Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

<p>Abstract</p> <p>Background</p> <p>Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations.</p> <p>Methods</p> <p>Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada): older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model.</p> <p>Results</p> <p>Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities), nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation) and 11 life habits (e.g. nutrition, interpersonal relationships). The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources.</p> <p>Conclusion</p> <p>Better knowledge of partially met or unmet rehabilitation needs expressed by the different types of people involved should lead to increased attention being paid to education for caregivers, orientation of caregivers towards resources in the community, and follow-up of patients' needs in terms of adjustment and rehabilitation, whether for improving their skills or for carrying out their activities of daily living.</p

Sympatry with the devil: reproductive interference could hamper species coexistence

1. As species are often considered discrete natural units, interspecific sexual interactions are often disregarded as potential factors determining community composition. Nevertheless reproductive interference, ranging from signal jamming to hybridization, can have significant costs for species sharing similar signal channels. 2. We combined laboratory and field experiments to test whether the coexistence of two congeneric ground-hopper species with overlapping ranges might be influenced by sexual interactions. 3. In the laboratory experiment the number of conspecific copulations of Tetrix ceperoi decreased substantially in the presence of Tetrix subulata. Males of T. ceperoi performed more mating attempts with heterospecific females, whereas females of T. subulata rejected these heterospecific approaches more often than those of conspecifics. Although no heterospecific matings occurred in the laboratory, the reproductive success of T. ceperoi was reduced substantially in field experiments. Negative effects on T. subulata were found only at high densities. 4 Our results suggest that reproductive interference could have similar consequences as competition, such as demographic displacement of one species (‘sexual exclusion’). As reproductive interference should be selected against, it may also drive the evolution of signals (reproductive character displacement) or promote habitat, spatial or temporal segregation

Distinguishing between interference and exploitation competition for shelter in a mobile fish population.

Understanding the functional significance of shelter for animal populations requires knowledge of the behavioural mechanisms that govern the dynamics of shelter use. Exploitation of shelters may be impeded by mutual interference, yet interference competition can be difficult to distinguish from exploitation competition. We used Bullheads (Cottus gobio) as a model system of mobile fish to investigate the effect of intraspecific competition on shelter use. A series of field experiments was conducted under controlled conditions of shelter availability and population density. For each experiment the location of each individual fish was observed over a period of 10 days. We then constructed a continuous-time Markov-chain model for the movement of fish between shelters and the open stream, which explicitly parameterised exploitation competition and interference competition for shelter, and which accounted for two different size classes of fish. By using a stochastic rather than a deterministic model, we were able to account for the distribution of fish across shelters, and not just the average occupation. Analysis of the model showed strong evidence of exploitation competition, which was highly dependent on body size, and an increased departure rate from shared shelters. Over and above exploitation, interference competition limited the ability of unsheltered fish to colonise vacant shelters at high population densities. Different formulations of the interference competition were compared using the AIC information criterion. The formulation that best fitted the observations modelled interference competition as an increasing function of average shelter occupancy, rather than population density per s