like growth factor-I (IGF-I) and vitamin B(12). Cognitive and functional status were evaluated using the Mini Mental State Examination (MMSE, 0-30 points, <24 points indicates impaired cognition) and the Katz activities of daily living (ADL) index, respectively. Two assessments were made with a 5-month interval. At the start, a 12-h education programme was given to the staff at one of the SF complexes. RESULTS: At baseline, the means of BMI and the biochemical nutritional indices were normal, whereas one-third had BMI <22 kg/m(2) and one-fourth had lost > or =10% of previous weight. According to SGA, 30% demonstrated possible or serious malnutrition. The median MMSE was 23 points (19.5-26.5, 25-75th percentile). Nearly 70% were ADL-independent. At the 5-month follow-up there were no differences in the nutritional and cognitive status of the residents. The nutritional knowledge of the staff improved slightly (P<0.05) at both SF complexes (NS between groups). CONCLUSIONS: Around one-third of SF residents appeared to be at nutritional risk. Five months after a 12-h staff nutrition education programme, no objective changes were seen in the nutritional status of the SF residents.

Activities of Daily Living↗

The learning of motor skills: sports science and ergonomics perspectives.

The paper describes some of the common origins of ergonomics and sports science in the UK with particular reference to research on motor learning. Attention is drawn to the value of analytical methods developed by ergonomists in deriving training prescriptions and their relationship with conventional learning theory is discussed. The cognitive revolution, which in the last 25 years has changed the face of psychology, has also had its impact on ergonomics and basic research on motor skills. The role of cognitive processes in motor learning is being reassessed and there is a renewed interest in topics such as verbal instruction, imitation, imagery, and mental practice which to earlier generations of behavioural scientists appeared beyond the scope of scientific investigation. The paper outlines some recent research into the role of imagery in motor learning illustrating these new approaches.

Attention↗

The nurse executive as integrator: creating a field of health caring.

Nurse executives are emerging from a state of cognitive dissonance resulting from conflicts of values and practice from the bedside to the boardroom. Three changes in hospital systems are offering the opportunity to resolve cognitive dissonance and become congruent. These are patient-focused care restructure with multidisciplinary teams, managed care and capitation calling for enhanced clinical management, and the new organizational paradigm characterized as flatter, decentralized, staff empowering, and manifesting new science concepts of self-organization within fields. The nurse executive role becomes that of integrator, pulling together the best practices of nursing and new leadership.

Hospital Restructuring↗

The dangerous practice of thinking.

Information processing theory views thinking as the adaptation of activity to environmental inputs. A dual cognitive structure is proposed to explain this adaptation, in which thoughts are selected by interactions between an explicit memory system (accessible to consciousness) and an implicit memory system (inaccessible to consciousness). Contrary to commonsense assumptions about cognition, the implicit system plays the dominant role in skilled thinking. The explicit system has a largely regulatory function, overriding the implicit system when it encounters novel situations for which it has no response. Although the explicit system may be developed by cognitive process instruction in the classroom, the all-important implicit system is developed mainly by direct experience of the work environment independently of conscious information processing. Paradoxically, there are no grounds for declaring any part of medical science irrelevant to practical decision-making, as its effects on implicit memory are unknown. Nevertheless, it should be taught as the basis for regulating a process of thinking that is mainly implicit.

Decision Making↗

The Sonda Project: prevention, prediction, and psychological disorder.

The Sonda Project began in Italy in 1985 and was created by Semeion Research Center of Sciences of Communication. It has been operating in approximately 30 Italian cities, ranging from large to small, since 1986. The aim of the Sonda Project is to undertake primary prevention measures at the level of personality organization disorder. Cognitive and communication disorders are, in the context of the Sonda Project, the common ground for many expressions of cultural disorders labeled drug addiction, alcoholism, violence, etc. From the point of view of the Sonda Project, measures aimed at combating drug-addiction and alcoholism are no more than superficial strategies incapable of dealing with the causes of self and hetero-destruction (of others). Such abuses are the most evident political symptoms. The methodological aim of the Sonda Project, therefore, consists in understanding, predicting, and acting upon the incubation disorder of human beings; a disorder which subsequently transforms itself into more or less recognizable symptoms. In order to attain its aim, the Sonda Project has made use of two instruments: 1) a series of Intelligent Computerized Observatories, able to predict, in each community, the typology of people who are more likely to exhibit forms of destructive suffering; 2) a local team able to use such advanced technology and able to utilize territorial activation techniques. These are designed to reinsert into the arena of the social game those people who are more "at risk" in terms of self and heterodestruction, and who are most exposed to psychological and sociological levels of relational "fatigue."

