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Sample records for older overweight long-term

  1. Demographic and placement variables associated with overweight and obesity in children in long-term foster care.

    Science.gov (United States)

    Schneiderman, Janet U; Arnold-Clark, Janet S; Smith, Caitlin; Duan, Lei; Fuentes, Jorge

    2013-11-01

    Overweight and obesity is a growing problem for children in foster care. This study describes the prevalence of overweight and obesity in an urban, ethnic minority population of children ages 2-19 in long-term foster care (N = 312) in Los Angeles, California. It also investigates whether demographics or placement settings are related to high body mass index. The estimates of prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) were presented for gender, age, ethnicity, and placement type. Multiple logistic regression was used to examine potential associations between demographic and placement variables and weight status. The prevalence of overweight/obesity was almost 40 % and obesity was 23 % for the study population. Children placed in a group home had the highest prevalence of overweight/obesity (60 %) and obesity (43 %) compared to other types of placement. Within this study, older children (ages 12-19) were more likely to be overweight/obese than normal weight compared to children between 2 and 5 years old when controlling for gender, ethnicity and placement (OR = 2.10, CI = 1.14-3.87). These findings suggest that older age and long-term foster care in general may be risk factors for obesity. Child welfare agencies and health care providers need to work together to train caregivers with children in long-term foster care in obesity treatment interventions and obesity prevention strategies.

  2. Effects of resistance training and dietary changes on physical function and body composition in overweight and obese older adults.

    Science.gov (United States)

    Straight, Chad R; Dorfman, Leah R; Cottell, Kathryn E; Krol, Julie M; Lofgren, Ingrid E; Delmonico, Matthew J

    2012-08-01

    Community-based interventions that incorporate resistance training (RT) and dietary changes have not been extensively studied in overweight and obese older adults. The purpose of this investigation was to determine the effects of a community-based RT and dietary intervention on physical function and body composition in overweight and obese older adults. Ninety-five overweight and obese (BMI=33.4±4.0 kg/m2) older adults aged 55-80 years completed an 8-week RT and dietary intervention at 4 Rhode Island senior centers. Participants performed RT twice-weekly using resistance tubing, dumbbells, and ankle weights. Participants also attended 1 weekly dietary counseling session on a modified Dietary Approaches to Stop Hypertension diet. Outcome measurements included anthropometrics, body composition, and physical function. There were small changes in body mass (-1.0±1.8 kg, Pfoot up-and-go test time (-0.56±0.89 s, P<.001). Community-based RT and dietary modifications can improve body composition, muscle strength, and physical function in overweight and obese older adults. Future investigations should determine if this intervention is effective for long-term changes.

  3. Assessing long-term QALYs gain from averting and reversing overweight and obesity in childhood.

    Science.gov (United States)

    Techakehakij, Win

    2016-10-01

    Interventions to tackle childhood obesity have been devised in response to the rising prevalence of childhood obesity. However, efficiency of these interventions remains a concern. Cost-utility analysis, representing health benefits in terms of quality-adjusted life years (QALYs), is a type of economic evaluation that has widely been recommended in assessing efficiency of health interventions. However, certain limitations in using QALYs remain specifically difficult in QALYs estimation. This study estimates the long-term QALYs gain from reversing childhood obesity in Thailand. An economic model was developed to estimate long-term QALYs of the youth aged 3-18 for the BMI status in childhood, which were categorized into three groups: normal weight, overweight, and obese. Long-term QALYs were estimated between ages 35 and 100, according to children's age, sex, and BMI status. Differences in QALYs between BMI status groups were calculated to represent the QALYs gain for youth from reversing obesity and overweight. The future outcomes were discounted at 3 % per annum in the base-case analysis; the discount rates of 0, 1.5, 3.5, and 5 % were also applied in the sensitivity analyses. QALYs gained from reversing childhood obesity increase with age, starting from 0.040 and 0.083 QALYs at age 3 to 0.590 and 0.553 QALYs at age 18 in boys and girls, respectively. Reversing overweight and obesity in girls produces more QALYs than in boys between ages 3 and 17. Efficiency is an important issue in allocating public healthcare resources to maximize social benefits. The results of this study facilitate long-term QALYs estimation with respect to BMI status in childhood, which could encourage more routine economic evaluation of child obesity interventions and maximize their health benefits.

  4. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial.

    Science.gov (United States)

    Morey, Miriam C; Snyder, Denise C; Sloane, Richard; Cohen, Harvey Jay; Peterson, Bercedis; Hartman, Terryl J; Miller, Paige; Mitchell, Diane C; Demark-Wahnefried, Wendy

    2009-05-13

    Five-year survival rates for early stage colorectal, breast, and prostate cancer currently exceed 90% and are increasing. Cancer survivors are at greater risk for second malignancies, other comorbidities, and accelerated functional decline. Lifestyle interventions may provide benefit, but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status. To determine whether a telephone counseling and mailed print material-based diet and exercise intervention is effective in reorienting functional decline in older, overweight cancer survivors. Randomized controlled trial of 641 overweight (body mass index > or = 25 and or = 5 years) survivors (aged 65-91 years) of colorectal, breast, and prostate cancer, who were randomly assigned to an intervention group (n = 319) or delayed intervention (control) group (n = 322) in Canada, the United Kingdom, and 21 US states. Individuals were recruited for the Reach out to Enhance Wellness (RENEW) trial from July 1, 2005, through May 17, 2007. A 12-month, home-based tailored program of telephone counseling and mailed materials promoting exercise, improved diet quality, and modest weight loss. The control group was wait-listed for 12 months. Change in self-reported physical function on the Short-Form 36 physical function subscale (score range, 0-100; a high score indicates better functioning) from baseline to 12 months was the primary end point. Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index (score range, 0-100), physical activity, body mass index, and overall health-related quality of life. The mean baseline Short-Form 36 physical function score was 75.7. At the 12-month follow-up, the mean function scores declined less rapidly in the intervention group (-2.15; 95% confidence interval [CI], -0.36 to -3.93) compared with the control group (-4.84; 95% CI, -3

  5. Assessing the associative deficit of older adults in long-term and short-term/working memory.

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    Chen, Tina; Naveh-Benjamin, Moshe

    2012-09-01

    Older adults exhibit a deficit in associative long-term memory relative to younger adults. However, the literature is inconclusive regarding whether this deficit is attenuated in short-term/working memory. To elucidate the issue, three experiments assessed younger and older adults' item and interitem associative memory and the effects of several variables that might potentially contribute to the inconsistent pattern of results in previous studies. In Experiment 1, participants were tested on item and associative recognition memory with both long-term and short-term retention intervals in a single, continuous recognition paradigm. There was an associative deficit for older adults in the short-term and long-term intervals. Using only short-term intervals, Experiment 2 utilized mixed and blocked test designs to examine the effect of test event salience. Blocking the test did not attenuate the age-related associative deficit seen in the mixed test blocks. Finally, an age-related associative deficit was found in Experiment 3, under both sequential and simultaneous presentation conditions. Even while accounting for some methodological issues, the associative deficit of older adults is evident in short-term/working memory.

  6. Barriers to ethical nursing practice for older adults in long-term care facilities.

    Science.gov (United States)

    Choe, Kwisoon; Kang, Hyunwook; Lee, Aekyung

    2018-03-01

    To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. To provide this population with quality care, a solid moral foundation should be emphasised to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analysed using qualitative content analysis. Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients and friction between nurses and nursing assistants. This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. Support programmes and educational opportunities are needed for nurses who experience emotional distress and lack of competency to strengthen their resilience towards some of the negative aspects of care and being a nurse that were identified in this study. © 2017 John Wiley & Sons Ltd.

  7. Long-Term Effects of Ambient PM2.5 on Hypertension and Blood Pressure and Attributable Risk Among Older Chinese Adults.

    Science.gov (United States)

    Lin, Hualiang; Guo, Yanfei; Zheng, Yang; Di, Qian; Liu, Tao; Xiao, Jianpeng; Li, Xing; Zeng, Weilin; Cummings-Vaughn, Lenise A; Howard, Steven W; Vaughn, Michael G; Qian, Zhengmin Min; Ma, Wenjun; Wu, Fan

    2017-05-01

    Long-term exposure to ambient fine particulate pollution (PM 2.5 ) has been associated with cardiovascular diseases. Hypertension, a major risk factor for cardiovascular diseases, has also been hypothesized to be linked to PM 2.5 However, epidemiological evidence has been mixed. We examined long-term association between ambient PM 2.5 and hypertension and blood pressure. We interviewed 12 665 participants aged 50 years and older and measured their blood pressures. Annual average PM 2.5 concentrations were estimated for each community using satellite data. We applied 2-level logistic regression models to examine the associations and estimated hypertension burden attributable to ambient PM 2.5 For each 10 μg/m 3 increase in ambient PM 2.5 , the adjusted odds ratio of hypertension was 1.14 (95% confidence interval, 1.07-1.22). Stratified analyses found that overweight and obesity could enhance the association, and consumption of fruit was associated with lower risk. We further estimated that 11.75% (95% confidence interval, 5.82%-18.53%) of the hypertension cases (corresponding to 914, 95% confidence interval, 453-1442 cases) could be attributable to ambient PM 2.5 in the study population. Findings suggest that long-term exposure to ambient PM 2.5 might be an important risk factor of hypertension and is responsible for significant hypertension burden in adults in China. A higher consumption of fruit may mitigate, whereas overweight and obesity could enhance this effect. © 2017 American Heart Association, Inc.

  8. [Falls and fractures among older adults living in long-term care].

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    Del Duca, Giovâni Firpo; Antes, Danielle Ledur; Hallal, Pedro Curi

    2013-03-01

    To investigate the prevalence of falls and fractures over the past 12 months and associated factors among older adults living in long-term care. Census of all long-term care located in the city of Pelotas, Brazil, in 2008. Falls over the past 12 months were assessed using the following question: "Over the last 12 months, have you fallen?" For those who replied positively, another question was asked: "In any of these falls, have you fractured a bone?" Sex, age, schooling, disability relating to basic activities of daily living, type of financing of the long-term care and hospital admissions were the independent variables. We used chi-square tests for heterogeneity and linear trend in the unadjusted analysis, and Poisson regression with robust variance in the adjusted one. Within the 24 long-term care studied, we collected data for 466 individuals. The prevalence of falls in the past year was 38.9% (95%CI 34.5; 43.4). Among those who have fallen, 19.2% had fractures. Femur (hip) was the most frequent site fractured (43.4%), followed by wrist (10%). In the adjusted analysis, older age, disability for 1-5 basic activities of daily living, living in public institutions and hospital admissions in the last year were associated with higher risk of falls. The high prevalence of falls and fractures highlights the fragility of the individuals living in long-term care. Special attention should be paid to older adults and those with hospital admissions in the last year.

  9. Overweight duration in older adults and cancer risk

    DEFF Research Database (Denmark)

    Arnold, Melina; Freisling, Heinz; Stolzenberg-Solomon, Rachael

    2016-01-01

    Recent studies have shown that cancer risk related to overweight and obesity is mediated by time and might be better approximated by using life years lived with excess weight. In this study we aimed to assess the impact of overweight duration and intensity in older adults on the risk of developing...

  10. Personality and psychological distress among older adult, long-term cancer survivors.

    Science.gov (United States)

    Deimling, Gary T; Albitz, Casey; Monnin, Kara; Renzhofer Pappada, Holly T; Nalepa, Elizabeth; Boehm, Melinda Laroco; Mitchell, Claire

    2017-01-01

    This research examines a model of how personality (Five-Factor Model) is related to adjustment to cancer in later life in terms of the presence of continuing cancer-related worry and depression among older adult, long-term cancer survivors. Data from an NCI-funded study with 275 older adult (age 60+), long-term (5+ years) survivors of breast, prostate, and colorectal cancer were examined. Regression analyses identified neuroticism as the strongest predictor of cancer-related worry along with continuing cancer-related symptoms. For depression, three personality dimensions (neuroticism, conscientiousness, and agreeableness) were significant predictors. Findings suggest the importance of considering the central role that survivors' personality characteristics play in understanding cancer-related worries and depression. Understanding these dispositional characteristics is key for social workers and health-care practitioners in counseling survivors experiencing these common mental health effects.

  11. Fall determinants in older long-term care residents with dementia: a systematic review.

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    Kröpelin, Tobias F; Neyens, Jacques C L; Halfens, Ruud J G; Kempen, Gertrudis I J M; Hamers, Jan P H

    2013-04-01

    Persons with dementia are two to three times more likely to fall compared to persons without dementia. In long-term care settings, the dementia prevalence is highest. Therefore, older long-term care residents with dementia can be considered a high-risk group for falls. Nevertheless, no systematic evaluation of fall determinants in this population was found. The purpose of this study was to identify fall determinants among older long-term care residents with dementia or cognitively impaired persons in long-term care, by conducting a systematic literature review. We searched English, French, Dutch, and German articles listed in: CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, and Web of Science. Additionally, references of included articles were screened. Studies were included if determinants or circumstances of falls in older persons with dementia living in long-term care were assessed. Eight studies met the inclusion criteria. Three studies were excluded from detailed analysis because of insufficient quality. Use of psychotropic drugs, a "fair or poor" general health, gait impairments, and age were associated with an increased fall risk. Also trunk restraints were associated with an increased number of falls while full bedrails and wandering behavior were protective against falls. Fall risk factors known from other populations, e.g. use of psychotropic drugs, physical restraints, and health conditions, are found in long-term care residents with dementia as well. Due to the limited evidence available, future studies with adequate sample sizes and prospective designs are required to determine specific fall risk factors and verify existing results in this population.

  12. Birth weight and long-term overweight risk: systematic review and a meta-analysis including 643,902 persons from 66 studies and 26 countries globally.

    Directory of Open Access Journals (Sweden)

    Karen Schellong

    Full Text Available Overweight is among the major challenging health risk factors. It has been claimed that birth weight, being a critical indicator of prenatal developmental conditions, is related to long-term overweight risk. In order to check this important assumption of developmental and preventive medicine, we performed a systematic review and comprehensive meta-analysis.Relevant studies published up to January 2011 that investigated the relation between birth weight and later risk of overweight were identified through literature searches using MEDLINE and EMBASE. For meta-analysis, 66 studies from 26 countries and five continents were identified to be eligible, including 643,902 persons aged 1 to 75 years. We constructed random-effects and fixed-effects models, performed subgroup-analyses, influence-analyses, assessed heterogeneity and publication bias, performed meta-regression analysis as well as analysis of confounder adjusted data. Meta-regression revealed a linear positive relationship between birth weight and later overweight risk (p4,000 g was associated with increased risk of overweight (OR=1.66; 95% CI 1.55-1.77. Results did not change significantly by using normal birth weight (2,500-4,000 g as reference category (OR=0.73, 95% CI 0.63-0.84, and OR=1.60, 95% CI 1.45-1.77, respectively. Subgroup- and influence-analyses revealed no indication for bias/confounding. Adjusted estimates indicate a doubling of long-term overweight risk in high as compared to normal birth weight subjects (OR=1.96, 95% CI 1.43-2.67.Findings demonstrate that low birth weight is followed by a decreased long-term risk of overweight, while high birth weight predisposes for later overweight. Preventing in-utero overnutrition, e.g., by avoiding maternal overnutrition, overweight and/or diabetes during pregnancy, might therefore be a promising strategy of genuine overweight prevention, globally.

  13. Low- and High-Resistance Exercise: Long-Term Adherence and Motivation among Older Adults.

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    Van Roie, Evelien; Bautmans, Ivan; Coudyzer, Walter; Boen, Filip; Delecluse, Christophe

    2015-01-01

    In terms of motivation and long-term adherence, low-resistance exercise might be more suitable for older adults than high-resistance exercise. However, more data are needed to support this claim. The objective was to investigate the effect of low- and high-resistance exercise protocols on long-term adherence and motivation. This study was designed as an exploratory 24-week follow-up of a randomized 12-week resistance training intervention in older adults. Participants were free to decide whether or not they continued resistance training at their own expense following the intervention. Fifty-six older adults were randomly assigned to HIGH [2 × 10-15 repetitions at 80% of one repetition maximum (1RM)], LOW (1 × 80-100 repetitions at 20% of 1RM), or LOW+ (1 × 60 repetitions at 20% of 1RM + 1 × 10-20 repetitions at 40% 1RM). Motivation, self-efficacy and the perceived barriers for continuing resistance exercise were measured after cessation of each supervised intervention and at follow-up, while long-term adherence was probed retrospectively at follow-up. Participants reported high levels of self-determined motivation before, during, and after the supervised intervention, with no differences between groups (p > 0.05). Nevertheless, only few participants continued strength training after the intervention: 17% in HIGH, 21% in LOW+, and 11% in LOW (p > 0.05). The most commonly reported barriers for continuing resistance exercise were perceived lack of time (46%), being more interested in other physical activities (40%), seasonal reasons (40%), and financial cost (28%). The results suggest no difference in long-term adherence after the end of a supervised exercise intervention at high or low external resistances. Long-term adherence was limited despite high levels of self-determined motivation during the interventions. These findings highlight the importance of further research on developing strategies to overcome barriers of older adults to adhere to resistance

  14. Conditions of long-term success in a lifestyle intervention for overweight and obese youths.

    Science.gov (United States)

    Fröhlich, Georg; Pott, Wilfried; Albayrak, Özgür; Hebebrand, Johannes; Pauli-Pott, Ursula

    2011-10-01

    Childhood lifestyle interventions usually involve the families. However, knowledge of family characteristics that promote or constrain a child's weight-reduction outcome is limited. Candidates for such factors might be family characteristics that have proven to be associated with social adjustment (development) in childhood. Thus, we analyzed whether family adversity, maternal depression, and attachment insecurity predict long-term success in children's weight reduction. Participants in the study were 111 parent-child dyads with overweight and obese children/adolescents (BMI mean: 29.07 [SD: 4.7] [range: 21.4-44.9]; BMI SD score mean: 2.43 [SD: 0.44] [range: 1.31-3.54]) aged between 7 and 15 years. The families took part in a best-practice lifestyle intervention of 1 year's duration. A longitudinal analysis with 3 assessment waves (baseline, conclusion, 1-year follow-up) was conducted. Hierarchical regression analyses revealed that long-term success (at least 5% weight reduction by the 1-year follow-up) versus failure (dropping out or less weight reduction) was significantly predicted by the set of psychosocial variables (family adversity, maternal depression, and attachment insecurity) when we controlled for familial obesity, preintervention overweight, age, and gender of the index child and parental educational level. Maternal depression proved to be the best predictor. Maintenance of weight reduction between the conclusion of the program and the 1-year-follow-up was also predicted by the set of psychosocial variables. Maternal insecure-anxious attachment attitudes best predicted this criterion. Although cross-validation is required, our results are the first evidence for proximal and distal family characteristics linked to long-term weight-reduction outcomes. The results suggest a need to create tailored intervention modules that address the difficulties of these families.

  15. Birth Weight and Long-Term Overweight Risk: Systematic Review and a Meta-Analysis Including 643,902 Persons from 66 Studies and 26 Countries Globally

    Science.gov (United States)

    Harder, Thomas; Plagemann, Andreas

    2012-01-01

    Background Overweight is among the major challenging health risk factors. It has been claimed that birth weight, being a critical indicator of prenatal developmental conditions, is related to long-term overweight risk. In order to check this important assumption of developmental and preventive medicine, we performed a systematic review and comprehensive meta-analysis. Methods and Findings Relevant studies published up to January 2011 that investigated the relation between birth weight and later risk of overweight were identified through literature searches using MEDLINE and EMBASE. For meta-analysis, 66 studies from 26 countries and five continents were identified to be eligible, including 643,902 persons aged 1 to 75 years. We constructed random-effects and fixed-effects models, performed subgroup-analyses, influence-analyses, assessed heterogeneity and publication bias, performed meta-regression analysis as well as analysis of confounder adjusted data. Meta-regression revealed a linear positive relationship between birth weight and later overweight risk (poverweight (odds ratio (OR) = 0.67; 95% confidence interval (CI) 0.59–0.76). High birth weight (>4,000 g) was associated with increased risk of overweight (OR = 1.66; 95% CI 1.55–1.77). Results did not change significantly by using normal birth weight (2,500–4,000 g) as reference category (OR = 0.73, 95% CI 0.63–0.84, and OR = 1.60, 95% CI 1.45–1.77, respectively). Subgroup- and influence-analyses revealed no indication for bias/confounding. Adjusted estimates indicate a doubling of long-term overweight risk in high as compared to normal birth weight subjects (OR = 1.96, 95% CI 1.43–2.67). Conclusions Findings demonstrate that low birth weight is followed by a decreased long-term risk of overweight, while high birth weight predisposes for later overweight. Preventing in-utero overnutrition, e.g., by avoiding maternal overnutrition, overweight and/or diabetes during pregnancy

  16. Approaches to long-term conditions management and care for older people: similarities or differences?

    Science.gov (United States)

    Tullett, Michael; Neno, Rebecca

    2008-03-01

    In the past few years, there has been an increased emphasis both on the care for older people and the management of long-term conditions within the United Kingdom. Currently, the Department of Health and the Scottish Executive identify and manage these two areas as separate entities. The aim of this article is to examine the current approaches to both of these areas of care and identify commonalities and articulate differences. The population across the world and particularly within the United Kingdom is ageing at an unprecedented rate. The numbers suffering long-term illness conditions has also risen sharply in recent years. As such, nurses need to be engaged at a strategic level in the design of robust and appropriate services for this increasing population group. A comprehensive literature review on long-term conditions and the care of older people was undertaken in an attempt to identify commonalities and differences in strategic and organizational approaches. A policy analysis was conducted to support the paper and establish links that may inform local service development. Proposing service development based on identified needs rather than organizational boundaries after the establishment of clear links between health and social care for those with long-term conditions and the ageing population. Nurse Managers need to be aware of the similarities and differences in political and theoretical approaches to the care for older people and the management of long-term conditions. By adopting this view, creativity in the service redesign and service provision can be fostered and nurtured as well as achieving a renewed focus on partnership working across organizational boundaries. With the current renewed political focus on health and social care, there is an opportunity in the UK to redefine the structure of care. This paper proposes similarities between caring for older people and for those with long-term conditions, and it is proposed these encapsulate the wider

  17. Patient, resident, or person: Recognition and the continuity of self in long-term care for older people.

    Science.gov (United States)

    Pirhonen, Jari; Pietilä, Ilkka

    2015-12-01

    Becoming a resident in a long-term care facility challenges older people's continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one's self. Secondly, modern-day care facilities have some features of 'total' institutions that produce patient-like role expectations and thus challenge older people's selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people's continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person-centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Low weight and overweightness in older adults: risk and clinical management.

    Science.gov (United States)

    Jahangir, Eiman; De Schutter, Alban; Lavie, Carl J

    2014-01-01

    The prevalence of individuals who are overweight or obese is growing exponentially in the United States and worldwide. This growth is concerning, as both overweightness and obesity lead to impaired physical function, decreased quality of life, and increased risk of chronic diseases. Additionally, overweightness and obesity are related to increased mortality among young and middle-aged adults. This weight-related risk of mortality is more ambiguous among older adults. In fact, obesity may be protective in this population, a relationship described as the "obesity paradox". In this review we discuss the effects of overweightness and obesity among the elderly on cardiovascular disease and all-cause mortality, along with the risks of low weight. We conclude by discussing the goal of weight management among older adults, focusing particularly on benefits of preserving lean body mass and muscular strength while stabilizing body fat. Ideally, overweight or mildly obese elderly individuals should devise a plan with their physicians to maintain their weight, while increasing lean body mass through a plan of healthy diet, behavioral therapy, and physical activity. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Should frail older adults be in long-term care facilities?

    Directory of Open Access Journals (Sweden)

    Sørbye LW

    2018-02-01

    Full Text Available Liv Wergeland Sørbye, Sidsel Sverdrup, Birgit Brunborg Pay Institute of Nursing and Health, VID Specialized University, Oslo, Norway Aim: Home-based nursing care is relatively easy to access in Norway compared to the rest of Europe, and the threshold for applying for assistance is relatively low. The aim of the present study was to analyze factors that enable frail older adults to live in their own homes, with a low level of care burden stress.Methodology: In 2015 and 2016, eight municipalities from different parts of Norway participated in a cross-sectional study. The quantitative part of the project consisted of assessing care of 71 older adults, aged ≥80 years, using a geriatric comprehensive assessment. The qualitative part consisted of semistructured telephone interviews with 14 leaders of nursing homes and home-based nursing care and interviews with 26 close relatives.Results: In this sample, 60% of the older adults were living alone, and 79% were at risk of permanent nursing home admission; 31% stated that they would be better-off at a higher caring level, mainly due to living alone. The relatives, their resources, and motivation to provide care seemed to be crucial for how long older adults with heavy care burden could stay at home. The municipalities offered a combination of comprehensive home care, day centers, and revolving short-term stays to enable them to live at home.Conclusion: The results reveal that the need for home care services is steadily increasing. The relatives are coping with the physical care, far better than the uncertainties and worries about what could happen when the older adults stay alone. The number of beds in institutional care in each municipality depends on various factors, such as the inhabitants’ life expectancy, social aspects, geography, well-functioning eldercare pathways, competence of the health professionals, and a well-planned housing policy. Keywords: home care, geriatric assessment

  20. Sexuality and Physical Intimacy in Long Term Care: Sexuality, long term care, capacity assessment

    OpenAIRE

    Lichtenberg, Peter A.

    2014-01-01

    Sexuality and sexual needs in older adults remains a neglected area of clinical intervention, particularly so in long term care settings. Because older adults in medical rehabilitation and long term care beds present with significant frailties, and often significant neurocognitive disorders it makes it difficult for occupational therapists and other staff to evaluate the capacity of an older adult resident to participate in sexual relationships. The current paper reviews the current literatur...

  1. The longitudinal relationship between the use of long-term care and depressive symptoms in older adults

    NARCIS (Netherlands)

    Pot, A.M.; Deeg, D.J.H.; Twisk, J.W.R.; Beekman, A.T.F.; Zarit, S.H.

