Evidence for the long term cost effectiveness of home care reablement programs

Background: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age

Diplomado de profundizacion cisco prueba de habilidades prácticas ccnp

Dentro de lo necesario para establecer una diferencia y garantizar un esquema de aprendizaje y fortalecimiento de conocimientos en el área de redes, es necesario contemplar la posibilidad de tomar el diplomado de CCNP, como un camino para dar un estado y permitir desarrollar las competencias necesarias que certificaran la teoría y los cimientos básicos en la mejor forma de abordar las redes, la conmutación de las mismas y sobre todo el enrutamiento de la información, esto garantiza la correcta administración de la red, y para el caso del diplomado de protocolos y estándares desarrollados por CISCO, interviniendo escenarios de pruebas con bastante acercamiento con la producción. Lo alcanzado en el diplomado permite validar los diferentes protocolos que se presentan en las redes, así como su comportamiento en las mismas, dando una visión general del uso de estos y de las posibilidades que brindan, además de una visión electrónica y muy lógica de como se pueden compartir los paquetes en las redes.Within what is necessary to establish a difference and guarantee a learning scheme and strengthening knowledge in the area of networks, it is necessary to consider the possibility of taking the CCNP diploma, as a way to give a status and allow the development of the necessary skills that They will certify the theory and the basic foundations in the best way to approach the networks, the switching of the same and especially the routing of the information, this guarantees the correct administration of the network, and in the case of the diploma of protocols and standards developed by CISCO, intervening test scenarios very closely with production. What has been achieved in the diploma allows to validate the different protocols that are presented in the networks, as well as their behavior in them, giving an overview of the use of these and the possibilities they offer, in addition to an electronic and very logical vision of how packages can be shared across network

Elevated plasma and urinary concentration of green tea catechins associated with improved plasma lipid profile in healthy Japanese women

This study investigated green tea catechins in plasma and urine and chronic disease biomarkers. We hypothesized that plasma and urinary concentration of green tea catechins are associated with cardiovascular disease and diabetes biomarkers. First void urine and fasting plasma samples were collected from 57 generally healthy females aged 38 to 73 years (mean, 52 ± 8 years) recruited in Himeji, Japan. The concentrations of plasma and urinary green tea catechins were determined by liquid chromatography coupled with mass tandem spectrometer. Low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, glucose, insulin, glycated hemoglobin, and C-reactive protein in plasma/serum samples were analyzed by a commercial diagnostic laboratory. Statistical associations were assessed using Spearman correlation coefficients. The results showed weak associations between plasma total catechin and triglyceride (r = -0.30) and LDL cholesterol (r = -0.28), whereas plasma (-)-epigallocatechin-3-gallate, (-)-epigallocatechin, (-)-epicatechin-3-gallate, and (-)-epicatechin exhibited weak to moderate associations with triglyceride or LDL cholesterol, but little associations with HDL cholesterol, body fat, and body mass index were evident. Urinary total catechin was weakly associated with triglyceride (r = -0.19) and LDL cholesterol (r = -0.15), whereas urinary (-)-epigallocatechin-3-gallate (r = -0.33), (-)-epigallocatechin (r = -0.23), and (-)-epicatechin-3-gallate (r = -0.33) had weak to moderate correlations with triglyceride and similarly with body fat and body mass index. Both plasma (r = -0.24) and urinary (r = -0.24) total catechin, as well as individual catechins, were weakly associated with glycated hemoglobin. Plasma total and individual catechins were weakly to moderately associated with C-reactive protein, but not the case for urinary catechins. In conclusion, we found weak to moderate associations between plasma and urinary green tea catechin concentrations and plasma biomarkers of cardiovascular disease and diabetes

Plasma retinol, carotene and vitamin E concentrations and lung function in a crocidolite-exposed cohort from Wittenoom, Western Australia: a cohort study

BACKGROUND: Increased rates of death from asbestos related diseases have been reported for people previously employed in the mining and milling operations at Wittenoom (Western Australia), and people who lived in the nearby town, where they were environmentally exposed to crocidolite. METHODS: Annual measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) and plasma concentrations of retinol, carotene and vitamin E have been made since 1992. Mixed effects models were used to examine the associations between lung function and the plasma vitamin levels of retinol, carotene and vitamin E. RESULTS: After adjusting for potential confounders, higher plasma retinol and carotene concentrations were significantly associated with higher levels of lung function at entry into the study, while vitamin E concentrations were associated with lower entry lung function. Retinol was associated with a less steep decline of lung function over time, while carotene concentrations were associated with an increased decline of lung function over time and vitamin E levels were not associated with changes of lung function over time. CONCLUSION: These results support a beneficial relationship between plasma concentrations of retinol on the levels and rates of change of lung function, while showing no such consistent beneficial effect for plasma levels of beta-carotene or vitamin E

Comparison of outcomes following a cytological or histological diagnosis of malignant mesothelioma

