BACKGROUND: Loneliness, a major public health concern, could be alleviated through social interventions with nature contact as a primary component. "Friends in Nature" is a complex nature-based social intervention designed to be implemented as part of "Reimagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces" (RECETAS). This project aims to alleviate loneliness and promote health-related quality of life in six different geographic areas worldwide. Feasibility studies are crucial to assess the viability of complex interventions and study procedures before conducting definitive studies. This paper aims to describe the design, implementation, and evaluation of the six-related feasibility studies on the "Friends in Nature" intervention. These studies specifically evaluate feasibility of recruitment and study procedures, intervention implementation, and data collection and distribution. METHODS: We defined a comprehensive set of indicators to assess the feasibility of "Friends in Nature." For the first domain, recruitment procedures were assessed to determine their adequacy, while attrition rates were examined to assess participant retention. For the second domain, the implementation of interventions was evaluated, along with the study design's ability to adapt to unexpected situations and participant adherence to the intervention. Finally, for the third domain, completion rates and the acceptability of the study activities were also analyzed. The feasibility of using specific scales to assess loneliness and well-being was also explored. RESULTS: The feasibility indicators defined for this study were useful to assess the feasibility of "Friends in Nature." Recruitment procedures were generally found to be adequate, and the number of dropouts was low. Interventions were implemented with minor adjustments, and facilitators played a vital role in the well-functioning of the interventions. Although some unexpected situations occurred during the study, adaptations were made, and participants were generally satisfied with the activities proposed. Scales used to assess loneliness and quality of life showed potential for measuring the effects of nature-based social prescribing in the full trial. CONCLUSION: This paper offers valuable insights into the design and execution of feasibility studies for complex interventions like "Friends in Nature." Findings from these assessments explore the feasibility of "Friends in Nature" and will inform the main RECETAS studies, which are designed to strengthen the evidence base to support the use of nature-based social prescribing to reduce loneliness and promote quality of life. TRIAL REGISTRATION: Barcelona trial: NCT05488496, Prague trial: NCT05522140, and Helsinki trial: NCT05507684.

• Publikační typ
• časopisecké články MeSH

Psychiatrická oddělení jsou místa, kde se setkává celá řada faktorů, které mohou vyústit v nejrůznější formy konfliktů či nežádoucího až ohrožujícího chování. Každý konflikt negativně ovlivňuje celkovou atmosféru na oddělení, má vliv na prožívání personálu a jeho pracovní výkon a také na pacienty, kteří napjatou atmosféru přirozeně vnímají. Příčinám konfliktů na psychiatrických odděleních a jejich spouštěčům se dlouhodobě věnoval tým prof. Lena Bowerse v UK. Výzkumníci se snažili pochopit a popsat základní zdroje konfliktů na psychiatrických odděleních, jejich spouštěče a možné reakce personálu. Na základě rozsáhlých výzkumů pak navrhli určité intervence, jejichž cílem je minimalizovat výskyt konfliktů, nežádoucích událostí a používání omezovacích opatření. Metodika Safewards je v současné době využívána na mnoha pracovištích v celé řadě evropských zemí, např. v Německu, Velké Británii, Dánsku, Švýcarsku, Holandsku, Polsku, Švédsku. Dosavadní zkušenosti s její implementací jsou velmi pozitivní a výsledky byly publikovány v mnoha odborných časopisech.

Psychiatric wards are places where many factors come together that can result in various forms of conflict or unwanted or challenging behaviour. Each conflict has a negative impact on the overall atmosphere of the ward, affecting the experience of staff and their work performance, as well as the patients who naturally perceive the tense atmosphere. The causes of conflicts in psychiatric wards and their triggers have long been the focus of prof. Len Bowers' team in the UK. Researchers have been trying to understand and describe the underlying sources of conflicts on psychiatric wards, their triggers and possible staff responses. Based on extensive research, they then proposed certain interventions aimed at minimising the occurrence of conflicts, adverse events and the use of restraint. The Safewards methodology is currently used in many workplaces in a number of European countries, e.g. Germany, UK, Denmark, Switzerland, the Netherlands, Poland, Sweden. The experience with its implementation so far has been very positive and the results have been published in many professional journals.

