Effects of preventive home visits on older people's use and costs of health care services : A systematic review

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Preventive home visits to promote the health-related quality of life of home-dwelling older people : Baseline findings and feasibility of a randomized, controlled trial

Background and aims: Studies on multiprofessional preventive home visits to older people are needed. We describe here the baseline findings and feasibility of a randomized controlled study on preventive home visits delivered by a multiprofessional team. Materials and methods: Participants (n = 422) were home-dwelling people who were 75+ years old. They were recruited from the Hyvinkaaa municipal area. They were randomized into intervention and control groups. Participants in the intervention group received three home visits, delivered by a nurse, physiotherapist and social worker. Health-related quality of life (HRQoL), measured by 15D, was used as our primary outcome measurement. Feedback on the intervention was gathered from the participants. Results: The mean age of our participants was 81 years. They scored 0.82 in the 15D HRQoL score, and 65% were female. The findings of both groups were similar in most background variables. The only differences between the groups were that lower proportions of participants in the intervention group had diabetes or used a walker. The professionals delivering the intervention reported that all intervention procedures had been delivered according to plan. Participants who responded to the feedback survey mostly reported having gained new information and were fairly content with the intervention. However, most participants felt the home visits had not improved their health or functioning. Conclusions: We have successfully randomized participants into two study groups in this trial examining the effectiveness of preventive home visits. The intervention seems feasible and has mostly been well received. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.Peer reviewe

Associations between pre-pregnancy obesity and asthma symptoms in adolescents

Background: The high prevalence of children's asthma symptoms, worldwide, is unexplained. We examined the relation between maternal pre-pregnancy weight and body mass index (BMI), and asthma symptoms in adolescents. Methods: Data from 6945 adolescents born within the Northern Finland Birth Cohort 1986 were used. Prospective antenatal and birth outcome data, including maternal pre-pregnancy weight and BMI, and asthma symptoms in adolescent offspring at age 15–16 years, were employed. Logistic regression analyses were performed to examine the associations between relevant prenatal factors and asthma symptoms during adolescence. Results: Current wheeze (within the past year) was reported by 10.6% of adolescents, and physician-diagnosed asthma by 6.0%. High maternal pre-pregnancy BMI was a significant predictor of wheeze in the adolescents (increase per kilogram per square metre unit; 2.7%, 95% CI 0.9 to 4.4 for ever wheeze; 3.5%, 95% CI 1.3 to 5.8 for current wheeze), and adjusting for potential confounders further increased the risk (2.8%, 95% CI 0.5 to 5.1; 4.7%, 95% CI 1.9 to 7.7, respectively). High maternal pre-pregnancy weight, in the top tertile, also significantly increased the odds of current wheeze in the adolescent by 20% (95% CI 4 to 39), and adjusting for potential confounders further increased the risk (OR=1.52, 95% CI 1.19 to 1.95). Results were similar for current asthma. Furthermore, these significant associations were observed only among adolescents without parental history of atopy but not among those with parental history of atopy. Conclusions: The association demonstrated here between maternal pre-pregnancy overweight and obesity, and asthma symptoms in adolescents suggests that increase in asthma may be partly related to the rapid rise in obesity in recent years

The universal functorial equivariant Lefschetz invariant

We introduce the universal functorial equivariant Lefschetz invariant for endomorphisms of finite proper G-CW-complexes, where G is a discrete group. We use K_0 of the category of "phi-endomorphisms of finitely generated free RPi(G,X)-modules". We derive results about fixed points of equivariant endomorphisms of cocompact proper smooth G-manifolds.Comment: 33 pages; shortened version of the author's PhD thesis, supervised by Wolfgang Lueck, Westfaelische Wilhelms-Universitaet Muenster, 200

Time dependence of Fe/O ratio within a 3D solar energetic particle propagation model including drift

