Kleinschalig wonen voor ouderen met dementie: een begripsverheldering

Small-scale group living for elderly with dementia: a clarification This article discusses the results of a Concept Mapping, held to clarify the concept of small-scale group living for elderly with dementia. Seventeen experts from different backgrounds formulated 91 statements about small-scale group living. These were subsequently depicted on a concept map with two dimensions: care versus living and individual versus context. The statements were then divided into six clusters by hierarchical clusteranalysis. Five of these clusters centred around the arrangements of the individual lives of the residents and the collective lives of residents and staff, while only one held statements about the physical characteristics of small-scale group living. Therefore, it can be concluded from this Concept Map that small-scale group living is not so much determined by the physical characteristics but by the organisational features of the care context.     

Comments on cephalometrical configurations of the Japanese

Cephalometrical configurations of Japanese people were investigated on two hundred and sixteen groups living on the four main islands of Japan: Hokkaido, Honshu, Shikoku, and Kyushu. The Japanese in Honshu were divided geographically into a narrow-featured eastern major group and a broad-featured western major group. A physical characteristic of Japanese living in the western mid-Honshu was the lengthened feature of their cephalic measurement, an influence of a long-headed group of Korean people; Japanese residents in eastern mid-Honshu, however, showed the result of mixing with a short-headed group of Korean people. Japanese people living in Hokkaido, the northernmost island, and in the Ryukyu Islands in the South of Japan, presented no important finding which suggests their influence on the physical characteristics of the Japanese. Ongoing studies indicating physical relationships between Kyushu or Shikoku residents and Honshu residents, are as yet insufficient.     

Urban Kampongs in Ambon: Whose Domain? Whose Desa?

A devastating fire in a poor quarter of the city of Ambon, Eastern Indonesia, provided the context in which a number of the social, cultural and historical factors shaping the lives of the city's residents came to the fore. The paper argues that to comprehend the experiences of people whose lives were touched by the fire, and to appreciate its significance, the meanings ascribed to the event, it is necessary to comprehend those multiple factors in all their complexity and interpenetration. The paper argues that the symbolic construction of urban space and its constitution as ‘place’ are continuously emergent out of processes which appear in transformational moments, such as this fire. Physical changes to the quarter through time are examined to demonstrate their relevance to understanding the contemporary social processes and their local interpretations. The migratory origins of the people; continuing divisions between Christian and Muslim populations; the ongoing relevance of ancestral spirits and magic; the role of colonial and postcolonial states, and Ambon's strategic position, are all argued to be important to understanding the meaning of the place and the use of space in the city. The implications of the intersection of at least four clusters of ideas about space and place are considered critical to any adequate account of the contemporary lives of Ambonese and to explaining how it comes to be that some residents can become permanently displaced. The argument emphasises the processual nature of the understandings of space in the urban context.     

An Evaluation of Dog-Assisted Therapy for Residents of Aged Care Facilities with Dementia

ABSTRACT

Although some research suggests that dog-assisted therapy may be beneficial for people with dementia living in residential aged care facilities, the intervention has not been adequately investigated. To address this shortcoming, we conducted a randomized controlled trial of dog-assisted therapy versus a human-therapist-only intervention for this population. Fifty-five residents with mild to moderate dementia living in three Australian residential aged care facilities completed an 11-week trial of the interventions. Allocation to the intervention was random and participants completed validated measures of mood, psychosocial functioning, and quality of life (QOL), both prior to and following the intervention. No adverse events were associated with the dog-assisted intervention, and following it participants who had worse baseline depression scores demonstrated significantly improved depression scores relative to participants in the human-therapist-only intervention. Participants in the dog-assisted intervention also showed significant improvements on a measure of QOL in one facility compared with those in the human-therapist-only group (although worse in another facility that had been affected by an outbreak of gastroenteritis). This study provides some evidence that dog-assisted therapy may be beneficial for some residents of aged care facilities with dementia.     

