Relationship of Physical Activity to Self-Care Agency and Physical Condition Among Older Adults in a Rural Area

[Background] Maintaining physical activity is important for older adults. “Self-care agency” is the ability to perform self-care, which is defined as people following their own will, managing themselves, and maintaining activities. We investigated the relationship among physical activity and self-care agency, demographic factors and physical condition in older adults. [Methods] Self-care agency was assessed by using the Self-Care Agency Questionnaire developed for Japanese patients with chronic diseases. Among 175 older adults aged 65 years or older living in a rural area, responses from 83 who performed physical activities were analyzed. Correspondence analysis was conducted to characterize demographic factors and self-care agency. [Results] A higher proportion of women than men were engaged in physical activity. Irrespective of age and sex, many of the participants performed stretching exercises, walking, radio exercises, TV exercises, and participated in community circles. Participants who engaged in physical activities had significantly higher self-care agency scores than inactive participants. Among the active participants, the self-care agency score was significantly higher for women than men (P = .04) and was also significantly higher for participants aged ≥ 75 years compared to those aged < 75 years. Individuals with a high self-care agency tended to participate in local programs and perform brief physical activities at home. [Conclusion] Physically active older adults demonstrated high self-care agency. Their activities were easily carried out in their daily lives, with activities varying by age and sex. Support from community health experts is needed to promote suitable physical activity among older adults tailored for age and sex, especially among older adults who have low self-care agency

A Path Model Analysis of the Causal Relationship between Self-care Agency and Healthy Behavior in Community-dwelling Older People from the GAINA Study

[Background] Self-care agency is an important determinant of self-care behavior. The purpose of this study was to identify the causal relationship between self-care agency and healthy behavior, and to construct a conceptual model of healthy behavior among older people living in a rural community. [Methods] This study was conducted as a cross-sectional survey at the Hino, a town in western Tottori Prefecture, Japan. Participants who were enrolled in the Good Ageing and Intervention against Nursing Care and Activity Decline (GAINA) study from 2014 to 2018 (467 new participants) were initially investigated. Of 398 participants aged ? 65 years, 5 were excluded due to missing data, and thus 393 were analyzed. Nurse researchers conducted face-to-face interviews with participants to check the accuracy of data obtained from a self-administered questionnaire, which included demographic information, physical condition (comorbidities, knee pain, low back pain, and locomotive syndrome), healthy behavior, and self-care agency. Correlations among variables were investigated by Pearson’s correlation coefficient analysis, and path analysis was performed to assess causal relationships. [Results] A total of 393 persons (160 men and 233 women) were investigated, ranging in age from 65 to 92 years, with a mean age of 75.1 years (SD: 6.9 years). Path analysis revealed poor fit of a model in which pain and locomotive syndrome were factors inhibiting healthy behavior. When the model included only self-care agency, the indices of model fit were almost satisfactory (Goodness-of-fit index = 0.967, Adjusted goodness-of-fit index = 0.900, Comparative fit index = 0.951, and Root mean square error of approximation = 0.088), and the coefficient of determination (R2) was 0.38. The self-care agency items with the greatest influence on healthy behavior were the ability to “grasp the techniques/tips needed to maintain health,” and the ability to “persist with healthy behavior.” [Conclusion] Self-care agency can promote healthy behavior among community-dwelling older people. Regardless of physical problems such as pain and locomotive syndrome, older people have the potential to adopt positive healthy behavior if they acquire self-care agency

Aplicação do protocolo de monitorização em paciente com risco de desenvolver úlcera de pressão: um estudo de caso

