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With an increasing global ageing population, the psychiatry of old age has become increasingly important. This revised second edition remains a succinct manual on the practice of psychiatry of old age, providing an up-to-date summary of existing knowledge, best practice and future challenges for the specialty, from a global perspective. Written by four leading clinicians, teachers and researchers, the book offers a much-needed international focus and is designed for use in a wide variety of countries and settings. Chapters are presented in a clear and practical way, enhanced by current and comprehensive further reading sections as well as tables and diagrams for quick assimilation and reference. The new edition is updated to incorporate new developments in assessment, investigation, classification, treatment and care since the publication of the first edition, including the ICD-11 and DSM-5. Essential reading for practising psychiatrists and geriatricians, as well as trainees, nurses and medical students.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70% agreement) on 30 evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
A purposeful sample of key stakeholders (NGT workshop, n=8 experts; Delphi survey, n=23 end-users).
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n=56 points); and ‘vegetable variety’ (complementary feeding, n=97 points; family diet, n=139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, 12 for research and four for food industry.
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
Dorsal root ganglia (DRG) at all levels of the spinal cord are a prominent target of Friedreich ataxia (FA). The lesions include hypoplasia of neurons, proliferation of satellite cells, infiltration by IBA- 1-reactive monocytes, and formation of residual nodules. Paucity and smallness of DRG neurons account for the lack of large myelinated axons in dorsal roots and sensory peripheral nerves. The lack of myelin in dorsal roots can be attributed to low levels of neuregulin 1 type III (NRG1[III]). Lysates of 13 DRG of genetically confirmed FA patients were analyzed by antibody microarray with 878 different validated antibodies that target structural and signaling proteins, and by Western blots. KIT and mTOR, two proteins involved in cellular proliferation, were significantly upregulated in the DRG of FA. KIT is a transmembrane receptor that dimerizes when it binds two molecules of stem cell factor (SCF) in its extracellular domain and becomes activated as protein tyrosine kinase. Immunohistochemistry with anti-KIT generated reaction product in satellite cells of normal DRG and prominent labeling of these cells in FA that co-localized with SCF on double- label immunofluorescence; SCF was present in S100-positive satellite cells rather than monocytes. Immunohistochemical reaction product of mTOR and other mTOR complex proteins, such as hamartin (TSC1), tuberin (TSC2), raptor (mTOR complex 1) and rictor (mTOR complex 2) was also present in satellite cells of normal DRG and DRG of FA. Antibodies to two downstream proteins that are considered to be indicators of mTOR activity, P70 S6K and 4E-binding protein 1, revealed no reaction product in DRG of FA. TSC1, TSC2, and mTOR are best known from their roles in tuberous sclerosis, but expression of these proteins, and KIT, in DRG may contribute to signaling cascades underlying the proliferation of satellite cells in FA.
This presentation will enable the learner to:
1. Discuss cellular proliferation in the pathogenesis of the DRG lesion in Friedreich ataxia
CONFLICT OF INTEREST
AHK is a consultant to PTC Therapeutics of South Plainfield, NJ USA. SP and CS are majority owners of Kinexus.
Were the ancient Coast Salish farmers? Conventional anthropological wisdom asserts that the ethnographically known communities of the Northwest Coast of North America were “complex hunter-fisher-gatherers” who lacked any form of concerted plant food cultivation and production. Despite decades of extensive ethnobotanical and paleoethnobotanical study throughout the Pacific Northwest demonstrating the contrary, this “classic anomaly” is still a cornerstone of anthropological and archaeological canons. The recent discovery of a spectacularly preserved wetland wapato (Indian potato, Sagittaria latifolia) garden, built 3,800 years ago in Katzie traditional territory near Vancouver, British Columbia, has helped recast this picture, alongside evidence for other forms of resource management practiced by Northwest Coast peoples. This article examines “origins of agriculture” stories from three distinctive perspectives: Coast Salish Katzie people who cultivated wapato for millennia; settlers who colonized the Fraser River Delta historically, bringing with them their own ideas about what constitutes farming; and archaeologists, who are challenged by these data to reevaluate their own understandings of these cultural constructs. These perspectives have critical bearing on the historical appropriation of lands and waterways by settler communities in British Columbia as well as contemporary questions of sovereignty and stewardship in this region and well beyond.
Consumption is driven by children’s sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety.
Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel.
A nationally representative sample of Australian children and adolescents aged 2–17·9 years (n 2812).
While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables.
Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.
We estimated the cost-effectiveness of home fortification with micronutrient powder delivered in a sales-based programme in reducing the prevalence of Fe deficiency anaemia among children 6–59 months in Bangladesh.
Cross-sectional interviews with local and central-level programme staff and document reviews were conducted. Using an activity-based costing approach, we estimated start-up and implementation costs of the programme. The incremental cost per anaemia case averted and disability-adjusted life years (DALY) averted were estimated by comparing the home fortification programme and no intervention scenarios.
The home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh.
Caregivers of child 6–59 months and BRAC staff members including community health workers were the participants for this study.
