Potentially preventable visits to the emergency department in older adults: Results from a national survey in Italy.

Despite older adults use emergency department more appropriately than other age groups, there is a significant share of admissions that can be considered potentially preventable.To identify socio-demographic characteristics and health care resources use of older adults admitted to emergency department for a potentially preventable visit.Data come from the Multipurpose Survey "Health conditions and use of health services", edition 2012-2013. A stratified multi-stage probability design was used to select a sample using municipal lists of households.50474 community dwelling Italians were interviewed. In this analysis, 27003 subjects aged 65 years or older were considered.Potentially preventable visits were defined as an emergency department visit that did not result in inpatient admission. Independent variables were classified based on the socio-behavioral model of Andersen-Newman. Descriptive statistics and a logistic regression model were developed.In the twelve months before the interview 3872 subjects (14.3%) had at least one potentially preventable visit. Factors associated with an increased risk of a potentially preventable visit were older age (75-84 years: OR 1.096, CI 1.001-1.199; 85+years: OR 1.022, CI 1.071-1.391), at least one hospital admission (OR 3.869, IC 3.547-4.221), to waive a visit (OR 1.188, CI 1.017-1.389) or an exam (OR 1.300, CI 1.077-1.570). Factors associated with a lower risk were female gender (OR 0.893, CI 0.819-0.975), area of residence (Center: OR 0.850; CI 0.766-0.943; Islands: OR 0.617, CI 0.539-0.706, South: OR 0.560; CI 0.505-0.622), private paid assistance (OR 0.761, CI 0.602-0.962); a better health-related quality of life (PCS score 46-54: OR 0.744, CI 0.659-0.841; PCS score >55: OR 0.746, CI 0.644-0.865).Our study identified several characteristics associated with an increased risk of potentially preventable visits to the emergency department. This might allow the development of specific interventions to prevent the access of at risk subjects to the emergency department

Potentially preventable visits to the emergency department in older adults: Results from a national survey in Italy

Despite older adults use emergency department more appropriately than other age groups, there is a significant share of admissions that can be considered potentially preventable.To identify socio-demographic characteristics and health care resources use of older adults admitted to emergency department for a potentially preventable visit.Data come from the Multipurpose Survey "Health conditions and use of health services", edition 2012-2013. A stratified multi-stage probability design was used to select a sample using municipal lists of households.50474 community dwelling Italians were interviewed. In this analysis, 27003 subjects aged 65 years or older were considered.Potentially preventable visits were defined as an emergency department visit that did not result in inpatient admission. Independent variables were classified based on the socio-behavioral model of Andersen-Newman. Descriptive statistics and a logistic regression model were developed.In the twelve months before the interview 3872 subjects (14.3%) had at least one potentially preventable visit. Factors associated with an increased risk of a potentially preventable visit were older age (75-84 years: OR 1.096, CI 1.001-1.199; 85+years: OR 1.022, CI 1.071-1.391), at least one hospital admission (OR 3.869, IC 3.547-4.221), to waive a visit (OR 1.188, CI 1.017-1.389) or an exam (OR 1.300, CI 1.077-1.570). Factors associated with a lower risk were female gender (OR 0.893, CI 0.819-0.975), area of residence (Center: OR 0.850; CI 0.766-0.943; Islands: OR 0.617, CI 0.539-0.706, South: OR 0.560; CI 0.505-0.622), private paid assistance (OR 0.761, CI 0.602-0.962); a better health-related quality of life (PCS score 46-54: OR 0.744, CI 0.659-0.841; PCS score >55: OR 0.746, CI 0.644-0.865).Our study identified several characteristics associated with an increased risk of potentially preventable visits to the emergency department. This might allow the development of specific interventions to prevent the access of at risk subjects to the emergency department

Neuroticism and Self-Confidence of Physically Challenged Viz. Hearing Impaired and Speech Impaired Secondary School Students of Kashmir Division

