Generationenzentrum Falkenstein

Diese Diplomarbeit befasst sich im weiteren Sinn mit dem Thema „Altern im Wandel der Zeit“. Im theoretischen Teil wird die Problematik „demographische Entwicklung der österreichischen Bevölkerung und deren Auswirkungen“ aufgegriffen sowie die Themen „ältere Menschen und ihre Autonomie“ und „Ehrenamtlichkeit als produktives Tätigkeitsfeld für ältere Menschen“ behandelt. Der empirische Teil legt den Fokus auf Seniorentagesstätten als mögliche Betreuungsform für ältere Menschen. Dazu wurde eine quantitative Studie durchgeführt, mit dem Ziel, die Akzeptanz der BewohnerInnen von Falkenstein gegenüber einer Seniorentagesstätte in Falkenstein zu evaluieren. Diese Information sollte dem Bürgermeister von Falkenstein als Grundlage zur Planung einer Seniorentagesstätte dienen. Im ersten Schritt wurden zwei narrative ExpertInneninterviews mit Personen in speziellen Führungspositionen in Falkenstein durchgeführt, um die Lebenskultur und -struktur der älteren Menschen von Falkenstein kennen zu lernen. Weiters erfolgte ein Besuch in einer Seniorentagesstätte in Wien, um einen Einblick in das Tagesgeschäft solch einer Institution zu erhalten. Im Anschluss wurde basierend auf diesen Erkenntnissen ein Fragebogen entwickelt, der an 205 BewohnerInnen von Falkenstein ausgesandt wurde. 90 Fragebogen wurden beantwortet und abgegeben, was eine Rücklaufquote von 43,90 % ist. Die Ergebnisse der Studie zeigten, dass knapp 90 % derer, die geantwortet haben (n = 82), Interesse an dem Generationenzentrum in Falkenstein haben. Die bevorzugten Nachmittagsaktivitäten der Befragten sind kulturelle Ausflüge und Wanderungen, Angebote zu Gedächtnisübungen, Diskussionsrunden und sportliche Aktivitäten, sowie Angebote zu Gesellschaftsspielen. Als Themenschwerpunkte für Informationsveranstaltungen werden Gesundheit / Prävention, Betreuungsangebote bezüglich Pflege, Ausflugsziele und eine sogenannte „Hilfs-Börse“ für die gesamten BewohnerInnen von Falkenstein bevorzugt. Fast 30 % der Befragten gaben an, selbst in dem Generationenzentrum ehrenamtlich tätig sein zu wollen. Die Ergebnisse wurden von der Autorin, in Rahmen einer offiziellen Informationsveranstaltung in Falkenstein, vor den Verantwortlichen des Projekts „Seniorentagesstätte in Falkenstein“ sowie den BewohnerInnen der Gemeinde Falkenstein präsentiert. Die Studienergebnisse und die Empfehlungen der Autorin, dienen zur inhaltlichen Gestaltung der geplanten Seniorentagesstätte

Patient experiences with oral mucositis caused by chemo-/radiotherapy: a critical qualitative literature review.

Mucositis is one of the most common side effects of chemotherapy and radiotherapy. In order to develop an evidence-based clinical practice guideline for the management of tumor therapy-induced-oral mucositis, it was neces- sary to capture the patients’ perspective. Therefore the aim of this critical literature review was to explore the experience of patients with therapy-induced-oral mucositis. Searches were carried out using a systematic search strategy in CINAHL and Medline. Qualitative studies investigating the view of cancer patients receiving chemotherapy and/or radio- therapy and suffering from oral mucositis were included. Study selection and quality assess- ment were performed by two independent reviewers. Only two qualitative studies (n=28 patients) met the inclusion criteria. Oral mucositis caused by cancer therapy is associat- ed with serious complications concerning pain, eating, swallowing, speaking, sadness, lack of energy, and distress. Mucositis was described as the worst side effect of cancer therapy. Providing patient-centered care requires under- standing the experience and the needs of patients and their families. Mucositis is associ- ated with complex physical, psychological and social consequences. Unfortunately, both stud- ies were performed in different cultural back- grounds and health care systems, so the results cannot simply be transferred to German-speak- ing countries. Further research is needed to gain a deeper understanding of living with mucositis

Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome

Context/Objective: Current diagnostic criteria for polycystic ovary syndrome (PCOS) have generated distinct PCOS phenotypes, based on the different combinations of diagnostic features found in each patient. Our aim was to assess whether either each single diagnostic feature or their combinations into the PCOS phenotypes may predict insulin resistance in these women. Patients/Design: A total of 137 consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of diagnostic and metabolic features. Insulin sensitivity was measured by the glucose clamp technique. Results: Among women with PCOS, 84.7% had hyperandrogenism, 84.7% had chronic oligoanovulation, and 89% had polycystic ovaries. According to the individual combinations of these features, 69.4% of women had the classic phenotype, 15.3% had the ovulatory phenotype, and 15.3% had the normoandrogenic phenotype. Most subjects (71.4%) were insulin resistant. However, insulin resistance frequency differed among phenotypes, being 80.4%, 65.0%, and 38.1%, respectively, in the 3 subgroups (P < .001). Although none of the PCOS diagnostic features per se was associated with the impairment in insulin action, after adjustment for covariates, the classic phenotype and, to a lesser extent, the ovulatory phenotype were independently associated with insulin resistance, whereas the normoandrogenic phenotype was not. Metabolic syndrome frequency was also different among phenotypes (P = .030). Conclusions: There is a scale of metabolic risk among women with PCOS. Although no single diagnostic features of PCOS are independently associated with insulin resistance, their combinations, which define PCOS phenotypes, may allow physicians to establish which women should undergo metabolic screening. In metabolic terms, women belonging to the normoandrogenic phenotype behave as a separate group