The home fortification programme had an estimated total start-up cost of 35·46 million BDT (456 thousand USD) and implementation cost of 1111·63 million BDT (14·12 million USD). The incremental cost per Fe deficiency anaemia case averted and per DALY averted was estimated to be 1749 BDT (22·2 USD) and 12 558 BDT (159·3 USD), respectively. Considering per capita gross domestic product (1516·5 USD) as the cost-effectiveness threshold, the home fortification programme was highly cost-effective. The programme coverage and costs for nutritional counselling of the beneficiary were influential parameters for cost per DALY averted in the one-way sensitivity analysis.
The market-based home fortification programme was a highly cost-effective mechanism for delivering micronutrients to a large number of children in Bangladesh. The policymakers should consider funding and sustaining large-scale sales-based micronutrient home fortification efforts assuming the clear population-level need and potential to benefit persists.
The criteria for objective memory impairment in mild cognitive impairment (MCI) are vaguely defined. Aggregating the number of abnormal memory scores (NAMS) is one way to operationalise memory impairment, which we hypothesised would predict progression to Alzheimer’s disease (AD) dementia.
As part of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing, 896 older adults who did not have dementia were administered a psychometric battery including three neuropsychological tests of memory, yielding 10 indices of memory. We calculated the number of memory scores corresponding to z ≤ −1.5 (i.e., NAMS) for each participant. Incident diagnosis of AD dementia was established by consensus of an expert panel after 3 years.
Of the 722 (80.6%) participants who were followed up, 54 (7.5%) developed AD dementia. There was a strong correlation between NAMS and probability of developing AD dementia (r = .91, p = .0003). Each abnormal memory score conferred an additional 9.8% risk of progressing to AD dementia. The area under the receiver operating characteristic curve for NAMS was 0.87 [95% confidence interval (CI) .81–.93, p < .01]. The odds ratio for NAMS was 1.67 (95% CI 1.40–2.01, p < .01) after correcting for age, sex, education, estimated intelligence quotient, subjective memory complaint, Mini-Mental State Exam (MMSE) score and apolipoprotein E ϵ4 status.
Aggregation of abnormal memory scores may be a useful way of operationalising objective memory impairment, predicting incident AD dementia and providing prognostic stratification for individuals with MCI.
Recent large-scale comparative archaeological studies of wealth differences have used Gini coefficients to assess inequality, employing house-floor area as a standardised, cross-cultural proxy for wealth. Two such studies have found that storage capacity produces higher Gini coefficients than floor area, suggesting that the latter measures household wealth, while the former reflects anticipated income. Here, the authors test these relationships using the floor area and storage capacity of excavated houses on the Lower Columbia River in the Pacific Northwest. The results, which reflect those from previous studies, support the cross-cultural nature of the pattern, and show that storage capacity reflects food-surplus deployment strategies rather than anticipated household income.
The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services.
This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures.
As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.
Introduction: Children with concussions presenting to emergency departments often receive very different recommendations for how to recover. In addition, there are no instructions for teachers to how children should return to learn and play after a concussion. Therefore, some children take too long to return to learn and play at school while others return too soon, thereby risking long-term problems because their brain injury is not fully healed. The purpose of this project is to determine the impact of a new integrated, standardized approach aimed to help a concussed child recover faster and whether the recovery experience for all involved has improved. Methods: Structured interviews were conducted with 11 parents of children treated for concussion at the Emergency Department of Pasqua Hospital in Regina, SK, four of whom received care after a change in practice whereby parents were provided with a return-to-school protocol form prior to discharge. Data were analyzed using an inductive qualitative content analysis approach using NVivo 12 software. Results: Three main categories were noted in the data: Parental response to the child's concussion, satisfaction with health services, and the communication amongst parents, physicians, and teachers. It was with regard to the last theme in particular that the impact of the return to school protocol was noted, helping to at least indirectly address the issue of the parent as the “middleman” in the communication triad. Most parents whose children received care prior to the introduction of the protocol suggested that providing written information at discharge to guide parents through the concussion recovery process would be helpful. Conclusion: Our initial results show a positive impact in regards to the process of children returning to learn and play after a concussion. Specifically, the increased communication between physician, teacher, and parent seems to benefit and improve the child's recovery process.
The clinical features and symptoms of postpartum psychoses are presented in relation to the classification according to the Research Diagnostic Criteria (RDC) and the concept of “puerperal psychosis”. A number of symptoms, ie confusional symptoms, depersonalization, misrecognitions and the “kaleidoscopic” picture are shown to be prominent features. In schizoaffective disorder and unspecified functional psychosis a higher frequency of confusional symptoms, misrecognitions, thematic delusions and a “kaleidoscopic” course of illness was found compared to schizophrenia, mania or depression. The findings of this study support a special status for postpartum psychosis and suggest a link with the concept of cycloid psychosis. In the management of postpartum mental disorder the risk of child-directed aggression, suicide and sudden relapses into psychosis requires special attention.