A lcera de Presso (UP) motivo de preocupao pela equipe de enfermagem, uma vez que seu aparecimentoe prognstico esto associado diretamente com a qualidade da assistncia prestada. Com base nos resultados satisfatriosobtidos com o Protocolo de Monitorizao do Paciente Crtico com Risco de Desenvolver lcera de Presso em pacientesinternados por curto perodo de tempo, realizou-se estudo de caso com o objetivo de constatar a efetividade deste mesmoprotocolo em paciente internado por longo perodo. O paciente do estudo, era do sexo feminino, permaneceu internadadurante 140 dias na UTI de hospital escola pblico. Entre os diagnsticos apresentados pela paciente, destacou-se o riscopara desenvolver UP, com escore de 11,48 pela escala de Braden, adaptada e validada na lngua portuguesa, sendo o mesmomonitorado com o protocolo. A partir de ento apresentou apenas um episdio de incio de ulcerao sendo intensifi cado asmedidas preventivas, com regresso completa do quadro, permanecendo assim at seu bito. Dentre os cuidados prestados,os realizados com maior freqncia, 135 dias (96,4%), referem-se a proteo de calcanhares e cotovelos, seguido de inspeodiria das reas de risco e mobilizao correta, ambos prescritos por 134 dias (95,7%); manuteno da nutrio e elevao dacabeceira a 30 graus realizados por 133 dias (95%); mudana de decbito de 2/2 horas, executado durante 132 dias (94,3%).Concluiu-se que o uso do protocolo apresentou plena efetividade na situao de paciente crtico internado por longo perodode dias, contribuindo para a reduo da incidncia das UP bem como para melhoria da assistncia de enfermagem

Cost analysis of hospitalized patients treated in a specialized university burn center

O objetivo desse estudo foi descrever os custos diretos do tratamento de pacientes admitidos na Unidade de Terapia Intensiva de um centro de referência no tratamento de queimaduras de um hospital terciário, universitário, público, no estado do Paraná, no sul do Brasil. Trata-se de um estudo longitudinal prospectivo, de pacientes consecutivamente admitidos nos leitos de terapia intensiva de queimados, no período de maio de 2011 a maio de 2013. Os pacientes que preenchiam os critérios de inclusão foram acompanhados diariamente até a alta hospitalar ou óbito. Os itens de custos diretos foram agrupados em cinco categorias: suporte clínico, medicamentos e hemoderivados, procedimentos médicos, procedimentos específicos para tratamento das queimaduras e taxas hospitalares. Os valores dos itens em moeda nacional (ano 2014) foram baseados nos índices de preços de procedimentos médicos da Associação Médica Brasileira (AMB) e para medicamentos, soluções e materiais de consumo hospitalar os índices de preços da tabela Brasíndice. Foram também coletados dados demográficos, etiologia, extensão e profundidade das queimaduras e os dados para o cálculo dos escores de prognósticos Acute Physiology and Chronic Health Evaluation (APACHE II) e Abbreviated Burn Severity Index (ABSI), o escore de disfunção orgânica (SOFA) e de intervenções terapêuticas (TISS 28) para caracterização da população do estudo. Não foram coletados os custos indiretos. Foram incluídos e analisados 180 pacientes. Houve predominância do sexo masculino 131 (72,8%). A média de idade foi de 42,0 ± 15,3 anos, a média de superfície corpórea queimada de 27,9 ± 17,8% e a média do tempo de internação de 28,0 ± 21,4 dias. A média do índice ABSI foi de 7.9 ± 2.3 e 16.4 ± 8.5 para o APACHE II. A maioria dos pacientes sofreu queimaduras decorrentes de acidentes domésticos (56,1%). As queimaduras térmicas foram as mais frequentes 154 (85,5%) e o agente acelerador foi o álcool líquido com 84 (46,7%) casos. O custo total médio diário foi de R$2.874,50 ± 1.111,95 e o custo total médio da internação foi de R$ 85.544,79 ± 81.541,20. Em concordância com literatura disponível, os custos do tratamento dos pacientes queimados foram elevados. Constatou se diferenças entre as estimativas de custos diretos publicados ao redor do mundo. As variações de abordagens metodológicas dos estudos, características populacionais e diferentes protocolos de cuidados podem justificar essas diferenças.The aim of this study was to describe the direct costs of treating patients admitted to the intensive care unit of a reference center for the treatment of burns of a tertiary university public hospital, at Paraná state, in southern Brazil. This is a prospective longitudinal study of consecutive patients admitted to the intensive burn care unit, from May 2011 to May 2013. Patients fulfilling inclusion criteria were followed daily until hospital discharge or death. The direct cost items were grouped into five categories: clinical support, medications and blood products, medical procedures, specific procedures for burn treatment and hospital fees. The values of the items in the national currency (2014) were based on price's index for medical procedures published by the Brazilian Medical Association (AMB) and Brasíndice price's index was applied for medicines, solutions and hospital's consumables. Demographic data, etiology, extent and depth of burns were collected. Data for the calculation of Acute Physiology and Chronic Health Evaluation (APACHE II) and Abbreviated Burn Severity Index (ABSI) prognostic indices, SOFA score of organ dysfunction and TISS 28 therapeutic interventions system to characterize the study population were also collected. No indirect costs were collected. We included and analyzed 180 patients. There was a predominance of male gender 131 (72.8%). The average age was 42.0 ± 15.3 years, mean total body surface burned area was 27.9 ± 17.8% and the average length of hospitalization was 28.0 ± 21.4 days. The average ABSI index was 7.9 ± 2.3 and 16.4 ± 8.5 for APACHE II. The majority of patients suffered burns due to domestic accidents (56.1%). Thermal burns were the most common 154 (85.5%) and the accelerating agent was liquid alcohol in 84 (46.7%) cases. The daily average total cost was R$2.874,50 ± 1.111,95 and the mean total cost of hospitalization was R$ 85.544,79 ± 81.541,20. In accordance with the literature, costs of treatment for burn patients are high. We found differences among estimates of direct costs published around the world. Variations in methodological approaches, population characteristics and different protocols of care can justify these differences