Background: Survival with the epithelioid subtype of malignant mesothelioma (MM) is longer than the biphasic or sarcomatoid subtypes. There is concern that cytology-diagnosed epithelioid MM may underdiagnose the biphasic subtype. This study examines survival differences between patients with epithelioid MM diagnosed by cytology only and other subtypes diagnosed by histology. Methods: Demographics, diagnosis method, MM subtype and survival were extracted from the Western Australia (WA) Mesothelioma Registry, which records details of all MM cases occurring in WA. Results: A total of 2024 MM cases were identified over 42 years. One thousand seven hundred forty-four (86.2%) were male, median (IQR) age was 68.6 (60.4–77.0) years. A total of 1212 (59.9%) cases were identified as epithelioid subtype of which 499 (41.2%) were diagnosed using fluid cytology only. Those with a cytology-only diagnosis were older than the histology group (median 70.2 vs 67.6 years, P<0.001), but median survival was similar (cytology 10.6 (5.5–19.2) vs histology 11.1 (4.8–19.8) months, P=0.727) and Cox regression modelling adjusting for age, sex, site and time since first exposure showed no difference in survival between the different diagnostic approaches. Conclusions: Survival of cytologically and histologically diagnosed epithelioid MM cases does not differ. A diagnostic tap should be considered adequate to diagnose epithelioid MM without need for further invasive testing

Which women stop smoking during pregnancy and the effect on breastfeeding duration

BACKGROUND: Cigarette smoking during pregnancy increases the risk of adverse pregnancy outcomes and women who quit smoking at this time are able to reduce the risk of low birth weight, preterm labour, spontaneous abortion and perinatal death. This study investigates the socio-demographic characteristics of pregnant women who stop smoking during pregnancy and the association between stopping smoking and breastfeeding duration. METHODS: A 12 month longitudinal study was conducted in two public maternity hospitals in Perth, Australia between mid-September 2002 and mid-July 2003. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. RESULTS: A total of 587 (55%) mothers participated in the study. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Women who were pregnant for the first time were twice as likely (OR = 2.05; 95% CI 1.047 – 4.03; p < 0.05) to quit smoking as multiparous women. Women who smoked more than 10 cigarettes per day were significantly less likely to quit smoking during pregnancy (OR = 0.36; 95% CI 0.18 – 0.69; p < 0.05). Women who consumed alcohol before pregnancy were three times more likely to quit smoking (OR = 2.58; 95% CI 1.00 – 6.66; p < 0.05). Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70; 95% CI 1.55 – 8.83; p < 0.05). CONCLUSION: Pregnancy is a time when many women are motivated to quit smoking and providing targeted smoking cessation interventions at this time, which take into account factors predictive of quitting smoking, are more likely to be successful

Maternal cigarette smoking and breastfeeding duration

Aim: To examine the relationship between cigarette smoking and breastfeeding duration at 2 wk, 6 mo, and longer. Methods: Design. A 12-mo longitudinal study. Setting. Two public maternity hospitals in the Perth metropolitan area (Western Australia). Subjects. Eligible mothers of healthy newborn infants. Interventions. Participants completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women regardless of their chosen infant feeding method were followed up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 wk postpartum. Main outcome measures. Prevalence of breastfeeding at 2 wk, 2 wk to 6 mo and &gt;6 mo in women who smoked during pregnancy, and breastfeeding duration. Results: Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 vs 11 wk, 95% CI 8.3 13.7). This effect remained even after adjustment for age, education, income, father's smoking status, mother's country of birth, intended duration of breastfeeding &gt;6 mo and birthweight (risk ratio 1.59, 95% CI 1.22 2.08).Conclusion: Women who smoke during pregnancy are at greater risk of not achieving national and international targets for breastfeeding. Encouraging smoking cessation in the antenatal setting is an area for considerable public health gain

Defining and Developing a Global Public Health Course for Public Health Graduates.

Global public health is increasingly being seen as a speciality field within the university education of public health. However, the exact meaning of global public health is still unclear, resulting in varied curricula and teaching units among universities. The contextual differences between high- and low- and middle-income countries, and the process of globalization need to be taken into account while developing any global public health course. Global public health and public health are not separable and global public health often appears as an extension of public health in the era of globalization and interdependence. Though global public health is readily understood as health of global population, it is mainly practiced as health problems and their solutions set within low- and middle-income countries. Additional specialist competencies relevant to the context of low- and middle-income countries are needed to work in this field. Although there can be a long list of competencies relevant to this broad topic, available literature suggests that knowledge and skills related with ethics and vulnerable groups/issues; globalization and its impact on health; disease burden; culture, society, and politics; and management are important

Use of pedometers in a workplace physical activity program

Hot Steppers is a pedometer-walking program developed for staff at Caulfield General Medical Centre (CGMC) in Melbourne, following a felt need expressed by staff that a physical activity program was required within the workplace. Participants were asked to complete a questionnaire adapted from the Active Australia survey at an introductory session. They were then asked to record the number of steps taken each day in a log book provided and to return it to the program coordinator at the end of each month in order to receive their log for the next month. After three months the participants were re-issued with the adapted Active Australia survey along with a process evaluation questionnaire. The evaluation enabled the coordinators to make a number of recommendations to improve the design of the program and also helped to identify a number of barriers and enablers to participation in physical activity for this group of people. This pilot program provides examples for podiatrists of how to implement a walking program using minimal resources; the use of pedometers for motivation; record keeping and evaluation; and an example of a simple and practical evaluation of a health promotion program