• Klíčová slova
• Safewards,
• MeSH
• behaviorální symptomy prevence a kontrola   MeSH
• duševní poruchy psychologie   terapie   MeSH
• hospitalizovaní pacienti psychologie   MeSH
• konflikt (psychologie) MeSH
• lidé MeSH
• porucha chování prevence a kontrola   MeSH
• primární prevence * klasifikace   metody   organizace a řízení   MeSH
• problémové chování * MeSH
• psychiatrické oddělení nemocnice MeSH
• vztahy mezi zdravotnickým pracovníkem a pacientem MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Many biological agents are epidemic or pandemic in nature (Ebola 2013, Spanish influenza 1918, Russian influenza 1989, SARS-CoV-2 2019). Recognising the onset of the spread of epidemics and pandemics remains a major challenge even in the 21st century despite the technologies and scientific knowledge at our disposal, as is the successful management of such situations. The reason concerns the existence of biological diversity and the laws that govern it, which are very difficult to predict and which are virtually uncontrollable. It is gradually becoming apparent that the current spread of SARS-CoV-2 that causes COVID-19 (9 million deaths since the beginning of the pandemic according to WHO) is characterised by very different characteristics (e.g. the exposure, transmission and spread of the viral infectious agent) in different populations and risk groups.Social services workers in the Czech Republic have been on the frontline for the duration of the pandemic and have been required to work in a high-risk infectious environment. This has led to the need for changes in their established working practices and approaches. Considerable creativity had to be employed particularly in the first year of the pandemic due to the scarcity of information on the new viral agent, the availability of which increased only slowly as the scientific community studied and analysed the various factors involved. Globally, the scientific community released its experimental data as soon as it became available; however, unfortunately, due to the nature of biomedical research, the release of the outputs failed to match the time requirements for their necessity in practice.Based on qualitative and quantitative research, the following text provides an analysis of the specific measures and the related difficulties, and the struggle to find solutions, that providers of selected types of social services faced during the spread of the COVID-19 pandemic.The survey results revealed that the issues in question had a common thread across the various types of social services, as well as a number of common features and challenges. The analysis of the results showed a noticeable shift between the initial period, which was characterised by the rapid onset of the spread of the pandemic, and the situation after 18 months of life under pandemic conditions, which was characterised by the lower incidence of problems and difficulties. One of the major outcomes of the study concerns the identification of the need for social service providers to be provided with a unified, clear and centrally managed process that is able to provide individualised methodological support. The results are based on a study conducted as part of "The Changes in Selected Social Services for People with Disabilities during the State of Emergency Instigated by a Viral Disease" project.

• MeSH
• COVID-19 * prevence a kontrola   MeSH
• lidé MeSH
• přístup k informacím MeSH
• průzkumy a dotazníky MeSH
• sociální práce organizace a řízení   MeSH
• sociální pracovníci * statistika a číselné údaje   MeSH
• statistika jako téma MeSH
• zjišťování skupinových postojů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND AND AIMS: Ileocaecal resection (ICR) is frequent in paediatric patients with Crohn's disease (pCD). Despite rates of reoperation being low, the risk of clinical or endoscopic post-operative recurrence (POR) is high; effective medical strategies to prevent POR are thus needed. The aim of this systematic review (SR) was to identify and evaluate the published literature on post-operative medical prevention of POR in pCD to draft a possible therapy guide for pCD patients undergoing ICR. METHODS: We performed an SR according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and registered it in the PROSPERO database (ID: CRD42024533855). The population, intervention, control, outcome (PICO) model was focussed on post-surgical medical prevention of POR in pCD with clearly expressed definition of recurrence (endoscopically using a standardized scoring system (e.g. Rutgeerts score) or by laboratory markers, for example, faecal calprotectin (F-CPT), C-reactive protein (CRP) or by histological findings or by clinical activity indexes [e.g. weighted paediatric Crohn's disease activity index - (w)PCDAI]. From inception until 29 February 2024, the following databases were searched: PubMed/MEDLINE, Scopus/Embase, Web of Sciences, Evidence-Based Medicine Reviews (including Cochrane), Cochrane Central Registrar of controlled Trials (CENTRAL), ClinicalTrials.gov and EudraCT. Retrieved articles were evaluated for eligibility and finally selected publications for risk of bias using ROBINS-I tool. RESULTS: Out of 811 publications identified by the search, only 5 fulfilled inclusion criteria of the SR. None of the studies fully answered our PICO question. The studies were overall of poor quality and the heterogeneity of the data did not allow us to perform meta-analysis, detailed statistical analysis or formal synthesis of data. Adverse events of post-operative medication were not described in any of the included studies. Existing guidelines of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), European Crohn's and Colitis Organisation (ECCO) and American Gastroenterological Association (AGA) were reviewed and paediatric therapy guide for pCD undergoing ICR was drafted with respect to recent SRs and meta-analyses in adult population and including scarce paediatric data identified by our SR. As pCD patients undergoing ICR are a high-risk population, they should not be left untreated post-operatively. Anti-tumour necrosis factor (anti-TNF) drugs should be considered as first-line therapy in the majority of patients. Non-anti-TNF biologics should be considered in case of anti-TNF failure. Regular endoscopic monitoring starting at 6 months after the surgery and supported by regular F-CPT evaluation should be used to identify early endoscopic recurrence and to escalate the treatment. CONCLUSION: Our SR revealed that there is wide variability in treatment strategies in children, and high-quality data are generally lacking. At the moment, paediatric prophylaxis of POR should be guided by available adult evidence with respect to the high-risk nature of pCD. Extensive research in pCD should be encouraged.