    2005-01-01

    PURPOSE: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables

  2. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review.

    Science.gov (United States)

    Reilly, J J; Kelly, J

    2011-07-01

    The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood. Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood. Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1-5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms. A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.

  3. Can home care services achieve cost savings in long-term care for older people?

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    Greene, V L; Ondrich, J; Laditka, S

    1998-07-01

    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  4. Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors.

    Science.gov (United States)

    Winger, Joseph G; Mosher, Catherine E; Rand, Kevin L; Morey, Miriam C; Snyder, Denise C; Demark-Wahnefried, Wendy

    2014-10-01

    Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence. We examined associations between adherence to components of a diet-exercise intervention and survivors' physical and mental health. A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention. Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β = 0.11, p < 0.05), basic and advanced lower extremity function (β = 0.10, p < 0.05/β = 0.09, p < 0.05), and mental health (β = 0.05, p < 0.05), and a negative indirect relationship with body mass index (β = -0.06, p < 0.05). Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).

  5. Problems identified by dual sensory impaired older adults in long-term care when using a self-management program : A qualitative study

    NARCIS (Netherlands)

    Roets-Merken, Lieve; Zuidema, Sytse; Vernooij-Dassen, Myrra; Dees, Marianne; Hermsen, Pieter; Kempen, Gertrudis; Graff, Maud

    2017-01-01

    OBJECTIVE: To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care. METHODS: A

  6. Problems identified by dual sensory impaired older adults in long-term care when using a self-management program : A qualitative study

    NARCIS (Netherlands)

    Roets-Merken, Lieve; Zuidema, Sytse; Vernooij-Dassen, Myrra; Dees, Marianne; Hermsen, Pieter; Kempen, Gertrudis; Graff, Maud

    2017-01-01

    Objective To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care. Methods A

  7. The Longitudinal Relationship between the Use of Long-Term Care and Depressive Symptoms in Older Adults

    Science.gov (United States)

    Pot, Anne Margriet; Deeg, Dorly J.H.; Twisk, Jos W.R.; Beekman, Aartjan T.F.; Zarit, Steven H.

    2005-01-01

    Purpose: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables including demographics, personality, and partner…

  8. Quality of Life and Health State of LongTerm Unemployed in Older Production Age

    OpenAIRE

    Worach-Kardas, Halina; Kostrzewski, Szymon

    2013-01-01

    The aim of the study was to evaluate the changes in the subjective quality of life (QoL) and health state of unemployed people at the age of 45 and older in the city environment. The study also aimed at evaluating some social and demographic factors on the quality of life and health of the unemployed. A group of 454 unemployed people aged 45 and older, registered in labour offices in the city of Łódź, Poland were included in the study. Two groups were formed: short-term and long-term unemploy...

  9. Activities of daily living and oral hygiene status of older Korean patients in a long-term care facility.

    Science.gov (United States)

    Seo, H-Y; Jeon, J-E; Chung, W-G; Kim, N-H

    2017-05-01

    This study investigated the relationship between oral hygiene conditions, activities of daily living (ADL) and cognitive ability in older Korean patients in long-term care facilities. Ninety older persons (65+) were randomly sampled from a possible 112 residents in a single facility. They participated in a 2-month-long survey. The Korean Modified Barthel Index was used to measure the ADL, and cognitive ability was measured using the Mini-Mental State Examination, Korean version. Oral hygiene status was measured using the Simplified Oral Hygiene Index and the Tongue Coating Index (TCI). Older participants with complete dependence manifested significantly poorer oral hygiene (P oral hygiene (P oral hygiene on tooth surfaces, while participants with partial dependence had poor tongue hygiene. In addition, dentulous older participants had poorer tongue hygiene than edentulous ones. This indicates the need to assess tooth status and provide oral care services via ADL in long-term care facilities. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Risks of long-term use of nitrofurantoin for urinary tract prophylaxis in the older patient

    Directory of Open Access Journals (Sweden)

    Lauren L. Rego

    2016-12-01

    Conclusions: Pulmonary, nerve, or liver ARs resulting from long-term NF prophylaxis in older patients treated for UTIs are potentially serious but extremely rare, and should not deter from the cautious use of NF in this population.

  11. Long-term moderate alcohol consumption does not exacerbate age-related cognitive decline in healthy, community-dwelling older adults

    Directory of Open Access Journals (Sweden)

    Malaak Nasser Moussa

    2015-01-01

    Full Text Available Recent census data has found that roughly 40% of adults 65 years and older not only consume alcohol but also drink more of it than previous generations. Older drinkers are more vulnerable than younger counterparts to the psychoactive effects of alcohol due to natural biological changes that occur with aging. This study was specifically designed to measure the effect of long-term moderate alcohol consumption on cognitive health in older adult drinkers. An extensive battery of validated tests commonly used in aging and substance use literature was used to measure performance in specific cognitive domains, including working memory and attention. An age (young, old * alcohol consumption (light, moderate factorial study design was used to evaluate the main effects of age and alcohol consumption on cognitive performance. The focus of the study was then limited to light and moderate older drinkers, and whether or not long–term moderate alcohol consumption exacerbated age-related cognitive decline. No evidence was found to support the idea that long-term moderate alcohol consumption in older adults exacerbates age-related cognitive decline. Findings were specific to healthy community dwelling social drinkers in older age and they should not be generalized to individuals with other consumption patterns, like heavy drinkers, binge drinkers or ex-drinkers.

  12. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.

    Science.gov (United States)

    Panagioti, Maria; Blakeman, Thomas; Hann, Mark; Bower, Peter

    2017-05-30

    Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Long-Term Effect of Motivational Interviewing on Dietary Intake and Weight Loss in Iranian Obese/Overweight Women

    Directory of Open Access Journals (Sweden)

    Mohsen Saffari

    2014-12-01

    Full Text Available Background: This study aimed to determine whether motivational interviewing (MI could change dietary habit and body mass index (BMI in obese/overweight women. Methods: A cluster-randomized controlled study was performed in four health centers in Qazvin, central Iran. In total, 327 obese/overweight women were selected by a multi-stage sampling method and randomly assigned into control and experimental groups. Food frequency (using questionnaire; FFQ, BMI, and metabolic markers including blood pressure, total serum cholesterol and fasting blood glucose levels were measured in all participants. Data were collected twice (before and one year after the MI interventions. Data were analyzed using student t-test, and Stepwise Linear Regression. Results: There was a significant increase in daily consumption of dietary fiber, whole grain products, fruits and vegetables in the MI group (P<0.05. The consumption of meat product, total fat, saturated fat, carbohydrate and total energy intake were also significantly reduced after MI intervention (P<0.05. As a result, body weight and BMI were significantly reduced in the intervention group compared to the control group (P<0.05. Conclusion: MI is suggested to be an effective strategy to change life style and reduce BMI in overweight/obese women in the long term. This effect needs to be further investigated in different gender and age populations.

  14. Gender Disparities in the Food Insecurity-Overweight and Food Insecurity-Obesity Paradox among Low-Income Older Adults.

    Science.gov (United States)

    Hernandez, Daphne C; Reesor, Layton; Murillo, Rosenda

    2017-07-01

    Obesity and obesity-related comorbidities are increasing among older adults. Food insecurity is a nutrition-related factor that coexists with obesity among low-income individuals. The majority of the research on the food insecurity-obesity paradox has been conducted on low-income mothers and children, with research lacking on large diverse samples of older adults. The purpose of this study was to assess gender disparities in the association between food insecurity and overweight and obesity among low-income older adults. Cross-sectional 2011 and 2012 National Health Interview Survey data were used. Food insecurity status was determined by ≥3 affirmative responses on the 10-item US Department of Agriculture Food Security Scale (FSS). Body mass index (BMI) was calculated as outlined by the Centers for Disease Control and Prevention based on self-reported height and weight. Adults included were low-income (≤1.99 federal poverty level [FPL]), older (aged ≥60 years), with a normal BMI (18.5) or greater who had complete data on FSS, BMI, and the following covariates: age, race or ethnicity, marital status, income, nativity status, physical activity, poor health status, health insurance coverage, problems paying medical bills or for medicine, and region of residency (N=5,506). Multivariate logistic regression models were stratified by gender to estimate the association between food insecurity and higher weight status. All models included covariates. In covariate-adjusted models, compared with low-income, food secure men, low-income, food-insecure men had 42% and 41% lower odds of being overweight and overweight or obese, respectively. Despite the high prevalence rate of obesity among low-income, food-insecure women, food insecurity was not significantly related to overweight, obesity, or overweight or obesity for older adult women in adjusted models. Food insecurity-overweight and -obesity paradox appears not to be present in older men. However, food insecurity and

  15. Long-term results of biopsy-guided selection and allocation of kidneys from older donors in older recipients.

    Science.gov (United States)

    Fernández-Lorente, L; Riera, L; Bestard, O; Carrera, M; Gomà, M; Porta, N; Torras, J; Melilli, E; Gil-Vernet, S; Grinyó, J M; Cruzado, J M

    2012-10-01

    In our old-for-old program, we discard or allocate older extended criteria donor kidneys to single (SKT) or dual kidney transplantation (DKT) depending on histological Remuzzi's score in recipients older than 60 years. Here, we analyze the long-term results of this program and try to identify independent predictors of patient and graft survival. Between December 1996 and January 2008, we performed 115 SKT and 88 DKT. Discard rate was 15%. Acute rejection incidence was higher in SKT than in DKT (22.6% vs. 11.4%, p = 0.04). Renal function was better in DKT than in SKT up to 5 years after transplantation. Surgical complications were frequent in DKT. Ten-year cumulative graft survival was significantly lower in the SKT group (31% vs. 53%, p = 0.03). In SKT, histological score 4 provided similar graft survival than 3 or less, whereas in DKT score 4, 5 or 6 displayed similar outcome. Finally, independent predictors of graft survival were history of major adverse cardiac event and 1-year serum creatinine, rather than SKT or DKT. In conclusion, this biopsy-guided old-for-old strategy resulted in acceptable long-term graft survival. Our results suggest that DKT should be considered for scores of 5 or 6 only. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

  16. Short- and long-term eating habit modification predict weight change in overweight, post-menopausal women: results from the WOMAN Study

    Science.gov (United States)

    Gibbs, Bethany Barone; Kinzel, Laura S.; Gabriel, Kelley Pettee; Chang, Yue-fang; Kuller, Lewis H.

    2012-01-01

    Background Standard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors, rather than caloric intake, may be an alternative strategy. Furthermore, important behaviors might differ for short- vs. long-term weight control. Objective To describe and compare associations between changes in eating behaviors and weight after 6 and 48 months Design Secondary analysis of data collected during a randomized weight loss intervention trial with 48-month follow-up Participants 465 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study Main outcome measures Changes in weight from baseline to 6 and 48 months. Statistical analyses performed Linear regression models examined the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group. Results At 6 months in the combined population, weight loss was independently associated with decreased desserts (pstudies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes. PMID:22939439

  17. Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study.

    Science.gov (United States)

    Barone Gibbs, Bethany; Kinzel, Laura S; Pettee Gabriel, Kelley; Chang, Yue-Fang; Kuller, Lewis H

    2012-09-01

    Standard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy. In addition, important behaviors might differ for short- vs long-term weight control. Our aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months. We performed secondary analysis of data collected during a randomized weight-loss intervention trial with 48-month follow-up. We studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study. We measured changes in weight from baseline to 6 and 48 months. Linear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group. At 6 months in the combined population, weight loss was independently associated with decreased desserts (Pstudies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  18. Potentially inappropriate prescriptions for older patients in long-term care

    Directory of Open Access Journals (Sweden)

    Laurin Danielle

    2004-10-01

    Full Text Available Abstract Background Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs in long-term care in metropolitan Quebec. Methods A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. Results Almost all residents (94.0% were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7% of treated patients had a potentially inappropriate prescription (PIP. Most common PIPs were drug interactions (33.9% of treated patients, followed by potentially inappropriate duration (23.6%, potentially inappropriate medication (14.7% and potentially inappropriate dosage (9.6%. PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication. The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43 and with the length of stay (OR: 1.78, CI: 1.43 – 2.20. On the other hand, the risk of receiving a PIP decreased with age. Conclusion Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

  19. Aromatherapy hand massage for older adults with chronic pain living in long-term care.

    Science.gov (United States)

    Cino, Kathleen

    2014-12-01

    Older adults living in long-term care experience high rates of chronic pain. Concerns with pharmacologic management have spurred alternative approaches. The purpose of this study was to examine a nursing intervention for older adults with chronic pain. This prospective, randomized control trial compared the effect of aromatherapy M technique hand massage, M technique without aromatherapy, and nurse presence on chronic pain. Chronic pain was measured with the Geriatric Multidimensional Pain and Illness Inventory factors, pain and suffering, life interference, and emotional distress and the Iowa Pain Thermometer, a pain intensity scale. Three groups of 39 to 40 participants recruited from seven long-term care facilities participated twice weekly for 4 weeks. Analysis included multivariate analysis of variance and analysis of variance. Participants experienced decreased levels of chronic pain intensity. Group membership had a significant effect on the Geriatric Multidimensional Pain Inventory Pain and Suffering scores; Iowa Pain Thermometer scores differed significantly within groups. M technique hand massage with or without aromatherapy significantly decreased chronic pain intensity compared to nurse presence visits. M technique hand massage is a safe, simple, but effective intervention. Caregivers using it could improve chronic pain management in this population. © The Author(s) 2014.

  20. Complaints in long-term care facilities for older persons: why residents do not give 'free advice'.

    NARCIS (Netherlands)

    Bomhoff, M.; Friele, R.

    2017-01-01

    In health care policies, the right to complain is presented as a key patient right. Complaints are also seen as a potential vehicle for quality improvement. However, in long-term care facilities for older persons in the Netherlands, relatively few complaints are registered. An explorative

  1. Complaints in long-term care facilities for older persons : Why residents do not give 'free advice'

    NARCIS (Netherlands)

    Bomhoff, Manja; Friele, R.D.

    2017-01-01

    In health care policies, the right to complain is presented as a key patient right. Complaints are also seen as a potential vehicle for quality improvement. However, in long-term care facilities for older persons in the Netherlands, relatively few complaints are registered. An explorative

  2. Long-term moderate alcohol consumption does not exacerbate age-related cognitive decline in healthy, community-dwelling older adults

    OpenAIRE

    Moussa, Malaak N.; Simpson, Sean L.; Mayhugh, Rhiannon E.; Grata, Michelle E.; Burdette, Jonathan H.; Porrino, Linda J.; Laurienti, Paul J.

    2015-01-01

    Recent census data has found that roughly 40% of adults 65 years and older not only consume alcohol but also drink more of it than previous generations. Older drinkers are more vulnerable than younger counterparts to the psychoactive effects of alcohol due to natural biological changes that occur with aging. This study was specifically designed to measure the effect of long-term moderate alcohol consumption on cognitive health in older adult drinkers. An extensive battery of validated tests c...

  3. Acute stress does not impair long-term memory retrieval in older people.

    Science.gov (United States)

    Pulopulos, Matias M; Almela, Mercedes; Hidalgo, Vanesa; Villada, Carolina; Puig-Perez, Sara; Salvador, Alicia

    2013-09-01

    Previous studies have shown that stress-induced cortisol increases impair memory retrieval in young people. This effect has not been studied in older people; however, some findings suggest that age-related changes in the brain can affect the relationships between acute stress, cortisol and memory in older people. Our aim was to investigate the effects of acute stress on long-term memory retrieval in healthy older people. To this end, 76 participants from 56 to 76 years old (38 men and 38 women) were exposed to an acute psychosocial stressor or a control task. After the stress/control task, the recall of pictures, words and stories learned the previous day was assessed. There were no differences in memory retrieval between the stress and control groups on any of the memory tasks. In addition, stress-induced cortisol response was not associated with memory retrieval. An age-related decrease in cortisol receptors and functional changes in the amygdala and hippocampus could underlie the differences observed between the results from this study and those found in studies performed with young people. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Long-term maintenance of weight loss after lifestyle intervention in frail, obese older adults.

    Science.gov (United States)

    Waters, D L; Vawter, R; Qualls, C; Chode, S; Armamento-Villareal, R; Villareal, D T

    2013-01-01

    To determine if long-term weight loss with associated improvement in physical and metabolic health can be maintained after lifestyle intervention in frail, obese older adults. Thirty-month follow-up pilot study of a 1-year lifestyle intervention trial. Community. Sixteen frail, obese (body mass index=36±2 kg/m2) older (71±1 yr.) adults. Body weight and composition, physical function, markers of the metabolic syndrome, glucose and insulin response to an oral glucose tolerance test, bone mineral density (BMD), liver and renal function tests, and food diaries. At 30-month follow-up, weight (101.5±3.8 vs. 94.5±3.9 kg) and BMI (36.0 ±1.7 vs. 33.5±1.7 kg/m2) remained significantly below baseline (all plean mass (24.1±1.0 vs. 24.1±1.1kg, all p>0.05) occurred between 12 months (end of trial) and 30 months. Improvements in the physical performance test (PPT 27±0.7 vs. 30.2±0.6), insulin sensitivity (4.1±0.8 vs. 3.0±0.6), and insulin area under the curve (12484±2042 vs. 9270±1139 min.mg/dl) remained at 30 months compared to baseline (all pmaintenance of clinically important weight loss is possible in frail, obese older adults. Weight maintenance appears to be achieved through continued caloric restriction. Larger, long-term studies are needed to follow up on these findings and investigate mechanisms and behaviors underlying maintenance of weight loss and physical function.

  5. A qualitative study explaining nurses' perceptions of quality care for older people in long-term care settings in Ireland.

    Science.gov (United States)

    Murphy, Kathy

    2007-03-01

    The aim of this research was to explore nurses' perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. The study was a qualitative exploration of nurses' perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care.

  6. Cross-sectional relationship between physical fitness components and functional performance in older persons living in long-term care facilities

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2006-02-01

    Full Text Available Abstract Background The age-related deterioration of physiological capacities such as muscle strength and balance is associated with increased dependence. Understanding the contribution of physical fitness components to functional performance facilitates the development of adequate exercise interventions aiming at preservation of function and independence of older people. The aim of the study was to investigate the relationship between physical fitness components and functional performance in older people living in long-term care facilities. Methods Design cross-sectional study Subjects 226 persons living in long-term care facilities (mean age: 81.6 ± 5.6. Outcome measures Physical fitness and functional performance were measured by performance-based tests. Results Knee and elbow extension strength were significantly higher in men (difference = 44.5 and 50.0 N, respectively, whereas women were more flexible (difference sit & reach test = 7.2 cm. Functional performance was not significantly different between the genders. In men, motor coordination (eye-hand coordination and measures of strength were the main contributors to functional performance, whereas in women flexibility (sit and reach test and motor coordination (tandem stance and eye-hand coordination played a major role. Conclusion The results of this study show that besides muscle strength, fitness components such as coordination and flexibility are associated with functional performance of older people living in long-term care facilities. This suggests that men and women living in long-term care facilities, differ considerably concerning the fitness factors contributing to functional performance. Women and men may, therefore, need exercise programs emphasizing different fitness aspects in order to improve functional performance.

  7. Comparison of major depressive disorder and subthreshold depression among older adults in community long-term care.

    Science.gov (United States)

    Lee, Mi Jin; Hasche, Leslie K; Choi, Sunha; Proctor, Enola K; Morrow-Howell, Nancy

    2013-01-01

    This study extends existing knowledge regarding the continuum between major depression (MD) and subthreshold depression (SD) by examining differences in symptomology and associative factors for a subpopulation of older adults with functional disability. Our sample consisted of clients age 60 and above entering public community long term care derived from the baseline survey of a longitudinal study (315 non-depressed, 74 MD, and 221 SD). We used the Diagnostic Interview Schedule to establish diagnoses of MD, the Center for Epidemiological Studies Depression Scale (CES-D) to assess SD, and other self-report measures to explore potential associative factors of demographics, comorbidity, social support, and stressors. No differences in CES-D identified symptoms occurred between the two groups. MD and SD were both associated with lower education, poorer social support, more severe medical conditions, and higher stress when compared to non-depressed older adults. Younger age and being female were associated solely with MD; whereas, worse perceived health and more trouble affording food were associated solely with SD. The only associative factor significantly different between MD and SD was age. Those with MD were more likely to be younger than those with SD. Our findings of symptom profiles and associative factors lend support to the continuum notion of depression. Identification of only older adults within the community long-term care service system who meet criteria for MD would leave many older adults, who also face multiple comorbidities, high levels of stress and social isolation, and substantial depressive symptoms undiagnosed and untreated.

  8. Sexuality and physical intimacy in long-term care.

    Science.gov (United States)

    Lichtenberg, Peter A

    2014-01-01

    Sexuality and sexual needs in older adults remains a neglected area of clinical intervention, particularly so in long-term care settings. Because older adults in medical rehabilitation and long-term care beds present with significant frailties, and often significant neurocognitive disorders, it makes it difficult for occupational therapists and other staff to evaluate the capacity of an older adult resident to participate in sexual relationships. The current paper reviews the current literature on sexuality and aging, examines some of the clinical practices and guidelines regarding sexual expression in long-term care, and presents two case examples. A semistructured interview and decision tree is presented to assist therapists in making careful and informed decisions and thereby balancing the needs for protection with the needs for autonomy.

  9. The effects of light therapy on depression and sleep disruption in older adults in a long-term care facility.

    Science.gov (United States)

    Wu, Mann-Chian; Sung, Huei-Chuan; Lee, Wen-Li; Smith, Graeme D

    2015-10-01

    This study aims to evaluate the effect of light therapy on depression and sleep disruption in older adults residing in a long-term care facility. Psychological morbidity is a problem commonly seen in older adults residing in long-term care facilities. Limited research has addressed the effect of light therapy on depression in this population. A quasi-experimental pretest and posttest design was used. Thirty-four participants in the experimental group received light therapy by sitting in front of a 10000-lux light box 30 min in the morning, three times a week for 4 weeks. Thirty-one participants in the control group received routine care without light therapy. Depression was measured by Geriatric Depression Scale-Short Form at baseline and week 4. After receiving 4 weeks of light therapy, the mean depression score in the experimental group decreased from 7.24 (SD3.42) at pretest to 5.91 (SD 3.40) at posttest, and had a significant reduction (t = 2.22, P = 0.03). However, there was no significant difference in depression score and sleep disruption between the experimental group and control group. Light therapy might have the potential to reduce depressive symptoms and sleep disruption and may be a viable intervention to improve mental health of older adults in the long-term care facilities. © 2014 Wiley Publishing Asia Pty Ltd.

  10. Oral health care in older people in long term care facilities : A systematic review of implementation strategies

    NARCIS (Netherlands)

    Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.

    Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the

  11. Improved postural control after dynamic balance training in older overweight women.

    Science.gov (United States)

    Bellafiore, Marianna; Battaglia, Giuseppe; Bianco, Antonino; Paoli, Antonio; Farina, Felicia; Palma, Antonio

    2011-01-01

    Many studies have reported a greater frequency of falls among older women than men in conditions which stress balance. Previously, we found an improvement in static balance in older women with an increased support surface area and equal load redistribution on both feet, in response to a dynamic balance training protocol. The aim of the present study was to examine whether the same training program and body composition would have effects on the postural control of older overweight women. Ten healthy women (68.67 ± 5.50 yrs; 28.17 ± 3.35 BMI) participated in a five-week physical activity program. This included dynamic balance exercises, such as heel-to-toe walking in different directions, putting their hands on their hips, eyes open (EO) or closed (EC), with a tablet on their heads, going up and down one step, and walking on a mat. Postural stability was assessed before and after training with an optoelectronic platform and a uni-pedal balance performance test. Body composition of the trunk, upper limbs and lower limbs was measured by bio-impedance analysis. The mean speed (MS), medial-lateral MS (MS-x), anterior-posterior MS (MS-y), sway path (SP) and ellipse surface area (ESA) of the pressure center was reduced after training in older women. However, only MS, MS-x, MS-y and SP significantly decreased in bipodalic conditions with EO and MS-y also with EC (punipedal static balance. Our dynamic balance training protocol appears to be feasible, safe and repeatable for older overweight women and to have positive effects in improving their lateral and anterior-posterior postural control, mainly acting on the visual and skeletal muscle components of the balance control system.

  12. Survival analysis of increases in care needs associated with dementia and living alone among older long-term care service users in Japan.

    Science.gov (United States)

    Lin, Huei-Ru; Otsubo, Tetsuya; Imanaka, Yuichi

    2017-08-15

    Japan is known for its long life expectancy and rapidly aging society that there are various demands of older adults need to be fulfilled with, and one of them is long-term care needs. Therefore, Japan implemented the Long-Term Care Insurance in year 2000 for citizens who are above 65-year old and citizens who are above 40-year old in needs of long-term care services. This study was undertaken to longitudinally examine the influence of dementia and living alone on care needs increases among older long-term care insurance service users in Japan. Long-term care insurance claims data were used to identify enrollees who applied for long-term care services between October 2010 and September 2011, and subjects were tracked until March 2015. A Kaplan-Meier survival analysis was conducted to examine increases in care needs over time in months. Cox regression models were used to examine the effects of dementia and living alone on care needs increases. The cumulative survival rates before care needs increased over the 4.5-year observation period were 17.6% in the dementia group and 31.9% in the non-dementia group. After adjusting for age, sex, care needs level, and status of living alone, the risk of care needs increases was found to be 1.5 times higher in the dementia group. Living alone was not a significant risk factor of care needs increases, but people with dementia who lived alone had a higher risk of care needs increases than those without dementia. Dementia, older age, the female sex, and lower care needs levels were associated with a higher risk of care needs increases over the study period. Among these variables, dementia had the strongest impact on care needs increases, especially in persons who lived alone.

  13. Supporting the long-term residential care needs of older homeless people with severe alcohol-related brain injury in Australia: the Wicking Project.

