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Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, a condition occurring in more than 40 million people worldwide. BPSD present a considerable treatment challenge for prescribers and healthcare professionals. Our purpose was to prioritize existing and emerging treatments for BPSD in Alzheimer's disease (AD) overall, as well as specifically for agitation and psychosis.
International Delphi consensus process. Two rounds of feedback were conducted, followed by an in-person meeting to ratify the outcome of the electronic process.
2015 International Psychogeriatric Association meeting.
Expert panel comprised of 11 international members with clinical and research expertise in BPSD management.
Consensus outcomes showed a clear preference for an escalating approach to the management of BPSD in AD commencing with the identification of underlying causes. For BPSD overall and for agitation, caregiver training, environmental adaptations, person-centered care, and tailored activities were identified as first-line approaches prior to any pharmacologic approaches. If pharmacologic strategies were needed, citalopram and analgesia were prioritized ahead of antipsychotics. In contrast, for psychosis, pharmacologic options, and in particular, risperidone, were prioritized following the assessment of underlying causes. Two tailored non-drug approaches (DICE and music therapy) were agreed upon as the most promising non-pharmacologic treatment approaches for BPSD overall and agitation, with dextromethorphan/quinidine as a promising potential pharmacologic candidate for agitation. Regarding future treatments for psychosis, the greatest priority was placed on pimavanserin.
This international consensus panel provided clear suggestions for potential refinement of current treatment criteria and prioritization of emerging therapies.
To examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes.
Fruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments.
Participants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2·88 (95 % CI 1·52, 4·25) servings weekly; the average increase from start to follow-up was 2·52 (95 % CI 1·09, 3·95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments.
Environmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.
There are two paths that gifted children can follow that can be facilitated by educators within the context of the public school system, and that subsequently will lead to productive lives. These paths reflect educational responses to two unique, although partially overlapping, domains of giftedness. The proposed overall construct of giftedness is not a totally new construct, but rather is a reflection of an attempt to resolve an artificial dichotomy that seems to have evolved in the gifted literature.
The conception of giftedness proposed is one based on student learning and performance needs, hence the label child-responsive model. The model accepts, while adapting, some basic premises of two existing paradigms of giftedness that have competed for attention in the schools. It is predicated on the belief that the school environment should recognize the behaviors and characteristics of the exceptional learner from these two realms and respond to the concomitant learner needs in each group by creating learning environments that will maximize the opportunities for exceptional learners to extend their achieved and potential expertise in areas of high performance. The response involves creating the most challenging learning tasks – requiring students to utilize the knowledge, skill, and understanding they bring to the situation at the highest level possible, but also challenging them to extend those achievements beyond their current stage of accomplishment. In other words, learning experiences should be based on Vygotsky's (1978) notion of zone of proximal development across the domains of performance excellence that the gifted learner brings to the learning situation.
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