Health Promotion↗

Preventive dental health in adolescents: short and long term pupil response to trials of an integrated curriculum package.

A controlled evaluation of a 3-week teacher mediated dental health education curriculum package was undertaken in 35 English secondary schools in three Area Health Authorities. 4500 13-14-year-old adolescents were involved. The package emphasized self-care potential and combined a scientifically accurate message with educational and behavioural science concepts. Evaluation was at the levels of process and outcome using changes in oral hygiene recorded on a random sample (n = 1491) by two trained examiners; self-complete pre/posttest questionnaires, pupil worksheets and home experiment diaries. Behavioural, cognitive and affective outcomes are reported. Significant improvements in oral hygiene status were recorded at the conclusion of the programme along with large gains in knowledge and positive changes in attitude. Long term follow-up oral hygiene examinations in six schools (n = 145) conducted in conjunction with a reinforcement programme, indicated a maintenance of the initial improvements in five schools. Further significant improvements were measured after the reinforcement programme.

Adolescent↗

Patterns of medical and nursing staff communication in nursing homes: implications and insights from complexity science.

Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization, and innovation in nursing homes. Two facilities participated in 6-month case studies using field observations, shadowing, and depth interviews. In one facility, the dominant pattern of communication was a vertical "chain of command" between care providers, characterized by thin connections and limited information exchange. This pattern limited cognitive diversity and innovation in clinical problem solving. The second facility used an open communication pattern between medical and frontline staff. The authors saw higher levels of information flow, cognitive diversity, innovation, and self-organization, although tempered by staff turnover. The patterns of communication between care providers in nursing facilities have an important impact on their ability to provide quality, innovative care.

Communication↗

Field processes in stereovision. A description of stereopsis appropriate to ophthalmology and visual perception.

There is, as yet, no satisfactory theory of stereopsis, despite the fact that our overt knowledge of "solid seeing" is now about 150 years old, and that contributions to our understanding come today from many fields: ophthalmology, psychology, psychophysics, neurophysiology, computer modelling, and optical-TV display technology. We review herein, and demonstrate for the reader whenever possible, certain key perceptual properties of the stereoscopic event of which any general theory must take account: vector stereoscopy and the neural grid, depth in empty visual fields, the relationship between stereoscopic and cognitive contours, stereoscopic contour formation in the presence of blur (thus, at low levels of central visual acuity), the phenomenon of cortical locking and of neural grid evocation in the presence of either peripheral or central rivalry, certain unusual ranges of figural mismatch and the concept of the horopter in relation to modern single cell electroneurophysiology in animals and to the constancy of visual directions. Some comments are also made on the concept of disparity processing by single cortical neurons, together with a short discussion of the implications of certain views of the genetics of stereovision for the perception of novel random texture sine-wave stereograms. We conclude that any theory pertinent to ophthalmology and visual science must combine the global concepts of cortical integration, the neural lock and the neural grid, herein introduced, with the more classical concepts of particulate or local binocular cortical correspondence. Certain preliminary steps in this direction are presented.

Cognition↗

The phenomenon of chemo brain.

During and following chemotherapy, some patients experience difficulties with memory, attention, and other aspects of cognitive function. This constellation of deficits commonly is referred to as chemo brain. Although the phenomenon is not understood completely, it is assuming greater significance as cancer survival improves. Return to prediagnosis levels of domestic, employment, and academic activity is expected in most survivors. Advances in basic, imaging, and clinical sciences are beginning to unravel pathophysiologic mechanisms and develop neuroprotective strategies. Pharmacologic options are borrowed from diverse diseases, including attention-deficit/hyperactivity disorder and neurodegenerative diseases. Conventional therapies soon may find new applications; for example, recent preclinical data suggest that erythropoietin may have some neuroprotective abilities, which may positively affect patients experiencing chemo brain. A collaborative model is bringing together international specialists interested in unraveling the mysteries of the phenomenon and developing management strategies to attenuate its effects. This article will review the clinical features of chemo brain as well as a working hypothesis regarding pathophysiology. The potential and emerging interventions that can be used by oncology nurses to assist patients and their families to cope with this enigmatic dysfunction will be discussed.