• MeSH
• cékum chirurgie   MeSH
• Crohnova nemoc * chirurgie   prevence a kontrola   MeSH
• dítě MeSH
• ileum chirurgie   MeSH
• lidé MeSH
• pooperační komplikace prevence a kontrola   MeSH
• recidiva * MeSH
• sekundární prevence metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

Systematické vzdělávání v jednooborovém vysokoškolském pregraduálním programu v rámci primární prevence rizikového chování není v České republice doposud akreditováno. Z tohoto důvodu jsou profesionálové, kteří v prevenci působí ve školách a školských zařízeních (primárně se jedná o školní metodiky prevence), odkázáni na institut celoživotního anebo dalšího vzdělávání pedagogických pracovníku. Jednou z možností profesního rozvoje preventivních pracovníku je podpora principu komunitní prevence. V rámci tohoto přístupu dochází k zapojení širokého spektra subjektu, jejichž role je v rámci prevence nezastupitelná, k jejich vzájemnému (pozitivnímu) ovlivňování, vzdělávání, kolaborativnímu učení a sdílení dobré praxe. V článku představujeme projekt Vývoj a pilotní ověření regionálního vzdělávacího modulu prevence duševního onemocnění dětí a dospívajících s důrazem na rizikové chování (dále jen „Coperisk“), resp. jeho klíčové výstupy. Jeho cílem bylo vytvořit, pilotně implementovat a evaluovat komplexní komunitní preventivní program, založený právě na nových a převzatých intervenčních nástrojích. Ten se zaměřoval na tři vybrané formy rizikového chování – závislosti a závislostní chování (látkové i nelátkové), sebepoškozování a poruchy příjmu potravy. Projektové aktivity byly realizovány ve třech na základe analýz vybraných lokalitách – Praha 11, Orlová a Havířov. Cílovou skupinou byli profesionálové, kteří participují v dané komunitě/ mikroregionu na prevenci rizikového chování. Jednalo se zejména o pedagogické pracovníky (zejm. školní metodiky prevence, výchovné poradce), pracovníky orgánu sociálně právní ochrany dětí (dále jen „OSPODu“ policisty a strážníky, pediatry a samozřejmě i ty, kteří z právního hlediska nesou odpovědnost za výchovu svých dětí – zákonné zástupce.

Systematic education conceived as a single-major undergraduate and graduate academic programme in the prevention of risk behaviour has not yet been accredited in the Czech Republic. Therefore, professionals engaged in school-based prevention (mainly those in the position of school prevention workers) must rely on institutions providing lifelong learning for education professionals. One possible way of supporting prevention workers' professional growth is to promote the principles of community prevention. Such an approach facilitates the involvement of a wide range of stakeholders who play key roles in prevention efforts, their (positive) interaction, education and training, collaborative learning, and sharing good practices. The paper describes the project titled The Development and Pilot Testing of a Regional Educational Module to Prevent Mental Illness among Children and Adolescents with an Emphasis on Risk Behaviour (“Coperisk”) and its key deliverables. The project sought to develop, pilot, and evaluate a comprehensive community-based prevention programme underpinned by new and adapted intervention tools. It addressed three selected forms of risk behaviour – substance use and other addictions, self-harming, and eating disorders. The project activities were implemented in three locations – the Prague 11 District and the municipalities of Orlová and Havířov – selected on the basis of analysis. The target group comprised professionals involved in the prevention of risk behaviour in the given communities/ microregions. These included education professionals (especially school prevention workers and school counsellors), child protection officers, law enforcement officers, paediatricians, and, of course, those who are by law responsible for the upbringing of their children, i.e. natural or legal guardians.

