Towards the development of the psychosocial impact of assistive devices scale for continence (C-PIADS)

BACKGROUND: Current outcome measures for continence management devices do not adequately address psychosocial impact. The PIADS is an assessment tool that has been shown to reliably predict the adoption and use of assistive technology devices, but it is not widely used for continence devices. OBJECTIVE: To explore whether the PIADS requires modification to address the particular needs of continence device users and to inform any subsequent item development. METHODS: The study used interpretive methods in which qualitative information from semi-structured interviews was combined with the findings from cognitive interviews for questionnaire pre-testing. A total of 40 participants in UK and Canada were interviewed. RESULTS: Few participants had difficulty in understanding or relating to the majority of PIADS items. Several items were not considered relevant to continence and some areas for potential new items were uncovered. Embarrassment and concealment of urinary incontinence from others were common topics. CONCLUSIONS: The PIADS appears to fundamentally address many, but not all, of the important psychosocial concerns of adults who have continence difficulties. A version for continence, the C-PIADS, will require modification of the PIADS and is likely to contain some new items

Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial

Background: Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown. Methods: This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction. Discussion: Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy.European Research Area on Ageing2 (ERA-AGE2) progra

A cláusula de barreira e o sistema eleitoral alemão: modelos à reforma do sistema eleitoral brasileiro.

TCC (graduação) - Universidade Federal de Santa Catarina. Centro de Ciências Jurídicas. Direito.Na atualidade, os países democráticos ocidentais estão passando por crises políticas atreladas a inúmeros fatores, porém o cerne destas crises é o descompasso da representação política com os interesses da sociedade, em que esta não se vê efetivamente representada pelo parlamento. Inicialmente, o presente trabalho monográfico elucida sobre os sistemas eleitorais de uma maneira geral, explicando suas principais características, formando, assim, as bases necessárias para um estudo sério acerca do assunto. Em sequência, parte-se para o sistema eleitoral alemão como um todo, esclarecendo como se deu sua formação e em que contexto histórico, ao mesmo tempo em que explica qual a dinâmica adotada. E, por fim, trabalha-se com o elemento da cláusula de barreira e sua razão de existir. Portanto, a presente obra monográfica visa responder se dentro do contexto político-social e jurídico da Alemanha, onde vigora um sistema eleitoral muito próprio e peculiar, em que existem diversas forças políticas com interesses distintos, se a cláusula de barreira contribui para o fortalecimento dos grandes partidos? O objetivo principal do presente trabalho monográfico é articular acerca da necessidade da cláusula de barreira dentro de sistema eleitoral eficaz, de uma democracia forte, buscando garantir a governabilidade do poder executivo

KAJIAN PENGELOLAAN SAMPAH DI KECAMATAN ALOK TIMUR KABUPATEN SIKKA PROVINSI NUSA TENGGARA TIMUR

KAJIAN PENGELOLAAN SAMPAH DI KECAMATAN ALOK TIMUR KABUPATEN SIKKA PROVINSI NUSA TENGGARA TIMUR INTISARI Kabupaten Sikka merupakan daerah yang semakin berkembang dengan bertambahnya pembangunan disemua sektor dan meningkatnya jumlah penduduk maka sampah yang akan ditimbulkan juga semakin meningkat. Oleh karena itu, dalam pengelolaannya harus cukup layak diterapkan sekaligus disertai upaya pemanfaatannya sehingga diharapakan mempunyai keuntungan berupa nilai tambah. Penelitian ini bertujuan untuk mengkaji sejauh mana pengelolaan sampah yang ada di Kecamatan Alok Timur, Kabupaten Sikka, Provinsi Nusa Tenggara Timur mulai dari pegumpulan sampah, pengangkutan dan pembuangan sampah. Metode yang digunakan dalam penelitian ini adalah metode survey, metode scoring, metode wawancara dan kuisioner serta analisis data. Metode survey dilakukan untuk mengetahui kondisi wilayah penelitian, metode scoring di gunakan untuk memberikan skor atau nilai pada parameter berdasarkan SNI 19-2454-2002 tentang tata cara teknik operasional pengelolaan sampah, wawancara digunakan untuk memperoleh informasi mengenai pengelolaan persampahan, kuisioner dilakukan untuk mengetahui pengetahuan masyarakat mengenai pengelolaan persampahan dengan menyebarkan angket kepada para pedagang. Sedangkan Analisis data digunakan untuk menganailisis data yang dikumpulkan melalui wawancara dan kuisoner yang dibagikan. Penelitian ini diharapkan dapat menjadi awal dari penelitian mengenai persampahan terutama dalam pengelolaan sampah karena berhubungan langsung dengan kehidupan sehari-hari yaitu lingkungan hidup Berdasarkan hasil penelitian yang telah dilakukan menunjukkan bahwa pengelolaan sampah yang ada di Kecamatan Alok Timur berdasarkan SNI 19- 2454- 2002 pada parameter kepentingan daerah pelayanan termasuk dalam kategori kurang baik. Dan dari hasil análisis data kuisioner melalui angket yang disebarkan maka diketahui tingkat pengetahuan masyarakat dalam hal ini pedagang sebagai sumber sampah paling banyak termasuk kategori kurang baik/kurang tahu dan juga kategori tahu/baik sebesar 40% . Hal ini disebabkan kurangnya perhatian masyarakat tentang persampahan dan minimnya sumber daya manusia yang dapat mendukung pengelolaan sampah terpadu antara masyarakat dan pemerintah daerah setempat. Kata kunci: Sampah, Pengelolaan sampah, Pengetahuan masyaraka

