Refexive Planning for Later Life: A Conceptual Model and Evidence from Canada

In this paper, we present a conceptual model to describe an individual's preparations for later life. Situated in the life course perspective, this model invites a comprehensive and systematic study of later life planning. It describes a dynamic process that portrays the interplay between social structure and human agency. Through its consideration of collective preparations (the public protection programs offered by the state), individual preparations (financial and non-financial), and the interplay between them, this model provides fresh insight into the existing literature on retirement planning, the timing of retirement, savings, and consumption patterns in later life. Moreover, the model may be used to structure research questions, to guide policy decision making and to point the direction for the design and content of future research studies. While the purpose of this paper is primarily the development of a conceptual model, we illustrate the model using the results of a self-completion semi-structured questionnaire on this topic that was completed by a convenience sample of 240 seniors in Canada. We conclude by suggesting a number of research questions that may be generated from the model.retirement planning, financial security, savings, independence

Posterior circulation stroke characteristics [POCSTROCH study]: An observational COHORT study

INTRODUCTION: Cerebrovascular accident is among the leading causes of acquired disability and death worldwide. Posterior circulation stroke [PCS] with its difficulty in early diagnosis, seldom have the appropriate evaluation or management done. Studies are scarce which looked into the independent predictors of long term bad outcomes of PCS. Our study aimed to characterize PCS among patients above 18 years age, presenting to Christian Medical College Vellore, over a period of 3 years. We wished to determine the short and long term outcomes of PCS. METHODS: We conducted a prospective observational cohort study in consecutive PCS patients who presented to our hospital. All patients from January 2014 to May 2017 were recruited, diagnostic criteria assessed and prognostic scores calculated. Morbidity and mortality at discharge, at 3 months and 6 months was studied. RESULTS: We recruited 291 PCS patients who were followed up in our cohort. Prevalence of posterior circulation stroke to the total strokes in our center in 1 year was 12.9% [111/860]. Mean age of presentation was 53.34 years (SD 13.34 years). Young strokes constituted 28.8%. The common co-morbidities were hypertension 72%, diabetes mellitus 52.6%, smoking 38.5% and dyslipidemia 32.6%. The common presenting symptoms were giddiness 79%, unsteadiness 75.35%, ataxia 56%, motor deficits 48.8% and nausea & vomiting 43%. Most were Ischemic strokes 86.5%. Among the arteries involved, posterior cerebral artery 45%, posterior inferior cerebellar artery 38% and basilar artery 19.2%. Among ischemic strokes, large artery atherosclerosis was 50.8%, cardio embolism and small vessel occlusion were 14.4% each. Dysphagia was seen in 32.6%, sepsis in 19.2% and invasive ventilation in 8%. Post stroke pain, a late complication was seen in 23%, followed by cognition decline in 10.3%. Mortality was 6.2% at discharge, 2.4% at 1-month, 1.7% at 3-months and 0.7% at 6 months, following discharge. Morbidity [modified Rankin Scale (mRS) 4 or 5] was 10.7% at discharge, 7.9% at 1 month, 4.1% at 3 months and 3.1% at 6 months. Bad outcome [mRS 4 to 6] was 16.8% at discharge, 16.4% at 1 month, 14.4% at 3 months and 13.8% at 6 months. Independent predictors of bad outcomes at 6-months were baseline National Institute of Health Stroke Scale (NIHSS) score [OR 1615.59 with CI 27.64-94447.7], invasive ventilation [OR 7.77 with CI 1.57-38.43], sepsis [OR 17.22 with CI 1.45-204.08], basilar artery involvement [OR 19.98 with CI 1.67-238.81]. Baseline NIHSS score has an area under the curve 94% showing good ability to discriminate between good and bad outcomes. NIHSS scores between 0 to 5 suggest a good outcome while scores more than 13 suggest a bad outcome at 6 months. Our cohort follow-up of 6 months is among the largest to date. CONCLUSION: The prevalence of PCS in our study was similar to the other studies in India and the West. Clinical features and co-morbidities were also similar to previous studies. Survival analysis suggest good survival at 3 and 6 months following PCS. The baseline NIHSS score is an independent predictor of bad outcomes at 6 months

The Role of Health and Age in Financial Preparations for Later Life

This paper concerns the self insurance preparations that people make for later life. Policy changes to the Canadian pension, old age security, and health care systems mean that the financial preparations that people make are becoming increasingly important as vehicles to economic independence in later life. Data from the Statistics Canada's Survey on Ageing and Independence are used to investigate the role of health and age in the financial preparations that households make for later life including contributions to RRSPs, savings, other investments, major purchases and access to company pension plans. Data are analyzed using logistic regression. Findings indicate that compared to respondents in poor health, respondents in better health are more likely to have made financial preparations for retirement. Having an activity limitation is associated with increasing odds of making other investments, paying off debts and making other purchases. Middle aged respondents (age 50-64) are more likely to have made RRSP contributions than both their younger and older counterparts. However, the older respondents were more likely to have built up savings, made other investments and paid off or avoided debts. The implications for policy are discussed.SAI; health; age; financial preparations