从蒙古人种典型体质特征发生率谈维吾尔族人种构成及演化

探讨维吾尔族的族源、人种构成、体质特征及演化过程可以更好地揭示该民族的历史与文化变迁的过程,有益于对该民族的保护和促进发展。关于维吾尔族的族源、人种构成及演化过程一直是争论的热点之一。考古人类学,尤其是分子考古的成果显示,新疆古代居民种族来源不是单一的,人种地理分布主要包含欧罗巴人种和蒙古人种两大成分,同时也有两大人种之间过渡的混血类型构成新疆地区复杂的人种类型。现代新疆维吾尔族体质特征和遗传性状的多态性,特别是不同地区维吾尔族之间的差异,无疑和这种古代复杂的种族生物学背景密切相关。现代维吾尔族主要表现蒙古人种的体质特征,表明现代维吾尔族的人种来源主要是蒙古人种。而部分蒙古人种标志性体质特征在维吾尔族的发生率介于欧罗巴人种和蒙古人种之间,显示现代维吾尔族具有相当成分的欧罗巴人种血统。蒙古人种标志性体质特征在新疆维吾尔自治区不同地区维吾尔族中发生率不同并呈现出东西方向梯度性变化趋势,体现现代维吾尔族在形成过程中,蒙古人种成分是由东部逐渐向西部渗入和融合的。     

Model-based reasoning: using visual tools to reveal student learning

Using visual models is common in science and should become more common in classrooms. Our research group has developed and completed studies on the use of a visual modeling tool, the Concept Connector. This modeling tool consists of an online concept mapping Java applet that has automatic scoring functions we refer to as Robograder. The Concept Connector enables students in large introductory science courses to visualize their thinking through online model building. The Concept Connector's flexible scoring system, based on tested grading schemes as well as instructor input, has enabled >1,000 physiology students to build maps of their ideas about plant and animal physiology with the guidance of automatic and immediate online scoring of homework. Criterion concept maps developed by instructors in this project contain numerous expert-generated or "correct" propositions connecting two concept words together with a linking phrase. In this study, holistic algorithms were used to test automated methods of scoring concept maps that might work as well as a human grader.     

Women's health. The childbearing years and after.

Health and development planners have tended to see women primarily in context of their reproductive role. As a result, solutions to women''s health needs have been restricted to expanding and improving maternal and child health systems. There has recently been a major shift in direction, largely because of the influence of the world conference on population and development held in Cairo in 1994. Dr Guiseppe Benagiano, director of the special programme of research, development and research training in human reproduction based at the WHO, says, "We need to remind ourselves constantly that reproductive health is not simply a biomedical issue but one with serious implications for our general health and by extension, for all our efforts in human social and economic development." The 1993 world development report on health identified the lack of a clear strategy for engaging women in health care and suggested that child health services, prenatal care, treatment of sexually transmitted diseases, and family planning services should be provided jointly at convenient times. In an example of this, the Chilean Institute of Reproductive Medicine now offers integrated family planning services at the same time as child health services, and Thailand is experimenting with mobile health clinics to reach women in their homes. As the proportion of elderly women increases, old age is increasingly being seen as a female issue. With the impact of urbanisation and industrialisation, more of these women are living isolated lives, often suffering from chronic debilitating diseases. In his opening statement to the global commission on women''s health in April 1995 which focused on health conditions of women in old age, Dr Hiroshi Nakajima, the WHO''s director general, said: "Our goal should not be solely to extend lives in the physical sense, but to ensure that the added years are worth living."     

Symptom Clusters in People Living with HIV Attending Five Palliative Care Facilities in Two Sub-Saharan African Countries: A Hierarchical Cluster Analysis

BackgroundSymptom research across conditions has historically focused on single symptoms, and the burden of multiple symptoms and their interactions has been relatively neglected especially in people living with HIV. Symptom cluster studies are required to set priorities in treatment planning, and to lessen the total symptom burden. This study aimed to identify and compare symptom clusters among people living with HIV attending five palliative care facilities in two sub-Saharan African countries.MethodsData from cross-sectional self-report of seven-day symptom prevalence on the 32-item Memorial Symptom Assessment Scale-Short Form were used. A hierarchical cluster analysis was conducted using Ward’s method applying squared Euclidean Distance as the similarity measure to determine the clusters. Contingency tables, X² tests and ANOVA were used to compare the clusters by patient specific characteristics and distress scores.ResultsAmong the sample (N=217) the mean age was 36.5 (SD 9.0), 73.2% were female, and 49.1% were on antiretroviral therapy (ART). The cluster analysis produced five symptom clusters identified as: 1) dermatological; 2) generalised anxiety and elimination; 3) social and image; 4) persistently present; and 5) a gastrointestinal-related symptom cluster. The patients in the first three symptom clusters reported the highest physical and psychological distress scores. Patient characteristics varied significantly across the five clusters by functional status (worst functional physical status in cluster one, p<0.001); being on ART (highest proportions for clusters two and three, p=0.012); global distress (F=26.8, p<0.001), physical distress (F=36.3, p<0.001) and psychological distress subscale (F=21.8, p<0.001) (all subscales worst for cluster one, best for cluster four).ConclusionsThe greatest burden is associated with cluster one, and should be prioritised in clinical management. Further symptom cluster research in people living with HIV with longitudinally collected symptom data to test cluster stability and identify common symptom trajectories is recommended.     