• MeSH
• chování snižující riziko MeSH
• duševní poruchy * etiologie   prevence a kontrola   MeSH
• lidé MeSH
• návykové chování prevence a kontrola   psychologie   terapie   MeSH
• poruchy příjmu potravy prevence a kontrola   psychologie   terapie   MeSH
• primární prevence metody   MeSH
• rodiče MeSH
• sebepoškozování prevence a kontrola   psychologie   terapie   MeSH
• školní zdravotnické služby MeSH
• služby v oblasti duševního zdraví komunity organizace a řízení   MeSH
• výchova a vzdělávání metody   MeSH
• zdravotně rizikové chování MeSH
• Check Tag
• lidé MeSH

OBJECTIVE: To ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour. DESIGN: Ethical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses. SETTING: The Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. MEASUREMENTS AND FINDINGS: Descriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had 'checking' visits from the midwife in labour. KEY CONCLUSIONS: Findings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent. IMPLICATIONS FOR PRACTICE: The examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.

• MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• porodní děj psychologie   MeSH
• postoj zdravotnického personálu MeSH
• průzkumy a dotazníky MeSH
• těhotenství MeSH
• těhotné ženy psychologie   MeSH
• uznání * MeSH
• vedení porodu psychologie   MeSH
• vztahy mezi zdravotnickým pracovníkem a pacientem MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Gene therapy is a focus of interest in both human and veterinary medicine, especially in recent years due to the potential applications of CRISPR/Cas9 technology. Another relatively new approach is that of epigenetic therapy, which involves an intervention based on epigenetic marks, including DNA methylation, histone post-translational modifications, and post-transcription modifications of distinct RNAs. The epigenome results from enzymatic reactions, which regulate gene expression without altering DNA sequences. In contrast to conventional CRISP/Cas9 techniques, the recently established methodology of epigenetic editing mediated by the CRISPR/dCas9 system is designed to target specific genes without causing DNA breaks. Both natural epigenetic processes and epigenetic editing regulate gene expression and thereby contribute to maintaining the balance between physiological functions and pathophysiological states. From this perspective, knowledge of specific epigenetic marks has immense potential in both human and veterinary medicine. For instance, the use of epigenetic drugs (chemical compounds with therapeutic potential affecting the epigenome) seems to be promising for the treatment of cancer, metabolic, and infectious diseases. Also, there is evidence that an epigenetic diet (nutrition-like factors affecting epigenome) should be considered as part of a healthy lifestyle and could contribute to the prevention of pathophysiological processes. In summary, epigenetic-based approaches in human and veterinary medicine have increasing significance in targeting aberrant gene expression associated with various diseases. In this case, CRISPR/dCas9, epigenetic targeting, and some epigenetic nutrition factors could contribute to reversing an abnormal epigenetic landscape to a healthy physiological state.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Oculomotor deficits are common in hereditary ataxia, but disproportionally neglected in clinical ataxia scales and as outcome measures for interventional trials. Quantitative assessment of oculomotor function has become increasingly available and thus applicable in multicenter trials and offers the opportunity to capture severity and progression of oculomotor impairment in a sensitive and reliable manner. In this consensus paper of the Ataxia Global Initiative Working Group On Digital Oculomotor Biomarkers, based on a systematic literature review, we propose harmonized methodology and measurement parameters for the quantitative assessment of oculomotor function in natural-history studies and clinical trials in hereditary ataxia. MEDLINE was searched for articles reporting on oculomotor/vestibular properties in ataxia patients and a study-tailored quality-assessment was performed. One-hundred-and-seventeen articles reporting on subjects with genetically confirmed (n=1134) or suspected hereditary ataxia (n=198), and degenerative ataxias with sporadic presentation (n=480) were included and subject to data extraction. Based on robust discrimination from controls, correlation with disease-severity, sensitivity to change, and feasibility in international multicenter settings as prerequisite for clinical trials, we prioritize a core-set of five eye-movement types: (i) pursuit eye movements, (ii) saccadic eye movements, (iii) fixation, (iv) eccentric gaze holding, and (v) rotational vestibulo-ocular reflex. We provide detailed guidelines for their acquisition, and recommendations on the quantitative parameters to extract. Limitations include low study quality, heterogeneity in patient populations, and lack of longitudinal studies. Standardization of quantitative oculomotor assessments will facilitate their implementation, interpretation, and validation in clinical trials, and ultimately advance our understanding of the evolution of oculomotor network dysfunction in hereditary ataxias.