FUSOGENIC LIPOSOME FOR THE TREATMENT OF FUNGAL MENINGITIS: AN OVERVIEW

Fungal meningitis is an infection which is caused by fungus which spreads through the blood to the spinal cord. People with weakened immunity get this disease easily like persons with AIDs, etc. To make sure the disease is fungal meningitis, a sample is taken from the cerebrospinal fluid and it is sent to the laboratory. Usually, fungal meningitis is not mediated from person to person, but it is caused when a fungi are inhaled from the surrounding and spread into the blood to the central nervous system. Normally medications such as vaccines, IV, and oral suspensions are given to the people for curing fungal meningitis. Commonly used drugs are Amphotericin B and fluconazole oral suspension. Amphotericin B is an antifungal, antiprotozoal, and hydrophobic drug. However, these drugs cannot give a directly as medication therapy for the patients, because it offers toxic effect and side effects, absorption rate is slower, and crossing the blood–brain barrier (BBB) is getting difficult. Adverse effects can be minimized with the application of nanotechnology. Therefore, in human medical services, the availability of molecular nanotechnology will provide rapid progress. Nanoparticle (NP) systems help to improve the solubility of poorly water-soluble drugs which has been explained using Noyes–Whitney equations. Nanoparticles offers several advantages as a drug delivery system, such as better drug bioavailability, reduction of dosing frequency enables them for the betterment of diseases, can cross the BBB, and it is very cost-effective. Types of NP include polymeric NP, carbon nanotubes, metallic structures, nanocrystals, and fusogenic liposomes. Fusogenic liposomes are a peculiar class of phospholipid vesicles. The fusogenic liposomes can deliver encapsulated NP into the targeted sites and also can cross the BBB. On comparing with cationic liposomes, fusogenic liposomes are more effective as well as rapid in the drug delivery

Disability Related Sources of Income and Expenses: An Examination Among the Elderly in Canada

The primary purpose of this paper is to examine disability-related sources of income and expenses among high and low income older Canadians. Specifically, the paper attempts to answer three questions: Do low and high income seniors experience disability equally? Do low and high income seniors incur equal disability- related non-reimbursed expenses? And, Do low and high income seniors receive equal disability-related pensions and tax credits? The analysis is based on the Health and Activity Limitation Surveys of 1986 and 1991. Both surveys were cross-sectional, designed to gather information on disabilities and their impact on daily living. Among the seniors (those 65 and over), between 10.3% (men in 1986) and 23.2% (women in 1991) were classified as low income and about 40% reporting having at least one disability, compared to one-quarter of women and men of all ages. The analysis indicates that low income seniors are disadvantaged in that they experience more disability, incur more non-reimbursed expenses, and receive less in terms of disability- related pensions and credits than do high income seniors. It thus appears that interventions should be policy based rather than individual based.elderly; disability; income

Reflexive Planning for Later Life: A Conceptual Model and Evidence from Canada

In this paper, we present a conceptual model to describe an individual's preparations for later life. Situated in the life course perspective, this model invites a comprehensive and systematic study of later life planning. It describes a dynamic process that portrays the interplay between social structure and human agency. Through its consideration of collective preparations (the public protection programs offered by the state), individual preparations (financial and non-financial), and the interplay between them, this model provides fresh insight into the existing literature on retirement planning, the timing of retirement, savings, and consumption patterns in later life. Moreover, the model may be used to structure research questions, to guide policy decision making and to point the direction for the design and content of future research studies. While the purpose of this paper is primarily the development of a conceptual model, we illustrate the model using the results of a self-completion semi-structured questionnaire on this topic that was completed by a convenience sample of 240 seniors in Canada. We conclude by suggesting a number of research questions that may be generated from the model.retirement planning,financial security,savings,independence

Implementing a package of essential non-communicable diseases interventions in low- and middle-income countries: a realist review protocol

IntroductionThe burden of non-communicable diseases (NCDs) is increasing rapidly, particularly in low- and middle-income countries (LMIC), accounting for 85% of premature deaths in the region. LMICs have been facing an increasing trend of a double burden of disease (infectious diseases and NCDs) that has led to multiple challenges in prioritising strategies for NCDs control amidst limited resources. Evidence indicates that measures such as the WHO’s package of essential non-communicable (PEN) diseases interventions can prevent and control NCDs. However, because of the complexity of such health interventions, there is limited evidence that explains how the intervention works, for whom and in what context. We aim to unpack the causal mechanisms explaining how, why, for whom and in what context PEN prevents and controls NCDs.Methods and analysisWe propose a realist review to understand how, why, for whom and under what circumstances PEN works or does not work. The review process includes five steps applied iteratively throughout the study: clarification of review scope, searching for evidence, appraising and extracting data, synthesising evidence and drawing conclusions, and disseminating the findings. Programme theories will be developed using the realist logic for theory formulation—Retroductive Theorising. The context-mechanism-outcome (CMO) heuristic tool will be used to develop the programme theories. Portions of the reviewed documents describing constructs of context, mechanism and outcomes will be coded inductively and extracted. These extracted constructs will then be linked abductively to formulate CMO configurations.Ethics and disseminationFormal ethical approval is not required for this review. Study findings will be disseminated through publications in peer-reviewed journals, conference presentations and formal and informal reports.</jats:sec

Management of endocrine disease:Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis

Objective: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses. Design: A systematic review and meta-analysis was conducted. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI, or F-18-fluoro-deoxyglucose (FDG)-PET compared with an adequate histological or imaging-based follow-up reference standard. Results: We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n = 16), MRI (n = 15), and FDG-PET (n = 9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10 HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, that is, masses with <= 10 HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers. Conclusions: Despite their widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis