Home and community care services: a major opportunity for preventive health care

BACKGROUND In Australia, the Home and Community Care (HACC) program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. METHODS We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. RESULTS 4,978 (4.8%) participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis. CONCLUSIONS HACC clients have high rates of modifiable lifestyle risk factors and health conditions that are amenable to primary and secondary prevention, presenting the potential for implementing preventive health care programs in the HACC service setting.This study was supported by a HACC grant from the NSW Department of Ageing, Disability and Home Care

The role of serotonin 1B in the representation of outcomes.

Disrupted serotonin neurotransmission has been implicated in the etiology of psychopathic traits. Empirical research has found that people with high levels of psychopathic traits have a deficit in reinforcement learning that is thought to be linked with amygdala dysfunction. Altered serotonin neurotransmission provides a plausible explanation for amygdala dysfunction in psychopathic traits and recent research suggests that this may be associated with serotonin 1B (5-HT1B) receptor function. This research used an animal model to test the hypothesis that 5-HT1B receptors are involved in the encoding of the specific features of reinforcing outcomes. An outcome devaluation task was used to test the effect of the systemic administration of a selective 5-HT1B receptor agonist administered before encoding of "action-outcome" associations. Results showed that while administration of a 5-HT1B receptor agonist allowed rats to acquire instrumental responding for food, when the content of that learning was further probed using an outcome devaluation task, performance differed from controls. 5-HT1B agonism impaired learning about the specific sensory qualities of food rewards associated with distinct instrumental responses, required to direct choice performance when the value of one outcome changed. These findings suggest a role for 5-HT1B receptor function in the encoding of the specific features of reinforcing outcomes

Achievement of home ownership among post-war Australian cohorts

There has been concern for many years that it has been becoming more difficult for people to afford to buy a home. Despite this, the proportion of home owners among Australian households has remained much the same for some twenty years or more. In part, this is probably because the longterm rewards from being a home owner have increased at the same time as the costs of becoming an owner. This paper examines in some detail the factors which have affected the ability of people to become owners. It uses a unique set of data which were gathered in a survey which collected retrospective information about the experience of women and men aged 20 to 60 over their adult life. The paper shows that more recent cohorts of women have become owners at younger ages than earlier cohorts. There is limited evidence that, in recent years, women who worked for a longer time after marriage, and men with higher incomes and higher occupations, were able to become owners more quickly. This may point to home ownership becoming increasingly confined to those on higher incomes, whether from high individual incomes or from having two incomes in household

Study of the Effects of Resorcinol on the Vapor-liquid Equilibria of the System Paraxylene-orthoxylene

Chemical Engineerin

End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study

BACKGROUND: Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use. METHODS: Survey data from 1,205 decedents from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS). RESULTS: 85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and 'other' causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation. CONCLUSIONS: Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management

Extension Programs Increased Missouri Cotton Farmer Use of Survey-Based Pest Management

In 1982, only 5% of Missouri cotton farmers surveyed fields for pests and used this information when selecting pest management strategies, i.e., survey based pest management (SBPM). University of Missouri faculty initiated a program that year to instruct farmers about the benefits of SBPM. They provided instruction from 1982 to 1999. During 1999, 3% of Missouri cotton farmers were surveyed by phone for their use of SBPM. That year, farmers used SBPM to protect 82% of Missouri cotton acres. In addition to better yields, the use of SBPM ensured more efficient use of all pest management strategies

Home and community care services: a major opportunity for preventive health care

<p>Abstract</p> <p>Background</p> <p>In Australia, the Home and Community Care (HACC) program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk.</p> <p>Methods</p> <p>We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models.</p> <p>Results</p> <p>4,978 (4.8%) participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis.</p> <p>Conclusions</p> <p>HACC clients have high rates of modifiable lifestyle risk factors and health conditions that are amenable to primary and secondary prevention, presenting the potential for implementing preventive health care programs in the HACC service setting.</p