Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study

BACKGROUND: Although physiotherapy (PT) plays an important role in improving activities of daily living (ADL functioning) and discharge rates, it is unclear how many nursing home residents receive treatment. Furthermore, there is a lack of insight into the determinants that influence the decision for treatment. In this study, we investigated how many nursing home residents receive PT. In addition, we analysed the factors that contribute to the variation in the provision of PT both between nursing homes and between residents. METHODS: A random sample of 600 elderly residents was taken from a random sample of 15 nursing homes. Residents had to be admitted for rehabilitation or for long-term care. Data were collected through interviews with the nursing home physician and the physiotherapist. Multilevel analysis was used to define the variation in the provision of PT and the factors that are associated with the question whether a resident receives PT or not. Furthermore the amount of PT provided was analysed and the factors that are associated with this. RESULTS: On average 69% of the residents received PT. The percentage of patients receiving treatment differed significantly across nursing homes, and especially the number of physiotherapists available, explained this difference between nursing homes. Residents admitted to a somatic ward for rehabilitation, and male residents in general, were most likely to receive PT. Residents who were treated by a physiotherapist received on average 55 minutes (sd 41) treatment a week. Residents admitted for rehabilitation received more PT a week, as were residents with a status after a total hip replacement. CONCLUSION: PT is most likely to be provided to residents on a somatic ward, recently admitted for rehabilitation to a nursing home, which has a relatively large number of physiotherapists. This suggests a potential under-use of PT for long-term residents with cognitive problems. It is recommended that physiotherapists reconsider which residents may benefit from treatment. This may require a shift in the focus of physiotherapists from 'recovery and discharge' to 'quality of life and well-being'

Portaria n. 478 de 24 de julho de 2008

Interrompe férias de servidor do Superior Tribunal de Justiça

Etapas metodológicas para a modelagem do nitrogênio na água na bacia Guapi-Macacu, Rio de Janeiro, RJ.

A qualidade da água depende de muitos fatores naturais e antrópicos. Estes impactos precisam ser caracterizados e quantificados para subsidiar cenários futuros e a gestão de recursos hídricos no âmbito das bacias hidrográficas. A Bacia Guapi-Macacu, pertencente ao Bioma Mata Atlântica, é a terceira no ranking de abastecimento de água no Estado do Rio de Janeiro. O propósito deste trabalho foi apresentar as etapas metodológicas para a modelagem hidrológica das formas de nitrogênio nesta bacia. Nesse caso, o modelo hidroquímico J2000-S foi aplicado. A fim de calibrar e validar o modelo, foi instalada uma rede de monitoramento hidrometeorológica e de qualidade da água. Dados secundários também foram organizados e utilizados. Etapas do trabalho: coleta e análise de dados, delimitação das unidades de resposta hidrológica; calibração e validação temporal do modelo hidroquímico; validação espacial e análise de incertezas. A principal fonte de nitrogênio é o esgoto doméstico, seguida das fontes difusas relacionadas à agricultura. Concluiu-se que a disponibilidade de dados é um grande desafio, mas a implantação de redes de monitoramento sólidas pode fornecer os dados necessários para a modelagem

De relatie van psychiatrische functiestoornissen met cognitie, activiteiten dagelijks leven (ADL) en biografische gegevens

Probleemstelling: Psychiatrische functiestoornissen (PFS) hebben een negatief effect op de kwaliteit van leven van psychogeriatrische patiënten, op hun levensduur en op het mantelzorgsysteem. Ook zijn PFS voorspellers voor zowel permanente opname als voor de kans op ontslag. De prevalentie van PFS bij psychogeriatrische patiënten in een verpleeghuis ligt tussen 70 en 80%. In een eerder onderzoek werden relatief zwakke relaties gevonden tussen PFS en cognitieve functiestoornissen, zelfzorg-problemen en biografische gegevens. Dit onderzoek wordt hier gerepliceerd. De prevalentie van PFS is onderzocht bij psychogeriatrische patiënten die zich aanmeldden voor onderzoek op een polikliniek voor cognitieve functiestoornissen. Onderzoek en methode: In de Indexconditie participeerden 70 patiënten (leeftijd ≥ 65) met klachten over cognitief functioneren die verwezen werden naar een polikliniek voor cognitieve functiestoornissen in de regio Nieuwe Waterweg Noord en van wie vermoed werd dat zij leden aan aanmerkelijke psychiatrische functiestoornissen. Van 35 patiënten waren volledige data op NPI, MMSE en Barthel Index (BI) beschikbaar. In de Referentieconditie participeerden 487 patiënten (leeftijd ≥ 65) uit de regio Nieuwe Waterweg Noord, verwezen voor trans- of intramurale verpleeghuiszorg en van wie vermoed werd dat zij leden aan cognitieve functiestoornissen (MMSE ≥ 29). Van 385 patiënten waren alle data beschikbaar op NPI, MMSE en BI. Resultaten: Van de patiënten had 92% minimaal 1 symptoom score of meer op de NPI; 82% had twee of meer symptomen. De NPI-symptomen Depressie, Apathie, Angst en Prikkelbaarheid toonden een hoge prevalentie in beide steekproeven. Logistische regressieanalyse liet zien dat MMSE, BI en biografische gegevens een geringe voorspellende waarde hadden voor zowel de totale NPI-score als voor afzonderlijke NPI-symptomen (R2 =0,11; max). Een niet-metrische principale componentenanalyse en een confirmatieve factoranalyse toonden aan dat de relaties tussen NPI, MMSE en BI in de twee steekproeven niet significant verschilden. MMSE en BI correleerden in de twee steekproeven met de dimensie ‘Cognitie’, en NPI met de dimensie ‘Psychiatrische functiestoornis’. Conclusie: In de Indexconditie (N=35) werden de bevindingen uit de Referentieconditie (N=385) bevestigd. Dit betrof de hoogte van de frequentie van PFS (NPI), de brede spreiding over de NPI-symptomen; de minimale prognostische rol van MMSE, BI en biografische gegevens voor zowel de totale NPI-score als de individuele NPI-symptomen. De PFS vormden ook in de Indexconditie een dimensie op zich. Met name bij verwijzing en indicatiestelling voor behandeling en zorg is het van belang een onderscheid te maken tussen de psychiatrische en de cognitieve dimensie