As per the directive principles of constitution, education should be fair without the any regional or communal bias and should make justice with every individual more than ever for all marginalized groups including visually, hearing, orthopedically and speech impaired. This would permit community participation in education at the basic level and would introduce deep-seated change, leading to the empowerment of learners with Special Educational Needs such as visually, hearing, orthopedically and speech impaired. Until the 1970s, the policy encouraged isolation because the majority of educators thought that children with physical, sensory, or intellectual disabilities were so dissimilar and unusual that they could not take part in the activities of a common school (Advani, 2002). The majority of disabled population is deprived and experience difficulties in accessing essential health as well as rehabilitation services. This costs immobility, isolation, dependency, inequality, often premature death and enlarged poverty. According to the national census (2001) there are 21.9 million disabled people in India– that constitutes about 2.13 per cent of the total population - 1.03 per cent are visually impaired, 0.59 per cent ’orthopedically impaired 0.16 per cent speech impaired, 0.12 per cent ‘hearing’ impaired, and 0.22 per cent ‘mentally’ retard of the total national population. Hearing impairment refers to a defect in or injure to the sensory mechanism. The injury or defect might occur in various parts of the ear. It leads to hearing impairment or loss of hearing. A person may become deaf or hard of hearing depending upon the nature of impairment and the degree of hearing loss. Hearing impaired are those in whom the sense of hearing is non-functional for ordinary function of living. These people do not have capacity to distinguish sound at all even with improved vocalizations. The various sensory defective subjects included in this class will be those having hearing loss of more than 70 decibels (Graham Bell’s Scale) in the better ear (profound) loss of hearing in both ears (ministry of social welfare 1987). A hearing impairment is a hearing loss that prevents a person from totally receiving sounds from side to side the ear. As such sensory hearing defect leads to various other social and psychological problems. These hearing defective persons are prescribed to use hearing aids in order to overcome the various problems. In persistent hearing loss, the someone can not to discriminate any sounds. There are four types of sensory hearing defects such as Conductive hearing defect, neural defect, varied hearing defect and innermost hearing defect

Predictors of Functional Changes in Italian Nursing Home Residents: The U.L.I.S.S.E. Study

OBJECTIVES: To identify independent predictors of the risk of functional decline in older nursing home (NH) residents. DESIGN: A longitudinal observational study. SETTING: Thirty-one NHs participating in the U.L.I.S.S.E. project, distributed throughout Italy. PARTICIPANTS: All older (≥65 years) long-term NH residents without complete disability and with at least one follow-up evaluation during the 12-month study period (n = 1263). MEASUREMENTS: All participants underwent a standardized comprehensive evaluation using the Italian version of the Minimum Data Set for NHs. The activities of daily living (ADLs) Long-Form scale was used to evaluate functional status. Facility characteristics were collected using an ad hoc designed questionnaire. RESULTS: Of the NH residents, 40.4% experienced a decline in the ADL during the follow-up. The mixed effect logistic regression model showed that depression (odds ratio [OR] 1.45, confidence interval [CI] 1.16-1.81, P = .005) and the use of antipsychotics (OR 1.30, CI 1.06-1.60, P = .016) were associated with a higher probability of ADL decline, whereas the presence of a geriatrician (OR 0.60, CI 0.41-0.88, P = .015) and a higher than median hour per resident per week of nursing care (OR 0.55, CI 0.37-0.80, P = .006) were associated with a lower risk. CONCLUSIONS: Our findings suggest that preventing functional decline in NH residents might be possible by optimizing the management of depression and by reducing the current high prescription rate of antipsychotics. Moreover, the presence of a geriatrician, associated with an adequate amount of nursing care, seem to be important facilities characteristics to achieve this goal. These findings should be tested in large-scale pragmatic clinical trials

Descriptive analysis of the sample: Socio-behavioural model.

<p>Socio-demographic characteristics of the total sample and of the subgroups with and without at least one potentially preventable visit to the ED in the previous year.</p

Prevalence of non dipping pattern in CKD.

<p>Prevalence of non dipping pattern in CKD.</p

Descriptive analysis of the sample: Health care resources use.

<p>Health care resources use of the total sample and of subgroups with and without at least a potentially preventable visit in ED in the previous year.</p

Night-time SBP associated with LVM/h^2.7 in a linear regression model.

<p>BMI and age were also two other important independent factors for LVM/h^2.7.</p>*<p>TIS = Treatment Intensity Score.</p

Difference in PP between patients with CKD and the rest of the population.

<p>Difference in PP between patients with CKD and the rest of the population.</p

Correlation between ABPM values and CKD stages.

<p>Panel A. Difference in night-time BP between CKD stages. Panel B. Difference in 24 h PP between CKD stages. Panel C. Difference in daytime PP between CKD stages. Panel D. Difference in night-time PP between CKD stages.</p