    Science.gov (United States)

    Rota-Bartelink, Alice; Lipmann, Bryan

    2007-01-01

    For years, community service providers have been frustrated with the lack in availability of long-term, specialized supported accommodation for older people, particularly older homeless people, with severe acquired brain injury (ABI) and challenging behaviors. Although the incidence of ABI (particularly alcohol-related brain injury) is far wider than being confined to the homeless population, it is frequently misdiagnosed and very often misunderstood Wintringham is an independent welfare company in Melbourne, Australia, that provides secure, affordable, long-term accommodation and high quality services to older homeless people. The high incidence of alcohol abuse among the resident population has led us to adapt our model ofcare to accommodate a complexity of need. However, there are some individuals with severely affected behaviors that continue to challenge Wintringham's capacity to provide adequate support. The deficiency in highly specialized, long-term supported accommodation for older people with severe alcohol-related brain injury (ARBI) is the driving force behind this project. We aim to further develop and improve the current Wintringham model of residential care to better support people with these complex care needs. We will report on the synthesis of this project which aims to test a specialized model that can be reproduced or adapted by other service providers to improve the life circumstances of these frequently forgotten people.

  14. A fall prevention guideline for older adults living in long-term care facilities.

    Science.gov (United States)

    Jung, D; Shin, S; Kim, H

    2014-12-01

    Falls are among the most frequent critical health problems for older adults over 65 years of age and often result in consequential injuries. This study developed a guideline covering risk factors and interventions for falls in order to prevent them from occurring in long-term care facilities. This study was grounded in the methodological approach of the Scottish Intercollegiate Guideline Network for establishing evidence-based guidelines: (1) establishment of the target population and scope of the guideline, (2) systematic literature review and critical analysis, (3) determination of the recommendation grade, (4) development of a draft nursing intervention guideline and algorithm, (5) expert evaluation of the draft nursing intervention guideline, and (6) confirmation of the final intervention guideline and completion of the algorithm. The resulting evidence-based fall prevention guideline consists of a three-step factor assessment and a three-step intervention approach. The resulting guideline was based on the literature and clinical experts. Further research is required to test the guideline's feasibility in across long term care facilities. This guideline can be used by nurses to screen patients who are at a high risk of falling to provide patient interventions to help prevent falls. Considering the high rate of falls at long-term care facilities and the absence of evidence-based guidelines to prevent them, additional studies on falls at long-term care facilities are necessary. Meanwhile, given prior research that indicates the importance of human resources in the application of such guidelines, continuous investigations are needed as to whether the research outcomes are actually conveyed to nurses. © 2014 International Council of Nurses.

  15. Deviations in energy sensing predict long-term weight change in overweight Native Americans.

    Science.gov (United States)

    Basolo, Alessio; Votruba, Susanne B; Heinitz, Sascha; Krakoff, Jonathan; Piaggi, Paolo

    2018-05-01

    Energy expenditure (EE), as reflective of body energy demand, has been proposed to be the key driver of food intake, possibly influencing weight change in humans. Variation in this energy-sensing link (overeating relative to weight-maintaining energy requirements) may lead to weight gain over time. Sixty-one overweight otherwise healthy Native Americans (age: 34.0 ± 7.9 years, body fat: 39.7 ± 9.5%, 36 males) were admitted to our clinical research unit for measurements of body composition by dual-energy X-ray absorptiometry, and 24-h EE and respiratory quotient (RQ) in a whole-room indirect calorimeter during energy balance and weight stability. Following this, ad libitum food intake was assessed for three days using computerized vending machines. Body weight change under unrestricted free-living conditions was assessed at an outpatient follow-up visit (median follow-up time = 1.7 years). Total ad libitum food intake (3-day average) was positively associated with 24-h EE (r = 0.44, p energy requirements can be assessed and predicts long-term weight gain, suggesting that variation in energy sensing may influence appetite by favoring overeating thus promoting obesity development. Copyright © 2018. Published by Elsevier Inc.

  16. What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults' occupational performance?

    DEFF Research Database (Denmark)

    Nielsen, Tove Lise; Petersen, Kirsten Schultz; Nielsen, Claus Vinther

    2016-01-01

    critically appraised 13 of 995 detected papers. Extracted data were presented and summarised descriptively. Results Eight high-quality papers showed that occupation-focused and occupation-based occupational therapy using cognitive, behavioural and environmental strategies may significantly improve......Abstract Title What are the short-term and long-term effects of occupation-focused and occupation-based occupational therapy in the home on older adults’ occupational performance? A systematic review Background There is a lack of evidence-based knowledge about the effectiveness of home......-based occupational therapy for older adults aimed at improving occupational performance by practicing activities and tasks. Aim This review synthesizes and discusses evidence for the effectiveness of occupation-focused and occupation-based occupational therapy for older adults at home. Material and methods Peer...

  17. OR25: Validity of predictive equations for resting energy expenditure for overweight older adults with and without diabetes

    NARCIS (Netherlands)

    Verreijen, A. M.; Garrido, V.; Engberink, M.F.; Memelink, R. G.; Visser, M.; Weijs, P. J.

    2017-01-01

    Rationale: Predictive equations for resting energy expenditure (REE) are used in the treatment of overweight and obesity, but the validity of these equations in overweight older adults is unknown. This study evaluates which predictive REE equation is the best alternative to indirect calorimetry in

  18. Home or foster home care versus institutional long-term care for functionally dependent older people.

    Science.gov (United States)

    Young, Camilla; Hall, Amanda M; Gonçalves-Bradley, Daniela C; Quinn, Terry J; Hooft, Lotty; van Munster, Barbara C; Stott, David J

    2017-04-03

    Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce costs and improve the quality of care compared. To assess the effects of long-term home or foster home care versus institutional care for functionally dependent older people. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, MEDLINE, Embase, CINAHL, and two trials registers to November 2015. We included randomised and non-randomised trials, controlled before-after studies and interrupted time series studies complying with the EPOC study design criteria and comparing the effects of long-term home care versus institutional care for functionally dependent older people. Two reviewers independently extracted data and assessed the risk of bias of each included study. We reported the results narratively, as the substantial heterogeneity across studies meant that meta-analysis was not appropriate. We included 10 studies involving 16,377 participants, all of which were conducted in high income countries. Included studies compared community-based care with institutional care (care homes). The sample size ranged from 98 to 11,803 (median N = 204). There was substantial heterogeneity in the healthcare context, interventions studied, and outcomes assessed. One study was a randomised trial (N = 112); other included studies used designs that had potential for bias, particularly due lack of randomisation, baseline imbalances, and non-blinded outcome assessment. Most studies did not select (or exclude) participants for any specific disease state, with the exception of one study that only included patients if they had a stroke. All studies had methodological limitations, so readers should interpret results with caution.It is uncertain

  19. Long-term health benefits of appetite suppressants remain unproven

    Directory of Open Access Journals (Sweden)

    Francisco José Roma Paumgartten

    2011-12-01

    Full Text Available Because of the increasing prevalence of obesity, prevention and treatment of overweight has become a major public health concern. In addition to diet and exercise, drugs are needed for patients who failed to lose weight with behavioral treatment. The current article aimed to summarize recent concerns on the safety and efficacy of appetite suppressants. Several appetite suppressants have been banned for safety reasons. In 2010, sibutramine was withdrawn from the market because a long-term study showed it increased the risks of cardiovascular events. So far no study with a sufficiently large sample size has demonstrated that appetite suppressants can reduce morbidity and mortality associated with overweight. The withdrawal of sibutramine highlights that guidelines for the evaluation of weight control drugs must be more stringent, and studies on their long-term health benefits are needed prior to their marketing.

  20. Long-term care services and support systems for older adults: The role of technology.

    Science.gov (United States)

    Czaja, Sara J

    2016-01-01

    The aging of the population, especially the increase in the "oldest old," is a remarkable achievement that presents both opportunities and challenges for policymakers, researchers, and society. Although many older adults enjoy relatively good health into their later years, many have one or more chronic conditions or diseases and need help with disease management activities or activities important to independent living. Technology is playing an increasingly important role in the health care arena and is becoming ubiquitous in health management activities. There are a variety of technology applications that can be used to enhance the mobility and quality of life of people who have limitations and help to foster the ability of those with chronic conditions to remain at home. Technology applications can also provide a central role in providing support to family caregivers in terms of enhancing access to information and community resources and connections to formal and informal support services. Monitoring technologies may also allow caregivers to check on the status or activities of their loved one while they are at work or at a distant location. Furthermore, telemedicine applications can aid the ability of care providers to monitor patients and deliver health services. The objective of this article is to highlight the potential role that technology can play in the provision of long-term support for older adults and their families. Challenges and barriers that currently limit the full potential of technology to be realized for these populations will also be discussed. Finally the role of psychological science toward maximizing the potential of technology applications in enhancing long term care and support services will be highlighted. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  1. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials.

    Science.gov (United States)

    Ahmed, Haroon; Davies, Freya; Francis, Nick; Farewell, Daniel; Butler, Christoper; Paranjothy, Shantini

    2017-05-29

    To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults. Systematic review andmeta-analysis of randomised trials. We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature( CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs. We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim-sulfamethoxazole after 1 month of prophylaxis. Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Long-term cortisol levels measured in scalp hair of obese patients.

    Science.gov (United States)

    Wester, Vincent L; Staufenbiel, Sabine M; Veldhorst, Margriet A B; Visser, Jenny A; Manenschijn, Laura; Koper, Jan W; Klessens-Godfroy, Francoise J M; van den Akker, Erica L T; van Rossum, Elisabeth F C

    2014-09-01

    In obese subjects a relatively high cortisol output in urine has been observed compared to nonobese individuals. However, cortisol levels in blood, saliva, and urine in association with obesity have been inconsistent across studies, possibly due to the high variability of systemic cortisol levels. Cortisol levels measured in scalp hair provide a marker for long-term cortisol exposure, and have been associated with cardiovascular disease in an elderly population and to disease course in Cushing's disease. We aimed to compare hair cortisol levels between obese patients and nonobese controls. Hair cortisol levels of 47 obese patients (median BMI 38.8, range 31.1-65.8), 41 overweight, and 87 normal-weight subjects using an enzyme-linked immunosorbent assay (ELISA) were measured. Obese patients had higher hair cortisol levels than overweight and normal weight subjects (respectively 30.8 vs 8.5 and 8.4 pg/mg hair, P cortisol levels was found between normal weight and overweight subjects. Our results suggest a higher long-term cortisol exposure in obese patients, which may contribute to cardiovascular disease risk. Future research will determine whether long-term cortisol levels provide a novel treatment target in the management of cardiovascular disease risk in obesity. © 2014 The Obesity Society.

  3. Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

    Directory of Open Access Journals (Sweden)

    Hantikainen Virpi

    2011-09-01

    Full Text Available Abstract Background Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs, such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1 to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2 to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use, living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group. Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion Little

  4. Leisure time physical activity among older adults with long-term spinal cord injury.

    Science.gov (United States)

    Jörgensen, S; Martin Ginis, K A; Lexell, J

    2017-09-01

    Cross-sectional. To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs). Home settings in southern Sweden. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression. Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants. Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.

  5. The availability and affordability of long-term care for disabled older people in China: The issues related to inequalities in social security benefits.

    Science.gov (United States)

    Lei, Peng; Feng, Zhixin; Wu, Zhuochun

    2016-01-01

    China is experiencing increasing pressure from issues relating to an ageing population. The rationality of different eligibility criteria of the benefits within the social security system has been widely challenged; however, to date, no previous study has explored its association with the availability and affordability of long-term care (LTC). This study evaluates the availability and affordability of Long-Term Care (LTC) services for disabled older people (aged 65 and above) in China, with special attention to the differences among groups in receipt of specific social security benefits. The data of availability and affordability of LTC services for disabled older people is from a nationally representative sample Chinese Longitudinal Healthy Longevity Survey (CLHLS). Three different social security benefits were identified and their effects on the long-term care services for disabled older people were explored. The overall proportions of disabled older people who have only limited or no available or affordable LTC services were remarkably high, especially for those who have moderate or no social security benefits. Compared to those who are entitled to generous social security benefits, older people who have no social security benefits are 18.45 times more likely to be unable to afford health care expenses. The findings imply that policy makers in China could focus on the LTC needs for the social security and socioeconomically disadvantaged (who have limited or no social security benefits and in low household income) disabled older people which could reduce the gap between them and those who are entitled to generous social security benefits. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report.

    Science.gov (United States)

    de Souto Barreto, Philipe; Morley, John E; Chodzko-Zajko, Wojtek; H Pitkala, Kaisu; Weening-Djiksterhuis, Elizabeth; Rodriguez-Mañas, Leocadio; Barbagallo, Mario; Rosendahl, Erik; Sinclair, Alan; Landi, Francesco; Izquierdo, Mikel; Vellas, Bruno; Rolland, Yves

    2016-05-01

    A taskforce, under the auspices of The International Association of Gerontology and Geriatrics-Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  7. Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

    Directory of Open Access Journals (Sweden)

    Carolline de Araújo Mariz

    2011-10-01

    Full Text Available A cross-sectional study was conducted using body mass index (BMI to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes.

  8. Physical activity enhances long-term quality of life in older adults: efficacy, esteem, and affective influences.

    Science.gov (United States)

    Elavsky, Steriani; McAuley, Edward; Motl, Robert W; Konopack, James F; Marquez, David X; Hu, Liang; Jerome, Gerald J; Diener, Ed

    2005-10-01

    Physical activity has been effective in enhancing quality of life (QOL) of older adults over relatively short periods of time. However, little is known about the long-term effects of physical activity and even less about the possible mediators of this relationship. We examined the mediating effects of psychological variables on the relationship between physical activity and global QOL (satisfaction with life) in older adults over a 4-year period. Participants (N = 174, M age = 66.7 years) completed a battery of psychosocial measures at 1 and 5 years following enrollment in a 6-month randomized controlled exercise trial. Panel analysis conducted within a covariance modeling framework indicated that physical activity was related to self-efficacy, physical self-esteem, and positive affect at 1 year, and in turn, greater levels of self-efficacy and positive affect were associated with higher levels of QOL. Analyses indicated that changes in physical activity over the 4-year period were related to increases in physical self-esteem and positive affect, but only positive affect directly influenced improvements in QOL. The findings lend support to the position that physical activity effects on QOL are in part mediated by intermediate psychological outcomes and that physical activity can have long-term effects on well-being.

  9. Accelerated long-term forgetting in aging and intra-sleep awakenings

    Directory of Open Access Journals (Sweden)

    Alison eMary

    2013-10-01

    Full Text Available The architecture of sleep and the functional neuroanatomical networks subtending memory consolidation processes are both modified with aging, possibly leading to accelerated forgetting in long-term memory. We investigated associative learning and declarative memory consolidation processes in 16 young (18–30 years and 16 older (65–75 years healthy adults. Performance was tested using a cued recall procedure at the end of learning (immediate recall, and 30 minutes and 7 days later. A delayed recognition test was also administered on day 7. Daily sleep diaries were completed during the entire experiment. Results revealed a similar percentage of correct responses at immediate and 30-minute recall in young and older participants. However, recall was significantly decreased 7 days later, with an increased forgetting in older participants. Additionally, intra-sleep awakenings were more frequent in older participants than young adults during the 7 nights, and were negatively correlated with delayed recall performance on day 7 in the older group. Altogether, our results suggest a decline in verbal declarative memory consolidation processes with aging, eventually leading to accelerated long-term forgetting indicating that increased sleep fragmentation due to more frequent intra-sleep awakenings in older participants contribute to the reported age-related decline in long-term memory retrieval. Our results highlight the sensitivity of long-term forgetting measures to evidence consolidation deficits in healthy aging.

  10. PTSD is negatively associated with physical performance and physical function in older overweight military veterans

    OpenAIRE

    Hall, Katherine S.; Beckham, Jean C.; Bosworth, Hayden B.; Sloane, Richard; Pieper, Carl F.; Morey, Miriam C.

    2014-01-01

    This study examines the effect of posttraumatic stress disorder (PTSD) on function and physical performance in older overweight military Veterans with comorbid conditions. This is a secondary data analysis of older Veterans (mean age = 62.9 yr) participating in a physical activity counseling trial. Study participants with PTSD (n = 67) and without PTSD (n = 235) were identified. Self-reported physical function (36-item Short Form Health Survey) and directly measured physical performance (mobi...

  11. Long-Term Effects of a Screening Intervention for Depression on Suicide Rates among Japanese Community-Dwelling Older Adults.

    Science.gov (United States)

    Oyama, Hirofumi; Sakashita, Tomoe

    2016-04-01

    To explore the long-term impact of a universal screening intervention for depression on suicide rates among older community-dwelling adults, with gender as an effect modifier. Controlled cohort study reporting long-term follow-up of previous research. Two sets of three municipalities in Japan were assigned as intervention and control regions and compared with the surrounding zone and prefecture. Intervention area residents aged 60 years and older (14,291) were invited to participate in a 2-year intervention (2005-2006). Four population-based dynamic cohorts of residents aged 65 years and older (1999-2010) were included as subjects, 6 years before and after the intervention started. At-risk residents within the intervention region (4,918) were invited for a two-step screening program; 2,552 participated in the program linked with care/support services for 2 years. An education program open to the public was held. Changes in suicide from a 6-year baseline to the 2-year intervention and a 4-year follow-up in the intervention region (11,700 adults ≥65 years) were compared with a matched control and two comparison areas using mixed-effects negative binomial regression models. Suicide rates among older adults exposed to screening were compared with those of the control region. Suicide rates in the intervention region decreased by 48%, which was significantly greater than in the three comparison areas. The program's benefits lasted longer for women than men. Screening exposure may be associated with decreased suicide risk over the 4-year follow-up. Universal screening may decrease suicide rates among older adults, with potential gender differences in treatment response. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. The association between alcohol use and long-term care placement among older Canadians: A 14-year population-based study

    Science.gov (United States)

    Kaplan, Mark S.; Huguet, Nathalie; Feeny, David; McFarland, Bentson H.; Caetano, Raul; Bernier, Julie; Giesbrecht, Norman; Oliver, Lisa; Ramage-Morin, Pamela; Ross, Nancy A.

    2013-01-01

    Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5,404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors. PMID:24169370

  13. Correlates of preferences for autonomy in long-term care: results of a population-based survey among older individuals in Germany

    Directory of Open Access Journals (Sweden)

    Hajek A

    2018-01-01

    Full Text Available André Hajek,1 Thomas Lehnert,1 Annemarie Wegener,1 Steffi G Riedel-Heller,2 Hans-Helmut König1 1Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, 2Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany Purpose: Thus far, there is little evidence concerning the factors associated with preferences for autonomy in long-term care. Therefore, the aim of the present study was to investigate the correlates of preferences for autonomy in long-term care among older individuals in Germany. Methods: Data were gathered from a population-based survey of the German population aged ≥65 years in 2015 (N=1,006. Results: Multiple logistic regressions revealed that preferences for freedom of choice for foods were positively associated with living with partner or spouse (OR: 1.5 [1.0–2.2], being born in Germany (OR: 1.9 [1.1–3.3], and lower self-rated health (OR: 1.3 [1.1–1.6]. Preferences for freedom in choosing bedtime and sleep duration were positively associated with lower age (OR: 1.1 [1.0–1.1] and having children (OR: 2.2 [1.0–4.9]. Preferences for customized living space were positively associated with being female (OR: 2.5 [1.4–4.5] and being born in Germany (OR: 3.7 [1.9–7.1]. Neither preferences for decent and sanitary housing nor preferences for shared decision-making were associated with any of the independent variables. Conclusion: Various independent variables were associated with preferences for autonomy in long-term care. This suggests that preferences for care-related autonomy are complex. Knowing these might help refine long-term care health services. Keywords: caregivers, older adult, long-term care, Germany

  14. Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index.

    Science.gov (United States)

    Miller, Paige E; Morey, Miriam C; Hartman, Terry J; Snyder, Denise C; Sloane, Richard; Cohen, Harvey Jay; Demark-Wahnefried, Wendy

    2012-06-01

    Older adult cancer survivors are at greater risk of cancer recurrence and other comorbidities that can be prevented through improved diet and weight management. The tertiary prevention needs of rural-dwelling survivors can be even greater, yet little is known about rural and urban differences in lifestyle factors among this high-risk population. To compare dietary patterns of urban and rural cancer survivors and to examine associations of dietary patterns with body mass index (BMI). A secondary analysis was performed of baseline data from the Reach Out to Enhance Wellness (RENEW) trial, a diet and exercise intervention among overweight, long-term (≥5 years), older survivors of colorectal, breast, and prostate cancer. Survivors in the present analysis (n=729) underwent two 45- to 60-minute telephone surveys, which included two 24-hour dietary recalls. Principal components analysis and multivariable general linear models were used to derive dietary patterns and to evaluate associations between dietary patterns and BMI, respectively. Principal components analysis identified three primary dietary patterns among rural dwellers (high sweets and starches, high reduced-fat dairy, cereal, nuts, and fruits, and mixed) and three among urban dwellers (high fruits and vegetables, high meat and refined grains, and high sugar-sweetened beverages). Among rural survivors, greater adherence to the high reduced-fat dairy, cereal, nuts, and fruits pattern was positively associated with lower BMI (P trend pattern was associated with greater BMI (P trend pattern among urban survivors was inversely associated with BMI (P trend dietary intake behavior should be considered in designing public health interventions among the increasing population of older cancer survivors. In addition, targeting overall dietary patterns might be one approach to help reduce the burden of obesity among this population. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All

  15. Overweight and obesity among older adults on admission to hospital.

    LENUS (Irish Health Repository)

    Lithander, F E

    2011-03-01

    Poor nutritional status, which includesboth under- a nd over-nutrition, i s associated w it h poor health outcomes. T his cross-sectional study assessed the nutritional status of older patients admitted to an acute geriatric ward of a Dublin hospital. Anthropometric and clinical measurements were made. Thirty patients, mean (sd) age 79 (7) y and body mass index 26.6 (4.7) kg\\/m2, participated. More patients were overweight (n = 12) or obese (n = 9) than underweight (n= 1) or healthy weight (n = 8) which indicates that this age-group may be part of the Irish obesity epidemic.

  16. Long-term care financing: lessons from France.

    Science.gov (United States)

    Doty, Pamela; Nadash, Pamela; Racco, Nathalie

    2015-06-01

    POLICY POINTS: France's model of third-party coverage for long-term services and supports (LTSS) combines a steeply income-adjusted universal public program for people 60 or older with voluntary supplemental private insurance. French and US policies differ: the former pay cash; premiums are lower; and take-up rates are higher, in part because employer sponsorship, with and without subsidization, is more common-but also because coverage targets higher levels of need and pays a smaller proportion of costs. Such inexpensive, bare-bones private coverage, especially if marketed as a supplement to a limited public benefit, would be more affordable to those Americans currently most at risk of "spending down" to Medicaid. An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long-term care could inform the United States' long-term care financing reform efforts. We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income

  17. Animal-Assisted Therapy and Application to Older Adults in Long Term Care

    Directory of Open Access Journals (Sweden)

    Kimberly Ann Mercer

    2015-05-01

    Full Text Available In the past thirty years animal-assisted therapy (AAT has moved beyond anecdotal status to a scientific evidence-based intervention. AAT comes in many shapes and sizes. There are a variety of animals which can be used such as dogs, cats, rabbits, horses, guinea pigs, goats, dolphins, and even fish aquariums. Loneliness is a common theme among older adults in long term care (LTC. Many older adults living in LTC facilities feel isolated. Some have little contact with family members or friends. Many describe feelings of loneliness and withdraw from social activities and interaction with others. Some feel as if they have nothing to look forward to and find no useful purpose in life.  The absence of having another to care for or nurture can also be distressing. The purpose of this project was to explore the use of AAT as an intervention to decrease loneliness in residents living in a LTC setting by introducing visits from a Sphynx cat registered by the Delta Society as a therapy animal. The project sample consisted of seven participants all over the age of 60 years who resided in a LTC facility in Texas. Pre-intervention and post-intervention checklists and open-ended questions were employed to collect data from participants. Analysis of the project findings revealed a notable decrease in loneliness.

  18. Are older people more vulnerable to long-term impacts of disasters?

    Directory of Open Access Journals (Sweden)

    Rafiey H

    2016-12-01

    Full Text Available Hassan Rafiey,1 Yadollah Abolfathi Momtaz,2,3 Fardin Alipour,1 Hamidreza Khankeh,4 Shokoufeh Ahmadi,4 Mohammad Sabzi Khoshnami,1 Sharifah Azizah Haron3 1Research Center of Social Welfare Management, Department of Social Work, 2Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 3Malaysian Research Institute on Ageing (MyAgeing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 4Department of Health in Emergency and Disaster, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Background: Despite the growing interest in the study of disasters, there is limited research addressing the elderly population that lead to prejudiced beliefs that older adults are more vulnerable to disasters than younger adults. This study aimed to compare positive mental health between elderly and young earthquake survivors.Method: Data for this study, consisting of 324 earthquake survivors, were obtained from a population-based cross-sectional survey conducted in Iran, 2015. The long-term effect of earthquake was assessed using the Mental Health Continuum-Short Form questionnaire. A one-way multivariate analysis of covariance (MANCOVA using SPSS (version 22 was used in data analysis.Results: Older adults scored significantly a higher level of overall positive mental health (mean [M]=34.31, standard deviation [SD]=10.52 than younger age group (M=27.48, SD=10.56, t=-4.41; P<0.001. Results of MANCOVA revealed a statistically significant difference between older and young adults on the combined positive mental health subscales (F(3,317=6.95; P<0.001, after controlling for marital status, sex, and employment status.Conclusion: The present findings showing a higher level of positive mental health among elderly earthquake survivors compared with their younger counterparts in the wake of natural disasters suggest that advancing age per se does not contribute to increasing vulnerability. Keywords

  19. Nutrition in children with long-term health conditions

    OpenAIRE

    Westwood, A

    2015-01-01

    Long-term health conditions (LTHCs) in children may affect nutrition and growth by means of multiple mechanisms. Both undernutrition and overweight/obesity are risk factors. Direct effects of the condition that may cause undernutrition include increased resting energy expenditure, excess losses through malabsorption, difficulty ingesting food, and decreased appetite. Indirect effects of LTHCs may be mediated by learnt or adaptive behaviours, secondary anorexia, inappropriate diets, or conditi...

