Differential characteristics of young and midlife adult users of psychotherapy, psychotropic medications, or both: information from a population representative sample in São Paulo, Brazil

Mutu pelayanan di rumah sakit tak lepas dari kinerja sumber daya manusia keperawatan. Setiap organisasi memiliki budaya yang merupakan faktor penting yang menentukan keberhasilan organisasi  dalam mencapai tujuannya. Penelitian yang bertujuan untuk mengidentifikasi hubungan antara persepsi perawat pelaksana tentang budaya organisasi dengan kinerjanya di ruang rawat inap sebuah RS di Bogor ini, merupakan penelitian cross sectional yang melibatkan 113 perawat. Instrumen yang digunakan adalah instrumen budaya organisasi dan kinerja yang telah dimodifikasi. Sebanyak 79.6% perawat pelaksana mempersepsikan kinerjanya baik dan 85% mempersepsikan budaya organisasinya baik. Perawat pelaksana yang berpersepsi baik terhadap organisasinya, mereka juga berkinerja lebih baik. Karakteristik perawat pelaksana dan persepsi perawat pelaksana terhadap budaya organisasi tidak berhubungan dengan kinerja. Budaya organisasi yang sudah baik dankinerja yang optimalperlu dipertahankan dengan selalu mengevaluasi tiap komponennya,baik oleh manajemen maupun individu keperawatan. Abstract The Nurse Practitioners’ Perception on OrganizationalCulture and Work Performance. The quality of hospital services is supported by several aspects, including the work performance of human resources in nursing. Every organization has a culture which is an important factor that determines the success of the organization in achieving its goals. The research aimed to identify the relationship between the perceptions of nurses about the organizational culture with theirwork performance in inpatient ward at a hospital in Bogor, a cross-sectional study involving 113 nurses. The instrument used was the modified instrument of organizational culture and work performance. A total of 79.6% of nurses perceiving good performance and 85% perceive the organizational culture good. Nurses who have good perception for the organizational cultura, they also perform better. Characteristics of nurses and nurses’ perceptions of the organizational culture is not related to the work performance.Good organizational and optimum work performance need to maintain with evaluating each its component. Keyword: nurse practitioners, organizational culture, work performanceMutu pelayanan di rumah sakit tak lepas dari kinerja sumber daya manusia keperawatan. Setiap organisasi memiliki budaya yang merupakan faktor penting yang menentukan keberhasilan organisasi dalam mencapai tujuannya. Penelitian yang bertujuan untuk mengidentifikasi hubungan antara persepsi perawat pelaksana tentang budaya organisasi dengan kinerjanya di ruang rawat inap sebuah Rumah Sakit di Bogor ini, merupakan penelitian cross sectional yang melibatkan 113 perawat. Instrumen yang digunakan adalah instrumen budaya organisasi dan kinerja yang telah dimodifikasi. Sebanyak 79.6% perawat pelaksana mempersepsikan kinerjanya baik dan 85% mempersepsikan budaya organisasinya baik. Perawat pelaksana yang berpersepsi baik terhadap organisasinya, mereka juga berkinerja lebih baik. Karakteristik perawat pelaksana dan persepsi perawat pelaksana terhadap budaya organisasi tidak berhubungan dengan kinerja. Budaya organisasi yang sudah baik dankinerja yang optimal perlu dipertahankan dengan selalu mengevaluasi tiap komponennya,baik oleh manajemen maupun individu keperawatan. Abstract The Nurse Practitioners’ Perception on Organizational Culture and Work Performance. The quality of hospital services is supported by several aspects, including the work performance of human resources in nursing. Every organization has a culture which is an important factor that determines the success of the organization in achieving its goals. The research aimed to identify the relationship between the perceptions of nurses about the organizational culture with theirwork performance in inpatient ward at a hospital in Bogor, a cross-sectional study involving 113 nurses. The instrument used was the modified instrument of organizational culture and work performance. A total of 79,6% of nurses perceiving good performance and 85% perceive the organizational culture good. Nurses who have good perception for the organizational cultura, they also perform better. Characteristics of nurses and nurses’ perceptions of the organizational culture is not related to the work performance. Good organizational and optimum work performance need to maintain with evaluating each its component. Keyword: nurse practitioners, organizational culture, work performanc

Prevalence and Correlates of Physical Inactivity among Older Adults in Rio Grande do Sul, Brazil