Context. The intensity profiles of iron and oxygen in Solar Energetic Particle (SEP) events often display differences that result in a decreasing Fe/O ratio over time. The physical mechanisms behind this behaviour are not fully understood, but these observational signatures provide important tests of physical modelling efforts. Aims. In this paper we study the propagation of iron and oxygen SEP ions using a 3D model of propagation which includes the effect of guiding centre drift in a Parker spiral magnetic field. We derive time intensity profiles for a variety of observer locations and study the temporal evolution of the Fe/O ratio. Methods. We use a 3D full orbit test particle model which includes scattering. The configuration of the interplanetary magnetic field is a unipolar Parker spiral. Particles are released instantaneously from a compact region at two solar radii and allowed to propagate in 3D. Results. Both Fe and O experience significant transport across the magnetic field due to gradient and curvature drifts. We find that Fe ions drift more than O ions due to their larger mass-to-charge ratio, so that an observer that is not magnetically well connected to the source region will observe Fe arriving before O, for particles within the same range in energy per nucleon. As a result, for the majority of observer locations, the Fe/O ratio displays a decrease in time. Conclusions. We conclude that propagation effects associated with drifts produce a decay over time of the Fe/O ratio, qualitatively reproducing that observed in SEP event profiles

Dyslipidemia treatment of patients with diabetes mellitus in a US managed care plan: a retrospective database analysis

<p>Abstract</p> <p>Background</p> <p>To evaluate real-world pharmacologic treatment of mixed dyslipidemia in patients with diabetes mellitus (DM).</p> <p>Methods</p> <p>All commercial health plan members in a large US managed care database with complete lipid panel results (HDL-C, LDL-C, TG) between 1/1/2006 and 12/31/2006 were identified (N = 529,236). DM patients (N = 53,679) with mixed dyslipidemia were defined as having any 2 suboptimal lipid parameters (N = 28,728). Lipid treatment status 6 months pre- and post-index date was determined using pharmacy claims for any lipid therapy.</p> <p>Results</p> <p>Post-index, 41.1% of DM patients with 2 abnormal lipid parameters and 45.1% with 3 abnormal lipid parameters did not receive lipid-modifying treatment. Post-index treatment rates were 57.4%, 63.6%, and 66.4% for patients with LDL-C, HDL-C, and TG in the most severe quartiles, respectively. Statin monotherapy was the primary lipid-modifying regimen prescribed (54.8% and 47.8% of patients with any 2 and all 3 lipids not at goal, respectively). Less than 30% of treated patients received combination therapy.</p> <p>Conclusion</p> <p>Over 40% of DM patients with mixed dyslipidemia received no lipid-modifying therapy during the follow-up period. Those who were treated were primarily prescribed statin monotherapy. This study suggests that DM patients are not being treated to ADA-suggested targets.</p

Evolution of kinklike fluctuations associated with ion pickup within reconnection outflows in the Earth's magnetotail

Magnetic reconnection (MR) in Earth's magnetotail is usually followed by a systemwide redistribution of explosively released kinetic and thermal energy. Recently, multispacecraft observations from the THEMIS mission were used to study localized explosions associated with MR in the magnetotail so as to understand subsequent Earthward propagation of MR outbursts during substorms. Here we investigate plasma and magnetic field fluctuations/structures associated with MR exhaust and ion-ion kink mode instability during a well documented MR event. Generation, evolution and fading of kinklike oscillations are followed over a distance of 70 000 km from the reconnection site in the midmagnetotail to the more dipolar region near the Earth. We have found that the kink oscillations driven by different ion populations within the outflow region can be at least 25 000 km from the reconnection site.Comment: 11 pages, 4 figure

The incidence of pelvic fractures and related surgery in the Finnish adult population: a nationwide study of 33,469 patients between 1997 and 2014

Background and purpose - Information on the epidemiological trends of pelvic fractures and fracture surgery in the general population is limited. We therefore determined the incidence of pelvic fractures in the Finnish adult population between 1997 and 2014 and assessed the incidence and trends of fracture surgery.Patients and methods - We used data from the Finnish National Discharge Register (NHDR) to calculate the incidence of pelvic fractures and fracture surgery. All patients 18 years of age or older were included in the study. The NHDR covers the whole Finnish population and gives information on health care services and the surgical procedures performed.Results and interpretation - We found that in Finnish adults the overall incidence of hospitalization for a pelvic fracture increased from 34 to 56/100,000 person-years between 1997 and 2014. This increase was most apparent for the low-energy fragility fractures of the elderly female population. The ageing of the population is likely therefore to partly explain this increase. The annual number and incidence of pelvic fracture surgery also rose between 1997 and 2014, from 118 (number) and 3.0 (incidence) in 1997 to 187 and 4.3 in 2014, respectively. The increasing number and incidence of pelvic fractures in the elderly population will increase the need for social and healthcare services. The main focus should be on fracture prevention.Peer reviewe