Projecting Family Support Needed to Assist Older Canadian Living in the Community, 2006-2031

Canadian policy makers are increasingly interested in planning for the inevitable increase in home care services that will be fuelled by population aging and community care policy. Our goal is to advance understanding of the patterns and predictors of disability and support among the population aged 65+ and use this information to project future health human resources. Using the 2002 General Social Survey, logistic regressions estimated the probability of an individual with specific characteristics of having a specific level of disability and those with a long term health problems using one of three types of support networks (formal, informal, or mixed). These parameters were applied at five-year intervals in Statistics Canada LifePaths microsimulation model to project future demand. When looking at the population needing assistance, results from the micro-simulations show an increase from 630,000 to over 1.3 millions between 2006-2031. Results also show an increase in the proportion of elderly having to rely exclusively on the formal network (40% in 2006 to 44% in 2031. By applying the median amount of assistance per week by age and sex (GSS 2002) to the projected population who will receive assistance, the number of hours per week received is projected to double from 2006 to 2031. This trend is most pronounced among the 85+ in that the amount of assistance is projected to almost triple from 2006-2031. Despite recognition of the steady increase in demand for home care, Canada has made little headway in developing consensus on policy directions. A discussion of the policy implications of these findings will highlight the need for greater recognition, better working conditions and career paths for front-line home support workers who provide the majority of care among paid home care providers. Yann Décarie is a Ph.D student in Demography at L’Institut National de la Recherche Scientifique (INRS) under the supervision of Alain Bélanger. Yann received a degree in Statistics from the Université de Sherbrooke and an undergraduate degree in Actuarial Science from the Université de Montréal. Since 2006, Yann has been working with Professor Jacques Légaré and Professor Janice Keefe as a research assistant on a project related to the projection of disabled people and home care needs. Yann’s research interests are on ageing, projection methods, microsimulation and population health

Epidemiology and clinical outcome of virus-positive respiratory samples in ventilated patients: a prospective cohort study

INTRODUCTION: Respiratory viruses are a major cause of respiratory tract infections. The prevalence of a virus-positive respiratory sample and its significance in patients requiring mechanical ventilation remain unknown. METHODS: We conducted a cohort study in all consecutive adults ventilated for more than 48 hours admitted to a 22-bed medical intensive care unit during a 12-month period. Respiratory samples at the time of intubation were assessed by culture, by indirect immunofluorescence assay or by molecular methods in systematic tracheobronchial aspirates. Patients with a virus-negative respiratory sample at the time of intubation were considered unexposed and served as the control group. RESULTS: Forty-five viruses were isolated in 41/187 (22%) patients. Rhinovirus was the most commonly isolated virus (42%), followed byherpes simplex virus type 1 (22%) and virus influenza A (16%). In multivariate analysis controlling for the Acute Pathophysiology and Chronic Health Evaluation II score, patients with respiratory disorder at admission (adjusted odds ratio, 2.1; 95% confidence interval, 0.8–5.1; P = 0.12), with chronic obstructive pulmonary disease/asthma patients (adjusted odds ratio, 3.0; 95% confidence interval, 1.3–6.7; P = 0.01) and with admission between 21 November and 21 March (adjusted odds ratio, 2.8; 95% confidence interval, 1.3–5.9; P = 0.008) were independently associated with a virus-positive sample. Among the 122 patients admitted with respiratory disorder, a tracheobronchial aspirate positive for respiratory viruses at the time of intubation (adjusted hazard ratio, 0.273; 95% confidence interval, 0.096–0.777; P < 0.006) was independently associated with better survival, controlling for the Simplified Acute Physiology Score II and admission for cardiogenic shock or cardiac arrest. Among the remaining 65 patients, a virus-positive sample on intubation did not predict survival. CONCLUSION: We confirmed the pathogenic role of respiratory viruses in the intensive care unit, particularly rhinovirus. We suggest, however, that the prognostic value of virus-associated respiratory disorder is better than that of other causes of respiratory disorder

Mild hypothermia during advanced life support: a preliminary study in out-of-hospital cardiac arrest

INTRODUCTION: Induction of mild hypothermia after cardiac arrest may confer neuroprotection. We assessed the feasibility, safety and effectiveness of therapeutic infusion of 2 l of normal saline at 4 degrees C before return of spontaneous circulation during cardiopulmonary resuscitation after out of hospital cardiac arrest. METHODS: This was a prospective, observational, multicenter clinical trial conducted in Emergency Medical Services units and in a medical intensive care unit at Caen University Hospital, Cen, France. RESULTS: In patients who had suffered out of hospital cardiac arrest, hypothermia was induced by infusing 2 l of 4 degrees C NaCl 0.9% over 30 minutes during advanced life support prior to arrival at the hospital. A total of 33 patients were included in the study. Eight patients presented with ventricular fibrillation as the initial cardiac rhythm. Mild hypothermia was achieved after a median of 16 minutes (interquartile range 11.5 to 25.0 minutes) after return of spontaneous circulation. After intravenous cooling, the temperature decreased by 2.1 degrees C (P < 0.0001) to a mean body temperature of 33.3 degrees C (interquartile range 32.3 to 34.3 degrees C). The only observed adverse event was pulmonary oedema, which occurred in one patient. CONCLUSION: We concluded that prehospital induction of therapeutic hypothermia using infusion of 2 l of 4 degrees C normal saline during advanced life support was feasible, effective and safe. Larger studies are required to assess the impact that this early cooling has on neurological outcomes after cardiac arrest

Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors.</p> <p>Methods</p> <p>We conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score.</p> <p>Results</p> <p>One hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; <it>p </it>< 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; <it>p </it>< 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (<it>p </it>= 0.04), and cognitive (<it>p </it>= 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 <b>± </b>132.8 at 3 months, suggesting an acceptable perception of their quality of life.</p> <p>Conclusions</p> <p>In a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.</p

Calorons, Nahm's equations on S^1 and bundles over P^1xP^1

The moduli space of solutions to Nahm's equations of rank (k,k+j) on the circle, and hence, of SU(2) calorons of charge (k,j), is shown to be equivalent to the moduli of holomorphic rank 2 bundles on P^1xP^1 trivialized at infinity with c_2=k and equipped with a flag of degree j along P^1x{0}. An explicit matrix description of these spaces is given by a monad constructio