The provision of housing and care for older persons in Zambia: an assessment

Housing is a basic social need and adequate housing is an indicator of a countrys level of socio-economic development. For low-income families, housing is both a form of investment and a source of income generation through the rental of rooms. In Zambia, statistics show that in both quantitative and qualitative terms, the level of housing provision is incongruent with the rate of population growth, and that housing stock nowhere near meets basic minimum standards. A lack of decent housing is greater in rural areas and peri-urban residential areas, where persons in low-income groups, who are in the majority, reside. The objectives of this study were (1) to determine home ownership and the conditions of houses occupied by older persons, and (2) to assess the role of family, the community and government in the provision of housing and care for older persons in Lusaka. Through meeting these objectives, the study would determine the types of assistance needed from family and the community which could improve the quality of older persons lives, bearing in mind the effects of the Structural Adjustment Programme and HIV/AIDS-related illnesses and deaths on the working population

An environmental assessment of Divine Providence Home in Lusaka, Zambia

This paper examines the physical and social environment of Divine Providence Home (DPH), a residential care facility for older persons in Lusaka, Zambia. It also assesses the homes future function and capacity in anticipation of an increasing demand for admissions as a result of AIDS-related deaths, whereby numerous older persons will be left without traditional support. An assessment of the physical environment of the home showed that in the planning and design of the home, neither people knowledgeable in gerontology nor prospective users were involved in the three steps of programming; as a result, problems which residents of advanced age may experience were not taken into account in the design and less physically competent residents were found to experience environmental press. An assessment of the social environment showed that the residents suffered boredom but also lacked initiative to start programmes to interest them; they preferred to wait for the appointment of a programme officer, yet are capable of organizing social and income-generating activities themselves. It is proposed that residential care facilities be designed at the outset to meet the needs of residents whose physical and mental capacity will decline with advanced age. It is also proposed that the residents at DPH be encouraged to arrange their own social programme, rather than wait for the appointment of a programme officer

Cardiac surgery in indigenous Australians: early onset cardiac disease with follow-up challenges

Objective To review the risk factors, complications and follow-up of Indigenous patients post cardiac surgery

Albumin use after cardiac surgery

To investigate the effect of albumin exposure in ICU after cardiac surgery on hospital mortality, complications, and costs.A retrospective, single-center cohort study with economic evaluation.Cardiothoracic ICU in Australia.Adult patients admitted to the ICU after cardiac surgery.None.Comparison of outcomes and costs in ICU after cardiac surgery based on 4% human albumin exposure. During the study period, 3,656 patients underwent cardiac surgery. After exclusions, 2,594 patients were suitable for analysis. One-thousand two-hundred sixty-four (48.7%) were exposed to albumin and 19 (1.4%) of those died. The adjusted hospital mortality of albumin exposure compared with no albumin was not significant (odds ratio, 1.24; 95% CI, 0.56-2.79; = 0.6). More patients exposed to albumin returned to the operating theater for bleeding and/or tamponade (6.1% vs 2.1%; odds ratio, 2.84; 95% CI, 1.81-4.45; < 0.01) and received packed red cell transfusions ( < 0.001). ICU and hospital lengths of stay were prolonged in those exposed to albumin (mean difference, 18 hr; 95% CI, 10.3-25.6; < 0.001 and 87.5 hr; 95% CI, 40.5-134.6; < 0.001). Costs (U.S. dollar) were higher in patients exposed to albumin, compared with those with no albumin exposure (mean difference in ICU costs, $2,728; 95$1,566-3,890 and mean difference in hospital costs, $5,427; 95$3,294-7,560).There is no increased mortality in patients who are exposed to albumin after cardiac surgery. The patients exposed to albumin had higher illness severity, suffered more complications, and incurred higher healthcare costs. A randomized controlled trial is required to determine whether albumin use is effective and safe in this setting

Fluid resuscitation after cardiac surgery in the intensive care unit: A bi-national survey of clinician practice. (The FRACS-ICU clinician survey)

Context and Aims: To describe current fluid and vasopressor practices after cardiac surgery in Australia and New Zealand cardiothoracic intensive care units (ICU). Design and Setting: This web-based survey was conducted in cardiothoracic ICUs in Australia and New Zealand. Methods: Intensivists, cardiac surgeons, and anesthetists were contacted to complete the online survey that asked questions regarding first and second choice fluids and vasopressors and the tools and factors that influenced these choices. Results: There were 96 respondents including 51 intensivists, 27 anesthetists, and 18 cardiac surgeons. Balanced crystalloids were the most preferred fluids (70%) followed by 4% albumin (18%) overall and among intensivists and anesthetists; however, cardiac surgeons (41%) preferred 4% albumin as their first choice. The most preferred second choice was 4% albumin (74%). Among vasopressors, noradrenaline was the preferred first choice (93%) and vasopressin the preferred second choice (80%). 53% initiated blood transfusion at a hemoglobin threshold of 70 g/L. Clinical acumen and mean arterial pressure were the most commonly used modalities in determining the need for fluids. Conclusions: There is practice variation in preference for fluids used in cardiac surgical patients in Australia and New Zealand; however, balanced crystalloids and 4% albumin were the most popular choices. In contrast, there is broad agreement with the use of noradrenaline and vasopressin as first and second-line vasopressors. These data will inform the design of future studies that aim to investigate hemodynamic management post cardiac surgery. </p

Cardiac tumors in adults: surgical management and follow-up of 19 patients in an Australian tertiary hospital

The objective of this report is to share our experience with the different types of cardiac tumors, surgical management, postoperative complications and mid-term outcome of patients in an Australian tertiary hospital. Nineteen patients underwent cardiac surgery for tumors between 2001 and 2008. Their data was prospectively collected and retrospectively analyzed. The mean follow-up was 17 months. The follow-up was 100% through telephone interviews. There were multiple presenting symptoms with shortness of breath (7/19) as the most common. The tumors were atrial myxoma (14/19), fibroelastoma (2/19), angiosarcoma (1/19) and intravascular leiomyomatosis (1/19). A calcified thrombus (1/19) was misdiagnosed as a tumor. The fibroelastomas were shaved preserving valvular function. The angiosarcoma was incompletely resected with palliation intent. The leiomyomatosis and atrial myxoma were completely resected with satisfactory outcome. There was no in-hospital mortality. All patients were alive and were in New York Heart Association (NYHA) class I, except for the patient with a high-grade angiosarcoma who died eight months postoperatively. There was no evidence of recurrence in follow-up echocardiograms. Our experience and outcome is consistent with current literature. Atrial myxoma is the most common cardiac tumor and is curable with complete surgical resection. Fibroelastomas can be shaved off with low-risk of recurrence. Surgical management of angiosarcoma is palliative