Comparison of Two Routines for Long-Term Oral Hygiene Treatment with Chlorhexidine Gel in Geriatric Patients1

The aims of the present study were to register the effect of toothbrushing with chlorhexidine gel for 51 weeks and compare the effect of two hygiene regimens, one with continuous use of chlorhexidine gel for toothbrushing twice a day and the other in which ordinary toothpaste was substituted for chlorhexidine 1 week every third week. The total number of participating patients was 152 institutionalized elderly, mean age 76.2 years, Gingival Index according to Löe-Silness and Plaque Index according to Bay-Ainamo were registered 12 times during the study. The long-term effect of Toothbrushing with chlorhexidine gel was equal for the two hygiene regimens. The incidence of side effects was surprising small. Moderate discolouration of teeth occurred with equal distribution in both groups.     

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

Objectives

Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need.

Methods

Data are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics.

Results

Weighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05).

Conclusions

CSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.     

妊娠期肝内胆汁淤积症的处理与预防护理研究

目的:研究妊娠期肝内胆汁淤积综合症(ICP)的产科处理及预防护理,探讨治疗对母婴预后的影响。方法:选取2009年1月至2010年1月第四军医大学西京医院妇产科收治ICP患者共67例,分为治疗组49例,经过丁烷二磺酸腺苷蛋氨酸(思美泰),对照组18例服用熊去氧胆酸治疗的孕妇。对孕妇症状、生化指标、母婴结局进行比较分析。结果:治疗组临床症状、生化指标较治疗前明显下降较对照组明显好转(p0.01),直接胆红素下降两组间无显著差异(p0.01)。将治疗组和对照组胎儿宫内窘迫率存在显著性差异(p0.01)。结论:应用丁烷二磺酸腺苷蛋氨酸(思美泰)积极正确处理ICP,可明显减轻孕妇瘙痒症状及肝功异常,同时明显降低胎儿宫内窘迫率,提高围生儿的生存质量。     

甲氨蝶呤治疗银屑病关节炎的护理

回顾性总结38例应用甲氨蝶呤治疗银屑病关节炎的护理经验,认为在护理该类患者时,护理重点是使病人保持心态平和,采用科学的治疗方法,坚持长期治疗的信心和健康的生活方式,药物的正确的使用和副作用的监测观察是服用药物提高疗效的保证。     

A Nation-Wide Study of Prevalence and Risk Factors for Fecal Impaction in Nursing Homes

Background

There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people.

Objective

Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population.

Design

Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study.

Setting

34 randomly selected nursing homes.

Measurements

The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination.

Subjects

Older subjects living in nursing homes.

Results

The prevalence of chronic constipation was 70.7% (95%CI: 67.3–74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6–51.0%) and 6.6% (4.7–8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2–18.4]) and uncontrolled constipation (OR: 37.21 [19.7–70.1]), the number of medications (OR: 1.2 [1.1–1.3]), reduced functional capacity (OR: 0.98 [0.97–0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction.

Conclusions

Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population.     

The Economics of Dementia-Care Mapping in Nursing Homes: A Cluster-Randomised Controlled Trial

Background

Dementia-care mapping (DCM) is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes.

Methods

Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units.

Results

34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0^.05) than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0^.02).

Conclusions

DCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes’ preferences, may determine whether they adopt the DCM method.

Trial Registration

Dutch Trials Registry NTR2314     

Prevalence and Molecular Epidemiology of Staphylococcus aureus among Residents of Seven Nursing Homes in Shanghai

Background

Residents in nursing homes (NHs) always represent potential reservoirs for Staphylococcus aureus and methicillin-resistant S. aureus (MRSA). To our knowledge, there is no epidemiological information up till now that describes the prevalence and molecular characteristics of S. aureus in nursing home residents in Shanghai, China.

Methods

Four hundred and ninety-one unique residents from 7 NHs were enrolled in this study. Specimens were collected among these residents including 491 nasal swabs, 487 axillary swabs and 119 skin swabs. S. aureus isolated and identified from the swabs was characterized according to antimicrobial susceptibility profiling, toxin gene prevalence, and multilocus sequence typing (MLST), spa and SCCmec typing.

Results

Among the 491 residents screened, S. aureus was isolated in 109 residents from 90 nasal swabs (90/491, 18.3%), 29 axillary swabs (29/487, 6.0%), and 22 skin swabs (22/119, 18.5%). Sixty-eight MRSA isolates were detected in 52 residents from 41 nasal carriers, 15 axillary carriers and 12 skin carriers. The overall prevalence rate of S. aureus and MRSA colonization was 22.2% and 10.6% respectively. Ten residents presented S. aureus in all three sample types and 12 residents presented S. aureus in two of the three sample types collected. Molecular analysis revealed CC1 (29.1%) to be the dominant clone in this study, followed by CC398 (19.9%), CC188 (13.5%) and CC5 (12.8%). The most common spa type was t127 (22.0%), followed by t14383 (12.8%) and t002 (10.6%).

Conclusions

A high prevalence of S. aureus and MRSA colonization was revealed in nursing home residents in Shanghai. CC1 was the most common clonal complex and t127 was the most common spa type among NH residents. The data provides an important baseline for future surveillance of S. aureus in NHs in Shanghai and other highly urbanized regions in China. Implementation of infection control strategies must be given high priority in NHs to fight such high prevalence of both MRSA and methicillin-susceptible S. aureus (MSSA).     