  20. Retrospective attention in short-term memory has a lasting effect on long-term memory across age.

    Science.gov (United States)

    Strunk, Jonathan; Morgan, Lauren; Reaves, Sarah; Verhaeghen, Paul; Duarte, Audrey

    2018-04-13

    Declines in both short- and long-term memory are typical of healthy aging. Recent findings suggest that retrodictive attentional cues ("retro-cues") that indicate the location of to-be-probed items in short-term memory (STM) have a lasting impact on long-term memory (LTM) performance in young adults. Whether older adults can also use retro-cues to facilitate both STM and LTM is unknown. Young and older adults performed a visual STM task in which spatially informative retro-cues or non-informative neutral-cues were presented during STM maintenance of real-world objects. We tested participants' memory at both STM and LTM delays for objects that were previously cued with retrodictive or neutral cues during STM order to measure the lasting impact of retrospective attention on LTM. Older adults showed reduced STM and LTM capacity compared to young adults. However, they showed similar magnitude retro-cue memory benefits as young adults at both STM and LTM delays. To the best of our knowledge, this is the first study to investigate whether retro-cues in STM facilitate the encoding of objects into LTM such that they are more likely to be subsequently retrieved by older adults. Our results support the idea that retrospective attention can be an effective means by which older adults can improve their short and long-term memory performance, even in the context of reduced memory capacity.

  1. Prevalence of Long-Term Opioid Use in Long-Stay Nursing Home Residents.

    Science.gov (United States)

    Hunnicutt, Jacob N; Chrysanthopoulou, Stavroula A; Ulbricht, Christine M; Hume, Anne L; Tjia, Jennifer; Lapane, Kate L

    2018-01-01

    Overall and long-term opioid use among older adults have increased since 1999. Less is known about opioid use in older adults in nursing homes (NHs). Cross-sectional. U.S. NHs (N = 13,522). Long-stay NH resident Medicare beneficiaries with a Minimum Data Set 3.0 (MDS) assessment between April 1, 2012, and June 30, 2012, and 120 days of follow-up (N = 315,949). We used Medicare Part D claims to measure length of opioid use in the 120 days from the index assessment (short-term: ≤30 days, medium-term: >30-89 days, long-term: ≥90 days), adjuvants (e.g., anticonvulsants), and other pain medications (e.g., corticosteroids). MDS assessments in the follow-up period were used to measure nonpharmacological pain management use. Modified Poisson models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for age, gender, race and ethnicity, cognitive and physical impairment, and long-term opioid use. Of all long-stay residents, 32.4% were prescribed any opioid, and 15.5% were prescribed opioids long-term. Opioid users (versus nonusers) were more commonly prescribed pain adjuvants (32.9% vs 14.9%), other pain medications (25.5% vs 11.0%), and nonpharmacological pain management (24.5% vs 9.3%). Long-term opioid use was higher in women (aPR = 1.21, 95% CI = 1.18-1.23) and lower in racial and ethnic minorities (non-Hispanic blacks vs whites: APR = 0.93, 95% CI = 0.90-0.94) and those with severe cognitive impairment (vs no or mild impairment, aPR = 0.82, 95% CI = 0.79-0.83). One in seven NH residents was prescribed opioids long-term. Recent guidelines on opioid prescribing for pain recommend reducing long-term opioid use, but this is challenging in NHs because residents may not benefit from nonpharmacological and nonopioid interventions. Studies to address concerns about opioid safety and effectiveness (e.g., on pain and functional status) in NHs are needed. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics

  2. Musical and Verbal Memory in Alzheimer's Disease: A Study of Long-Term and Short-Term Memory

    Science.gov (United States)

    Menard, Marie-Claude; Belleville, Sylvie

    2009-01-01

    Musical memory was tested in Alzheimer patients and in healthy older adults using long-term and short-term memory tasks. Long-term memory (LTM) was tested with a recognition procedure using unfamiliar melodies. Short-term memory (STM) was evaluated with same/different judgment tasks on short series of notes. Musical memory was compared to verbal…

  3. Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management.

    Science.gov (United States)

    Jump, Robin L P; Crnich, Christopher J; Mody, Lona; Bradley, Suzanne F; Nicolle, Lindsay E; Yoshikawa, Thomas T

    2018-04-01

    The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review. Following this discussion, salient points on clinical relevance, clinical presentation, diagnostic approach, therapy, and prevention are discussed for skin and soft tissue infections, infectious diarrhea (Clostridium difficile and norovirus infections), bacterial pneumonia, and urinary tract infection, as well as some of the newer approaches to preventive interventions in the LTCF setting. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  4. Impact of negative emotion on the neural correlates of long-term recognition in younger and older adults

    Directory of Open Access Journals (Sweden)

    Grégoria eKalpouzos

    2012-09-01

    Full Text Available Some studies have suggested that the memory advantage for negative emotional information over neutral information (negativity effect is reduced in aging. Besides the fact that most findings are based on immediate retrieval, the neural underpinnings of long-term emotional memory in aging have so far not been investigated. To address these issues, we assessed recognition of neutral and negative scenes after one- and 3-week retention intervals in younger and older adults using fMRI. We further used an event-related design in order to disentangle successful, false and true recognition. This study revealed 4 key findings: 1 Increased retention interval induced an increased rate of false recognitions for negative scenes, cancelling out the negativity effect (present for hit rates only on discrimination in both younger and older adults; 2 In younger, but not older, adults, reduced activity of the medial temporal lobe was observed over time for neutral scenes, but not for negative scenes, where stable or increased activity was seen; 3 Engagement of amygdala was observed in older adults after a 3-week delay during successful recognition of negative scenes (hits versus misses in comparison with neutral scenes, which may indicate engagement of automatic processes, but engagement of ventrolateral prefrontal cortex was unrelated to amygdala activity and performance; and 4 After 3 weeks, but not after one week, true recognition of negative scenes was characterized by more activity in left hippocampus and lateral occipito-temporal regions (hits versus false alarms. As these regions are known to be related to consolidation mechanisms, the observed pattern may indicate the presence of delayed consolidation of true memories. Nonetheless, older adults’ low performance in discrimination of negative scenes could reflect the fact that overall, after long delays of retention, they rely more on general information rather than on perceptual detail in making

  5. Direct and indirect effects of nutritional status, physical function and cognitive function on activities of daily living in Japanese older adults requiring long-term care.

    Science.gov (United States)

    Kamo, Tomohiko; Nishida, Yuusuke

    2014-10-01

    To identify the direct and indirect effects of nutritional status, physical function, and cognitive function on activities of daily living in Japanese older adults requiring long-term care. In total, 179 participants aged ≥ 65 years who were eligible for long-term care insurance (mean age 85.5 ± 7.8 years) were recruited for this study. Nutritional status (Mini Nutritional Assessment, Short Form) and physical function (Short Physical Performance Battery) were examined. Activities of daily living, cognitive function and frailty were assessed using the Barthel Index, Mini-Mental State Examination and Clinical Frailty Scale, respectively. Path analysis was used to determine relationships between these factors and the activities of daily living. For Japanese older adults requiring long-term care, pathways were modeled for nutritional status, physical function and the activities of daily living. The total effect of nutritional status was 0.516 (Pphysical function on the activities of daily living was 0.458 (Pphysical function in aged Japanese people requiring long-term care. These findings suggest that maintaining good nutritional status and nutritional support might delay physical function decline, and prolong the activities of daily living. © 2013 Japan Geriatrics Society.

  6. Health-Related Quality of Life: Expanding a Conceptual Framework to Include Older Adults Who Receive Long-Term Services and Supports

    Science.gov (United States)

    Zubritsky, Cynthia; Abbott, Katherine M.; Hirschman, Karen B.; Bowles, Kathryn H.; Foust, Janice B.; Naylor, Mary D.

    2013-01-01

    For older adults receiving long-term services and supports (LTSS), health-related quality of life (HRQoL) has emerged as a critical construct to examine because of its focus on components of well-being, which are affected by progressive changes in health status, health care, and social support. HRQoL is a health-focused quality of life (QOL)…

  7. Short- and Long-Term Impacts of Neighborhood Built Environment on Self-Rated Health of Older Adults.

    Science.gov (United States)

    Spring, Amy

    2018-01-18

    Proximity to health care, healthy foods, and recreation is linked to improved health in older adults while deterioration of the built environment is a risk factor for poor health. Yet, it remains unclear whether individuals prone to good health self-select into favorable built environments and how long-term exposure to deteriorated environments impacts health. This study uses a longitudinal framework to address these questions. The study analyzes 3,240 Americans aged 45 or older from the Panel Study of Income Dynamics with good self-reported health at baseline, and follows them from 1999 to 2013. At each biennial survey wave, individual data are combined with data on services in the neighborhood of residence (defined as the zip code) from the Economic Census. The analysis overcomes the problem of residential self-selection by employing marginal structural models and inverse probability of treatment weights. Logistic regression estimates indicate that long-term exposure to neighborhood built environments that lack health-supportive services (e.g., physicians, pharmacies, grocery stores, senior centers, and recreational facilities) and are commercially declined (i.e., have a high density of liquor stores, pawn shops, and fast food outlets) increases the risk of fair/poor self-rated health compared to more average neighborhoods. Short-term exposure to the same environments as compared to average neighborhoods has no bearing on self-rated health after adjusting for self-selection. Results highlight the importance of expanding individuals' access to health-supportive services prior to their reaching old age, and expanding access for people unlikely to attain residence in service-dense neighborhoods. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Short-term and long-term collaboration benefits on individual recall in younger and older adults

    Science.gov (United States)

    Stern, Yaakov

    2011-01-01

    A recent study of younger adults suggests that, compared to repeated individual recall trials, repeated collaborative recall trials produce better individual recall after a short delay (Blumen & Rajaram, 2008). Our study was designed to determine if such collaboration benefits would remain after a one-week delay, in both younger and older adults. Sixty younger (M age = 24.60) and 60 older (M age = 67.35) adults studied a list of words and then completed either two collaborative recall trials followed by two individual recall trials, or four individual recall trials. A five-min delay was inserted between the first three recall trials. The fourth recall trial was administered 1 week later. Collaborative recall was completed in groups of three individuals working together. Both younger and older adults benefitted from repeated collaborative recall trials to a greater extent than repeated individual recall trials, and such collaboration benefits remained after a one-week delay. This is the first demonstration of collaboration benefits on later individual recall at delays as long as 1 week, in both younger and older adults. Findings are discussed within the context of the negative effects of collaboration associated with group memory (collaborative inhibition) and the positive effects of collaboration associated with later individual memory (collaboration benefits). PMID:21264617

  9. Long-term outcome of sports injuries : results after inpatient treatment

    NARCIS (Netherlands)

    Dekker, R; van der Sluis, CK; Groothoff, JW; Eisma, WH; ten Duis, HJ

    Objective: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences. Materials and methods: All patients older than 17 years of age and admitted to the University

  10. Cardiovascular responses to orthostasis: methods, assessments, and their association with falls in older adults in long-term care

    OpenAIRE

    Shaw, Brett Harrison

    2013-01-01

    Background: Orthostatic hypotension (OH) refers to a significant decline in blood pressure that occurs upon assuming an upright posture and represents an intrinsic risk factor for falls in older adults. Methods: Beat-to-beat blood pressure and cerebral blood flow velocity responses were assessed during a passive seated orthostatic stress test (PSOST). In healthy controls, PSOST responses were compared to head up tilt (the ‘gold-standard’). In a cohort of long-term care residents, data from PS...

  11. Does the method of weight loss effect long-term changes in weight, body composition or chronic disease risk factors in overweight or obese adults? A systematic review.

    Directory of Open Access Journals (Sweden)

    Richard A Washburn

    Full Text Available Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain.To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors.PubMed and Embase were searched (January 1990-October 2013 for studies with data on the effect of energy restriction, exercise (aerobic and resistance on long-term weight loss. Twenty articles were included in this review.Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included.Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc. and study design (long-term or weight loss/follow-up.Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼ 55% of loss was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise.

  12. Long-term management of GERD in the elderly with pantoprazole

    Directory of Open Access Journals (Sweden)

    Carlo Calabrese

    2007-04-01

    Full Text Available Carlo Calabrese, Anna Fabbri, Giulio Di FeboDepartment of Internal Medicine and Gastroenterology, University of Bologna, ItalyAbstract: The prevalence of gastroesophageal reflux disease (GERD increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.Keywords: GERD, long-term management, pantoprazole, safety, efficacy, tolerability

  13. Classification trees for identifying non-use of community-based long-term care services among older adults.

    Science.gov (United States)

    Penkunas, Michael James; Eom, Kirsten Yuna; Chan, Angelique Wei-Ming

    2017-10-01

    Home- and center-based long-term care (LTC) services allow older adults to remain in the community while simultaneously helping caregivers cope with the stresses associated with providing care. Despite these benefits, the uptake of community-based LTC services among older adults remains low. We analyzed data from a longitudinal study in Singapore to identify the characteristics of individuals with referrals to home-based LTC services or day rehabilitation services at the time of hospital discharge. Classification and regression tree analysis was employed to identify combinations of clinical and sociodemographic characteristics of patients and their caregivers for individuals who did not take up their referred services. Patients' level of limitation in activities of daily living (ADL) and caregivers' ethnicity and educational level were the most distinguishing characteristics for identifying older adults who failed to take up their referred home-based services. For day rehabilitation services, patients' level of ADL limitation, home size, age, and possession of a national medical savings account, as well as caregivers' education level, and gender were significant factors influencing service uptake. Identifying subgroups of patients with high rates of non-use can help clinicians target individuals who are need of community-based LTC services but unlikely to engage in formal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Does the Method of Weight Loss Effect Long-Term Changes in Weight, Body Composition or Chronic Disease Risk Factors in Overweight or Obese Adults? A Systematic Review

    Science.gov (United States)

    Washburn, Richard A.; Szabo, Amanda N.; Lambourne, Kate; Willis, Erik A.; Ptomey, Lauren T.; Honas, Jeffery J.; Herrmann, Stephen D.; Donnelly, Joseph E.

    2014-01-01

    Background Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain. Objective To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors. Data Sources PubMed and Embase were searched (January 1990-October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review. Study Eligibility Criteria Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included. Study Appraisal and Synthesis Methods Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc.) and study design (long-term or weight loss/follow-up). Results Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise. PMID:25333384

  15. Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan.

    Science.gov (United States)

    Hsieh, Yen-Ping; Huang, Ying-Chia; Lan, Shou-Jen; Ho, Ching-Sung

    2017-09-01

    To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327. © 2016 Japan Geriatrics Society.

  16. The Appropriateness of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review.

    Science.gov (United States)

    Stern, Cindy; Pearson, Alan; Chur-Hansen, Anna

    2011-01-01

    Background: Canine-assisted interventions are used frequently in long term care settings, even though their effectiveness has not been definitively proven. One concern commonly described in the literature is the risk of zoonotic infection or animal-related injury/allergy associated with this type of interaction. To date, no systematic review has been undertaken to determine the appropriateness of canine-assisted interventions in relation to these issues. The aim of the review was to synthesise the best available evidence on the appropriateness of canine-assisted interventions on the health and social care of the older population residing in long term care with regards to zoonotic infection or animal-related injury/allergy. A comprehensive search was undertaken on 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies and papers were considered. The review took an inclusive approach and considered quantitative and qualitative studies that focussed on zoonotic risk/exposure/infection or animal-related injury/allergy from canine-assisted interventions used in long term care settings. In the absence of research studies, text and opinion were also considered. Critical appraisal of papers was to be undertaken using the appropriate Joanna Briggs Institute critical appraisal instrument and data extraction was to be via the Joanna Briggs Institute data extraction forms, dependant on design. There were no studies located the met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to long term care, older people and canines. There is currently no evidence available to determine the appropriateness of canine-assisted interventions used for older people in long term care in regards to zoonotic risk/exposure/infection or animal-related injuries/allergies. There is a small body of literature available that focuses

  17. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial.

    Science.gov (United States)

    Rozati, Mitra; Barnett, Junaidah; Wu, Dayong; Handelman, Garry; Saltzman, Edward; Wilson, Thomas; Li, Lijun; Wang, Junpeng; Marcos, Ascensión; Ordovás, José M; Lee, Yu-Chi; Meydani, Mohsen; Meydani, Simin Nikbin

    2015-01-01

    Both aging and obesity are related to dysregulated immune function, which may be responsible for increased risk of infection and also chronic non-infectious diseases. Dietary lipids have been shown to impact immune and inflammatory responses and cardio-metabolic risk factors. No information on the impact of olive oil on immune responses of overweight and obese older adults is available. We aimed to determine the effect of replacing oils used in a typical American diet with extra virgin olive oil for 3 months on immune responses and cardio-metabolic risk factors in overweight and obese older adults. This was a randomized, single-blinded and placebo-controlled trial in 41 overweight or obese participants (aged ≥ 65) who consumed a typical American diet. Participants in the control (CON, n = 21) group were provided with a mixture of corn, soybean oil and butter, and those in the olive oil (OO, n = 20) group, with extra virgin olive oil, to replace substitutable oils in their diet. At baseline and 3 months, we measured blood pressure, biochemical and immunological parameters using fasting blood, and delayed-type hypersensitivity (DTH) skin response. Compared to the CON group, the OO group showed decreased systolic blood pressure (P groups. Our results indicate that substitution of oils used in a typical American diet with extra virgin olive oil in overweight and obese older adults may have cardio-metabolic and immunological health benefits. This trial was registered at clinicaltrials.gov as NCT01903304.

  18. Symptoms of delirium predict incident delirium in older long-term care residents.

    Science.gov (United States)

    Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Dyachenko, Alina; Belzile, Eric

    2013-06-01

    Detection of long-term care (LTC) residents at risk of delirium may lead to prevention of this disorder. The primary objective of this study was to determine if the presence of one or more Confusion Assessment Method (CAM) core symptoms of delirium at baseline assessment predicts incident delirium. Secondary objectives were to determine if the number or the type of symptoms predict incident delirium. The study was a secondary analysis of data collected for a prospective study of delirium among older residents of seven LTC facilities in Montreal and Quebec City, Canada. The Mini-Mental State Exam (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for six months. Multivariate Cox regression models were used to determine if baseline symptoms predict incident delirium. Of 273 residents, 40 (14.7%) developed incident delirium. Mean (SD) time to onset of delirium was 10.8 (7.4) weeks. When one or more CAM core symptoms were present at baseline, the Hazard Ratio (HR) for incident delirium was 3.5 (95% CI = 1.4, 8.9). The HRs for number of symptoms present ranged from 2.9 (95% CI = 1.0, 8.3) for one symptom to 3.8 (95% CI = 1.3, 11.0) for three symptoms. The HR for one type of symptom, fluctuation, was 2.2 (95% CI = 1.2, 4.2). The presence of CAM core symptoms at baseline assessment predicts incident delirium in older LTC residents. These findings have potentially important implications for clinical practice and research in LTC settings.

  19. Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: A long-term follow-up study.

    Science.gov (United States)

    Hagström, Hannes; Nasr, Patrik; Ekstedt, Mattias; Hammar, Ulf; Stål, Per; Hultcrantz, Rolf; Kechagias, Stergios

    2018-01-01

    Most patients with nonalcoholic fatty liver disease (NAFLD) are overweight or obese. However, a significant proportion of patients have a normal body mass index (BMI), denoted as lean NAFLD. The long-term prognosis of lean NAFLD is unclear. We conducted a cohort study of 646 patients with biopsy-proven NAFLD. Patients were defined as lean (BMI lean and nonlean NAFLD. Lean NAFLD was seen in 19% of patients, while 52% were overweight and 29% were obese. Patients with lean NAFLD were older, had lower transaminases, lower stages of fibrosis, and lower prevalence of nonalcoholic steatohepatitis at baseline compared to patients with a higher BMI. During a mean follow-up of 19.9 years (range 0.4-40 years) representing 12,631 person years and compared to patients who were overweight, patients with lean NAFLD had no increased risk for overall mortality (hazard ratio 1.06; P =  0.73) while an increased risk for development of severe liver disease was found (hazard ratio 2.69; P =  0.007). Conclusion : Although patients with lean NAFLD have lower stages of fibrosis, they are at higher risk for development of severe liver disease compared to patients with NAFLD and a higher BMI, independent of available confounders. ( Hepatology Communications 2018;2:48-57).

  20. Recommendations for successful sensory screening in older adults with dementia in long-term care: a qualitative environmental scan of Canadian specialists.

    Science.gov (United States)

    Wittich, Walter; Höbler, Fiona; Jarry, Jonathan; McGilton, Katherine S

    2018-01-26

    This study aimed to identify screening tools, technologies and strategies that vision and hearing care specialists recommend to front-line healthcare professionals for the screening of older adults in long-term care homes who have dementia. An environmental scan of healthcare professionals took place via telephone interviews between December 2015 and March 2016. All interviews were audio recorded, transcribed, proofed for accuracy, and their contents thematically analysed by two members of the research team. A convenience sample of 11 professionals from across Canada specialising in the fields of vision and hearing healthcare and technology for older adults with cognitive impairment were included in the study. As part of a larger mixed-methods project, this qualitative study used semistructured interviews and their subsequent content analysis. Following a two-step content analysis of interview data, coded citations were grouped into three main categories: (1) barriers, (2) facilitators and (3) tools and strategies that do or do not work for sensory screening of older adults with dementia. We report on the information offered by participants within each of these themes, along with a summary of tools and strategies that work for screening older adults with dementia. Recommendations from sensory specialists to nurses working in long-term care included the need for improved interprofessional communication and collaboration, as well as flexibility, additional time and strategic use of clinical intuition and ingenuity. These suggestions at times contradicted the realities of service provision or the need for standardised and validated measures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Long-Term Acupuncture Therapy for Low-Income Older Adults with Multimorbidity: A Qualitative Study of Patient Perceptions.

    Science.gov (United States)

    Pagones, Rachel; Lee, Janet L; Hurst, Samantha

    2018-02-01

    Multimorbidity is common, but often poorly managed, among the rapidly growing population of older adults. The existing guidelines followed by physicians frequently lead to polypharmacy and a complex treatment burden. The objective of this study was to explore what benefits are perceived by older adults with multimorbidity as a result of long-term, regular acupuncture treatment. A qualitative design with inductive thematic analysis of semistructured interviews. Participants were recruited from a no-cost, college-affiliated acupuncture clinic for low-income older adults in an urban, racially/ethnically diverse neighborhood in southern California. Fifteen patients aged 60 years and older suffering from at least two chronic conditions. Five themes were identified: (1) mind-body effects, (2) the enhanced therapeutic alliance, (3) what they liked best, (4) the conventional healthcare system, and (5) importance of regular schedule. A notable mind-body effect, reported by a substantial number of participants, was medication reduction. Participants also cited changes in mood, energy, and well-being as important benefits. In addition, they voiced widespread dissatisfaction with conventional healthcare. Keeping up regular treatments as a way to deal with new complaints and encourage a healthier lifestyle was seen an important aspect of care at the clinic. This cohort of older adults with multimorbidity valued acupuncture as a way to reduce medication as well as a means to maintain physical and mental health. In addition, they developed a strong trust in the clinic's ability to support the totality of their health as individuals, which they contrasted to the specialized and impersonal approach of the conventional medical clinic.

  2. The role of long-term memory in digit-symbol test performance in young and older adults.

    Science.gov (United States)

    Stephens, R; Kaufman, A

    2009-03-01

    The psychological functions assessed by substitution tests, and the age-related performance decline, are not well understood. Here several aspects of long-term memory were manipulated across younger and older adults. A 45-page Digit-Symbol test was employed. Each page contained a 9-item digit symbol code-table and 9 response items. There were 9 study conditions with each condition deployed across 5 pages, or trials, of the test. The conditions were formed by crossing two within-subjects factors, each with 3 levels. The first factor, Digit Order, pertained to having the code table digits in numerical order vs. a pseudo-random order fixed across trials vs. a pseudo-random order that varied across trials. The second factor, Symbol Pairing, pertained to having a fixed digit-symbol pairing across trials vs. having a varying digit-symbol pairing across trials vs. having a novel set of 9 symbols introduced on each of the 5 trials. Including the additional factor, Age, resulted in a 2 x 3 x 3 mixed randomised block design. The older group was slowed, F(1, 22) = 17.267, p Symbol-Order interaction indicated that use of novel symbols disadvantaged only the older participants, F(1, 44) = 6.577, p = .014. While there was no evidence that incidental paired-associate learning or spatial memory affect digit-symbol performance, symbol familiarity may be important to digit symbol test completion in older adults. The benefit of ordinally arranged digits in the coding table highlights a fundamental process difference between Digit-Symbol and Symbol-Digit test formats.

  3. A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries.

    Science.gov (United States)

    Wolinsky, Fredric D; Bentler, Suzanne E; Hockenberry, Jason; Jones, Michael P; Weigel, Paula A; Kaskie, Brian; Wallace, Robert B

    2011-09-20

    Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function. We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests. Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline

  4. Short- and Long-Term Effects of Wholegrain Oat Intake on Weight Management and Glucolipid Metabolism in Overweight Type-2 Diabetics: A Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Xue Li

    2016-09-01

    Full Text Available Glycemic control and weight reduction are primary goals for the management of overweight and obese type 2 diabetes mellitus (T2DM. Effective management cannot be achieved without an appropriate diet. Our study aimed to evaluate the short- and long-term effects of oat intake and develop a reasonable dietary plan for overweight T2DM patients. A randomized control trial, registered under ClinicalTrials.gov (Identification code: NCT01495052, was carried out among adult T2DM patients. A subgroup of 298 overweight subjects was selected and received a 30-day centralized intervention and 1-year free-living follow-up. Participants were randomly allocated to one of the following four groups. The usual care group (n = 60 received no intervention; the healthy diet group (n = 79 received a low-fat and high-fiber diet (“healthy diet”; the 50 g-oats group (n = 80 and 100 g-oats group (n = 79 received the “healthy diet” with the same amount of cereals replaced by 50 g and 100 g oats respectively. Anthropometric, blood glycemic and lipid variables were measured. For the 30-day intervention, significant differences in the changes of FPG (fasting plasma glucose, PPG (postprandial plasma glucose, HbA1c (glycosylated hemoglobin, HOMA-IR (homeostasis model assessment of insulin resistance, TC (total cholesterol, TG (total triglycerides, and LDL-c (low-density lipoprotein cholesterol were observed among the four groups. Compared to the healthy diet group, the 50 g-oats group had a bigger reduction in PPG (mean difference (MD: −1.04 mmol/L; 95% CI: −2.03, −0.05 and TC (MD: −0.24 mmol/L; 95% CI: −0.47, −0.01; the 100 g-oats group had a bigger reduction in PPG (MD: −1.48 mmol/L; 95% CI: −2.57, −0.39, HOMA-IR (MD: −1.77 mU·mol/L2; 95% CI: −3.49, −0.05, TC (MD: −0.33 mmol/L; 95% CI: −0.56, −0.10 and LDL-c (MD: −0.22 mmol/L; 95% CI: −0.41, −0.03. In the 1-year follow-up, greater effects in reducing weight (MD: −0.89 kg; 95% CI

  5. Long-term care policy for older Americans: building a continuum of care.

    Science.gov (United States)

    Palley, Howard A

    2003-01-01

    This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.