BackgroundCurrent information on the epidemiology of physical inactivity among older adults is lacking, making it difficult to target the inactive and to plan for interventions to ameliorate adverse effects.ObjectivesTo present statewide representative findings on the prevalence of physical inactivity among older community residents, its correlates and associated health service use.MethodsA representative non-institutionalized random sample of 6963 individuals in Rio Grande do Sul, Brazil, aged >= 60 years, was interviewed face-to-face. Information was obtained on demographic characteristics, social resources, health conditions and behaviors, health service use, and physical inactivity. Controlled logistic regression was used to determine the association of physical inactivity with these characteristics.ResultsOverall, 62% reported no regular physical activity. Physical inactivity was significantly more prevalent among women, older persons, those with lower education and income, Afro-Brazilians (73%; White: 61%; other: 64%), those no longer married, and was associated with multiple individual health conditions and impaired activities of daily living (ADL). in adjusted analyses, associations remained for sociodemographic characteristics, social participation, impaired self-rated health, ADL, vision, and depression (odds ratios (OR) 1.2-1.7). Physically inactive respondents were less likely to report outpatient visits (OR 0.81), but more likely to be hospitalized (OR 1.41).ConclusionsPhysical inactivity is highly prevalent, particularly among Afro -Brazilians. It is associated with adverse sociodemographic characteristics; lack of social interaction; and poor self-rated health, ADL, vision, and depression; although not with other health conditions. Self-care may be neglected, resulting in hospitalization.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Bolsista de Produtividade em PesquisaNational Institute on AgingUniversidade Federal de São Paulo, Escola Paulista Med, Dept Psychiat, São Paulo, BrazilDuke Univ, Med Ctr, Ctr Study Aging & Human Dev, Durham, NC 27710 USAUniversidade Federal de São Paulo, Escola Paulista Med, Dept Psychiat, São Paulo, BrazilBolsista de Produtividade em Pesquisa: 306156/2011-3National Institute on Aging: 1P30 AG028716Web of Scienc

Prevalence and Concomitants of Arthritis in the Elderly in Rio Grande do Sul, Brazil

Objectives: Information on the prevalence and concomitants of arthritis in developing countries is sparse. It is unclear whether they are comparable to findings in developed countries. To ascertain the prevalence, demographic characteristics, and health-related concomitants of arthritis in older persons in the southern state of Rio Grande do Sul, Brazil, a middle income country.Methods: the state of Rio Grande do Sul, Brazil, was subdivided into nine regions. Stratified random sampling was used to identify 880 community residents age >= 60 years in each region. One region with suspect data was excluded. of 7040 community residents contacted in eight regions, 6963 participated (1.1% refusal rate). in 1995, trained, monitored interviewers, using structured questionnaires, conducted in-home interviews gathering information on demographic characteristics (age, sex, race/ethnicity, education, income, living arrangements, employment status), health behaviors (physical activity, tobacco use, social activity), functional limitations, depression, and 15 self-reported health conditions, including arthritis. Data were analyzed using descriptive statistics and logistic regression.Results: Arthritis, reported by 43% of the sample, was more prevalent in women, among the less educated, those with lower income, and higher age. Severity, but not prevalence, differed by race/ethnicity. Controlled analyses indicated significant association with female gender, lower education, and less social activity. Arthritis was associated with reduced odds of stroke, but increased odds of hypertension, varicosities, bronchitis, renal problems, headache, gastrointestinal disorders, and depression. Arthritis was not significantly associated with age or functional limitations, and associations did not differ by gender.Conclusions: the prevalence, demographic and health characteristics associated with self-reported arthritis in this southern state in Brazil are similar to findings elsewhere in Brazil, and in developed countries.Conselho Estadual do Idoso, Secretaria do Trabalho, Cidadania e Assistencia SocialGoverno do Estado do Rio Grande do Sul, the National Council for Scientific and Technological DevelopmentNational Institute on AgingUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilDuke Univ, Med Ctr, Ctr Study Aging & Human Dev, Durham, NC 27710 USAVet Adm Med Ctr, Geriatr Res Educ & Clin Ctr, Durham, NC USAProject Sci Comm, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilGoverno do Estado do Rio Grande do Sul, the National Council for Scientific and Technological Development: 470724/2011-0Governo do Estado do Rio Grande do Sul, the National Council for Scientific and Technological Development: 306156/2011-3National Institute on Aging: 1P30 AG028716-02Web of Scienc

Neuropsychological Test Performance in African-American and White Patients with Alzheimer's Disease

Little information exists on the performance of black versus white patients with Alzheimer's disease on neuropsychological tests for dementia.In this study, we compared performance on the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) neuropsychological battery between white (n equals 830) and black (n equals 158) patients with Alzheimer's disease enrolled in the CERAD study at 23 university medical centers in the United States. The black patients were older, had fewer years of formal education, and were more impaired in their activities of daily living than were the white patients. After controlling for these characteristics and for duration of the disease and severity of dementia, there were differences in the performance of black and white patients on several of the cognitive measures. Black patients scored lower than whites on tests of visual naming and constructional praxis and on the Mini-Mental State Examination. There were no statistical differences in performance on tests of fluency and word list memory. These findings suggest that cultural or experiential differences may modify performance on specific neuropsychological tests. These factors, in addition to age and educational background, should be considered when interpreting performance on neuropsychological tests in elderly black patients with dementia