• MeSH
• biologické markery MeSH
• konsensus * MeSH
• lidé MeSH
• pohyby očí fyziologie   MeSH
• poruchy hybnosti oka diagnóza   patofyziologie   genetika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

Úvod: Depresivní porucha, jako jedno z nejčastějších duševních onemocnění, nepříznivě ovlivňuje životy a zdravotní stav mnoha lidí po celém světě. Vyskytuje se v jakémkoliv věku, nejčastěji však mezi 20. a 40. rokem života. Celosvětově trpí každoročně depresivními poruchami přibližně 100 milionů lidí, přičemž u řady jedinců je terapie doprovázena částečnou léčebnou odpovědí nebo přímo rezistencí k léčbě, což trvale zvyšuje potřebu hledání efektivních strategií prevence a léčby, ale také průběžné monitorování a vyhodnocování aktuálně využívaných přístupů v běžné klinické praxi. Materiály a metody: Šířeji koncipovaná studie s pracovním názvem UMBRELLA byla neintervenční, observační, multicentrická studie, jejíž první etapa je zaměřená na tzv. "real world evidence" důvodů pro změnu psychofarmakologické léčby a jejího detailního charakteru u pacientů trpících depresivní epizodou periodické depresivní poruchy. Do závěrečného vyhodnocení byla zařazena data 267 pacientů léčených v psychiatrických ambulancích v České republice, které na sondě mapující reálnou klinickou praxi participovaly. Výsledky: Analyzována byla data od 74 mužů (27,7 %) a 193 žen (72,3 %) s průměrným věkem 49 let. Změny léčby byly prováděny lékařem na základě vyhodnocení přítomných reziduálních příznaků onemocnění, přičemž nejčastějšími problémy byly perzistující depresivní nálada, únava a anhedonie. Nejčastěji používané léčivé přípravky zahrnovaly antidepresiva (např. escitalopram, venlafaxin, sertralin), atypická antipsychotika (např. quetiapin) a klasická antipsychotika (např. chlorprothixen). Úprava farmakologické léčby byla nejčastěji provedena manipulací s antidepresivy, změnou účinné látky či úpravami jejich denních dávek. Diskuse a závěr: Předkládaná naturalistická observační studie zmapovala důvody pro změnu farmakologického přístupu a vlastní charakter nově zvolené léčebné strategie. Zjištěná heterogenita způsobů manipulace s farmakologickou léčbou potvrzuje, že léčba depresivních epizod v klinické praxi probíhá individualizovaným postupem u každého jednotlivého pacienta. Zde narážíme na snahu po uplatňování doporučených postupů v léčbě tohoto rozšířeného duševního onemocnění, které velmi efektivně popisují léčbu iniciálních epizod a v případě opakovaných epizod by také měly obsahovat základní principy terapeutického přístupu k řešení této problematiky. Zjištění, že i v rámci opakovaných epizod periodické depresivní poruchy lze efektivně zasáhnout zvýšením dávky antidepresiva nebo jeho změnou, podporuje snahu po edukaci specialistů i praktických lékařů v těchto bazálních postupech léčby. Celkově studie přináší informace reflektující běžnou klinickou praxi a podtrhuje význam iniciace strategie změny farmakologického přístupu u každého pacienta, v kterékoliv etapě léčby tohoto duševního onemocnění.