Antineoplastic Agents↗

Behavior therapy and the experimental analysis of behavior: contributions of the science of human behavior and radical behavioral philosophy.

It has been argued that clinical psychologists, including clinical behavior therapists, are not aware of or knowledgeable about advances being made in basic behavioral research (Marks, Behavioral Psychotherapy, 9, 137-154, 1981). The present paper addresses the arguments advanced by clinical and experimental psychologists that behavior therapy and cognitive-behavior therapy are moving away from their respective ties to the experimental operant laboratory. It is argued that there are many areas of mutual interest between basic behavioral and clinical research and application. Several major research programs of operant psychology are analyzed in order to demonstrate conclusively that advances in basic behavioral studies have relevance for application by clinical psychologists. Progress in the experimental fields of the quantitative law of effect (the matching law), operant/classical interactions, including behavioral momentum, modeling and verbal and rule-governed behavior are analyzed. Applications of these basic behavioral principles to clinical settings are also illustrated. It is concluded that the experimental analysis of behavior can add much to the continuing development of a scientifically-based clinical psychology, and that mutual interest research in both sub-disciplines of psychology will lead to a greater understanding of the causes and conditions of human behavior, as well as direct the ability of clinical psychologists to effect meaningful behavioral change.

Animals↗

Research on aging in behavioral sciences in the Federal Republic of Germany.

The paper reports on cross-sectional and longitudinal studies on psychological, sociological, as well as physical aspects of aging completed or going on in the Federal Republic of Germany. Most of these studies are referring to community aged and point to the complex conditions of consistency and change in cognitive functioning and personality adjustment during the middle and later years. They stress the high degree of interindividual variability of the aging process and ask for a differential instead of a normative gerontology.

Adult↗

Depression following a spinal cord injury.

OBJECT: Depression is a common problem following a spinal cord injury (SCI) and can greatly interfere with the rehabilitation process because of reduced energy, negative expectations, and social withdrawal. Understanding various factors which influence a vulnerability to depression may improve the diagnosis and treatment of depressive disorders and can improve rehabilitation outcome. METHOD: A thorough literature search was conducted using Medline, PsychLit, Pyschinfo, and Social Science Citation Index to identify relevant articles published between 1967 and 1995. RESULTS: A diathesis-stress model is proposed to explain the increased risk of depressive symptoms after a SCI. Biological changes associated with SCI and pre-existing cognitive biases may influence the individual's vulnerability to stressful life events following the injury. The nature and frequency of stressful life events following the injury can tax the individual's coping resources. Furthermore, the perceived quality of social support and the severity of conflict within the family can influence the individual's adaptation. CONCLUSIONS: Social support and recent stressors should be assessed to identify patients at high risk for depression. Patients are less likely to become depressed if their independence is fostered and they are encouraged to develop new sources of self-esteem. Relatives can be counseled to help maintain supportive relationships within the family.

Adaptation, Psychological↗

The effect of a nutrition education programme 'learning by teaching' on the dietary attitudes of a group of adolescents.

The purpose of this study was (1) to examine the structure of attitudes towards healthy food in a group of adolescents and (2) to evaluate the impact of a health education programme on these attitudes. The strategy used was to make 14-year-old schoolchildren learn about nutrition and dental health by teaching these topics to 10-year-old children. A pre-test/post-test non-equivalent control group design was used. The experimental group consisted of four classes of 14-year-old children from two schools and the reference group of four classes of the same age from two comparable schools. The data were collected prior to, immediately after, and, for the experimental group, two months after the implementation of the programme. Factor analysis revealed three dimensions of attitudes: PROHEALTH, TASTE, and SIGNIFICANT OTHERS. Analysis of covariance with pre-test measures as covariates showed a significant effect of the programme on PROHEALTH, no effect on TASTE, and a significant study group by gender interaction effect on SIGNIFICANT OTHERS, which, however, was impaired two months later. It is concluded that the change in attitudes can be explained by two mechanisms: dissonance arousal and discrepancy between personal attitudes and group norms; and that future programmes should emphasise affection rather than cognition.

Adolescent↗