Validating the Time and Change test to screen for dementia in elderly Koreans

BACKGROUND: We assessed the applicability of the T&C test as an accurate and convenient means to screen for dementia in primary care and community settings. METHODS: The study group comprised 59 patients and 405 community participants, all of who were aged 65 years and over. The time component of the T&C test evaluated the ability of a subject to comprehend clock hands that indicated a time of 11:10, while the change component of the T&C test evaluated the ability of a subject to make 1,000 Won from a group of coins with smaller denominations (one 500, seven 100, and seven 50 Won coins). RESULTS: The T&C test had a sensitivity and specificity of 73.0 and 90.9%, respectively, and positive and negative predictive values of 93.1, and 66.7%, respectively. The test-retest and interobserver agreement rates were both 95% (κ = 0.91) (time interval, 24 hours). The association between the T&C test and K-MMSE test was modest, while significant (r = 0.422, p < 0.001). The T&C test scores were not influenced by educational status. CONCLUSIONS: We conclude that the T&C test is useful as supplemental testing of important domains (e.g., calculation, conceptualization, visuospatial) to traditional measures such as the MMSE. However, because T&C test is simple, rapid, and easy to use, it can be applied conveniently to elderly subjects by non-specialist personnel who receive training

Lipoprotein Particle Profiles Mark Familial and Sporadic Human Longevity

BACKGROUND: Genetic and biochemical studies have indicated an important role for lipid metabolism in human longevity. Ashkenazi Jewish centenarians and their offspring have large low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particles as compared with control individuals. This profile also coincided with a lower prevalence of disease. Here, we investigate whether this observation can be confirmed for familial longevity in an outbred European population and whether it can be extended to sporadic longevity in the general population. METHODS AND FINDINGS: NMR-measured lipoprotein profiles were analyzed in 165 families from the Leiden Longevity Study, consisting of 340 long-lived siblings (females >91 y, males >89 y), 511 of their offspring, and 243 partners of the offspring. Offspring had larger (21.3 versus 21.1 nm; p = 0.020) and fewer (1,470 versus 1,561 nmol/l; p = 0.011) LDL particles than their same-aged partners. This effect was even more prominent in the long-lived siblings (p < 10(−3)) and could be pinpointed to a reduction specifically in the concentration of small LDL particles. No differences were observed for HDL particle phenotypes. The mean LDL particle sizes in 259 90-y-old singletons from a population-based study were similar to those in the long-lived siblings and thus significantly larger than in partners of the offspring, suggesting that the relevance of this phenotype extends beyond familial longevity. A low concentration of small LDL particles was associated with better overall health among both long-lived siblings (p = 0.003) and 90-y-old singletons (p = 0.007). CONCLUSIONS: Our study indicates that LDL particle profiles mark both familial and sporadic human longevity already in middle age

The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India

OBJECTIVES: To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden, promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia. METHODOLOGY AND PRINCIPAL FINDINGS: This was a randomised controlled trial in which the person with dementia-caregiver dyad was randomly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months. It was carried out in communities based in two talukas (administrative blocks) in Goa, India. Mild to moderate cases with dementia (diagnosed using the DSM IV criteria and graded using the Clinical Dementia Rating scale) and their caregivers were included in the trial. Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist, focusing on supporting the caregiver through information on dementia, guidance on behaviour management, a single psychiatric assessment and psychotropic medication if needed. We measured caregiver mental health (General Health Questionnaire), caregiver burden (Zarit Burden Score), distress due to behavioural disturbances (NPI-D), behavioural problems in the subject (NPI-S) and activities of daily living in the elder with dementia (EASI). Outcome evaluations were masked to the allocation status. We analysed each outcome with a mixed effects model. 81 families enrolled in the trial; 41 were randomly allocated to the intervention. 59 completed the trial and 18 died during the trial. The intervention led to a significant reduction of GHQ (-1.12, 95% CI -2.07 to -0.17) and NPI-D scores (-1.96, 95%CI -3.51 to -0.41) and non-significant reductions in the ZBS, EASI and NPI-S scores. We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm (OR 0.34, 95% CI 0.01 to 1.03). CONCLUSION: Home based support for caregivers of persons with dementia, which emphasizes the use of locally available, low-cost human resources, is feasible, acceptable and leads to significant improvements in caregiver mental health and burden of caring. ClinicalTrials.gov NCT00479271