  6. Correlates of preferences for autonomy in long-term care: results of a population-based survey among older individuals in Germany.

    Science.gov (United States)

    Hajek, André; Lehnert, Thomas; Wegener, Annemarie; Riedel-Heller, Steffi G; König, Hans-Helmut

    2018-01-01

    Thus far, there is little evidence concerning the factors associated with preferences for autonomy in long-term care. Therefore, the aim of the present study was to investigate the correlates of preferences for autonomy in long-term care among older individuals in Germany. Data were gathered from a population-based survey of the German population aged ≥65 years in 2015 (N=1,006). Multiple logistic regressions revealed that preferences for freedom of choice for foods were positively associated with living with partner or spouse (OR: 1.5 [1.0-2.2]), being born in Germany (OR: 1.9 [1.1-3.3]), and lower self-rated health (OR: 1.3 [1.1-1.6]). Preferences for freedom in choosing bedtime and sleep duration were positively associated with lower age (OR: 1.1 [1.0-1.1]) and having children (OR: 2.2 [1.0-4.9]). Preferences for customized living space were positively associated with being female (OR: 2.5 [1.4-4.5]) and being born in Germany (OR: 3.7 [1.9-7.1]). Neither preferences for decent and sanitary housing nor preferences for shared decision-making were associated with any of the independent variables. Various independent variables were associated with preferences for autonomy in long-term care. This suggests that preferences for care-related autonomy are complex. Knowing these might help refine long-term care health services.

  7. Intergroup Contact: Using Storytelling to Increase Awareness of Lesbian and Gay Older Adults in Long-Term Care Settings.

    Science.gov (United States)

    Pelts, Michael D; Galambos, Colleen

    2017-01-01

    Due to societally imposed stigmatization, lesbian and gay (LG) older adults fear and prolong accessing long-term care (LTC) even though they need LTC at higher rates. Interventions that decrease negative attitudes toward LG older adults among LTC staff are a first step in addressing this problem. In this study, the influence of intergroup contact (IGC) on LTC staff members' attitudes toward LG was explored through the use of storytelling as a training mechanism. An embedded mixed-method approach was employed to collect and analyze responses of 60 LTC staff who participated in a storytelling event. Participants completed pretests, posttests, and participated in audio-recorded group discussions. The findings showed that storytelling had a significant (p =0.001) and positive effect (d =0.57) on participants attitudes toward LG. Qualitative analysis revealed 90 codes, 13 process codes, and 4 themes: making meaning of stories, seeking understanding, application to LTC setting, and debating. When guided by IGC theory, storytelling has potential for positively influencing attitudes of LTC staff members toward LG older adults. There is a need for longitudinal work to further test this model.

  8. Prevalence of risk factors for falls among elderly people living in long-term care homes

    OpenAIRE

    Pradnya Dhargave, PhD; Ragupathy Sendhilkumar, MSc, MPT

    2016-01-01

    Background: Falls are common among the geriatric population, causing frequent morbidity and mortality. There is an increased risk of fall among older people living in long-term care homes. Identifying risk factors for falls among older people living in old-age homes can help in the care and prevention of falls in this population. Aim: To evaluate the prevalence of various risk factors for falls among older people living in long-term care homes. Methods: A total of 163 elderly men and wo...

  9. Survival in Malnourished Older Patients Receiving Post-Discharge Nutritional Support; Long-Term Results of a Randomized Controlled Trial.

    Science.gov (United States)

    Neelemaat, F; van Keeken, S; Langius, J A E; de van der Schueren, M A E; Thijs, A; Bosmans, J E

    2017-01-01

    Previous analyses have shown that a post-discharge individualized nutritional intervention had positive effects on body weight, lean body mass, functional limitations and fall incidents in malnourished older patients. However, the impact of this intervention on survival has not yet been studied. The objective of this randomized controlled study was to examine the effect of a post-discharge individualized nutritional intervention on survival in malnourished older patients. Malnourished older patients, aged ≥ 60 years, were randomized during hospitalization to a three-months post-discharge nutritional intervention group (protein and energy enriched diet, oral nutritional supplements, vitamin D3/calcium supplement and telephone counseling by a dietitian) or to a usual care regimen (control group). Survival data were collected 4 years after enrollment. Survival analyses were performed using intention-to-treat analysis by Log-rank tests and Cox regression adjusted for confounders. The study population consisted of 94 men (45%) and 116 women with a mean age of 74.5 (SD 9.5) years. There were no statistically significant differences in baseline characteristics. Survival data was available in 208 out of 210 patients. After 1 and 4 years of follow-up, survival rates were respectively 66% and 29% in the intervention group (n=104) and 73% and 30% in the control group (n=104). There were no statistically significant differences in survival between the two groups 1 year (HR= 0.933, 95% CI=0.675-1.289) and 4 years after enrollment (HR=0.928, 95% CI=0.671-1.283). The current study failed to show an effect of a three-months post-discharge multi-component nutritional intervention in malnourished older patients on long-term survival, despite the positive effects on short-term outcome such as functional limitations and falls.

  10. Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia - a pilot evaluation.

    Science.gov (United States)

    Lenoir-Wijnkoop, Irene; van der Beek, Eline M; Garssen, Johan; Nuijten, Mark J C; Uauy, Ricardo D

    2015-01-01

    Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life. Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences. Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country

  11. Physiotherapists' perceived motivators and barriers for organizing physical activity for older long-term care facility residents.

    Science.gov (United States)

    Baert, Veerle; Gorus, Ellen; Guldemont, Nele; De Coster, Sofie; Bautmans, Ivan

    2015-05-01

    Information regarding factors that hinder or stimulate older adults in long-term care facilities (LTCF) for being physically active is available in the literature, but much less is known regarding perceived motivators and barriers among physiotherapists (PTs) to organize physical activity (PA) in LTCF. The main purpose of this study was to examine factors influencing PTs to organize PA in LTCF for older adults. A secondary goal was to examine the PTs' knowledge about and their barriers at the PA guidelines for older adults of the World Health Organization (WHO). A mixed qualitative and quantitative study was carried out using semistructured interviews (n = 24) followed by an online survey (n = 254). As a frame the social-ecological model (McLeroy) was used, distinguishing factors at the intrapersonal, interpersonal, and community level. In the qualitative component the PTs reported 41 motivators and 35 barriers for organizing PA in LTCF. The survey revealed that although the majority of the respondents (71%) are convinced of the usefulness of PA in LTCF, 84% are not familiar with the WHO-guidelines. Seventy-five percent of the respondents believe that the WHO-guidelines are not feasible for LTCF-residents. The strongest motivators on the intrapersonal level were maintaining the independence of the residents (98%), reducing the risk of falling (98%), and improving the physical (93%) and psychological (90%) wellbeing of LTCF-residents. The social interaction among LTCF-residents (91%) during PA was the strongest motivator on the interpersonal level. Motivators on the community level are the belief that PA is the basis of their physiotherapeutic work (89%) and that offering varied activities avoids PA becoming monotonous (71%). Barriers on the intra- and interpersonal level were of less influence. On the community level, they felt hindered to organize PA because of lack of time (38%) and the overload of paperwork (33%). This study described different motivators

  12. Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

    Science.gov (United States)

    Roets-Merken, Lieve M; Vernooij-Dassen, Myrra J F J; Zuidema, Sytse U; Dees, Marianne K; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

    2016-01-01

    Objectives To gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Design Qualitative study alongside a cluster randomised controlled trial. Setting 17 long-term care homes spread across the Netherlands. Participants 34 licensed practical nurses supporting 54 dual sensory impaired older adults. Intervention A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. Primary outcomes Nurses’ perceptions on relevance and feasibility of the self-management programme collected from nurses’ semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers’ reports. Results Nurses’ initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults’ autonomy needs. However, nurses’ initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. Conclusions Longitudinal data collection enabled exploration of nurses’ changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond ‘protocol thinking’, discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer

  13. Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes.

    Science.gov (United States)

    Alharbi, Muaddi; Gallagher, Robyn; Kirkness, Ann; Sibbritt, David; Tofler, Geoffrey

    2016-02-01

    The benefits of exercise and weight reduction for overweight or obese people with coronary heart disease and/or diabetes mellitus are well recognised. The Healthy Eating and Exercise Lifestyle Program demonstrated these outcomes at 4 months, but longer-term outcomes are not yet reported. To determine whether positive weight, body mass index, waist and exercise duration outcomes were sustained in the long term (12 months) and to identify the independent predictors of these outcomes at 4 and 12 months. Longitudinal design, combining data of all Healthy Eating and Exercise Lifestyle Program participants (intervention and wait-list control, n = 134). Participants had a body mass index between 27 and 39 kg/m(2) and had completed cardiac rehabilitation and/or diabetes education programmes. Healthy Eating and Exercise Lifestyle Program intervention included an active phase of two 1-hour group-based supervised structured exercise sessions every week for 4 months and four 90-minute group information and support sessions. The maintenance phase included one 90-minute group-based booster information session and three 15-minute goal-focused telephone follow-up calls over 8 months. Participants had statistically significant reductions from baseline in weight, body mass index and waist circumference and improvements in exercise duration and capacity at 4 and 12 months. Time, self-efficacy, depressive symptoms and male gender were independent predictors for body mass index, waist and/or exercise duration (p Healthy Eating and Exercise Lifestyle Program was an effective programme to achieve and sustain weight loss and increase exercise participation over 1 year. © The European Society of Cardiology 2014.

  14. A Literature Review on the Experience of Long-Term Mental Illness.

    Science.gov (United States)

    Collier, Elizabeth; Grant, Maria J

    2018-06-01

    To illuminate long-term experiences of mental illness from both research and autobiographical accounts. A literature review of English-language papers, 1950-2014, relating to the experience of long-term mental illness indexed in AgeInfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, PsycEXTRA, and PsychINFO. Twenty-five research papers and nine autobiographic accounts met the review criteria. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research Implications: There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length-of-time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the Western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples' perspectives. Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence-based services cannot be provided if we do not have an holistic understanding of long-term mental illness. Social Implications: This review questions our ability to provide effective support for those experiencing long-term mental illness, in particular older people and different cultural perspectives. There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.

  15. Effects of Exercise Training and Weight Loss on Plasma Fetuin-A Levels and Insulin Sensitivity in Overweight Older Men

    Directory of Open Access Journals (Sweden)

    Jacob B. Blumenthal

    2017-01-01

    Full Text Available Aerobic exercise training and weight loss (AEX+WL improves insulin sensitivity in overweight adults; however, the underlying pathways are incompletely understood. Fetuin-A, a hepatokine that inhibits insulin signaling, may be involved in the salutary effects of AEX+WL. Therefore, we examined the effects of 6-month AEX+WL on plasma fetuin-A levels (36–48 hours after the last bout of exercise, aerobic capacity (VO2max, body composition, glucose tolerance, and insulin sensitivity (M in 16 sedentary, overweight-obese older men (age = 60 ± 2 years, BMI = 31 ± 1 kg/m2 with no history of cardiovascular disease or diabetes. At baseline, fetuin-A levels correlated directly with adiposity and had a borderline inverse correlation with M. After AEX+WL, body weight decreased by ~10 kg, while both VO2max and M increased by 16% (P<0.005 for all. Contrary to our hypothesis, plasma fetuin-A levels increased after AEX+WL (1.16 ± 0.10 g/L versus 1.70 ± 0.19 g/L, P=0.006. This increase was unrelated to changes in body composition or glucose metabolism, but directly correlated with changes in VO2max (r=0.57, P<0.05. Thus, in overweight-to-obese older men, AEX+WL appears to increase plasma fetuin-A levels. Although not associated with improvements in insulin sensitivity, this increase in fetuin-A was related to improvements in aerobic capacity and could be representative of the cardioprotective effects of AEX+WL in older men.

  16. Effects of Exercise Training and Weight Loss on Plasma Fetuin-A Levels and Insulin Sensitivity in Overweight Older Men.

    Science.gov (United States)

    Blumenthal, Jacob B; Gitterman, Anna; Ryan, Alice S; Prior, Steven J

    2017-01-01

    Aerobic exercise training and weight loss (AEX+WL) improves insulin sensitivity in overweight adults; however, the underlying pathways are incompletely understood. Fetuin-A, a hepatokine that inhibits insulin signaling, may be involved in the salutary effects of AEX+WL. Therefore, we examined the effects of 6-month AEX+WL on plasma fetuin-A levels (36-48 hours after the last bout of exercise), aerobic capacity (VO 2max ), body composition, glucose tolerance, and insulin sensitivity (M) in 16 sedentary, overweight-obese older men (age = 60 ± 2 years, BMI = 31 ± 1 kg/m 2 ) with no history of cardiovascular disease or diabetes. At baseline, fetuin-A levels correlated directly with adiposity and had a borderline inverse correlation with M. After AEX+WL, body weight decreased by ~10 kg, while both VO 2max and M increased by 16% ( P < 0.005 for all). Contrary to our hypothesis, plasma fetuin-A levels increased after AEX+WL (1.16 ± 0.10 g/L versus 1.70 ± 0.19 g/L, P = 0.006). This increase was unrelated to changes in body composition or glucose metabolism, but directly correlated with changes in VO 2max ( r = 0.57, P < 0.05). Thus, in overweight-to-obese older men, AEX+WL appears to increase plasma fetuin-A levels. Although not associated with improvements in insulin sensitivity, this increase in fetuin-A was related to improvements in aerobic capacity and could be representative of the cardioprotective effects of AEX+WL in older men.

  17. Associations of long-term fine particulate matter exposure with prevalent hypertension and increased blood pressure in older Americans.

    Science.gov (United States)

    Honda, Trenton; Pun, Vivian C; Manjourides, Justin; Suh, Helen

    2018-07-01

    Hypertension is a highly prevalent cardiovascular risk factor. It is possible that air pollution, also an established cardiovascular risk factor, may contribute to cardiovascular disease through increasing blood pressure. Previous studies evaluating associations between air pollution and blood pressure have had mixed results. We examined the association between long-term (one-year moving average) air pollutant exposures, prevalent hypertension and blood pressure in 4121 older Americans (57+ years) enrolled in the National Social Life, Health, and Aging Project. We estimated exposures to PM 2.5 using spatio-temporal models and used logistic regression accounting for repeated measures to evaluate the association between long-term average PM 2.5 and prevalence odds of hypertension. We additionally used linear regression to evaluate the associations between air pollutants and systolic, diastolic, mean arterial, and pulse pressures. Health effect models were adjusted for a number of demographic, health and socioeconomic covariates. An inter-quartile range (3.91 μg/m 3 ) increase in the one-year moving average of PM 2.5 was associated with increased: Odds of prevalent hypertension (POR 1.24, 95% CI: 1.11, 1.38), systolic blood pressure (0.93 mm Hg, 95% CI: 0.05, 1.80) and pulse pressure (0.89 mm Hg, 95% CI: 0.21, 1.58). Dose-response relationships were also observed. PM 2.5 was associated with increased odds of prevalent hypertension, and increased systolic pressure and pulse pressure in a cohort of older Americans. These findings add to the growing evidence that air pollution may be an important risk factor for hypertension and perturbations in blood pressure. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Pre-meal inulin consumption does not affect acute energy intake in overweight and obese middle-aged and older adults: A randomized controlled crossover pilot trial.

    Science.gov (United States)

    Smiljanec, Katarina; Mitchell, Cassie M; Privitera, Olivia F; Neilson, Andrew P; Davy, Kevin P; Davy, Brenda M

    2017-06-01

    Three-fourths of adults older than 55 years in the United States are overweight or obese. Prebiotics including inulin-type fructans may benefit with weight management. We aimed to investigate the acute effects of pre-meal inulin consumption on energy intake (EI) and appetite in older adults. Sedentary, overweight or obese middle-aged and older adults ( n = 7, 60.9 ± 4.4 years, BMI 32.9 ± 4.3 kg/m 2 ) ingested inulin (10 g) or a water preload before each test period in a randomly assigned order. EI, appetite and gastrointestinal symptoms were monitored during the following 24 h. No differences in EI were noted between conditions (inulin: 14744 ± 5552 kJ, control: 13924 ± 4904 kJ, p > 0.05). Rumbling was increased with inulin consumption ( p inulin consumption does not acutely decrease EI or suppress appetite in older adults. Further research should address individual differences among diets, eating behaviors, and microbiota profiles.

  19. Long term effects of a continuous and intermittent aerobic exercise on weight changes and body fat percentage in overweight and obese women

    Directory of Open Access Journals (Sweden)

    Alizadeh Z

    2013-01-01

    Full Text Available Background: Obesity and sedentary lifestyle are growing problem. The global community's concern is to find the best strategy to obtain a more efficient process of weight reduction, increase physical activity, and minimize weight regain level. The purpose of this study was to evaluate the long-term effects of a short-term intervention on weight changes.Methods: The present study is a one-year follow-up study of a 12-week intervention during which the 15 individuals in the intermittent group performed 40 minutes exercise in three bouts per day; however, the 15 participants of the continuous group did the same but 40 minutes continuously. The 15 participants in the control group had no exercise prescription. After one year, weight changes, body fat percentage, and BMI were re-evaluated in the groups.Results: After adjusting the baseline weight, patterns of change in the mean weights from the end of the third month to the twelfth month were different across groups (P=0.02. After significant weight loss in the intermittent group, the mean weight in this group increased by 2.32 kilograms during the period, although not statistically significant. No increase was observed in the control group’s mean weight (P=1.00. In the continuous group, the mean weight increased statistically (P=0.048, 3.63 kilograms.Conclusion: It seems that long-term effects of moderate intensity intermittent aerobic exercise in overweight and obese women on weight control are more efficient than those of continuous exercise. However, for a change in lifestyle and prevention of weight regain, longer follow-ups are required.

  20. Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care

    OpenAIRE

    Gallo, Joseph J; Morales, Knashawn H; Bogner, Hillary R; Raue, Patrick J; Zee, Jarcy; Bruce, Martha L; Reynolds, Charles F

    2013-01-01

    Objective To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Design Long term follow-up of multi-site practice randomized controlled trial (PROSPECT?Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Setting 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. Participants 1226 participants...

  1. LONG-TERM OUTCOME IN PEDIATRIC TRICHOTILLOMANIA.

    Science.gov (United States)

    Schumer, Maya C; Panza, Kaitlyn E; Mulqueen, Jilian M; Jakubovski, Ewgeni; Bloch, Michael H

    2015-10-01

    To examine long-term outcome in children with trichotillomania. We conducted follow-up clinical assessments an average of 2.8 ± 0.8 years after baseline evaluation in 30 of 39 children who previously participated in a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) for pediatric trichotillomania. Our primary outcome was change in hairpulling severity on the Massachusetts General Hospital Hairpulling Hospital Hairpulling Scale (MGH-HPS) between the end of the acute phase and follow-up evaluation. We also obtained secondary measures examining styles of hairpulling, comorbid anxiety and depressive symptoms, as well as continued treatment utilization. We examined both correlates and predictors of outcome (change in MGH-HPS score) using linear regression. None of the participants continued to take NAC at the time of follow-up assessment. No significant changes in hairpulling severity were reported over the follow-up period. Subjects reported significantly increased anxiety and depressive symptoms but improvement in automatic pulling symptoms. Increased hairpulling symptoms during the follow-up period were associated with increased depression and anxiety symptoms and increased focused pulling. Older age and greater focused pulling at baseline assessment were associated with poor long-term prognosis. Our findings suggest that few children with trichotillomania experience a significant improvement in trichotillomania symptoms if behavioral treatments are inaccessible or have failed to produce adequate symptom relief. Our findings also confirm results of previous cross-sectional studies that suggest an increased risk of depression and anxiety symptoms with age in pediatric trichotillomania. Increased focused pulling and older age among children with trichotillomania symptoms may be associated with poorer long-term prognosis. © 2015 Wiley Periodicals, Inc.

  2. Death wishes among older people assessed for home support and long-term aged residential care.

    Science.gov (United States)

    Cheung, Gary; Edwards, Siobhan; Sundram, Frederick

    2017-12-01

    Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Long working hours and overweight and obesity in working adults.

    Science.gov (United States)

    Kim, Byung-Mi; Lee, Bo-Eun; Park, Hye-Sook; Kim, Young-Ju; Suh, Young-Ju; Kim, Jeong-Youn; Shin, Ji-Young; Ha, Eun-Hee

    2016-01-01

    Previous studies have identified a link between gender and the various risk factors associated with obesity. We examined obesity risk factors in working adults to identify the effects of differences in body mass index (BMI) and percentage body fat (PBF) between women and men. A total of 1,120 adults agreed to participate in the study. Data from 711 participants, including 411 women and 300 men, were analyzed. Multiple logistic regression analysis was used to estimate the effects of risk factors on obesity and being overweight. In addition, the least-squares (LS) means of both BMI and PBF were estimated by analysis of covariance (ANCOVA) in a generalized linear model. Increases in BMI and PBF were significantly related to an age > 50 years and long working hours in women after compensating for confounding factors. Using the PBF criterion, the odds ratio (OR) of being overweight or obese in women > 50 years of age who worked for > 9 h a day was 3.9 (95% confidence interval [CI], 1.05-11.00). For BMI, women who were > 50 years of age and worked for > 9 h a day were 3.82 times (95% CI, 1.31-11.14) more likely to be overweight or obese than those who were worked for working adults was associated with > 50 years of age and long working hours in women. Further studies are needed to investigate the underlying mechanisms of this relationship and its potential implications for the prevention and management of excess weight and obesity.

  4. Increased long-term recreational physical activity is associated with older age at natural menopause among heavy smokers: the California Teachers Study.

    Science.gov (United States)

    Emaus, Aina; Dieli-Conwright, Christina; Xu, Xinxin; Lacey, James V; Ingles, Sue A; Reynolds, Peggy; Bernstein, Leslie; Henderson, Katherine D

    2013-03-01

    Although physical activity modulates the hypothalamic-pituitary-ovarian axis, the few studies that have investigated whether physical activity is associated with age at natural menopause have yielded mixed results. We set out to determine whether physical activity is associated with the timing of natural menopause in a large cohort of California women overall and by smoking history. We investigated the association between long-term physical activity (h/wk/y) and age at natural menopause among 97,945 women in the California Teachers Study. Multivariable Cox proportional hazards regression methods were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). The impact of cigarette smoking (never smoker, former light smoker, former heavy smoker, current light smoker, and current heavy smoker) as an effect modifier was evaluated. In a multivariable model adjusted for body mass index at age 18 years, age at menarche, race/ethnicity, and age at first full-term pregnancy, increased physical activity was statistically significantly associated with older age at natural menopause (P(trend) = 0.005). Higher body mass index at age 18 years (P(trend) = 0.0003) and older age at menarche (P(trend) = 0.0003) were also associated with older age at natural menopause. Hispanic ethnicity (vs non-Hispanic whites; HR, 1.17; 95% CI, 1.09-1.26), current smokers (vs never smokers; HR, 1.68; 95% CI, 1.60-1.75 for current light smokers; HR, 1.38; 95% CI, 1.33-1.44 for current heavy smokers), and older age at first full-term pregnancy (HR(≥29, 2+ full-term pregnancies) vs HR(menopause. Upon stratification by smoking history, increased physical activity was statistically significantly associated with older age at natural menopause among heavy smokers only (HR(highest quartile) vs HR(lowest quartile), 0.88; 95% CI, 0.81-0.97; P(trend) = 0.02 for former heavy smokers; HR(highest quartile) vs HR(lowest quartile), 0.89; 95% CI, 0.80-0.99; P(trend) = 0.04 for current heavy

  5. Optimal retraining time for regaining functional fitness using multicomponent training after long-term detraining in older adults.

    Science.gov (United States)

    Lee, Minyoung; Lim, Taehyun; Lee, Jaehyuk; Kim, Kimyeong; Yoon, BumChul

    2017-11-01

    Little is known about the optimal retraining time for regaining functional fitness through multicomponent training following long-term detraining in older adults. This study first investigated the time course of functional fitness changes during 12-month multicomponent training, 12-month detraining, and 9-month retraining in 18 older adults (68.33±3.46) and then determined the optimal retraining time for regaining the post-training functional fitness level after a 12-month detraining period. Functional fitness, including lower and upper limb strength, lower and upper limb flexibility, aerobic endurance, and dynamic balance, was assessed at baseline, 12 months post-training, 12 months post-detraining, and 3, 6, and 9 months post-retraining. There were significant increases in all of the functional fitness components except upper limb flexibility at post-training and no significant decreases at post-detraining. For lower and upper limb strength and lower limb flexibility, a 3-month period was required to regain the post-training condition. For aerobic endurance and dynamic balance, a retraining period ≥9months was necessary to regain the post-training functional fitness condition. To regain the post-training condition of all functional fitness components, a retraining period ≥9months was required. This information might be useful for health professionals to encourage older adults not to interrupt retraining until they regain their post-training functional fitness condition. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review.