Trends in Oral Disease and Health1

Geriatric dentistry researchers are building a basic knowledge basic pertaining to the oral health status of older adults. Important findings on the prevalence of disease that run counter to “conventional wisdom” surrounding the oral health of older adults are that edentulism is decreasing, that both coronal and root caries are prevalent, that serious periodontal disease is not as prevalent as thought, that chronological age is not strongly associated with disease in older adults, and that oral lesions, especially those related to dentures, are prevalent. An important finding has been that the majority of disease seems to occur in a minority of the population. While the prevalence of oral diseases have been shown to be associated with water fluoridation, systemic diseases, use of medications, social and behavioral factors, and a variety of other oral conditions, there is only preliminary information on the incidence of disease and actual risk factors. The data available on the incidence of disease come from a study of community-dwelling older adults in Iowa, and these data generally confirm the prevalence results. Coronal and root caries are active in this older population with caries being the best predictor of tooth loss. Furthermore, most disease occurs in a high risk group. Multivariate models predicting people at highest risk for root and coronal caries implicate stress and anxiety, use of tobacco, and recent onset of illness as risk factors. In addition, preliminary results indicate that some dental conditions may be predictive of general health status.     

布氏田鼠越冬集群贮草面积的两种估算方法比较

布氏田鼠 (Ｍｉｃｒｏｔｕｓｂｒａｎｄｔｉ)为内蒙古典型草原区的主要害鼠 ,具贮草越冬习性[2 ,5～ 7] 。因此 ,研究其越冬集群的贮草面积 ,对于分析该鼠的越冬生态特征以及定量衡量其危害程度 ,具有重要的意义。本文提出两种估算布氏田鼠越冬集群贮草面积的方法 ,即黄蒿根计数法和跑道测量法 ,并对两种估算方法进行了比较。1　材料与方法本项研究是于 1 995年度在内蒙古赤峰市克什克腾旗阿其乌拉苏木 ( 1 1 6°2 5′Ｎ ,37°5 1′Ｅ)以及中国科学院内蒙古草原生态系统定位研究站 ( 43°37′Ｎ ,1 1 6°4 1′Ｅ)进行的。1 0月中旬 ,在阿其…     

Rumination and Loneliness Independently Predict Six-Month Later Depression Symptoms among Chinese Elderly in Nursing Homes

Background

Previous studies conducted in Western countries independently demonstrated that loneliness and rumination are remarkable risk factors of depression among the elderly in both community and nursing homes. However, knowledge on the relationship between these three constructs among the elderly in Eastern countries is scarce. The current study aims to determine the relationship between loneliness, rumination, and depression among Chinese elderly in nursing homes.

Methods

A total of 71 elderly participants with an average age of 82.49 years completed this six-month longitudinal study. Physical reports indicated that none of the participants were clinically depressed before the study. At Time 1, their loneliness and rumination were measured using UCLA-8 Loneliness Scale and Ruminative Responses Scale. Six months later, the participants completed the Center for Epidemiologic Studies Depression Scale to assess depressive symptoms (Time 2).

Results

Multiple regression analysis revealed that both loneliness and rumination at Time 1 were the predictors of depression symptoms at Time 2 among the Chinese elderly in nursing homes. However, in the mediation analysis using PROCESS, the indirect effect between loneliness at Time 1 and depression symptoms at Time 2 was insignificant.

Conclusions

Results suggest that previous loneliness and rumination thinking are predictors of future depression symptoms among the Chinese elderly in nursing homes. However, the insignificant mediation further suggests that the differences between loneliness and rumination should be explored in future studies. Findings have important implications for mental health professionals in nursing homes in China.     

The Use and Nonuse of Companion Animals by Volunteers in Nursing Homes: A Comparative Study

Abstract

This report compares motivation and satisfaction of volunteers who visited residents in nursing homes accompanied by a dog with volunteers who visited the same residents but without a dog. The sample consisted of 40 people, 21 of whom were accompanied by a pet. A questionnaire of 111 items were developed and administered to all participants. Both groups of volunteers had equivalent volunteer experience and their reasons for volunteering were almost identical. No significant differences between the two groups were identified, possibly because of the small size of the sample, but an increased level of staff-volunteer interaction was reported for the pet group.     

Questions in Lessons: Activity Settings in the Homes and School of Two Puerto Rican Kindergartners

This ethnographic study describes continuities and discontinuities between a bilingual kindergarten and the homes of two Spanish-dominant Puerto Rican children. The concept of activity setting was used to explore the relation of culture to question use in lessons taught in both settings. Findings highlight a complex web of continuities and discontinuities and the importance of the joint construction of a culture of teaching and learning by parents, teachers, and children.     

血液灌流救治危重型毒蛇咬伤的临床护理

目的探讨血液灌流(HP)救治重型毒蛇咬伤的临床治疗和护理方法.方法采用德国生产的型号为Adsorda300C的血液灌流器、CVVH导管为重症毒蛇咬伤病人行HP救治,护士配合医生,认真做好HP术前、术中、术后的观察与护理工作.结果5例患者行HP时间为4h,均为一次性炭肾治疗成功,痊愈出院.结论HP能及时有效的清除血中毒物,治疗效果确切,疗效快.在行HP技术时,护士应充分做好准备,掌握娴熟的专科操作技术,密切观察病情变化,保持各种管道通畅,保护好穿刺部位,及时处理各种并发症,才能保证HP的顺利进行.