Interventions targeting social isolation in older people: a systematic review

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.BACKGROUND: Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. METHODS: Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. RESULTS: Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting. CONCLUSIONS: More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.National Institute for Health Researc

An Unusual Case of Cor Triatriatum: Clinical Presentation and the Haemodynamics of a Rare Anomaly

The case of a 24-year-old woman with cor triatriatum sinister and a persistent left superior vena cava connected to the junction of the left upper pulmonary vein and left atrium is reported. A diagnosis of partial anomalous pulmonary venous return had been made and the patient underwent surgery. Inspection of the left atrium revealed a complex form of left triatrial heart. The general haemodynamics of the malformation are discussed, with particular emphasis on the features accounting for variation in the clinical presentation. This rare anomaly often remains undiagnosed before surgery and should be considered whenever obstruction of pulmonary venous flow above the mitral valve is not explained by pulmonary vein stenosis, mitral or mitral valve-linked abnormalities, atrial tumours or anomalous pulmonary venous drainage with high resistance to flow

The nexus: reconsidering environmental security and adaptive capacity

The water energy food nexus has emerged as a productive discourse and methodology in academic research, science policy dialogues, and development agendas. While the nexus provides a robust framework for interdisciplinary study, research remains focused on synergies and tradeoffs in resource 'security' and fails to adequately acknowledge the environment as the set of natural processes underpinning the nexus, particularly interactions among water, energy, and food. Resource security as a reductionist discourse does not address the limitations and potential of natural processes and the dynamic nature of human processes, especially adaptation to global change. A review of recent literature highlights the need to redefine the nexus to fundamentally incorporate the environment, and, drawing on social ecological systems thinking, to integrate considerations of adaptive capacity and resilience within nexus theory and practice. Future directions for this line of inquiry include identifying feasible ways of assessing the nexus in the context of dynamic social and ecological systems, and implications that adaptive actions have across resource-use sectors and the environment. A more holistic nexus framework enhances our options to manage environmental interactions, human activities, and policies to adapt to global-change uncertainties.International Water Security Network - Lloyd's Register Foundation (LRF); U.S. National Science Foundation (NSF) [GEO-1138881, SGP-CRA005]; NSF [CRN3056, GEO-1128040, DEB-1010495]24 month embargo; Available online 22nd November 2016This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Left Cor Triatriatum. Literature Review. Apropos of a Case Report

peer reviewe

Unraveling transboundary water security in the arid Americas

Transboundary waters are characterized by diverse and complex socio-politico-economic obstacles to effective water management. We examine five distinct cases in the arid Americas–in locations from the US–Mexico border to the Andes mountains–employing water security as a conceptual prism to unravel the multiple and varied attributes of transboundary water challenges. We describe how borders complicate water security in arid regions and explore how institutional arrangements and practices–within and across jurisdictions–respond to these challenges. We find that institutional capacity is needed on multiple levels for effective water management, and institutions must be responsive and flexible to change.Fil: Albrecht, Tamee R.. University of Arizona; Estados UnidosFil: Varady, Robert G.. University of Arizona; Estados UnidosFil: Zuniga Teran, Adriana A.. University of Arizona; Estados UnidosFil: Gerlak, Andrea K.. University of Arizona; Estados UnidosFil: Routson De Grenade, Rafael. University of Arizona; Estados UnidosFil: Lutz Ley, América. El Colegio de Sonora; MéxicoFil: Martin, Facundo Damian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; ArgentinaFil: Megdal, Sharon B.. University of Arizona; Estados UnidosFil: Meza, Francisco. Pontificia Universidad Católica de Chile; ChileFil: Ocampo Melgar, Diego. Pontificia Universidad Católica de Chile; ChileFil: Pineda, Nicolás. Colegio de Sonora; MéxicoFil: Rojas, Juan Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales; ArgentinaFil: Taboada Hermoza, Rossi. Universidad Nacional Mayor de San Marcos; PerúFil: Willems, Bram. Universidad Nacional Mayor de San Marcos; Per

Human T-cell lymphotropic virus types I and II infections in a cohort of patients with neurological disorders in Belém, Pará, Brazil Infecção pelos vírus linfotrópicos humanos de células T tipos I e II entre pacientes com doença neurológica em Belém, Pará, Brasil

Serum- and/or- cerebrospinal fluid (CSF) samples obtained from 190 patients suffering from chronic, progressive neurological disease were screened for the presence of human T-cell lymphotropic viruses type I (HTLV-I) and type II (HTLV-II) antibodies over a six-year period (1996 to 2001) in Belém, Pará, Brazil. Patients were of both sexes (male subjects, 52%) with ages ranging from 2 to 79 years (mean, 35.9). Overall, 15 (7.9%) subjects - of whom 12 (80%) were female adults - reacted HTLV-I/II-seropositive when screened by enzyme-linked immunosorbent assay (ELISA). Serum samples from 14 of these patients were also analyzed using a recombinant Western blot (WB) assay that yielded HTLV-I-, HTLV-II-, and HTLV-I/II- reactivities for 10 (71.4%), 3 (21.4%) and 1 (7.2%) of them, respectively. The yearly rates of HTLV-I/II antibodies ranged from 2.6% (2001) to 21.7% (2000), with progressively increasing seropositivities from 1998 to 2000. Altogether, walking difficulty (n = 5 subjects), spasticity (n = 4) and leg weakness (n = 3) accounted for 80% of symptoms recorded among the 15 patients whose sera had antibodies to HTLV-I/II as detected by ELISA. These findings provide evidence that both HTLV-I and HTLV-II play a role in the development of chronic myelopathy in Belém, Pará, Northern Brazil.<br>Amostras de soro e/ou líquido céfalo-raquidiano (LCR) foram obtidas de 190 pacientes com quadro de doença neurológica crônica e progressiva, com vistas à detecção de anticorpos para os vírus linfotrópicos humanos de células T dos tipos I (HTLV-I) e II (HTLV-II), durante um período de seis anos (1996 a 2001) em Belém, Pará, Brasil. O grupo compreendia ambos os sexos (homens, 52%), com idades variando de 2 a 79 anos (média, 35,9 anos). Tomando-se os resultados como um todo, 15 (7,9%) indivíduos, incluindo 12 (80%) mulheres adultas, apresentaram anticorpos para HTLV-I/II a partir da triagem pelo procedimento imunoenzimático (ELISA). Soros de 14 desses pacientes também foram testados utilizando-se procedimento de Western blot (WB), alcançando-se freqüências de anticorpos para HTLV-I, HTLV-II e dupla reação (HTLV-I e HTLV-II) em 10 (71,4%), 3 (21,4%) e 1 (7,2%) indivíduos, respectivamente. As freqüências anuais de positividade para HTLV-I/II variaram de 2,6% (2001) a 21,7% (2000), em escala crescente no período de 1998 a 2000. Em conjunto, dificuldade na deambulação (n = 5 pacientes), espasticidade (n = 4) e hipotonia crural compreenderam 80% das manifestações clínicas registradas entre os 15 pacientes cujas amostras de soro continham anticorpos para HTLV-I/II, com base em ELISA. Tais resultados oferecem indicadores quanto a uma possível associação do HTLV-I e do HTLV-II à gênese das mielopatias crônicas em Belém, norte do Brasil