    Science.gov (United States)

    Bunn, Diane; Jimoh, Florence; Wilsher, Stephanie Howard; Hooper, Lee

    2015-02-01

    To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. Systematic review of intervention and observational studies. Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed. A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker

  7. Determinants of overweight or obesity among ever-married adult women in Bangladesh.

    Science.gov (United States)

    Sarma, Haribondhu; Saquib, Nazmus; Hasan, Md Mehedi; Saquib, Juliann; Rahman, Ahmed Shafiqur; Khan, Jahidur Rahman; Uddin, Md Jasim; Cullen, Mark R; Ahmed, Tahmeed

    2016-01-01

    The prevalence of overweight and obesity is increasing in Bangladesh. It is higher among Bangladeshi women than among men. This study was conducted to assess a host of demographic and socioeconomic correlates of overweight and obesity, separately for the urban and rural women of Bangladesh. We used data from the Bangladesh Demographic and Health Survey (BDHS) 2011. The BDHS provides cross-sectional data on a wide range of indicators relating to population, health, and nutrition. We analyzed nutrition-related data to identify the factors associated with being overweight or obese among ever-married women aged 18-49 years. Of 16,493 women, about 18 % (95 % CI 17 · 80-18 · 99) were overweight or obese. Unemployed urban women were at 1 · 44 (95 % CI 1 · 18-1 · 76, p women who were involved in manual-labored work. Watching television at least once a week was another significant predictor among urban women (OR 1 · 49; 95 % CI 1 · 24-1 · 80; p women (OR 1 · 31; 95 % CI 1 · 14-1 · 51; p women. The findings of the study indicate that a large number of women in Bangladesh are suffering from being overweight or obese, and multiple factors are responsible for this including, older age, being from wealthy households, higher education, being from food-secured households, watching TV at least once a week, and being an unemployed urban woman. Given the anticipated long-term effects, the factors that are associated with being overweight or obese should be considered while formulating an effective intervention for the women of Bangladesh.

  8. Determinants of Walking among Middle-Aged and Older Overweight and Obese Adults: Sociodemographic, Health, and Built Environmental Factors

    Directory of Open Access Journals (Sweden)

    Samuel N. Forjuoh

    2017-01-01

    Full Text Available Background. This study examined the association between selected sociodemographic, health, and built environmental factors and walking behaviors of middle-aged and older overweight/obese adults. Methods. Subjective data were obtained from surveys administered to community-dwelling overweight/obese adults aged ≥50 years residing in four Texas cities from October 2013 to June 2014, along with objective data on neighborhood walkability (Walk Score™. Multivariate logistic regression identified factors predicting the odds of walking the recommended ≥150 minutes per week for any purpose. Results. Of 253 participants, the majority were non-Hispanic white (81.8%, married (74.5%, and male (53.4% and reported an annual income of ≥$50,000 (65.5%. Approximately, half were employed (49.6% or had at least a college degree (51.6%. Walking the recommended ≥150 minutes per week for any purpose (n=57, 22.5% was significantly associated with having at least a college degree (OR=5.55, 95% CI = 1.79–17.25, having no difficulty walking a quarter of a mile (OR=5.18, 95% CI = 1.30–20.83, and being unemployed (OR=3.25, 95% CI = 1.18–8.93 as well as perceived presence of sidewalks/protected walkways (OR=3.56, 95% CI = 1.10–11.50 and perceived absence of distracted drivers in the neighborhood (OR=4.08, 95% CI = 1.47–11.36. Conclusion. Addressing neighborhood conditions related to distracted drivers and pedestrian infrastructure may promote walking among middle-aged and older overweight/obese individuals.

  9. Effects of 6 months of aerobic and resistance exercise training on carotid artery intima media thickness in overweight and obese older women.

    Science.gov (United States)

    Park, Jinkee; Park, Hyuntea

    2017-12-01

    We studied the effects of exercise on carotid intima-media thickness, luminal diameter, and flow velocity in overweight and obese older women, and the associations between carotid parameters changes and other variables. A total of 41 overweight and obese older women (aged 65-77 years, fat mass percent ≥ 32%), who were divided into a control group (n = 20) and a supervised combined exercise group (n = 21). The 24-week combined exercise program (aerobic and resistance exercise) consisted of sessions 40-80 min in length 5 days per week under the supervision of an exercise specialist. Body composition, blood pressure, physical function and carotid variables were assessed. The differences in all variables, and the relative changes between baseline and 24 weeks' follow up were evaluated. Carotid intima-media thickness, systolic carotid luminal diameter, peak systolic flow velocity and end diastolic flow velocity showed a significant group × time interaction. No interaction was observed for diastolic luminal diameter. In the exercise group, the change of carotid intima-media thickness was significantly associated with systolic blood pressure, maximal walking speed, 1-mile walking time and maximal oxygen uptake. Also, the change of peak systolic flow velocity was significantly associated with skeletal muscle mass, diastolic blood pressure and maximum walking speed. Combined exercise can effectively improve carotid intima-media thickness in overweight and obese older women. In addition, exercise training increases the systolic carotid luminal diameter and flow velocity in older women. Therefore, regular combined exercise might help prevent atherosclerotic disease by improving the carotid artery. Geriatr Gerontol Int 2017; 17: 2304-2310. © 2017 Japan Geriatrics Society.

  10. A systematic approach to assessing indoor air quality of long term care facilities

    NARCIS (Netherlands)

    te Kulve, M.; Loomans, M.G.L.C.; Huisman, E.R.C.M.; Kort, H.S.M.

    2018-01-01

    Not much is known about the favourable indoor air quality in long term care facilities (LTCFs), where older adults suffering from dementia live. Older adults, especially those who suffer from dementia, are more sensible to the indoor environment. However, no special requirements for the indoor air

  11. The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.

    Directory of Open Access Journals (Sweden)

    David B Agus

    Full Text Available The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50 and would add 900,000 people (95% CI 300,000-1,400,000 to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975 in net health benefits over that period.Expanded use of aspirin by older Americans with

  12. The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.

    Science.gov (United States)

    Agus, David B; Gaudette, Étienne; Goldman, Dana P; Messali, Andrew

    2016-01-01

    The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease. We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50) and would add 900,000 people (95% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975) in net health benefits over that period. Expanded use of aspirin by older Americans with elevated risk

  13. Optimizing Eating Performance for Older Adults With Dementia Living in Long-term Care: A Systematic Review.

    Science.gov (United States)

    Liu, Wen; Galik, Elizabeth; Boltz, Marie; Nahm, Eun-Shim; Resnick, Barbara

    2015-08-01

    Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance. To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long-term care (LTC). A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, and intervention. Intervention studies that optimize eating performance and evaluate change of self-feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full texts were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Eleven intervention studies (five randomized controlled trials [RCTs]) were identified, and classified into four types: training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate (four studies were rated as strong, four moderate, and three weak in quality), with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance. This review provided preliminary support for using training and mealtime

  14. [Frailty and long term mortality, disability and hospitalisation in Spanish older adults. The FRADEA Study].

    Science.gov (United States)

    Martínez-Reig, Marta; Flores Ruano, Teresa; Fernández Sánchez, Miguel; Noguerón García, Alicia; Romero Rizos, Luis; Abizanda Soler, Pedro

    2016-01-01

    The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study.

    Science.gov (United States)

    Baptista, Liliana C; Dias, Gonçalo; Souza, Nelba R; Veríssimo, Manuel T; Martins, Raul A

    2017-08-01

    To establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D). This longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n = 279). Participants underwent one of two conditions: LTMEX (n = 241) trained three times per week; and unchanged lifestyle-the control group (CO; n = 38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO 2 peak). LTMEX improves HRQoL, specifically physical functioning (P health (P health (MH; P older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.

  16. Long-Term Consequences for Teens with Older Sexual Partners. Fact Sheet. Publication #2008-16

    Science.gov (United States)

    Schelar, Erin; Ryan, Suzanne; Manlove, Jennifer

    2008-01-01

    Existing research on the risks of having sex at a young age with an older partner has focused on poorer reproductive health outcomes in the adolescent years, but scant attention has been paid to the longer-term implications of these relationships. Using survey data from high school students, this "Fact Sheet" presents findings from recent Child…

  17. Overweight and Obesity in Older People with Intellectual Disability

    Science.gov (United States)

    de Winter, C. F.; Bastiaanse, L. P.; Hilgenkamp, T. I. M.; Evenhuis, H. M.; Echteld, M. A.

    2012-01-01

    Overweight and obesity are major health problems associated with increased cardiovascular disease risk, which is not sufficiently studied in people with intellectual disability yet. The present study was part of the Healthy Ageing in Intellectual Disability (HA-ID) study. The aim of this study was to establish (1) the prevalence of overweight,…

  18. Telomere Length, Long-Term Black Carbon Exposure, and Cognitive Function in a Cohort of Older Men: The VA Normative Aging Study.

    Science.gov (United States)

    Colicino, Elena; Wilson, Ander; Frisardi, Maria Chiara; Prada, Diddier; Power, Melinda C; Hoxha, Mirjam; Dioni, Laura; Spiro, Avron; Vokonas, Pantel S; Weisskopf, Marc G; Schwartz, Joel D; Baccarelli, Andrea A

    2017-01-01

    Long-term air pollution exposure has been associated with age-related cognitive impairment, possibly because of enhanced inflammation. Leukocytes with longer telomere length (TL) are more responsive to inflammatory stimuli, yet TL has not been evaluated in relation to air pollution and cognition. We assessed whether TL modifies the association of 1-year exposure to black carbon (BC), a marker of traffic-related air pollution, with cognitive function in older men, and we examined whether this modification is independent of age and of C-reactive protein (CRP), a marker of inflammation. Between 1999 and 2007, we conducted 1-3 cognitive examinations of 428 older men in the Veterans Affairs (VA) Normative Aging Study. We used covariate-adjusted repeated-measure logistic regression to estimate associations of 1-year BC exposure with relative odds of being a low scorer (≤ 25) on the Mini-Mental State Examination (MMSE), which is a proxy of poor cognition. Confounders included age, CRP, and lifestyle and sociodemographic factors. Each doubling in BC level was associated with 1.57 (95% CI: 1.20, 2.05) times higher odds of low MMSE scores. The BC-MMSE association was greater only among individuals with longer blood TL (5th quintile) (OR = 3.23; 95% CI: 1.37, 7.59; p = 0.04 for BC-by-TL-interaction). TL and CRP were associated neither with each other nor with MMSE. However, CRP modified the BC-MMSE relationship, with stronger associations only at higher CRP (5th quintile) and reference TL level (1st quintile) (OR = 2.68; 95% CI: 1.06, 6.79; p = 0.04 for BC-by-CRP-interaction). TL and CRP levels may help predict the impact of BC exposure on cognitive function in older men. Citation: Colicino E, Wilson A, Frisardi MC, Prada D, Power MC, Hoxha M, Dioni L, Spiro A III, Vokonas PS, Weisskopf MG, Schwartz JD, Baccarelli AA. 2017. Telomere length, long-term black carbon exposure, and cognitive function in a cohort of older men: the VA Normative Aging Study. Environ Health Perspect

  19. Motivators and Barriers to Reducing Sedentary Behavior Among Overweight and Obese Older Adults.

    Science.gov (United States)

    Greenwood-Hickman, Mikael Anne; Renz, Anne; Rosenberg, Dori E

    2016-08-01

    To explore individual, social, environmental, and program-related motivators, barriers, and impacts of sedentary behavior (SB) reduction among a group of overweight and obese older adults aged 60 and older. Semistructured interviews were conducted with 24 participants following a SB reduction intervention. Transcripts from these interviews were iteratively coded by a team, and key themes were defined and refined guided by the social-ecological framework. Motivators included the desire to improve health, newly acquired awareness of SB, the ease of incorporating SB reduction into current lifestyle, an adaptable environment, and the use of reminders. Barriers included existing health conditions, enjoyment of sedentary activities, unadaptable environments, fatigue, and difficulty understanding SB reduction as distinct from physical activity (PA). Participants reported impacts on physical and mental health and changes in awareness, exercise, and daily activity. Although in many ways motivators and barriers to reducing SB are similar to those of PA, SB interventions have special considerations and may ultimately be easier for some individuals to incorporate into their lifestyle. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Accelerated long-term forgetting in children with temporal lobe epilepsy.

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    Gascoigne, Michael B; Smith, Mary Lou; Barton, Belinda; Webster, Richard; Gill, Deepak; Lah, Suncica

    2014-07-01

    Adults with temporal lobe epilepsy (TLE) have been found to have accelerated long-term forgetting, but this phenomenon has not yet been investigated in children. Although deficits in recall of materials after short (20- to 30-minute) delays have been shown to slowly emerge from childhood to adolescence in patients with TLE, it is unknown whether such a trend will also be found in recall of materials after long delays. This study examined the presence of accelerated long-term forgetting in children with TLE and how it relates to chronological age. Twenty-three children with TLE and 58 healthy controls of similar age, sex distribution and socioeconomic status completed a battery of neuropsychological tests, including standardised tests of story recall and design location, as well as two experimental tests requiring the learning of words and design locations to a criterion, both of which assessed recall after short (30-min) and long (7-day) delays. Word recall at the 7-day delay (relative to the 30-min recall) was significantly poorer in the TLE group, compared to the control group. The TLE group also exhibited worse 30-min recall performance on a standardised test of story recall. Individual patient analyses revealed dissociation between performance on the experimental and standardised verbal memory tests; children who were impaired on the experimental test (7-day delay) were not impaired on the standardised test (30-min delay). Compared to controls, patients with a left-hemisphere seizure focus recalled fewer words at short and long delays while patients with an abnormal hippocampus recalled fewer words at the long delay. No between-group differences were found with respect to the design location task. Age negatively correlated with the recall of words after short- and long-term delays within the TLE group, where older age was associated with worse memory. This association was not present in the control group. To our knowledge, this is the first study to show

  1. Role of autonomic nervous activity, as measured by heart rate variability, on the effect of mortality in disabled older adults with low blood pressure in long-term care.

    Science.gov (United States)

    Shibasaki, Koji; Ogawa, Sumito; Yamada, Shizuru; Ouchi, Yasuyoshi; Akishita, Masahiro

    2018-04-11

    Previous studies have shown the relationship between low blood pressure and high mortality in frail, disabled older adults in long-term care. However, the mechanism of this relationship is still unclear. We hypothesized that autonomic nervous activity decline is involved in the relationship between low blood pressure and high mortality. The present prospective cohort study recruited 61 participants aged ≥75 years. The data from 24-h Holter monitoring and blood pressure recorded by ambulatory blood pressure monitoring were collected. Measured data were divided into three categories: 24-h, daytime and night-time. From power spectral density in the electrocardiogram, low frequency, high frequency and low frequency/high frequency ratio were calculated. The primary end-point was death. High blood pressure was connected to both high daytime low frequency and high frequency (partial correlation coefficients: 0.42, P blood pressure group had higher mortality than the high blood pressure group, and disabled older adults in long-term care and those with elevated daytime systolic and diastolic blood pressure had less risk of mortality compared with those without (systolic: hazard ratio 0.89, 95% confidence interval 0.83-0.96, P = 0.003; diastolic: hazard ratio 0.98, 95% confidence interval 0.79-1.00, P = 0.049). The average blood pressures in the high blood pressure groups were approximately 140/80 mmHg and were connected to low mortality. Attenuated autonomic nervous activity might lead to low blood pressure in the daytime and high mortality in disabled older adults in long-term care. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

  2. A family-based intervention targeting parents of preschool children with overweight and obesity: conceptual framework and study design of LOOPS- Lund overweight and obesity preschool study

    Directory of Open Access Journals (Sweden)

    Önnerfält Jenny

    2012-10-01

    Full Text Available Abstract Background As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years will have reduced their BMI-for-age z-score. Methods/Design The study is a randomized controlled trial, including overweight (n=160 and obese (n=80 children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1 supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2 influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of

  3. A family-based intervention targeting parents of preschool children with overweight and obesity: conceptual framework and study design of LOOPS- Lund overweight and obesity preschool study.

    Science.gov (United States)

    Önnerfält, Jenny; Erlandsson, Lena-Karin; Orban, Kristina; Broberg, Malin; Helgason, Christina; Thorngren-Jerneck, Kristina

    2012-10-17

    As the rate of overweight among children is rising there is a need for evidence-based research that will clarify what the best interventional strategies to normalize weight development are. The overall aim of the Lund Overweight and Obesity Preschool Study (LOOPS) is to evaluate if a family-based intervention, targeting parents of preschool children with overweight and obesity, has a long-term positive effect on weight development of the children. The hypothesis is that preschool children with overweight and obesity, whose parents participate in a one-year intervention, both at completion of the one-year intervention and at long term follow up (2-, 3- and 5-years) will have reduced their BMI-for-age z-score. The study is a randomized controlled trial, including overweight (n=160) and obese (n=80) children 4-6-years-old. The intervention is targeting the parents, who get general information about nutrition and exercise recommendations through a website and are invited to participate in a group intervention with the purpose of supporting them to accomplish preferred lifestyle changes, both in the short and long term. To evaluate the effect of various supports, the parents are randomized to different interventions with the main focus of: 1) supporting the parents in limit setting by emphasizing the importance of positive interactions between parents and children and 2) influencing the patterns of daily activities to induce alterations of everyday life that will lead to healthier lifestyle. The primary outcome variable, child BMI-for-age z-score will be measured at referral, inclusion, after 6 months, at the end of intervention and at 2-, 3- and 5-years post intervention. Secondary outcome variables, measured at inclusion and at the end of intervention, are child activity pattern, eating habits and biochemical markers as well as parent BMI, exercise habits, perception of health, experience of parenthood and level of parental stress. The LOOPS project will provide

  4. Assessing the market for long-term care services.

    Science.gov (United States)

    Rice, J A; Taylor, S

    1984-02-01

    Traditionally, long-term care services have been used by a diverse marketplace. The chronically ill, developmentally disabled, mentally ill and aging population has looked to long-term care support services as a means of physical and emotional support. Much of the time these services were housed together for the sake of efficiency. The enormous burden these services are creating on the economy, and the growing aging population, have forced the recognition that long-term care service delivery systems must change. Alternate programming for long-term care services that reach out into the community and into individual homes is becoming an attractive approach to meeting the growing demands of the marketplace. Home health, specialized housing and creative funding mechanisms such as HMOs, are examples of initiatives undertaken by healthcare organizations that view diversification as a vehicle for survival. Market research techniques that have been used in other industries are being adapted to the healthcare industry to ensure the proper mix of services that are demanded by older, more knowledgeable consumers. The programs of the future will be market driven, with the ability of the individual to pay for such services playing a significant role. The healthcare provider of today is in a position to serve the community in new ways. By becoming an integral link in the long-term care system and by developing new programs, the organization can serve as a catalyst for change. It is up to the governing bodies and managers of these facilities to become visionaries and to accept responsibility for assessing the market for long-term care services and to guide their organization into the future.

  5. Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults : a randomized controlled trial

    NARCIS (Netherlands)

    Verreijen, Amely M; Engberink, Mariëlle F; Memelink, Robert G; van der Plas, Suzanne E; Visser, Marjolein; Weijs, Peter J M

    2017-01-01

    BACKGROUND: Intentional weight loss in obese older adults is a risk factor for accelerated muscle mass loss. We investigated whether a high protein diet and/or resistance exercise preserves fat free mass (FFM) during weight loss in overweight and obese older adults. METHODS: We included 100

  6. Obesity: a systematic review on parental involvement in long-term European childhood weight control interventions with a nutritional focus

    NARCIS (Netherlands)

    van der Kruk, Joke; Kortekaas, F.; Lucas, Cees; Jager-Wittenaar, Harriët

    2013-01-01

    In Europe, about 20% of children are overweight. Focus on parental responsibility is an effective method in weight control interventions in children. In this systematic review we describe the intensity of parental involvement and behaviour change aimed at parents in long-term European childhood

  7. Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents.

    Science.gov (United States)

    Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Dyachenko, Alina; Belzile, Eric

    2012-12-01

    To describe Confusion Assessment Method (CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care (LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status. Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months. Seven LTC facilities in Montreal and Quebec City, Canada. Forty-one older LTC residents who had at least one CAM-defined incident episode of delirium. The Mini-Mental State Examination (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. The frequency, mean number, type, and duration of CAM core symptoms of delirium occurring before and after incident episodes were examined using descriptive statistics, frequency analysis, and survival analysis. CAM core symptoms of delirium preceded 38 (92.7%) episodes of delirium for many weeks; core symptoms followed 37 (90.2%) episodes for many weeks. Symptoms of inattention and disorganized thinking occurred most commonly. The mean number of symptoms was higher in residents with dementia but not significantly so. CAM core symptoms of delirium were frequent and protracted before and after most incident episodes of delirium in LTC residents with and without dementia. If replicated, these findings have potentially important implications for clinical practice and research in LTC settings. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  8. Depressive symptoms among older adults with long-term spinal cord injury: Associations with secondary health conditions, sense of coherence, coping strategies and physical activity

    Directory of Open Access Journals (Sweden)

    Sophie Jörgensen

    2017-07-01

    Full Text Available Objectives: To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms. Design: Cross-sectional study. Subjects: A total of 122 individuals (70% men, injury levels C1–L5, American Spinal Injury Association Impairment Scale A–D, mean age 63 years, mean time since injury 24 years. Methods: Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression. Results: A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms. Conclusion: Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

  9. Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients

    Directory of Open Access Journals (Sweden)

    Argoff CE

    2011-09-01

    Full Text Available Charles E Argoff1, F Michael Gloth2 1Albany Medical College and Comprehensive Pain Center, Albany Medical Center, Albany, NY, USA; 2Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Osteoarthritis is common in patients ≥65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG and diclofenac sodium 1.5% in 45.5% dimethylsulfoxide solution (D-DMSO, are approved in the US for the treatment of osteoarthritis pain. Topical NSAIDs have shown efficacy and safety in knee (DSG, D-DMSO and hand (DSG osteoarthritis. Analyses of data from randomized controlled trials of DSG in hand and knee osteoarthritis demonstrate significant improvement of pain and function in both younger patients (<65 years and older patients (≥65 years and suggest good safety and tolerability. However, long-term safety data in older patients are limited. Topical NSAIDs can ease medication administration and help address barriers to pain management in older patients, such as taking multiple medications and inability to swallow, and are a valuable option for long-term care providers. Keywords: nonsteroidal anti-inflammatory drugs, long-term care, nursing homes, chronic pain, topical analgesics

  10. The long-term health of vegetarians and vegans.

    Science.gov (United States)

    Appleby, Paul N; Key, Timothy J

    2016-08-01

    Vegetarians, who do not eat any meat, poultry or fish, constitute a significant minority of the world's population. Lacto-ovo-vegetarians consume dairy products and/or eggs, whereas vegans do not eat any foods derived wholly or partly from animals. Concerns over the health, environmental and economic consequences of a diet rich in meat and other animal products have focussed attention on those who exclude some or all of these foods from their diet. There has been extensive research into the nutritional adequacy of vegetarian diets, but less is known about the long-term health of vegetarians and vegans. We summarise the main findings from large cross-sectional and prospective cohort studies in western countries with a high proportion of vegetarian participants. Vegetarians have a lower prevalence of overweight and obesity and a lower risk of IHD compared with non-vegetarians from a similar background, whereas the data are equivocal for stroke. For cancer, there is some evidence that the risk for all cancer sites combined is slightly lower in vegetarians than in non-vegetarians, but findings for individual cancer sites are inconclusive. Vegetarians have also been found to have lower risks for diabetes, diverticular disease and eye cataract. Overall mortality is similar for vegetarians and comparable non-vegetarians, but vegetarian groups compare favourably with the general population. The long-term health of vegetarians appears to be generally good, and for some diseases and medical conditions it may be better than that of comparable omnivores. Much more research is needed, particularly on the long-term health of vegans.

  11. Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand.

    Science.gov (United States)

    Boyd, Michal; Broad, Joanna B; Zhang, Tony Xian; Kerse, Ngaire; Gott, Merryn; Connolly, Martin J

    2016-07-01

    global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry. the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases. all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P < 0.0001)). increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Older adults benefit from music training early in life: biological evidence for long-term training-driven plasticity.

    Science.gov (United States)

    White-Schwoch, Travis; Woodruff Carr, Kali; Anderson, Samira; Strait, Dana L; Kraus, Nina

    2013-11-06

    Aging results in pervasive declines in nervous system function. In the auditory system, these declines include neural timing delays in response to fast-changing speech elements; this causes older adults to experience difficulty understanding speech, especially in challenging listening environments. These age-related declines are not inevitable, however: older adults with a lifetime of music training do not exhibit neural timing delays. Yet many people play an instrument for a few years without making a lifelong commitment. Here, we examined neural timing in a group of human older adults who had nominal amounts of music training early in life, but who had not played an instrument for decades. We found that a moderate amount (4-14 years) of music training early in life is associated with faster neural timing in response to speech later in life, long after training stopped (>40 years). We suggest that early music training sets the stage for subsequent interactions with sound. These experiences may interact over time to sustain sharpened neural processing in central auditory nuclei well into older age.

  13. Reduced body weight or increased muscle quality: Which is more important for improving physical function following exercise and weight loss in overweight and obese older women?

    Science.gov (United States)

    Straight, Chad R; Berg, Alison C; Reed, Rachelle A; Johnson, Mary Ann; Evans, Ellen M

    2018-04-19

    The purpose of this study was to examine the relative contributions of changes in muscle quality and body composition to changes in lower-extremity physical function (LEPF) following a 6-month exercise and weight loss intervention in overweight and obese older women. Thirty-eight overweight and obese (BMI = 30.0 ± 4.4 kg/m 2 ) older (age = 69.3 ± 4.1 y) women completed 6 months of multicomponent exercise (cardiorespiratory, resistance, balance and flexibility training) and weight loss (hypocaloric diet that reduced energy intake by ~500 kcal/d). Body composition was measured via dual-energy X-ray absorptiometry and muscle quality (N-m/kg) was defined as maximal concentric isokinetic knee torque divided by upper-leg lean mass. The standardized scores of four objective measures of physical function were summed to yield a composite LEPF Z-score. At 6 months, there were significant reductions in body weight (-9.6 ± 3.5%, p quality (+1.6 ± 1.8 N-m/kg, p quality was the strongest independent predictor of an improvement in LEPF Z-score (standardized β = 0.64, p quality. In conclusion, muscle quality can be increased in the presence of clinically meaningful weight loss, and is the primary determinant of improved physical function in overweight/obese older women. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. The long-term patient in the era of community treatment.