Assessing the stigma content of urinary incontinence intervention outcome measures

The goal of this narrative review is to evaluate the efficacy of available questionnaires for assessing the outcomes of ‘‘continence difficulty’’ interventions and to assess the selected questionnaires concerning aspects of stigmatization. The literature was searched for research related to urinary incontinence, as well as questionnaires and rating scale outcome measurement tools. The following sources were searched: Cochrane Library, EMBASE, Medline, and PubMed. The following keywords were used separately or in combination: ‘‘Urinary incontinence,’’ ‘‘therapy,’’ ’’treatment outcome,’’ ‘‘patient satisfaction,’’ ‘‘quality of life,’’ ‘‘systematic reviews,’’ ‘‘aged 65þ years,’’ and ‘‘questionnaire.’’ The search yielded 194 references, of which 11 questionnaires fit the inclusion criteria; 6 of the 11 questionnaires did not have any stigma content and the content regarding stigma that was identified in the other five was very limited. A representative model of how stigma impacts continence difficulty interventions was proposed. While the 11 incontinence specific measurement tools that were assessed were well researched and designed specifically to measure the outcomes of incontinence interventions, they have not been used consistently or extensively and none of the measures thoroughly assess stigma. Further studies are required to examine how the stigma associated with continence difficulty impacts upon health care interventions

Assistive technology in Australia: integrating theory and evidence into action

Background: Occupational therapists use a range of strategies to influence the relationship between person, environment and occupation and facilitate people's participation and inclusion in society. Technology is a fundamental environmental factor capable of enabling inclusion, and occupational therapy models articulate a role for assistive technology (AT) devices and services, but there is a gap between theory, research and practice. The context of AT provision in Australia presents systemic barriers that prevent optimal application of AT devices and services for societal health promotion and in individualised solutions. Methods: The Integrating Theory, Evidence and Action method (ITEA) was used to answer the question ‘How can occupational therapy support AT provision to enable older people and people with disability?’ A wide range of sources were systematically analysed to explore the complexities of AT provision in Australia. Results: The International Classification of Functioning, Disability and Health (ICF) and IMPACT2 model are used as frameworks to reconstruct evidence into statements that summarise the theory, process and outcomes of AT provision. Analysis of the influence of the global disability rights and local policies and AT provision systems is used to highlight important aspects for occupational therapists to consider in research and practice. Pragmatic recommendations are provided to enable practitioners to translate theory and evidence into action. Conclusion AT provision can be improved by focusing on evidence for and congruence between theory, process and outcomes, rather than isolated interventions. Occupational therapists should consider the influence of contextual factors on practice, and work with consumers to improve access and equity in AT provision systems

Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop

Background The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop. Methods Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors. Results Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified. Conclusions Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking

Is there a standard procedure for assessing and providing assistive devices for people with neuro-disabling conditions in United Kingdom? A nation-wide survey

Background: Assistive devices are currently provided to people with neuro-disabling conditions to promote or maintain independence in activities of daily living. However, it is unclear whether assessment procedures performed by health care professionals to guide the provision of assistive devices are standardized.  Objective: To explore the assessment and service-delivery processes of assistive devices for people with multiple sclerosis, cerebrovascular disease and Parkinson's disease experiencing physical disability by health care professionals in the United Kingdom.  Methods: A survey was conducted among UK health care professionals working with people with neuro-disabling conditions. Descriptive and content analyses were used to code survey data.  Results: In total, 231 health care professionals completed the survey: 93 occupational therapists, 136 physiotherapists and 2 assistant practitioners. Less than half of the respondents (46%) reported use of local, national, or combined guidelines when assessing a service user's suitability or need for assistive devices. When guidelines were used, they were not consistent and not specifically for assistive devices. The respondents stated that when users were allocated small and portable assistive devices, they were supplied within four weeks. This period increased for large equipment, major home adaptions or if external specialist services and/or funding was needed.  Conclusions: Standardized operating procedures for assistive device provision are not being carried out within the UK. Variable access to assistive devices supplied by the state indicates inequity across regions. Future research should explore potential benefits of developing standardized assessment procedures for the provision of assistive devices and devise methods to reduce current variability in service delivery