Alcohol use and health outcomes in the oldest old

BACKGROUND: As the United States population ages, an unprecedented proportion of the population will be aged 70 and older. Knowledge of alcohol use and its consequences in this age group is not well known. In light of the disparate findings pointing to negative outcomes with excessive drinking yet also benefits of moderate drinking, the true risk of alcohol use in late life needs more investigation. METHODS: This study examined the correlates and 2-year health outcomes related to alcohol use in 7,434 elders aged 70 years or older. Data was collected as part of the Assets and Health Dynamics of the Oldest Old (AHEAD), a nationwide health and economic study of elders. Data from Wave 1 and Wave 2 of AHEAD are presented. Frequency and quantity of drinking was assessed by self-report as was health status, lifetime alcohol or psychiatric problems, presence of chronic illness, functional impairment, and depressive symptoms. Cognitive status was assessed using a brief measure. RESULTS: Approximately 44% of the sample reported any alcohol use in the past three months, with the majority of drinking less than daily. Daily drinking was associated with being Caucasian, married, in relatively good health, and having good affective and cognitive status. Drinking was not associated with negative health outcomes two years later and was protective against stroke and functional impairment. Decline in drinking between Wave 1 and Wave 2 was strongly associated with poor health. CONCLUSION: This study offers no evidence of negative health outcomes for drinking moderately and confirms the U-shaped curve often found in studies of alcohol and health. Nonetheless, cessation of drinking was associated with poor health suggesting the health benefits of moderate drinking may result from selection of a healthy group of people capable of sustained moderate drinking. Public health recommendations for moderate drinking must take this phenomenon into account

Deriving utility scores for co-morbid conditions: a test of the multiplicative model for combining individual condition scores

BACKGROUND: The co-morbidity of health conditions is becoming a significant health issue, particularly as populations age, and presents important methodological challenges for population health research. For example, the calculation of summary measures of population health (SMPH) can be compromised if co-morbidity is not taken into account. One popular co-morbidity adjustment used in SMPH computations relies on a straightforward multiplicative combination of the severity weights for the individual conditions involved. While the convenience and simplicity of the multiplicative model are attractive, its appropriateness has yet to be formally tested. The primary objective of the current study was therefore to examine the empirical evidence in support of this approach. METHODS: The present study drew on information on the prevalence of chronic conditions and a utility-based measure of health-related quality of life (HRQoL), namely the Health Utilities Index Mark 3 (HUI3), available from Cycle 1.1 of the Canadian Community Health Survey (CCHS; 2000–01). Average HUI3 scores were computed for both single and co-morbid conditions, and were also purified by statistically removing the loss of functional health due to health problems other than the chronic conditions reported. The co-morbidity rule was specified as a multiplicative combination of the purified average observed HUI3 utility scores for the individual conditions involved, with the addition of a synergy coefficient s for capturing any interaction between the conditions not explained by the product of their utilities. The fit of the model to the purified average observed utilities for the co-morbid conditions was optimized using ordinary least squares regression to estimate s. Replicability of the results was assessed by applying the method to triple co-morbidities from the CCHS cycle 1.1 database, as well as to double and triple co-morbidities from cycle 2.1 of the CCHS (2003–04). RESULTS: Model fit was optimized at s = .99 (i.e., essentially a straightforward multiplicative model). These results were closely replicated with triple co-morbidities reported on CCHS 2000–01, as well as with double and triple co-morbidities reported on CCHS 2003–04. CONCLUSION: The findings support the simple multiplicative model for computing utilities for co-morbid conditions from the utilities for the individual conditions involved. Future work using a wider variety of conditions and data sources could serve to further evaluate and refine the approach

Helping family doctors detect vulnerable caregivers after an emergency department visit for an elderly relative: results of a longitudinal study

BACKGROUND: Family doctors have been ascribed a role in monitoring patients and their informal caregivers. Little is known about the factors that might alert physicians to changing circumstances or needs of the caregivers. The study objective was to examine changes in family caregivers' quality of life following an emergency department (ED) visit by an older community-dwelling relative that might cue doctors to subsequent caregiver distress. METHODS: A longitudinal study with follow-up at 1- and 4-months was conducted in the EDs of 4 hospitals in Montreal, Canada. Caregivers reported on demographics and quality of life (SF-36). Patients reported on demographics and functional disability. Multiple linear regression for repeated measures was used to evaluate changes in caregiver quality of life and factors related to these changes. RESULTS: 159 caregivers (60.5 yrs ± 15.8%; 73.0% female), including 68 (42.8%) spouses, 60 (37.7%) adult children, and 31 (19.5%) other relatives participated. Following an initial ED visit by older relatives, caregiver general health and physical functioning declined over time, while mental health status improved. Compared to the other relative caregiver group, spouses were at increased risk for decline in general health, mental health, and physical functioning at 1 month, while adult children were at increased risk for decline in physical health at 1 month. CONCLUSION: Spouses were most at risk for decline in quality of life. Primary care physicians who become aware of an ED visit by an elderly person may be alerted to possible subsequent deterioration in family caregivers, especially spouses