THE SPECIES OF THE BIRDS-OF-PARADISE (PARADISAEIDAE): APPLYING THE PHYLOGENETIC SPECIES CONCEPT TO A COMPLEX PATTERN OF DIVERSIFICATION

Abstract The phylogenetic species concept is applied for the first time to a major radiation of birds, the birds-of-paradise (Paradisaeidae) of Australasia. Using the biological species concept, previous workers have postulated approximately 40–42 species in the family. Of these, approximately 13 are monotypic and 27 are polytypic with about 100 subspecies. Phylogenetic species are irreducible (basal) clusters of organisms (terminal taxa) that are diagnosably distinct from other such clusters. Within the context of this concept, approximately 90 species of paradisaeids are postulated to have diversified within Australasia. The phylogenetic species concept more accurately describes evolutionary diversity within the family and provides a better theoretical and empirical framework for analysing speciation, historical biogeography and patterns of morphological, behavioral and ecological diversification within this group than does the biological species concept.     

Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech-language pathologists and dental hygienists

doi: 10.1111/j.1741‐2358.2011.00513.x Health care professionals’ perspectives on oral care for long‐term care residents: Nursing staff, speech–language pathologists and dental hygienists Background: Oral health has been identified as a key factor in general health and systemic disease in long‐term care populations. To optimise oral health of this population, it is important to understand the oral care perspectives held by health care professionals involved in oral care provision. Objectives: To explore perspectives regarding oral care held by nursing staff, speech–language pathologists (SLPs) and dental hygienists (DHs) in long‐term care institutions and to understand how their perspectives impact activities and processes involved in the delivery of oral care. Methods: A focus group methodology was utilised. Separate focus groups for each targeted profession were held. Transcribed data were analysed using constant comparative analysis. Results: Daily oral health maintenance and monitoring was considered a role of nursing staff. SLPs and DHs have roles focusing on advocacy, education and supplemental care. Social factors motivate nursing staff to provide oral care, whereas factors related to the general health consequences of poor oral health underlined the motivations of SLPs and DHs. Conclusions: Education and training initiatives incorporating social aspects of oral health may be more effective for motivating nursing staff than approaches emphasising physical risk factors. Organisations can foster environments that support collaboration and communication amongst the members of multidisciplinary teams in order to promote oral health as a priority.     

Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study

Background

Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany.

Methods

In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure.

Results

In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG) and control group (CG). During the one-year intervention period femoral fracture rates were 33.6 (IG) and 41.0/1000 person years (CG), respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93) in residents exposed to the fall and fracture prevention program compared to residents from CG.

Conclusions

The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.     

Estudio preliminar de la efectividad de la terapia asistida con perros en personas de la tercera edad

IntroductionAnimal-assisted therapy is increasingly present in several educational and health areas. The aim of this study is to assess the effectiveness of such interventions in the elderly population living in residential settings.Materials and methodsA 12-week dog-assisted intervention program was designed, with 16 participants from a nursing home divided into an experimental group and a control group.ResultsSeveral physical and psychological variables were assessed before and after the intervention. While there were no significant differences in the control group, the experimental group improved significantly after participating in the program.DiscussionThe results support the hypothesis that animal-assisted interventions may be beneficial for residents in elderly care homes.     

Selenoprotein P in subjects exposed to mercury and other stress situations such as physical load or metal chelation treatment

In plasma, Se is found in plasma glutathione peroxidase (pGSH-Px), selenoprotein P (Sel-P), and albumins. The aim of the present study was to determine the influence of lifelong exposure to various levels of mercury vapor (Hg⁰) on plasma Se content and the fraction bound to Sel-P. Second, a pilot study was performed on the influence of short-term excessive physical stress and metal chelation (DIMAVAL) treatment. Samples of human plasma/serum obtained from a control group, Idrija residents living in a Hg-polluted environment because of the vicinity of the Idrija mercury mine (closed 1994), a few Idrija residents exposed to excessive physical stress, and two retired miners treated with the drug DIMAVAL were investigated. Selenoprotein P was isolated by affinity chromatography (heparin-Sepharose), and the concentrations of selenium were determined by radiochemical neutron activation analysis and hydride generation-atomic fluorescence spectrometry. Regardless of the group investigated, plasma Se average values were very similar (about 70–90 ngSe/g). A significant change of Sel P (7–24% decrease) was noted only in the group exposed to physical stress as compared to the same subjects before the test, to the control group, and to the Hg exposed group. The decrease of Se bound on Sel-P was accompanied by its increase in fraction of pGSH-Px with albumin.     

