Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition

Background: Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs. Methods: The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process. Results: Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as strongly agree or somewhat agree (68-88 across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications. Conclusions: A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment. Copyright © International Psychogeriatric Association 2014

Integrating the Technical, Risk Management and Economic Implications of Animal Disease Control to Advise Policy Change: The Example of Foot-and-Mouth Disease Control in Uruguay

Countries contemplating a change in their animal disease control policy face a variety of considerations, particularly in circumstances in which disease status, and the use (or not) of vaccines to control or minimise disease risk, has major implications for international trade. Foot-and-mouth disease (FMD) exemplifies these trade-offs, and is particularly important in South America, where FMD virus circulation has declined and appears limited to certain regions. As a result, opportunities for higher-value exports in sustainably produced pasture-fed beef and lamb are growing. Uruguay is arguably at the forefront of these developments. It is renowned for an efficient livestock production base, high standards of animal health, and a pasture-based, extensive feeding system. Uruguay exports over four per cent of the world’s fresh and frozen meat (https://oec.world/en/profile/country/ury/), and in 2018, 70% of these exports went to China (Joseph 2019). Parts of neighbouring countries such as Brazil, Argentina and Paraguay share the advantages of pasture-based feeding, and also aspire to sell to more diverse international markets. Export market access for all these countries depends on the successful control of FMD. A country’s FMD status (whether endemic, free with vaccination, or free without vaccination) has implications for market access and prices, and these depend on trading partners’ willingness to accept different levels of risk. Some of the highest value markets for beef, such as Japan and Korea, only allow imports from the very small subset of countries that are FMD-free without vaccination against FMD (Rich and Winter-Nelson 2007). Uruguay and its neighbours are contemplating new FMD policy measures, including the cessation of blanket vaccination, in order to improve the quality, quantity and diversity of their markets. This will also contribute to the broader hemispheric aspirations of PHEFA (Hemispheric Foot and Mouth Disease Control Programme 2011–2020), together with the countries of South America and Panama, to eradicate FMD under the coordination of PANAFTOSA.Footnote1 In May 2019, the Uruguayan Ministry of Livestock, Agriculture and Fisheries (MGAP), the Instituto Nacional de Investigación Agropecuaria (INIA), and the Instituto Nacional de Carnes (INAC) jointly commissioned an independent evaluation of the implications of moving to a no FMD vaccination policy in the country, and to assess the technical, risk management and economic implications of any such change. The authors undertook this study, and in-country meetings and workshops were conducted in May, June, August and October 2019. Here, we present the study results and the broader implications of such interdisciplinary team studies to underlie animal health policy change in other counties and for other trade-related diseases

Craniocerebral involvement in lymphoma

Nine-hundred-eighty-nine patients with lymphoma were studied. Fifty-three cases (5.3%) had lymphomatous craniocerebral infiltration. The principal factors of risk for this complication were: advanced stage of the lymphoma (III or IV), diffuse histiocytic, diffuse poorly differentiated lymphocytic, or mixed cellularity lymphoma histological type, bone marrow involvement, and previous systemic chemotherapy. Thirty-two per cent of the cases of meningeal lymphomatous infiltration were asymptomatic and represented autopsy findings. CT-scan was an useful test to detect brain focal parenchymatous infiltration, as opposed to meningeal infiltration. Mean survival time in patients with lymphomatous meningeal infiltration was 4.3 months, following the combined use of systemic chemotherapy, radiation therapy and intrathecal methotrexate. Two cases had primary cerebral lymphoma, although without associated immunodeficiency Twenty patients (2%) had intracranial hemorrhage, in clear relationship with platelet alterations. Fifteen patients (1.5%) had CNS infection, caused by common bacteriae or opportunistic agents. In 7 cases, the diagnosis was made at autopsy. Thirty-six autopsies were performed. In 8 cases (22%), pathologic findings such as, demyelination, microcalcificat ons, coagulative necrosis, or gliosis, suggested complications from treatment

ENCOMS: Argentinian survey in cost of illness and unmet needs in multiple sclerosis

The objective of the study was to assess the cost of multiple sclerosis (MS) patients in Argentina categorized by disease severity using a societal perspective. Method: Cross-sectional study including MS patients from 21 MS centers in 12 cities of Argentina. Patients were stratified by disease severity using the expanded disability status scale (EDSS) (group 1 with EDSS score between 0 and 3; group 2 with EDSS >3 and 3 and <7, and USD 50,712 (95%CI 47,825-62,104) for patients with EDSS ≥7. Conclusions: This is the first Argentine study evaluating the costs of MS considering disease severity

Comunidade, globalização e educação: um ensaio sobre a desconversão do social Community, globalization and education: an essay about deconverting the social instance

Junto com algumas teorias sociológicas clássicas produzidas entre os séculos XIX e XX, o texto começa problematizando a constituição histórica do "social estatal-nacional". Analisam-se os processos em curso que marcam sua "desconversão". As palavras-chave desses processos são "comunidade" e " globalização". A partir desta premissa teórica, conclui-se, fazendo uma reflexão sobre algumas das realidades sócio-educacionais do presente.<br>Taking some of the classical sociological theories produced between the 19th and the 20th centuries, the text starts with the questioning of the historical constitution of a construct named "lo social-estato-nacional". The current processes which evidence its "desconversión" are then analyzed. The key words of these processes are "community" and "globalization". With a basis on this theoretical premise, conclusions are drawn on some of the socio-educational realities of the present times

Ciclos longos e cenários contemporâneos da sociedade internacional Long cycles of the international society

A despeito da anarquia que resulta da ausência uma autoridade legítima comum, as relações internacionais pós-Westphalia têm elementos de ordem que são suficientes para caracterizá-las como uma forma de "associação prática". Esses elementos são a (igual) soberania nacional, a diplomacia, o direito internacional e o equilíbrio de poder. Discute-se, neste artigo, em que medida esses pilares da ordem mundial pós-Westphalia ainda se prestam para pensar as relações internacionais no pós-Guerra Fria. Trata-se de saber em que medida essas relações hoje se afastam do modelo de "associação prática" em direção a um modelo, normativamente mais exigente, de "associação de objetivos".<br>Despite the lack of a common legitimate authority the international relations after Westphalia share enough elements of order for being characterized as a form of "practical association": (equal) national sovereignty, diplomacy, international law and the balance of power. The fit-ness of those pilars of the post-Westphalian world order for thinking the international relations after the Cold War is discussed. It is asked how far those relations are leaving the model of a practical association towards another normatively more demanding model, of "goals association"