    Science.gov (United States)

    Lamb, H R; Goertzel, V

    1977-06-01

    Post hospital follow-up studies do not encompass the total population of long-term, psychiatrically disabled patients in the community, because a large proportion (in this study, 64%) have not had a recent hospitalization, either state or local. The authors identified a population of long-term, psychiatrically disabled patients in the community, all of whom carried functional psychotic diagnoses. Long-term disabled patients generally lead inactive lives, but in California seldom return to state hospitals. One third have been hospitalized locally within the past two years-younger patients much more than older patients. Almost half use private (Medicaid) outpatient services, but one fourth receive no mental health services at all. Less than a third live in board and care homes or cheap hotels; most live in nonsegregated, noninsitutional settings. The role of Supplemental Security Income (SSI) in enhancing adaptation of the chronically disabled was impressive to the research team.

  15. Sustainable Living in Long-Term Care: For People with Dementia/Alzheimer's

    Science.gov (United States)

    Simmons, Daniela

    2011-01-01

    Nonhome-based long-term care sustainable living arrangements for elderly people with Alzheimer's is presented. Characteristics contributing to sustainability are discussed. The ultimate goal in sustainable design for older adult communities is a people-centered model of care in environments that improve their quality of life. Without sustainable…

  16. Health economic modelling to assess short-term costs of maternal overweight, gestational diabetes and related macrosomia – a pilot evaluation

    Directory of Open Access Journals (Sweden)

    Irene eLenoir-Wijnkoop

    2015-05-01

    Full Text Available Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes (GDM and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g. macrosomia, body adiposity and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life.Objective: Provide insight in the short-term health-economic impact of maternal overweight, gestational diabetes (GDM and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data. Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences.Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop

  17. Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries

    Directory of Open Access Journals (Sweden)

    Wolinsky Fredric D

    2011-08-01

    Full Text Available Abstract Background Most prior studies have focused on short-term (≤ 2 years functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines. Methods The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs, instrumental ADLs (IADLs, and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop. Results The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline

  18. Body mass index, initial neurological severity and long-term mortality in ischemic stroke.

    Science.gov (United States)

    Ryu, Wi-Sun; Lee, Seung-Hoon; Kim, Chi Kyung; Kim, Beom Joon; Yoon, Byung-Woo

    2011-01-01

    Obesity is believed to increase the risks of ischemic stroke or coronary heart disease; however, regarding outcome after established vascular diseases, recent unexpected evidence has suggested that an increased body mass index (BMI) might have beneficial effects (obesity paradox). The aim of this study was to evaluate the independent association between BMI and long-term mortality after ischemic stroke. A total of 1,592 consecutive patients with ischemic stroke were prospectively included through our stroke cohort. In this study, the levels of BMI were classified based on guidelines for the Asian-Pacific population. Initial neurological severity was estimated by the National Institutes of Health Stroke Scale (NIHSS) score. Information on mortality was collected until the end of 2009, and the median follow-up period was 4 years. To examine the association between BMI and long-term mortality, we used Cox's proportional regression analysis. During follow-up, 23% of patients died. Linear regression analysis showed that the level of BMI was inversely related to initial neurological severity (p = 0.002). In the model of adjustment of age and gender using Cox's proportional regression analysis, this inverse trend was also significant (reference, normal weight; hazard ratio of underweight, 2.45; overweight, 0.77; obesity, 0.60). However, after adjustment of all covariates, including initial neurological severity, only the harmful effect of underweight remained significant (2.79; 95% CI, 1.92-4.05); however, beneficial effects of overweight and obesity did not. Our study showed that an independent association between BMI and long-term mortality after ischemic stroke was found only in underweight patients. The obesity paradox phenomenon seems to be limited, and might not be interpreted as a direct causal relationship due to a strong association with initial neurological severity. Copyright © 2011 S. Karger AG, Basel.

  19. A basic strategy for financing long term care.

    Science.gov (United States)

    Greenberg, J A; Leutz, W N

    1984-02-01

    As pressure mounts to contain Medicaid long term care spending, short-range "quick fixes" must be avoided. Three such false solutions in particular have shortcomings that may actually exacerbate long term care's financial dilemma because they are based on inadequate definitions of the problem. Two of these proposals--legislation to broaden family responsibility toward institutionalized elders on Medicaid and expanded state power to put liens on such elders' real property--err by trying to mandate "caring" and are predicated on a misunderstanding of the "spend-down" problem. The other proposal--to provide tax incentives to family members who care for elders--requires a large administrative apparatus, assumes an elasticity of supply that may not exist, and could disrupt the "gift relationship" on which family exchanges are often based. What is needed is a strategy with short term, intermediate, and long term objectives that move toward an insurance approach. The short term plan should lay the groundwork for intermediate strategy and control costs by changing rate-setting methods and putting limits on facility construction. The intermediate plan should change the problem's definition from one of merely controlling Medicaid long term care expenditures to one of efficiently managing state resources for the elderly through the development of state financing and local delivery systems that target older persons in greatest need. An effective means of doing this is through the creation of social/HMOs, which have five key features: integration of service responsibility and authority; flexibility in organizational design; balanced clientele; pooled prepaid funding; and financial risk for the provider organization. Finally, the long term strategy should transfer much of the long term care financial burden from individuals and state Medicaid agencies to insurance mechanisms. Many individuals would thus avoid impoverishment caused by health care spending and Medicaid would

  20. Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

    Science.gov (United States)

    Matthews, Fiona E; Bennett, Holly; Wittenberg, Raphael; Jagger, Carol; Dening, Tom; Brayne, Carol

    2016-01-01

    There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England. Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3-53.1) and CFAS II (62.7%, 95% CI: 54.8-70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%). Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.

  1. Who Lives Where and Does It Matter? Changes in the Health Profiles of Older People Living in Long Term Care and the Community over Two Decades in a High Income Country.

    Directory of Open Access Journals (Sweden)

    Fiona E Matthews

    Full Text Available There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England.Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response, two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3-53.1 and CFAS II (62.7%, 95% CI: 54.8-70.0 and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52% to 67% (95% CI: 62%-71%.Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.

  2. Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study.

    Science.gov (United States)

    Bao, Tian; Carender, Wendy J; Kinnaird, Catherine; Barone, Vincent J; Peethambaran, Geeta; Whitney, Susan L; Kabeto, Mohammed; Seidler, Rachael D; Sienko, Kathleen H

    2018-01-18

    Sensory augmentation has been shown to improve postural stability during real-time balance applications. Limited long-term controlled studies have examined retention of balance improvements in healthy older adults after training with sensory augmentation has ceased. This pilot study aimed to assess the efficacy of long-term balance training with and without sensory augmentation among community-dwelling healthy older adults. Twelve participants (four males, eight females; 75.6 ± 4.9 yrs) were randomly assigned to the experimental group (n = 6) or control group (n = 6). Participants trained in their homes for eight weeks, completing three 45-min exercise sessions per week using smart phone balance trainers that provided written, graphic, and video guidance, and monitored trunk sway. During each session, participants performed six repetitions of six exercises selected from five categories (static standing, compliant surface standing, weight shifting, modified center of gravity, and gait). The experimental group received vibrotactile sensory augmentation for four of the six repetitions per exercise via the smart phone balance trainers, while the control group performed exercises without sensory augmentation. The smart phone balance trainers sent exercise performance data to a physical therapist, who recommended exercises on a weekly basis. Balance performance was assessed using a battery of clinical balance tests (Activity Balance Confidence Scale, Sensory Organization Test, Mini Balance Evaluation Systems Test, Five Times Sit to Stand Test, Four Square Step Test, Functional Reach Test, Gait Speed Test, Timed Up and Go, and Timed Up and Go with Cognitive Task) before training, after four weeks of training, and after eight weeks of training. Participants in the experimental group were able to use vibrotactile sensory augmentation independently in their homes. After training, the experimental group had significantly greater improvements in Sensory

  3. Formation of healthy lifestyle among schoolchildren with overweight and obesity

    Directory of Open Access Journals (Sweden)

    O.L. Palladina

    2013-03-01

    Full Text Available The problem of overweight and obesity in school children is considered. It is shown that the problem of child obesity underlie the development of many serious medical illness. It is introduced the analysis of publications on the problem of overweight and obesity in schoolchildren. It is defined methods for detection and possible non-pharmacological correction of the condition. The necessity of creating and putting into practice of long-term training programs to promote healthy lifestyle among schoolchildren are overweight or obese, to prevent the development of cardiovascular disease and other metabolic complications. Conceptually, it is determined the main directions of teaching and physical education students who are overweight and obese. It is shown that it is advisable to inform children and parents about the need to combine a balanced diet with exercise stress.

  4. Children’s Attitudes and Stereotype Content Toward Thin, Average-Weight, and Overweight Peers

    Directory of Open Access Journals (Sweden)

    Federica Durante

    2014-05-01

    Full Text Available Six- to 11-year-old children’s attitudes toward thin, average-weight, and overweight targets were investigated with associated warmth and competence stereotypes. The results showed positive attitudes toward average-weight targets and negative attitudes toward overweight peers: Both attitudes decreased as a function of children’s age. Thin targets were perceived more positively than overweight ones but less positively than average-weight targets. Notably, social desirability concerns predicted the decline of anti-fat bias in older children. Finally, the results showed ambivalent stereotypes toward thin and overweight targets—particularly among older children—mirroring the stereotypes observed in adults. This result suggests that by the end of elementary school, children manage the two fundamental dimensions of social judgment similar to adults.

  5. [Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: A systematic review and meta-analysis].

    Science.gov (United States)

    González-Román, Loreto; Bagur-Calafat, Caritat; Urrútia-Cuchí, Gerard; Garrido-Pedrosa, Jèssica

    2016-01-01

    This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities. In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered. Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate. Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  6. Change in Bone Mineral Density During Weight Loss with Resistance Versus Aerobic Exercise Training in Older Adults.

    Science.gov (United States)

    Beavers, Kristen M; Beavers, Daniel P; Martin, Sarah B; Marsh, Anthony P; Lyles, Mary F; Lenchik, Leon; Shapses, Sue A; Nicklas, Barbara J

    2017-10-12

    To examine the effect of exercise modality during weight loss on hip and spine bone mineral density (BMD) in overweight and obese, older adults. This analysis compared data from two 5-month, randomized controlled trials of caloric restriction (CR; inducing 5-10% weight loss) with either resistance training (RT) or aerobic training (AT) in overweight and obese, older adults. Participants in the RT + CR study underwent 3 days/week of 8 upper/lower body exercises (3 sets, 10 repetitions at 70% 1 RM) and participants in the AT+CR study underwent 4 days/week of treadmill walking (30 min at 65-70% heart rate reserve). BMD at the total hip, femoral neck, and lumbar spine was assessed via dual-energy X-ray absorptiometry at baseline and 5 months. A total of 123 adults (69.4 ± 3.5 years, 67% female, 81% Caucasian) participated in the RT+CR (n = 60) and AT+CR (n = 63) interventions. Average weight loss was 5.7% (95% CI: 4.6-6.7%) and 8.2% (95% CI: 7.2-9.3%) in RT+CR and AT+CR groups, respectively. After adjustment for age, gender, race, baseline BMI and BMD, and weight change, differential treatment effects were observed for total hip and femoral neck (both p resistance, rather than aerobic, training during CR may attenuate loss of hip and femoral neck BMD in overweight and obese older adults. Findings warrant replication from a long-term, adequately powered, RCT. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. How Can Adult Children Influence Parents’ Long-Term Care Insurance Purchase Decisions?

    Science.gov (United States)

    Voils, Corrine I.; Coe, Norma B.; Konetzka, R. Tamara; Boles, Jillian; Van Houtven, Courtney Harold

    2017-01-01

    Abstract Purpose of the Study: Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents’ LTC preferences and plans, including LTCI purchase? Design and Methods: We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Results: Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Implications: Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. PMID:25209446

  8. Predicting Discharge to Institutional Long-Term Care After Stroke: A Systematic Review and Metaanalysis.

    Science.gov (United States)

    Burton, Jennifer K; Ferguson, Eilidh E C; Barugh, Amanda J; Walesby, Katherine E; MacLullich, Alasdair M J; Shenkin, Susan D; Quinn, Terry J

    2018-01-01

    Stroke is a leading cause of disability worldwide, and a significant proportion of stroke survivors require long-term institutional care. Understanding who cannot be discharged home is important for health and social care planning. Our aim was to establish predictive factors for discharge to institutional care after hospitalization for stroke. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42015023497) of observational studies. We searched MEDLINE, EMBASE, and CINAHL Plus to February 2017. Quantitative synthesis was performed where data allowed. Acute and rehabilitation hospitals. Adults hospitalized for stroke who were newly admitted directly to long-term institutional care at the time of hospital discharge. Factors associated with new institutionalization. From 10,420 records, we included 18 studies (n = 32,139 participants). The studies were heterogeneous and conducted in Europe, North America, and East Asia. Eight studies were at high risk of selection bias. The proportion of those surviving to discharge who were newly discharged to long-term care varied from 7% to 39% (median 17%, interquartile range 12%), and the model of care received in the long-term care setting was not defined. Older age and greater stroke severity had a consistently positive association with the need for long-term care admission. Individuals who had a severe stroke were 26 times as likely to be admitted to long-term care than those who had a minor stroke. Individuals aged 65 and older had a risk of stroke that was three times as great as that of younger individuals. Potentially modifiable factors were rarely examined. Age and stroke severity are important predictors of institutional long-term care admission directly from the hospital after an acute stroke. Potentially modifiable factors should be the target of future research. Stroke outcome studies should report discharge destination, defining the model of care provided in the long-term care setting.

  9. Discharge-planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals.

    Science.gov (United States)

    Denson, Linley A; Winefield, Helen R; Beilby, Justin J

    2013-03-01

    Discharge-planning decisions about long-term care (LTC) can be difficult and distressing for older people, families and discharge-planning health professionals. Retrospective research suggests that despite good intentions and a shared focus on the best interests of the older person, stakeholders may hold very different values about good outcomes and how to decide them. We aimed to compare the opinions and values of frail elders living at home, younger relatives and health professionals experienced in discharge-planning, prospectively: before, not after, a LTC decision. We interviewed three types of stakeholders (10 older people, 8 relatives and 18 health professionals) using a hypothetical vignette about a frail elder leaving hospital. In a mixed methods design, we quantitatively compared the discharge plans and decision-makers that stakeholders suggested, and qualitatively analysed the 36 interview transcripts for participants' articulation of underlying values during these discussions. Older participants often suggested safe restrictive options (residential care, proxy decision-making) for the hypothetical frail elder, while advocating autonomy for themselves. Younger people generally endorsed autonomous decision-making and less restrictive discharge options especially if the elder was mentally competent, but reported difficult ethical tensions between safety and autonomy. Individual personality and preferences, mental capacity, and the importance of personal care in supporting autonomy were central themes consistent with the Ecological Theory of Aging. Accordingly, discharge planners can usefully articulate the balance of safety and autonomy, conceptualizing home care as maintaining independence rather than accepting dependence. Ethical training should incorporate sophisticated models of practice specifying both psychological and physical safety as components of beneficence. Few elders adopt a consumer approach to LTC: health professionals can encourage mid

  10. Study of Duchenne muscular dystrophy long-term survivors aged 40 years and older living in specialized institutions in Japan.

    Science.gov (United States)

    Saito, Toshio; Kawai, Mitsuru; Kimura, En; Ogata, Katsuhisa; Takahashi, Toshiaki; Kobayashi, Michio; Takada, Hiroto; Kuru, Satoshi; Mikata, Takashi; Matsumura, Tsuyoshi; Yonemoto, Naohiro; Fujimura, Harutoshi; Sakoda, Saburo

    2017-02-01

    The national muscular dystrophy wards database of Japan lists 118 long-term Duchenne muscular dystrophy (DMD) patients who were at least 40 years old as of October 1, 2013. To elucidate the clinical features of DMD patients aged 40 years and older, we obtained gene analysis and muscle biopsy findings, as well as medical condition information. Ninety-four of the registered patients consented to participate, of whom 55 meeting genetic or biochemical criteria confirming DMD were analyzed. The mean age at the time of the study was 43.6 ± 3.0 years, while at the time of independent ambulation loss it was 10.6 ± 1.5 years and at mechanical ventilation introduction it was 24.1 ± 5.5 years. All were receiving continuous ventilation support, 27 with non-invasive positive pressure ventilation and 28 with tracheal intermittent positive pressure ventilation. Thirty-eight were receiving β-blockers or a renin-angiotensin system inhibitor, while 9 were free from those agents. Forty had maintained oral nutrition. The 55 analyzed patients had survived into their 40s by receiving multidisciplinary intervention. Our findings emphasize the need of future studies to investigate disease modifiers and the mechanism of long-term survival. In addition, establishment of a worldwide care standard with focus on quality of life for adult males with DMD is important. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. The Importance of Sexuality Program Objectives to Long-Term Care Staff.

    Science.gov (United States)

    Walker, Bonnie L.; Osgood, Nancy J.

    The opinions of long-term care staff were surveyed regarding the importance of objectives of a program that would provide staff education and training regarding the sexuality of older people. A literature review determined what staff needed to know about elderly sexuality, the needs of elderly people related to their sexuality, and how caregivers…

  12. Consequences of sarcopenia among nursing home residents at long-term follow-up.

    Science.gov (United States)

    Henwood, Tim; Hassan, Bothaina; Swinton, Paul; Senior, Hugh; Keogh, Justin

    The consequences of and transition into sarcopenia with long-term survival was investigated in the nursing home setting. Eligible residents from 11 nursing homes were followed-up 18-months after their assessment for sarcopenia using the European Working Group on Sarcopenia in Older People criteria, with other demographic, physical and cognitive health measures collected. Of the 102 older adults who consented at baseline, 22 had died and 58 agreed to participate at follow-up, 51.7% of whom had sarcopenic. Sarcopenia at baseline was associated with a depression (p sarcopenia is high and increases with long-term survival in end-of-life care. However, the risk of sarcopenia-related mortality is not as great as from increasing age alone. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Maternal Distress during Pregnancy and Offspring Childhood Overweight

    DEFF Research Database (Denmark)

    Ingstrup, Katja Glejsted; Schou Andersen, Camilla; Adeltoft, Teresa Ajslev

    2012-01-01

    Background. Maternal distress during pregnancy increases the intrauterine level of glucocorticoids, which may have long-term health consequences for the child. Objective. To examine if distress as a combined measure of anxiety, depression, and stress of the mother during pregnancy was associated...... with offspring childhood overweight at age 7. Methods. We performed a cohort study using prospective data from 37,764 women and child dyads from the Danish National Birth Cohort (1996-2002). At a telephone interview at approximately 30 weeks gestation, the women reported whether they felt anxious, depressed......, or stressed. The 95 percentile for body mass index in an international reference defined childhood overweight at any given age. Logistic regression was used for the analyses. Results. The prevalence of overweight children at 7 years of age was 9.9%. Prenatal exposure to maternal distress during pregnancy...

  14. ANOTHER "LETHAL TRIAD"-RISK FACTORS FOR VIOLENT INJURY AND LONG-TERM MORTALITY AMONG ADULT VICTIMS OF VIOLENT INJURY.

    Science.gov (United States)

    Laytin, Adam D; Shumway, Martha; Boccellari, Alicia; Juillard, Catherine J; Dicker, Rochelle A

    2018-04-14

    Mental illness, substance abuse, and poverty are risk factors for violent injury, and violent injury is a risk factor for early mortality that can be attenuated through hospital-based violence intervention programs. Most of these programs focus on victims under the age of 30 years. Little is known about risk factors or long-term mortality among older victims of violent injury. To explore the prevalence of risk factors for violent injury among younger (age < 30 years) and older (age 30 ≥ years) victims of violent injury, to determine the long-term mortality rates in these age groups, and to explore the association between risk factors for violent injury and long-term mortality. Adults with violent injuries were enrolled between 2001 and 2004. Demographic and injury data were recorded on enrollment. Ten-year mortality rates were measured. Descriptive analysis and logistic regression were used to compare older and younger subjects. Among 541 subjects, 70% were over age 30. The overall 10-year mortality rate was 15%, and was much higher than in the age-matched general population in both age groups. Risk factors for violent injury including mental illness, substance abuse, and poverty were prevalent, especially among older subjects, and were each independently associated with increased risk of long-term mortality. Mental illness, substance abuse, and poverty constitute a "lethal triad" that is associated with an increased risk of long-term mortality among victims of violent injury, including both younger adults and those over age 30 years. Both groups may benefit from targeted risk-reduction efforts. Emergency department visits offer an invaluable opportunity to engage these vulnerable patients. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Indoor air in long term care facilities and spread of infectious diseases

    NARCIS (Netherlands)

    te Kulve, M.; Loomans, M.G.L.C.; Huisman, E.; Kort, H.S.M.

    2014-01-01

    Not much is known about the favourable indoor air conditions in long term care facilities (ltcf’s), where older adults suffering from dementia live. Due to the decrease in cognition function, it is hard to evaluate comfort and health in this group. Nevertheless, infectious diseases are a persistent

  16. Smoking history, knowledge, and attitudes among older residents of a long-term care facility.

    Science.gov (United States)

    Carosella, Ann Marie; Ossip-Klein, Deborah J; Watt, Celia A; Podgorski, Carol

    2002-05-01

    In the absence of empirical literature from the resident perspective, this study provided a first assessment of smoking history, knowledge of the risks of smoking, the risks of environmental tobacco exposure, and the benefits of quitting among older (age 50+) nursing home unit residents, as well as readiness to quit, barriers to quitting, frequency of cessation advice by healthcare givers, and quit-attempt history of residents who smoke. Subjects were 25 smokers and 70 non-smokers housed on long-term nursing home units in a county hospital. Results indicated that smoking status for the majority of residents was similar to when they were admitted, although smokers smoked fewer cigarettes (M = 11.6, SD = 9.2) than prior to admission (M = 18.6, SD = 11.8). Smokers were less likely than non-smokers to agree that smoking is harmful to their health. Both smokers and non-smokers were not well informed of the dangers of passive smoke exposure. The majority of smokers were in precontemplation (no interest in quitting within the next 6 months). Fewer than half of residents who smoked reported receiving cessation advice from physicians (40%) or nurses (36%), and no in-house cessation programs were available. These results suggest gaps in knowledge and resources for smoking cessation in this setting and an opportunity for intervention. This study begins to build an evidence base from the residents' perspective that can be used by healthcare providers, administrators, and policy makers in addressing smoking in the nursing home.

  17. Physicians' Knowledge of and Attitudes Toward Use of Opioids in Long-Term Care Facilities.

    Science.gov (United States)

    Griffioen, Charlotte; Willems, Eva G; Kouwenhoven, Sanne M; Caljouw, Monique A A; Achterberg, Wilco P

    2017-06-01

    Insufficient pain management in vulnerable older persons living in long-term care facilities is common, and opiophobia might contribute to this. As opiophobia and its related factors have not been investigated in long-term care, this study evaluates the degree of knowledge of opioids among elderly-care physicians (ECPs) and ECP trainees, as well as their attitudes and other factors possibly influencing the clinical use of opioids in these facilities. A questionnaire was designed and distributed among ECPs and ECP trainees by email, regional symposia, and all three university training faculties for elderly-care medicine in the Netherlands. Respondents were 324 ECPs and 111 ECP trainees. Fear of addiction did not influence the prescription of opioids. Main barriers to the clinical use of opioids were patients' reluctance to take opioids (83.3%); unknown degree of pain (79.2%); and pain of unknown origin (51.4%). ECPs' average knowledge scores were sufficient: those who felt that their knowledge of opioids was poor scored lower than those who felt that their knowledge was good. Factors identified in this study may help provide better pain management for vulnerable older persons living in a long-term care facility. Also, more patient information on the pros and cons of opioid use is needed, as well as appropriate tools for better clinical assessment of pain in a long-term care population. © 2016 World Institute of Pain.

  18. Structured medium and long chain triglycerides show short-term increases in fat oxidation, but no changes in adiposity in men.

    Science.gov (United States)

    Roynette, Catherine E; Rudkowska, Iwona; Nakhasi, Dilip K; Jones, Peter J H

    2008-05-01

    Medium chain triglycerides (MCT) have been suggested as modulators of human energy expenditure (EE) and thus may influence total and regional body fat distribution. To investigate in overweight men the effects of structured medium and long chain triglycerides on EE, substrate oxidation and body adiposity, compared to extra virgin olive oil (OO). In a 6 week single-blind crossover study, 23 overweight men were randomly assigned to consume a standard high-fat diet of which 75% total fat was provided as either structured medium and long chain triglycerides referred to as structured oil (StO), or OO. EE and body composition were measured using indirect calorimetry and magnetic resonance imaging, respectively, at weeks 1 and 6 of each phase. Body weight decreased (pstructured medium and long chain triglyceride oil increases short-term fat oxidation but fails to modulate body weight or adiposity through a change in EE.

