НОВЫЕ РЕШЕНИЯ ПОВЫШЕНИЯ ЭКСПЛУАТАЦИОННОЙ УСТОЙЧИВОСТИ ГОРНЫХ ВЫРАБОТОК

Розглянуто два концептуальних підходи про початковий напружено- деформований стан навколо виробок різного призначення. Обґрунтовано наукові передумови зі створення кріплень нового технічного рівня. Представлено блок-схему реалізованих і перспективних заходів щодо створення нових конструкцій металорамних кріплень, які забезпечують ресурсозберігаючу експлуатаційну стійкість гірничих виробок для складних гірничо-геологічних умов. Рассмотрены два концептуальных подхода о начальном напряженно- деформированном состоянии в окрестности выработок различного назначения. Обоснованы научные предпосылки по созданию крепей нового технического уровня. Представлена блок-схема реализуемых и перспективных мероприятий по созданию новых конструкций металлорамных крепей обеспечивающих ресурсосберегающую эксплуатационную устойчивость горных вы- работок для сложных горно-геологических условий. Two conceptual approaches about initial stress-strain state in the vicinity of mine workings of various purpose are considered. Scientific preconditions focused on new technical level mine supports creation are substantiated. Block diagram of the realized and perspective measures focused on new constructions of metal- frame supports creation that provide resource-saving exploitation stability of mine workings for complex mining-geological conditions is presented

Prevalence of challenging behaviour in adults with intellectual disabilities, correlates, and association with mental health

Purpose of Review To summarise findings about the prevalence and correlates of challenging behaviour in adults with intellectual disabilities from robust research. We also describe findings on the interplay between challenging behaviour and mental health. Recent Findings Recent studies that have utilised psychometrically evaluated tools, with clear operational definitions, show similar findings on the prevalence of challenging behaviour of about 1 in every 5–6 adults known to services. We describe common correlates identified such as communication impairments, severity of intellectual disability, and living in institutional settings or congregate care. We also describe the complex and multifaceted relationship between challenging behaviour and mental health. Summary Based on recent studies, we propose a revised framework model to help understand challenging behaviour. We propose a number of areas where more research is required, particularly the development of risk tools clinicians can utilise in practice

Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation

Treatment with psychotropic drugs is highly prevalent in people with intellectual disability, especially in those with behavioural problems. The high rates of psychotropic drug use in this population is contrasted by the limited evidence on their effectiveness and the high risk of adverse events. The overall objective of this thesis was to critically evaluate psychotropic drug use in people with mild to borderline intellectual disability and behavioural problems. This thesis showed that people with intellectual disability are underrepresented in randomised controlled trials (RCTs) of pharmacological treatment of behavioural problems. At the same time psychotropic drugs are used extensively, often for long periods of time and without a clear indication for use. Psychotropic drug use often starts young, with 30% of institutionalised children and adolescents with intellectual disability and behavioural problems being treated with at least one psychotropic drug. Adverse drug events are common in treatment with psychotropic drugs, but are often not diagnosed in people with intellectual disability. Adverse events, such as serious movement disorders are very common, 44% of in-patient adults with mild to borderline intellectual disability and behavioural problems had a movement disorder. To improve the quality of pharmacotherapy a medication review intervention was performed in which the medication used by people with intellectual disability was thoroughly reviewed by a team consisting of the psychiatrist, a pharmacist and a nurse. In over a third of all medications used a drug-related problem was found, that needed intervention. In almost 60% of those cases the recommended actions were also executed. The research in this thesis has increased the knowledge on psychotropic drug use in people with mild to borderline intellectual disability and behavioural problems. The findings from this thesis show that psychotropic drugs play a major role in treatment of people with intellectual disability and behavioural problems, even though the evidence base is weak. People with intellectual disability and behavioural problems are at risk of starting psychotropic drugs at a young age and for unclear indications. The adverse events associated with psychotropic drug use can have a negative impact on the quality of life. To improve care for people with intellectual disability more attention is needed for pharmaceutical care during regular treatment plan evaluations, in combination with periodic structured medication reviews for complicated patients. Prescribing psychotropic drugs in people with intellectual disability and behavioural problems is complicated. The 6-step model of the World Health Organization (WHO) Guide to Good Prescribing can provide tools in the process of prescribing a (psychotropic) drug in people with intellectual disability. We propose the medication review as an additional step (6A) in the 6-step model. In the process of decision-making to start, continue or discontinue (psychotropic) drugs, a multidisciplinary approach is essential