Cancer screening barriers and facilitators for under and never screened populations: A mixed methods study

BackgroundCancer screening is below targets in Ontario, Canada. Our objective was to identify and quantify the barriers and facilitators for breast, cervical and colorectal cancer screening for under and never screened (UNS) residents living in Ontario between 2011 and 2013.MethodsWe used a multi-phased mixed methods study design. Results from thematic analysis of focus group discussions with health care providers and UNS community members were used to develop an on-line, province-wide, cross-sectional survey to estimate the prevalence of barriers and facilitators for the provincial population. Adjusted prevalence odds ratios and 95% confidence intervals were estimated for UNS compared to regularly screened participants using logistic regression.ResultsFour focus groups were held with health service providers and sixteen with UNS community members. Top barriers and facilitators themed around provider-patient communication, fear and embarrassment, history of physical or sexual abuse, social determinants of health (including low literacy, lack of awareness, and health insurance), symptoms appearing, and family and friends. 3075 participants completed the online survey. Compared to regularly screened participants, UNS had significantly higher odds of reporting: no regular health care provider; not feeling comfortable talking about screening; or the Doctor or Nurse Practitioner not suggesting screening. UNS also had significantly higher odds of reporting the facilitators: the test being less scary/painful or uncomfortable; friend/family insisting on getting screened; starting to have symptoms; or an easier test that could be done at home.ConclusionsInterventions addressing fear through individual, interpersonal and structural facilitators may increase cancer screening.     

Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial.

STUDY OBJECTIVE--To compare a community support scheme using care attendants with standard aftercare for their effects on independence and morale of elderly patients discharged from hospital and on their use of health and social services. DESIGN--Randomised controlled study of cohort of patients over 75 discharged to their own homes. SETTING--District general hospital and community. PATIENTS--Total of 903 patients (mean age 82, 25% over 85). INTERVENTIONS--Total of 464 patients received support from care attendants on first day at home and for up to 12 hours a week for two weeks. Support comprised practical care, help with rehabilitation, and organising social help. The remaining 439 patients received standard aftercare. END POINT--Difference between two groups of 7% in hospital readmission rates or one point on activities of daily living scale (power 80%, significance level 5%). MEASUREMENTS AND MAIN RESULTS--Three months after the initial discharge 763 patients were interviewed (84%). There were no significant differences between the two groups in physical independence (activities of daily living scale), in measures of morale (Philadelphia scale), or in death rates. Hospital readmission rates within 18 months of discharge, however, were significantly higher in the control group and they spent more days in hospital (mean; control group 30.6 days, support group 17.1 days; p = 0.014). Of the patients living alone who were followed up for 18 months 21 (15%) receiving standard aftercare were readmitted more than twice compared with 6 (5%) supported by care attendants (p less than 0.01). CONCLUSIONS--If the findings are confirmed, and the policy extended to all patients over the age of 75 living alone, an average health district might expect either to save about 23 hospital beds at a net annual saving of about pounds 220,000 in the short term or to increase available beds by this number.     

The 'Soarchmjitter'. The use of a Frisian lingual measurement instrument in care of the elderly

In this article a research has been described funded by the province Fryslan. The aim of this research project is bipartite. First, to determine the reliability and the validity of the instrument and, secondly, to inquire the involved residents living in old people's homes after the valuation of the use of the Frisian language in the care. The research is conducted among 73 residents living in nine old people's homes in the province Fryslan. On two moments in time residents of the old people's homes are asked to fill in a questionnaire with regard to their own care (in)dependency and once with regard to the use of the Frisian language in the care. Reliability analysis shows with regard to internal consistency high Cronbach's alpha values. Test-retest reliability (Cohen's kappa and Spearman Correlation) reveals fair to moderate values. Factor analysis (principal components analysis) results in a one-factor solution. According to the residents, the 'Soarchmjitter' gives a good picture of their care dependency and its questions and answers join their needs. It can be concluded that the 'Soarchmjitter' is a useful instrument to communicate in the own spoken language of the resident and to come in this way to an agreement with nurses about their care demands.     