Introduction: Depressive disorder, as one of the most common mental illnesses, adversely affects the lives and health of many people around the world. It occurs at any age, but most commonly between the ages of 20 and 40. Worldwide, approximately 100 million people suffer from depressive disorders each year, with many individuals experiencing partial treatment response or treatment resistance, which continually increases the need to find effective prevention and treatment strategies, as well as to monitor and evaluate currently used approaches in routine clinical practice. Materials and methods: The more broadly conceived study, working title UMBRELLA, was a non-interventional, observational, multicentre study, the first phase of which focused on the so-called "real world evidence? of reasons for changing psychopharmacological treatment and its detailed nature in patients suffering from a depressive episode of periodic depressive disorder. The final evaluation included data from 267 patients treated in psychiatric outpatient clinics in the Czech Republic that participated in the probe into their own clinical practice. Results: Data from 74 men (27.7%) and 193 women (72.3%) with a mean age of 49 years were analysed. Changes in treatment were made by the physician based on an assessment of the residual symptoms present, with persistent depressed mood, fatigue and anhedonia being the most common problems. The most commonly used medications included antidepressants (e.g., escitalopram, venlafaxine, sertraline), atypical antipsychotics (e.g., quetiapine), and classic antipsychotics (e.g., chlorprothixene). Adjustments to pharmacological treatment were most commonly made by manipulating antidepressants, changing the active ingredient, or modifying their daily doses. Discussion and conclusion: The present naturalistic observational study mapped the reasons for the change in pharmacological approach and the actual nature of the newly chosen treatment strategy. The observed heterogeneity of pharmacological treatment manipulation patterns confirms that the treatment of depressive episodes in clinical practice follows an individualized approach for each individual patient. Here, we encounter a desire for the application of recommended practices in the treatment of this widespread mental illness, which very effectively describe the treatment of initial episodes and, in the case of recurrent episodes, should provide the basic principles of a therapeutic approach to the management of this problem. The finding that, even in the context of recurrent episodes of periodic depressive disorder, effective intervention can be achieved by increasing the dose of antidepressant medication or changing it, supports the drive to educate specialists and practitioners in these basic treatment approaches. Overall, the study provides information that reflects common clinical practice and underscores the importance of initiating a strategy to change the pharmacological approach in any patient, at any stage of the treatment of this mental illness.

• MeSH
• ambulantní péče MeSH
• antidepresiva klasifikace   terapeutické užití   MeSH
• antipsychotika klasifikace   terapeutické užití   MeSH
• deprese nereagující na léčbu farmakoterapie   patofyziologie   prevence a kontrola   MeSH
• kombinovaná farmakoterapie MeSH
• lékařská praxe založená na důkazech MeSH
• lidé středního věku MeSH
• lidé MeSH
• revize medikace MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• multicentrická studie MeSH
• pozorovací studie MeSH

PURPOSE: Global population growth and increasing longevity means that the need for Assistive Technology (AT) will continue to increase. The level of unmet need for AT is greatest in low-income settings. The aim of this study is to identify age-related increase in impairment and to estimate the AT needs. MATERIALS AND METHODS: We analysed secondary data from the 2018 Malawi Population and Housing Census (MPHC) based on the Washington Group on Disability Statistics (WG) short-set of questions. RESULTS: Out of the 1,556,670 persons with one or more functional limitations or disabilities identified in the census, self-reported difficulties in all domains were markedly higher from age 40 and above. The proportion reporting one functional limitation is higher compared to two or more limitations, but at age 78-80 the proportion reporting two or more functional limitations increased above those reporting one functional limitation. Although 60.9% (60.7-61.0) and 63.5% (63.3-63.6) of those who reported difficulty in seeing and hearing were using glasses and hearing aids respectively, the estimated total need for glasses and hearing aids in this group was 98.9% (98.0-99.0) and 98.4% (98.3-98.5) respectively. The unmet need for glasses and hearing aids were therefore 38.1% and 34.9% respectively. CONCLUSION: The differential slope of impairment curves against age is a guide to the increasing demand for AT across the life course and across different domains of functioning. Country specific analysis of impairment across age and domains is essential to understand and plan for the growing need for AT globally.IMPLICATIONS FOR REHABILITATIONIt is important to estimate and plan for impairment across life course to address the age-related increase in impairment and the increasing need for AT with age.The Zomba curves show the cumulative nature of impairment with age and the need for age and need specific provision of AT across the life course through proactive policy level actions.The significant high unmet need for glasses and hearing aids attests to similar need for other assistive products and the need for setting specific interventions to address needs of affected persons.The differential slope of impairment curves against age is a guide to the differing and increasing demand for assistive technology across the life course and across different domains of functioning.

• MeSH
• dospělí MeSH
• dostupnost zdravotnických služeb MeSH
• lidé MeSH
• pomůcky pro sebeobsluhu * MeSH
• postižení * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sluchové pomůcky * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Malawi MeSH