No need for a pregnant pause : physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia

Background: Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability. Methods: In a treatment facility for people with mild to borderline intellectual disability and severe behavioural problems, a structured medication review was performed. Prevalence and type of drug-related problems (DRPs) and of the recommended and executed actions were calculated. Results: In a total of 55 patients with intellectual disability and behavioural problems, 284 medications were prescribed, in which a DRP was seen in 106 (34%). No indication/unclear indication was the most prevalent DRP (70). Almost 60% of the recommended actions were also executed. Conclusions: This high prevalence of DRPs is worrying. The structured medication review is a valuable instrument to optimize pharmacotherapy and to support psychiatrists in adequate prescribing of both psychotropic and somatic drugs

Prevalence and characteristics of psychotropic drug use in institutionalized children and adolescents with mild intellectual disability

Item does not contain fulltextPsychotropic drugs are a cornerstone in the treatment of psychopathology and/or behavioral problems in children with intellectual disability (ID), despite concerns about efficacy and safety. Studies on the prevalence of psychotropic drug use have mainly been focused on adults with ID or children without ID. Therefore the aim of this cross sectional study was to assess the prevalence and characteristics of psychotropic drug use in children with mild ID who were institutionalized in specialized inpatient treatment facilities in The Netherlands. Demographic data, psychiatric diagnoses, the nature of the behavioral problems, level of intellectual functioning, and medication data were extracted from medical records using a standardized data collection form. Adjusted relative risks (ARR) for the association between patient characteristics and psychotropic drug use were estimated with Cox regression analysis. Of the 472 included children, 29.4% (n=139) used any psychotropic drug, of which 15.3% (n=72) used antipsychotics (mainly risperidone), and 14.8% (n=70) used psychostimulants (mainly methylphenidate). Age, sex, and behavioral problems were associated with psychotropic drug use. Boys had a 1.7 (95%CI 1.1-2.4) higher probability of using psychotropic drugs, compared to girls adjusted for age and behavioral problems. Having any behavioral problem was associated with psychotropic drug use with an ARR of 2.1 (95%CI 1.3-3.3), adjusted for sex and age. The high prevalence of psychotropic drug use in children with ID is worrisome because of the lack of evidence of effectiveness (especially for behavioral problems) at this young age, and the potential of adverse drug reactions

Adverse events and the relation with quality of life in adults with intellectual disability and challenging behaviour using psychotropic drugs

Contains fulltext : 155600.pdf (publisher's version ) (Closed access)Background: Psychotropic drugs are prescribed to approximately 30-40% of adults with intellectual disability (ID) and challenging behaviour, despite the limited evidence of effectiveness and the potential of adverse events. Aims: To assess the prevalence of adverse events in association with psychotropic drug use in adults with ID and challenging behaviour and to examine the relation of these adverse events with the person's quality of life. Method: The presence of adverse events was measured with a questionnaire that had to be filled in by the physicians of the participants. Movement disorders were measured separately with a standardised protocol. The strength of the association between adverse events and Intellectual Disability Quality of Life-16 (IDQOL-16), and daily functioning was investigated using linear regression analyses, taking into account the severity of disease (CGI-S) as potential confounder. Results: Virtually all of 103 adults with ID and challenging behaviour had at least one adverse event (84.4%) and almost half had >= 3 adverse events (45.6%) across different subclasses. Using psychotropic drugs increased the prevalence of adverse events significantly. Respectively 13% of the patients without psychotropic drugs and 61% of the patients with >= 2 psychotropic drugs had >= 3 adverse events. Having adverse events had a significantly negative influence on the quality of life. Conclusions: A large majority of all patients had at least one adverse event associated with psychotropic drug use. More attention is needed for these adverse events and their negative influence on the quality of life of these patients, taking into account the lack of evidence of effectiveness of psychotropic drugs for challenging behaviour.9 p