Communication, advice exchange and job satisfaction of nursing staff: a social network analyses of 35 long-term care units

Background: The behaviour of individuals is affected by the social networks in which they are embedded. Networks are also important for the diffusion of information and the influence of employees in organisations. Yet, at the moment little is known about the social networks of nursing staff in healthcare settings. This is the first study that investigates informal communication and advice networks of nursing staff in long-term care. We examine the structure of the networks, how they are related to the size of units and characteristics of nursing staff, and their relationship with job satisfaction. Methods: We collected social network data of 380 nursing staff of 35 units in group projects and psychogeriatric units in nursing homes and residential homes in the Netherlands. Communication and advice networks were analyzed in a social network application (UCINET), focusing on the number of contacts (density) between nursing staff on the units. We then studied the correlation between the density of networks, size of the units and characteristics of nursing staff. We used multilevel analyses to investigate the relationship between social networks and job satisfaction of nursing staff, taking characteristics of units and nursing staff into account. Results: Both communication and advice networks were negatively related to the number of residents and the number of nursing staff of the units. Communication and advice networks were more dense when more staff worked part-time. Furthermore, density of communication networks was positively related to the age of nursing staff of the units. Multilevel analyses showed that job satisfaction differed significantly between individual staff members and units and was influenced by the number of nursing staff of the units. However, this relationship disappeared when density of communication networks was added to the model. Conclusions: Overall, communication and advice networks of nursing staff in long-term care are relatively dense. This fits with the high level of cooperation that is needed to provide good care to residents. Social networks are more dense in small units and are also shaped by characteristics of staff members. The results furthermore show that communication networks are important for staff's job satisfaction. (aut. ref.

The Butterfly Fauna Of The Italian Maritime Alps:Results Of The «Edit» Project

Bonelli, Simona, Barbero, Francesca, Casacci, Luca Pietro, Cerrato, Cristiana, Balletto, Emilio (2015): The butterfly fauna of the Italian Maritime Alps: results of the EDIT project. Zoosystema 37 (1): 139-167, DOI: 10.5252/z2015n1a6, URL: http://dx.doi.org/10.5252/z2015n1a

Violent aggression predicted by multiple pre-adult environmental hits

Early exposure to negative environmental impact shapes individual behavior and potentially contributes to any mental disease. We reported previously that accumulated environmental risk markedly decreases age at schizophrenia onset. Follow-up of matched extreme group individuals (≤1 vs. ≥3 risks) unexpectedly revealed that high-risk subjects had >5 times greater probability of forensic hospitalization. In line with longstanding sociological theories, we hypothesized that risk accumulation before adulthood induces violent aggression and criminal conduct, independent of mental illness. We determined in 6 independent cohorts (4 schizophrenia and 2 general population samples) pre-adult risk exposure, comprising urbanicity, migration, physical and sexual abuse as primary, and cannabis or alcohol as secondary hits. All single hits by themselves were marginally associated with higher violent aggression. Most strikingly, however, their accumulation strongly predicted violent aggression (odds ratio 10.5). An epigenome-wide association scan to detect differential methylation of blood-derived DNA of selected extreme group individuals yielded overall negative results. Conversely, determination in peripheral blood mononuclear cells of histone-deacetylase1 mRNA as 'umbrella mediator' of epigenetic processes revealed an increase in the high-risk group, suggesting lasting epigenetic alterations. Together, we provide sound evidence of a disease-independent unfortunate relationship between well-defined pre-adult environmental hits and violent aggression, calling for more efficient prevention