Characteristics of human intestinal Escherichia coli with changing environments

To investigate if the characteristics of human intestinal Escherichia coli are changing with the environment of the host, we studied intestinal E. coli from subjects having recently migrated from a temperate to a tropical area. We determined the phylogenetic group, the prevalence of the antibiotic resistance, the presence of integrons and the strain diversity in faecal isolates from 25 subjects originally from metropolitan France and expatriated to French Guyana. These characteristics were compared with those of 25 previously studied Wayampi Amerindian natives of French Guyana and from 25 metropolitan French residents. The three groups of subjects were matched for age and sex, had not taken antibiotics for at least 1 month, nor had been hospitalized within the past year. In all, the characteristics of intestinal E. coli from Expatriates were intermediate between those found in residents from metropolitan France and those found in natives of French Guyana. Prevalence of carriage of resistant Gram-negative bacteria in Expatriates was intermediate between French residents and Wayampi as were the prevalence of integrons in E. coli (12.3% versus 16.3% and 7.8% respectively), and the intra-host diversity of E. coli (2.3 strains/subject versus 1.9 and 3.1, respectively); lastly, in Expatriates, the prevalence of carriage of phylogenetic group B2 strains was lower than in French residents (16% versus 56%, P  = 0.005), while carriage of phylogenetic group A strains was lower than in Wayampi (56% versus 88%, P  = 0.03). Our results suggest that the composition of the commensal intestinal flora of humans is not static but changes dynamically in response to new environmental conditions.     

Treatment of residents in 74 nursing homes: the opinion of caregivers

This study is based on the outcomes of the program "Privacy In Nursing Homes" that has been initiated by the Dutch Department of Health in the late 90's. In this study, personnel of 74 nursing homes were asked to reflect on the way they treat residents. The attitudes of personnel were measured with a questionnaire that contains 80 propositions about their behaviour towards residents. The propositions can be reduced to five factors: kindness, structural environment, control, freedom to choose, and respect. First, we give the general results on these five factors. After that we give insight in the correlations between the five different aspects of treatment and the results of regression analysis. The general conclusion is that the behaviour towards residents in nursing homes at the beginning of the 21st Century is far from optimal. Residents most notably lack personal freedom and control over their received care and their way of living. This result is especially worrying because client conformed care has been an important point of attention for some time now. Another important conclusion is that the care for residents has a positive relation with the mangement policy of an organization and so, it is possible to improve the care.     

Oral hygiene of elderly people in long-term care institutions--a cross-sectional study

Objective: The aim of this cross‐sectional study was to assess the level of oral hygiene in elderly people living in long‐term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long‐term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.     

Fluvial landscape ecology: addressing uniqueness within the river discontinuum

1. As rivers and streams are patchy and strongly hierarchical systems, a hierarchical patch dynamics perspective can be used as a framework for visualising interactions between structure and function in fluvial landscapes. The perspective is useful for addressing fundamental attributes of lotic ecosystems, such as heterogeneity, hierarchy, directionality and process feedback occurring across spatial scales and for illustrating spatio‐temporal linkages between disparate concepts in lotic system ecology such as the River Continuum Concept, the Serial Discontinuity Concept, the Flood Pulse Concept and the Hyporheic Corridor Concept. 2. At coarse spatial scales, the hierarchical patch dynamics perspective describes each river network as a unique, patchy discontinuum from headwaters to mouth. The discontinuum is comprised of a longitudinal series of alternating stream segments with different geomorphological structures. Each confluence in the steam network further punctuates the discontinuum because the sudden change in stream characteristics can create a `gap' in the expected pattern of downstream transitions. The discontinuum view recognises general trends in habitat characteristics along the longitudinal profile, but creates a framework for studying and understanding the ecological importance of each stream's individual pattern of habitat transitions along longitudinal, lateral or vertical vectors at any scale. 3. Object‐oriented modelling and programming techniques provide a means for developing robust, quantitative simulation models that describe the dynamic structure of patch hierarchies. Such models can simulate how the structure and function of lotic ecosystems are influenced by the landscape context of the system (the ecological conditions within which the system is set) and the metastructure (structural characteristics and juxtaposition) of finer‐scale patches comprising the system. 4. A simple object‐oriented, multiscale, discontinuum model of solute transformation and biological response along a stream channel illustrates how changing the branching pattern of a stream and the arrangement of its component patches along the downstream profile will result in substantial changes in predicted patterns of solute concentration and biotic community structure. 5. The importance of context, structure, and metastructure in determining lotic ecosystem function serves to underscore 27 ) concept that `every stream is likely to be individual.' Advancing the discipline of fluvial landscape ecology provides an excellent opportunity to develop general concepts and tools that address the individual character of each stream network and integrate the concept of `uniqueness within the river discontinuum' into our ecological understanding of rivers and streams.