Metabolic inflexibility is a feature of women with polycystic ovary syndrome and is associated with both insulin resistance and hyperandrogenism

Context: Metabolic inflexibility, ie, the impaired ability of the body to switch from fat to carbohydrate oxidation under insulin-stimulated conditions, is associated with insulin resistance. This alteration in metabolic plasticity can lead to organ dysfunction and is considered a key issue among the abnormalities of the metabolic syndrome. It is still unknown whether this phenomenon occurs in women with polycystic ovary syndrome (PCOS). Objective: Our objective was to examine whether metabolic inflexibility is a feature of PCOS women and whether hyperandrogenism may contribute to this phenomenon. Design and Patients: Eighty-nine Caucasian women with PCOS were submitted to hyperinsulinemic-euglycemic clamp. Respiratory exchange ratios were evaluated at baseline and during hyperinsulinemia by indirect calorimetry to quantify substrate oxidative metabolism. Total testosterone was measured by liquid chromatography mass spectrometry and free testosterone by equilibrium dialysis. Setting: Outpatients were seen in a tertiary care academic center. Main Outcome Measure: Metabolic flexibility was assessed by the change in respiratory quotient upon insulin stimulation. Results: Sixty-five of the 89 PCOS women(73%) had increased serum free testosterone, 68 (76%) were insulin resistant, and 62 (70%) had an impaired metabolic flexibility. Comparison of hyperandrogenemic and normoandrogenemic women showed that the 2 subgroups were of similar age but differed in terms of several anthropometric and metabolic features. In particular, hyperandrogenemic women had greater body mass index (32.9 +/- 1.0 vs 24.7 +/- 0.9 kg/m(2), P < .001) and lower glucose utilization during the clamp (9.2 +/- 0.4 vs 10.9 +/- 0.7 mg/kg fat-free mass . min, P < .023) and metabolic flexibility (0.09 +/- 0.06 vs 0.12 +/- 0.01, P < .014). In univariate analysis, metabolic flexibility was associated with several anthropometric, endocrine, and metabolic features. In multivariate analysis, this feature was directly associated with baseline respiratory quotient and insulin sensitivity and inversely with free testosterone and free fatty acids concentrations under insulin suppression (R-2 = 0.634, P < .001). Conclusions: Metabolic inflexibility is a feature of PCOS women. Both insulin resistance and androgen excess might contribute to this abnormality

Patient experiences with oral mucositis caused by chemo-/radiotherapy: a critical qualitative literature review

Mucositis is one of the most common side effects of chemotherapy and radiotherapy. In order to develop an evidence-based clinical practice guideline for the management of tumor therapy-induced-oral mucositis, it was necessary to capture the patients’ perspective. Therefore the aim of this critical literature review was to explore the experience of patients with therapy-induced-oral mucositis. Searches were carried out using a systematic search strategy in CINAHL and Medline. Qualitative studies investigating the view of cancer patients receiving chemotherapy and/or radiotherapy and suffering from oral mucositis were included. Study selection and quality assessment were performed by two independent reviewers. Only two qualitative studies (n=28 patients) met the inclusion criteria. Oral mucositis caused by cancer therapy is associated with serious complications concerning pain, eating, swallowing, speaking, sadness, lack of energy, and distress. Mucositis was described as the worst side effect of cancer therapy. Providing patient-centered care requires understanding the experience and the needs of patients and their families. Mucositis is associated with complex physical, psychological and social consequences. Unfortunately, both studies were performed in different cultural backgrounds and health care systems, so the results cannot simply be transferred to German-speaking countries. Further research is needed to gain a deeper understanding of living with mucositis

Total body fat and central fat mass independently predict insulin resistance but not hyperandrogenemia in women with polycystic ovary syndrome

Context/Objective: Obesity is a common feature of women with polycystic ovary syndrome (PCOS). The aim of this study was to assess the role of body fat on insulin resistance and androgen excess in these subjects. Patients/Design: One hundred sixteen consecutive Caucasian women with PCOS, diagnosed by the Rotterdam criteria, underwent accurate assessment of clinical, anthropometric, hormonal, and metabolic features. In particular, total fat mass and fat distribution were assessed by dual-energy x-ray absorptiometry, serum-free T by liquid chromatography mass spectrometry and equilibrium dialysis and insulin sensitivity by the glucose clamp technique. Results: Total fat mass and truncal fat were significantly higher in insulin-resistant than in insulin-sensitive PCOS subjects (+/- 89% and +127%, respectively, both P < .001), and both tended to be higher in hyperandrogenemic than in normoandrogenemic women (+22% and +28%, respectively, P = .087 and P = .090). All parameters of adiposity correlated inversely with insulin sensitivity (P < .001) and directly with serum-free T (P <= .001). A statistically significant inverse relationship was observed between insulin sensitivity and serum-free T concentrations (r = -0.527, P < .001). In a multiple regression analysis, either total fat mass or truncal fat, in addition to serum-free T and age, were independent predictors of insulin sensitivity. However, insulin sensitivity, but not total fat mass or truncal fat, was an independent predictor of free T concentrations. Conclusions: These data suggest that body fat contributes to determining insulin resistance in PCOS women. However, the association between body fat and hyperandrogenism seems to be to a large extent explained by insulin resistance