Factors related to continuing to receive annual medical check-ups in residents living in Hino town in the Tottori prefecture : a two-year prospective investigation in the GAINA study

The aim of this study in residents living in Hino town in the Tottori prefecture was to determine the factors related to them continuing to receive annual medical check-ups. A total of 223 subjects participated in the study and received a baseline assessment that included a blood test, measurement of bone mass, muscle mass, pain, gait speed, and grip strength, recording whether or not the locomotive syndrome or sarcopenia were present, and the incidence of falls and fractures. Yearly follow-up assessments were performed in the two-year period after the baseline assessment. The subjects were stratified into two groups: continuing to receive medical check-ups during the three years （G1） and not receiving medical check-ups over the two-year follow-up period （G2）. Ninety-seven subjects received medical check-ups over three years, while 17 subjects received a baseline assessment but never had follow-up assessments despite answering a postal follow-up questionnaire. Taking analgesic medicine at the baseline assessment was significantly higher in the G2 group than in the G1 group. The incidence of fractures was also significantly higher in the G2 group than in the G1 group at the follow-up assessment. Multiple regression analysis showed sarcopenia was the factor that had the most influence on the subjects continuing to receive medical check-ups. By causing a loss of muscle mass and lower physical performance, sarcopenia may prevent residents from maintaining regular healthcare behavior

Advantageous characteristics of the diatom Chaetoceros gracilis as a sustainable biofuel producer

[Background]Diatoms have attracted interest as biofuel producers. Here, the contents of lipids and photosynthetic pigments were analyzed in a marine centric diatom, Chaetoceros gracilis. This diatom can be genetically engineered using our previously reported transformation technique and has a potential to produce valuable materials photosynthetically. Sustainable culture conditions for cost-effective production of biological materials under autotrophic conditions with atmospheric carbon dioxide were investigated in the laboratory. A large-scale, open-air culture was also performed. [Results]Cell population doubling time was ~10 h under continuous illumination without CO2enrichment, and large amounts of triacylglycerols (TAG) and fucoxanthin accumulated under a wide range of salinity and nutrient conditions, reaching ~200 and 18.5 mg/L, respectively. It was also shown that C. gracilis produced high amounts of TAG without the need for nitrogen or silica deprivation, which is frequently imposed to induce lipid production in many other microalgae. Furthermore, C. gracilis was confirmed to be highly tolerant to changes in environmental conditions, such as salinity. The diatom grew well and produced abundant lipids when using sewage water or liquid fertilizer derived from cattle feces without augmented carbon dioxide. High growth rates (doubling time <20 h) were obtained in a large-scale, open-air culture, in which light irradiance and temperature fluctuated and were largely different from laboratory conditions. [Conclusions]The ability of this microalga to accumulate TAG without nutrient deprivation, which incurs added labor, high costs, and complicates scalability, is important for low-cost industrial applications. Furthermore, its high tolerance to changes in environmental conditions and high growth rates observed in large-scale, open-air culture implied scalability of this diatom for industrial applications. Therefore, C. gracilis would have great potential as a biofactory