  19. The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long-term survivors of prostate cancer.

    Science.gov (United States)

    Buffart, Laurien M; Newton, Robert U; Chinapaw, Mai J; Taaffe, Dennis R; Spry, Nigel A; Denham, James W; Joseph, David J; Lamb, David S; Brug, Johannes; Galvão, Daniel A

    2015-08-15

    The current study examined effects, moderators (for whom), and mediators (working mechanisms) of 12 months of exercise on health-related quality of life (HRQoL) in older long-term survivors of prostate cancer. In total, 100 men aged 71.7 years (standard deviation, 6.4 years) were randomly assigned to 6 months of supervised aerobic and resistance exercise followed by 6 months of a home-based exercise maintenance program (EX group) or printed education material regarding physical activity for 12 months (PA group). Assessments took place at baseline and after 6 and 12 months. Generalized estimating equations were used to study the effects of EX versus PA on HRQoL at 6 and 12 months, adjusting for baseline HRQoL. The authors examined potential sociodemographic and clinical moderators by adding interaction terms, and potential physical and psychological mediators using the product-of-coefficients test. At 6 months, significant beneficial effects were found for global QoL, physical function, and social function in the EX group compared with the PA group. For physical function, beneficial effects were sustained at 12 months. Moderation analyses demonstrated larger effects of EX versus PA for patients who were married, started exercising sooner after their diagnosis, and previously used bisphosphonates. Changes in lower body functional performance significantly mediated the effect of EX on global QoL, physical function, and social function. No mediating effects on HRQoL were found for aerobic fitness, physical activity, fatigue, distress, or falls self-efficacy. Aerobic and resistance exercise appears to have beneficial effects on HRQoL among older, long-term survivors of prostate cancer. Effects were moderated by marital status, time since diagnosis, and use of bisphosphonates, and were mediated by lower body functional performance. © 2015 American Cancer Society.

  20. Long-term exposure to anticholinergic and sedative drugs and cognitive and physical function in later life

    NARCIS (Netherlands)

    Wouters, H.; Hilmer, S.; Gnjidic, D.; Van Campen, J.; Teichert, M.; Van Der Meer, H.; Schaap, L.; Huisman, M.; Denig, P.; Lamoth, C.; Taxis, K.

    2017-01-01

    Introduction: Anticholinergic and sedative drugs from various therapeutic classes are frequently prescribed to older people. These drugs are known to impair cognitive and physical function in the short-term. However, long-term exposure to these drugs remains less examined. Methods: Data from the

  1. Nutrient Intake During Diet-Induced Weight Loss and Exercise Interventions in a Randomized Trial in Older Overweight and Obese Adults.

    Science.gov (United States)

    Miller, G D; Beavers, D P; Hamm, D; Mihalko, S L; Messier, S P

    2017-01-01

    Dietary restriction in obese older adults undergoing weight loss may exacerbate nutrient deficiencies common in this group; the nutritional health of older adults is a factor in their quality of life, disability, and mortality. This study examined the effect of an 18-month weight loss program based in social cognitive theory incorporating partial meal replacements, on nutrient intake in older overweight and obese adults. The following analysis is from the Intensive Diet and Exercise for Arthritis (IDEA) trial, a single-blind, randomized controlled trial. Individuals were randomized into one of three 18-month interventions: exercise (E); intensive diet-induced weight loss (D); or intensive diet-induced weight loss plus exercise (D+E). The study setting was at a university research facility. Overweight and obese older adults (n=388; BMI=33.7±3.8 kg/m2; 65.8±6.1 years) were recruited. The D and D+E interventions (group mean goal of ≥10% loss by 18-months) utilized partial meal replacements (2 meal replacement shakes/day for 6-months). Exercise training for E and D+E was 3 days/week, 60 minutes/day. Three day food records were collected at baseline, 6-months, and 18-months and analyzed for total energy and macro- and micronutrient intake. Comparisons of dietary intake among treatment groups were performed at 6 and 18 months using mixed linear models. Weight loss at 18-months was 11.3±8.3% (D), 10.3±6.8% (D+E), and 1.2±4.2% (E). Meal replacements were used by more than 60% (6-months) and 50% (18-months) of D and D+E participants, compared to ≤15% for E. Both D and D+E consumed less energy and fat, and more carbohydrates and selected micronutrients than E during follow-up. More than 50% of all participants consumed less than the recommended intake of particular vitamins and minerals. The diet intervention improved intakes of several nutrients. However, inadequate intake of several vitamins and minerals of concern for older adults suggests they need further

  2. Long-term exposure to air pollution and asthma hospitalisations in older adults: a cohort study

    DEFF Research Database (Denmark)

    Andersen, Zorana Jovanovic; Bønnelykke, Klaus; Hvidberg, Martin

    2012-01-01

    Exposure to air pollution in early life contributes to the burden of childhood asthma, but it is not clear whether long-term exposure to air pollution can lead to asthma onset or progression in adulthood.......Exposure to air pollution in early life contributes to the burden of childhood asthma, but it is not clear whether long-term exposure to air pollution can lead to asthma onset or progression in adulthood....

  3. Number of siblings, birth order, and childhood overweight: a population-based cross-sectional study in Japan.

    Science.gov (United States)

    Ochiai, Hirotaka; Shirasawa, Takako; Ohtsu, Tadahiro; Nishimura, Rimei; Morimoto, Aya; Obuchi, Ritsuko; Hoshino, Hiromi; Tajima, Naoko; Kokaze, Akatsuki

    2012-09-11

    Although several studies have investigated the relationship between the number of siblings or birth order and childhood overweight, the results are inconsistent. In addition, little is known about the impact of having older or younger siblings on overweight among elementary schoolchildren. The present population-based study investigated the relationship of the number of siblings and birth order with childhood overweight and evaluated the impact of having younger or older siblings on childhood overweight among elementary schoolchildren in Japan. Subjects comprised fourth-grade schoolchildren (age, 9-10 years) in Ina Town during 1999-2009. Information about subjects' sex, age, birth weight, birth order, number of siblings, lifestyle, and parents' age, height, and weight was collected by a self-administered questionnaire, while measurements of subjects' height and weight were done at school. Childhood overweight was defined according to age- and sex-specific cut-off points proposed by the International Obesity Task Force. A logistic regression model was used to calculate the odds ratio (OR) and 95% confidence intervals (95% CI) of "number of siblings" or "birth order" for overweight. Data from 4026 children were analyzed. Only children (OR: 2.13, 95% CI: 1.45-3.14) and youngest children (1.56, 1.13-2.16) significantly increased ORs for overweight compared with middle children. A larger number of siblings decreased the OR for overweight (P for trend < 0.001). Although there was no statistically significant relationship between a larger number of older siblings and overweight, a larger number of younger siblings resulted in a lower OR for overweight (P for trend < 0.001). Being an only or youngest child was associated with childhood overweight, and having a larger number of younger siblings was negatively associated with overweight. The present study suggests that public health interventions to prevent childhood overweight need to focus on children from these

  4. The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto.

    Science.gov (United States)

    Mendes, Ana; Papoila, Ana Luísa; Carreiro-Martins, Pedro; Bonassi, Stefano; Caires, Iolanda; Palmeiro, Teresa; Aguiar, Lívia; Pereira, Cristiana; Neves, Paula; Mendes, Diana; Botelho, Maria Amália Silveira; Neuparth, Nuno; Teixeira, João Paulo

    2016-01-01

    persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. to evaluate the influence of indoor air quality and contaminants on older people's respiratory health. cross-sectional study. 21 long-term care residences (LTC) in the city of Porto, Portugal. older people living in LTC with ≥65 years old. the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (22%) the main self-reported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1-7.2). high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. How low-income mothers with overweight preschool children make sense of obesity.

    Science.gov (United States)

    Hughes, Cayce C; Sherman, Susan N; Whitaker, Robert C

    2010-04-01

    Epidemiologic and qualitative studies have found that most mothers with overweight preschool children do not think their children are overweight. This might present a challenge for clinicians who wish to address obesity in young children. To understand mothers' perceptions of their overweight children's weight, we conducted semistructured interviews with 21 mothers of overweight preschool children enrolled in Kentucky's Special Supplemental Nutrition Program for Women, Infants, and Children. Although these mothers did not label their children as overweight, they were worried about children's weight, particularly as it related to their emotional well-being. These worries about obesity were reflected in three central tensions that shaped the way mothers perceived their children's weight and informed maternal feeding strategies: (a) nature vs. nurture, (b) medical authority vs. lived experience, and (c) relieving immediate stress vs. preventing long-term consequences. Acknowledging mothers' concerns and tensions might help clinicians communicate more effectively with them about obesity.

  6. How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions?

    Science.gov (United States)

    Sperber, Nina R; Voils, Corrine I; Coe, Norma B; Konetzka, R Tamara; Boles, Jillian; Van Houtven, Courtney Harold

    2017-04-01

    Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents' LTC preferences and plans, including LTCI purchase? We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Marital stability, satisfaction and well-being in old age: variability and continuity in long-term continuously married older persons.

    Science.gov (United States)

    Margelisch, Katja; Schneewind, Klaus A; Violette, Jeanine; Perrig-Chiello, Pasqualina

    2017-04-01

    Recent research shows that the well-documented positive effects of marital stability on well-being and health outcomes are conditional upon the quality of marriage. To date, few studies have explored the relationship between marital satisfaction, well-being and health among very long-term married individuals. This study aims at identifying groups of long-term married persons with respect to marital satisfaction and comparing them longitudinally concerning their well-being outcomes, marital stressors, personality and socio-demographic variables. Data are derived from a survey (data collection 2012 and 2014) with 374 continuously married individuals at wave 1 (mean age: 74.2 years, length of marriage: 49.2 years) and 252 at wave 2. Cluster analyses were performed comparing the clusters with regard to various well-being outcomes. The predictive power of cluster affiliation and various predictors at wave 1 on well-being outcomes at wave 2 was tested using regression analyses. Two groups were identified, one happily the other unhappily married, with the happily married scoring higher on all well-being and health outcomes. Regression analyses revealed that group affiliation at wave 1 was not any longer predictive of health, emotional loneliness and hopelessness two years later, when taking into account socio-demographic variables, psychological resilience and marital strain, whereas it remained an important predictor of life satisfaction and social loneliness. Marital satisfaction is associated with health and well-being in older couples over time, whereas psychological resilience and marital strain are major predictors explaining the variance of these outcomes.

  8. The effect of theory-based interventions on physical activity participation among overweight/obese individuals: a systematic review.

    Science.gov (United States)

    Bélanger-Gravel, A; Godin, G; Vézina-Im, L-A; Amireault, S; Poirier, P

    2011-06-01

    Little attention has been paid to the evaluation of the long-term impact of theory-based interventions on physical activity participation among overweight/obese individuals after the interventions have ended. The primary aim of this systematic review was to investigate the long-term effectiveness of theory-based interventions increasing physical activity and identify the most effective techniques for behaviour change among overweight/obese individuals. The secondary aim was to investigate the effect of these interventions on theoretical variables. Eighteen studies were reviewed. Among these studies, three reported significant short-term and two long-term effects of interventions on physical activity participation. Most of the studies observed a significant short- or long-term effect of time on this behaviour. Theoretical frameworks most often applied included the Behavioural Model and the Social Learning/Cognitive Theory. However, few of the studies reported any impact on theoretical variables. The most prevalent techniques consisted of providing opportunities for social comparison and instruction as well as self-monitoring. Leading techniques differentiating the experimental group from the control group included prompting practice and intentions formation and barriers identification. Although the combination of these three techniques appears successful, the long-term impact of theory-based interventions remains ambiguous. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.

  9. Audit of long-term and short-term liabilities

    Directory of Open Access Journals (Sweden)

    Korinko M.D.

    2017-03-01

    Full Text Available The article determines the importance of long-term and short-term liabilities for the management of financial and material resources of an enterprise. It reviews the aim, objects and information generators for realization of audit of short-term and long-term obligations. The organizing and methodical providing of audit of long-term and short-term liabilities of an enterprise are generalized. The authors distinguish the stages of realization of audit of long-term and short-term liabilities, the aim of audit on each of the presented stages, and recommend methodical techniques. It is fixed that it is necessary to conduct the estimation of the systems of internal control and record-keeping of an enterprise by implementation of public accountant procedures for determination of volume and maintenance of selection realization. After estimating the indicated systems, a public accountant determines the methodology for realization of public accountant verification of long-term and short-term liabilities. The analytical procedures that public accountants are expedient to use for realization of audit of short-term and long-term obligations are determined. The authors suggest the classification of the educed defects on the results of the conducted public accountant verification of short-term and long-term obligations.

  10. Sex-dependent association between erythrocyte n-3 PUFA and type 2 diabetes in older overweight people.

    Science.gov (United States)

    Abbott, Kylie A; Veysey, Martin; Lucock, Mark; Niblett, Suzanne; King, Katrina; Burrows, Tracy; Garg, Manohar L

    2016-04-01

    The association between n-3 PUFA intake and type 2 diabetes (T2D) is unclear, and studies relating objective biomarkers of n-3 PUFA consumption to diabetic status remain limited. The aim of this study was to determine whether erythrocyte n-3 PUFA levels (n-3 index; n-3I) are associated with T2D in a cohort of older adults (n 608). To achieve this, the n-3I (erythrocyte %EPA+%DHA) was determined by GC and associated with fasting blood glucose; HbA1c; and plasma insulin. Insulin resistance (IR) was assessed using the homeostatic model assessment of insulin resistance (HOMA--IR). OR for T2D were calculated for each quartile of n-3I. In all, eighty-two type 2 diabetic (46·3 % female; 76·7 (sd 5·9) years) and 466 non-diabetic (57·9 % female; 77·8 (sd 7·1) years) individuals were included in the analysis. In overweight/obese (BMI≥27 kg/m2), the prevalence of T2D decreased across ascending n-3I quartiles: 1·0 (reference), 0·82 (95 % CI 0·31, 2·18), 0·56 (95 % CI 0·21, 1·52) and 0·22 (95 % CI 0·06, 0·82) (P trend=0·015). A similar but non-significant trend was seen in overweight men. After adjusting for BMI, no associations were found between n-3I and fasting blood glucose, HbA1c, insulin or HOMA-IR. In conclusion, higher erythrocyte n-3 PUFA status may be protective against the development of T2D in overweight women. Further research is warranted to determine whether dietary interventions that improve n-3 PUFA status can improve measures of IR, and to further elucidate sex-dependent differences.

  11. Health and participation problems in older adults with long-term disability.

    Science.gov (United States)

    Hilberink, Sander R; van der Slot, Wilma M A; Klem, Martijn

    2017-04-01

    More attention and understanding of the health and participation problems of adults with early and later onset disabilities in the Netherlands is needed. To explore health/participation problems and unmet needs in adults aged ≥40 years with long-term disabilities and their relationship with the time of onset. Participants were recruited in the Netherlands through newsletters and social media to participate in a web-based questionnaire. The questionnaire assessed background characteristics, (change in) health/participation problems, and unmet needs. Spearman's rho was used to examine the relationships with time of onset. Of the 163 survey respondents, 42% acquired their disability before age 25 years and reported fatigue (77%), walking problems (66%), and pain (59%). In 21% of the respondents with early-onset disability fatigue, pain and depressive feelings co-occurred. Early-onset disability correlated with joint deformities, pain and anxiety. Participation problems included loss of income and fewer social activities. Early-onset correlated with the need for more information about diagnosis and prognosis. People aged over 40 years with long-term disability have significant and increasing health and participation problems. Adults with early-onset disability are more likely to have health or participation problems than adults with late-onset disability. Early identification is needed for preventive care and access to specialized services that focus on improving and maintaining physical symptoms, energy management, and participation. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults.

    Science.gov (United States)

    Aartolahti, Eeva; Tolppanen, Anna-Maija; Lönnroos, Eija; Hartikainen, Sirpa; Häkkinen, Arja

    2015-01-01

    Strength and balance training (SBT) has remarkable health benefits, but little is known regarding exercise adherence in older adults. We examined the adherence to strength and balance training and determinants of adherence among ≥75 year old adults. 182 community-dwelling individuals (aged 75-98 years, 71% female) began group-based SBT as part of a population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Adherence was defined as the proportion of attended sessions relative to offered sessions. Participants were classified based on their adherence level into low (≤33.3%), moderate (33.4-66.5%) and high (≥66.6%) adherers. The mean length of training was 19 ± 9 months, and 68% continued participation for at least two years. The mean training adherence was 55 ± 29% for all participants and 18%, 53% and 82% for low, moderate and high adherers, respectively. High adherence was predicted by female sex; younger age; better cognition; independence in Instrumental Activities of Daily Living; higher knee extension strength; faster walking speed; and better performance on the Berg Balance Scale and Timed Up and Go tests. Poorer self-perceived health and the use of a walking aid were related to low adherence. Long-term continuation of training is possible for older community-dwelling adults, although poorer health and functional limitations affect training adherence. Our findings have implications for tailoring interventions and support for older adults to optimize their exercise adherence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Tracking of childhood overweight into adulthood: a systematic review of the literature

    NARCIS (Netherlands)

    Singh, A.S.; Mulder, C.; Twisk, J.W.R.; van Mechelen, W.; Chin A Paw, M.J.M.

    2008-01-01

    Overweight and obesity in youth are important public health concerns and are of particular interest because of possible long-term associations with adult weight status and morbidity. The aim of this study was to systematically review the literature and update evidence concerning persistence of

  14. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park

    2010-04-01

    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  15. Nutrient adequacy and diet quality in non-overweight and overweight Hispanic children of low socioeconomic status - the VIVA LA FAMILIA Study

    Science.gov (United States)

    Wilson, Theresa A.; Adolph, Anne L.; Butte, Nancy F.

    2009-01-01

    Objective The role of diet quality and nutrient adequacy in the etiology of childhood obesity is poorly understood. The specific aims of these analyses were to 1) assess overall diet quality and nutrient adequacy, and 2) test for association between weight status and diet in children from low socioeconomic status (SES) Hispanic families at high risk for obesity. Design A cross-sectional study design was used to assess dietary intake in low-SES non-overweight and overweight Hispanic children enrolled in the VIVA LA FAMILIA Study. Multiple-pass 24-h dietary recalls were recorded on two random, weekday occasions. Diet quality was evaluated according to United States (US) Dietary Guidelines. Nutrient adequacy was assessed using z-scores based on estimated average requirement (EAR) or adequate intake (AI). Subjects/Setting The study included 1030 Hispanic children and adolescents, ages 4-19 y, in Houston, Texas who participated between November 2000 and August 2004. Statistical analysis STATA was used for generalized estimating equations and random effects regression. Results Diet quality did not adhere to US dietary guidelines for fat, cholesterol, saturated fatty acids, fiber, added sugar and sodium. Although energy intake was significantly higher in overweight children, food sources, diet quality, macro- and micronutrient composition were similar between non-overweight and overweight children. Relative to EAR or AI, mean nutrient intakes were adequate (70-98% probability) in the non-overweight and overweight children, except for vitamins D and E, pantothenic acid, calcium and potassium for which z-scores cannot be interpreted given the uncertainty of their AI's. Conclusion While the diets of low-SES, non-overweight and overweight Hispanic children were adequate in most essential nutrients, other components of a healthy diet, which promote long-term health, were suboptimal. Knowledge of the diet of high risk Hispanic children will inform nutritional interventions and

  16. Quedas e fraturas entre residentes de instituições de longa permanência para idosos Falls and fractures among older adults living in long-term care

    Directory of Open Access Journals (Sweden)

    Giovâni Firpo Del Duca

    2013-03-01

    Full Text Available OBJETIVO: Investigar a ocorrência de quedas e fraturas no último ano e fatores associados entre residentes de instituições de longa permanência para idosos (ILPI. MÉTODOS: Estudo transversal exploratório, a partir de um censo realizado em ILPI localizadas em Pelotas, Rio Grande do Sul, em 2008. As quedas e fraturas decorrentes dessas foram investigadas a partir de autorrelato referente ao último ano. Sexo, idade, escolaridade, incapacidade funcional para atividades básicas da vida diária, tipo de financiamento da instituição e hospitalização no último ano foram coletados como potencias fatores associados à ocorrência de queda no último ano. Empregou-se o teste qui-quadrado para heterogeneidade e tendência linear e, na análise ajustada, a regressão de Poisson com variância robusta. RESULTADOS: Nas 24 ILPI incluídas no estudo, coletaram-se dados de 466 indivíduos. A prevalência de quedas no último ano foi de 38,9% (IC95%: 34,5 - 43,4. Dentre aqueles que caíram, as fraturas acometeram 19,2%. As fraturas mais frequentes foram: fêmur/quadril (43,3% e punho (10%. Na análise ajustada, o avanço da idade, apresentar incapacidade funcional em uma a cinco atividades da vida diária, residir em instituições públicas/filantrópicas e ter sido hospitalizado no último ano associaram-se à queda no último ano. CONCLUSÃO: A alta ocorrência de quedas e fraturas entre residentes de instituições de longa permanência para idosos revela a fragilidade da população avaliada. Atenção específica deve ser destinada a indivíduos mais velhos e hospitalizados no último ano. OBJECTIVE: To investigate the prevalence of falls and fractures over the past 12 months and associated factors among older adults living in long-term care. METHODS: Census of all long-term care located in the city of Pelotas, Brazil, in 2008. Falls over the past 12 months were assessed using the following question: "Over the last 12 months, have you fallen

  17. Predictors of Short- and Long-Term Attrition From the Parents as Agents of Change Randomized Controlled Trial for Managing Pediatric Obesity.

    Science.gov (United States)

    Spence, Nicholas D; Newton, Amanda S; Keaschuk, Rachel A; Ambler, Kathryn A; Jetha, Mary M; Holt, Nicholas L; Rosychuk, Rhonda J; Spence, John C; Sharma, Arya M; Ball, Geoff D C

    Attrition in pediatric weight management is a substantial problem. This study examined factors associated with short- and long-term attrition from a lifestyle and behavioral intervention for parents of children with overweight or obesity. Fifty-two families with children ages 6 to 12 years old and body mass index at or above the 85th percentile participated in a randomized controlled trial focused on parents, comparing parent-based cognitive behavioral therapy with parent-based psychoeducation for pediatric weight management. We examined program attrition using two clinical phases of the intervention: short-term and long-term attrition, modeled using the general linear model. Predictors included intervention type, child/parent weight status, sociodemographic factors, and health of the family system. Higher self-assessed health of the family system was associated with lower short-term attrition; higher percentage of intervention sessions attended by parents was associated with lower long-term attrition. Different variables were significant in our short- and long-term models. Attrition might best be conceptualized based on short- and long-term phases of clinical, parent-based interventions for pediatric weight management. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  18. Long-term portfolio investments: New insight into return and risk

    Directory of Open Access Journals (Sweden)

    Alexander Abramov

    2015-09-01

    Emphasis is placed on the need for regular adjustments to long-term investors’ portfolios. As portfolios get older, those investors see a reduction in the returns’ dispersion, while differences in risk between various portfolios increase. This means that to maintain a fixed risk–return ratio for a portfolio as the horizon increases, an investor needs to increase the share of lower-risk financial assets during asset allocation process. This thesis becomes especially relevant in the context of retirement savings management.

  19. Perceptions of adolescents on overweight and obesity: the weight of opinion study.

    Science.gov (United States)

    Booth, Michael L; Wilkenfeld, Rachel L; Pagnini, Deanna L; Booth, Susan L; King, Lesley A

    2008-05-01

    The incidence and prevalence of overweight and obesity are rising around the world. Health promotion planning must be informed by the knowledge, perceptions, motivations and perceived needs of the target population, but little is known about how adolescents perceive overweight and obesity, its causes and solutions. A cross-sectional, non-representative sample of 12- to 17-year-old boys and girls (n = 58) attending schools in diverse metropolitan areas and one rural area in NSW, Australia. Focus groups were conducted in 2005 and content analysis was used to identify key themes. The students were aware that overweight was becoming increasingly common. They perceived the negative consequences primarily in psycho-social terms, but were also aware of the long-term physical health consequences. Behaviours, appearance, motivation and self-esteem were used as criteria to judge if a person was overweight and the students distinguished between 'healthy' and 'ideal' (physically attractive) weight. The major barriers to maintaining a healthy weight were home, school and community environments in which fatty/high sugar foods were too easily accessible and where opportunities for participating in physical activity were sometimes limited. Student-identified strategies to address the issue encompassed government policy, advertising and media, schools and home. The students have a mature and complex understanding of overweight and its potential solutions, making them likely to be creative contributors and responsive to wide-ranging, multi-component interventions.

  20. [Long-term psychiatric hospitalizations].

    Science.gov (United States)

    Plancke, L; Amariei, A

    2017-02-01

    Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

  1. The long-term benefits of a multi-component exercise intervention to balance and mobility in healthy older adults.

    Science.gov (United States)

    Bird, M; Hill, K D; Ball, M; Hetherington, S; Williams, A D

    2011-01-01

    We examined the long-term effects of a multi-component exercise program on balance, mobility and exercise behavior. The benefits of a community-based resistance and flexibility exercise intervention in a group of healthy older (60-75 years) individuals were recorded 12 months after completion of the randomized control intervention. Differences between those participants who continued to exercise and those who discontinued were investigated. Significant improvements from baseline in sit to stand (pexercise intervention group, with a control group unchanged. Participants who continued exercising had significantly greater improvements in strength immediately after the intervention, compared to those who discontinued (p=0.004). Those who continued regular resistance training performed better in the step test at 12-month follow up (p=0.009) and believed that the program was of more benefit to their physical activity (pexercising. Benefits to balance and mobility persist 1 year after participation in a multi-component exercise program, due in part to some continuing participation in resistance training. Motivation to continue resistance training may be related real and perceived benefits attained from the intervention as well as the environmental context of the intervention. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  2. Obesity: a systematic review on parental involvement in long-term European childhood weight control interventions with a nutritional focus

    OpenAIRE

    Kruk, J J; Kortekaas, F; Lucas, C; Jager-Wittenaar, H

    2013-01-01

    In Europe, about 20% of children are overweight. Focus on parental responsibility is an effective method in weight control interventions in children. In this systematic review we describe the intensity of parental involvement and behaviour change aimed at parents in long-term European childhood weight control interventions. We include European Union studies targeting parents in order to improve children's weight status in multi-component (parental, behaviour change and nutrition) health promo...

  3. Increased Butyrate Production During Long-Term Fermentation of In Vitro-Digested High Amylose Cornstarch Residues with Human Feces.

    Science.gov (United States)

    Li, Li; Jiang, Hongxin; Kim, Hyun-Jung; Yum, Man-Yu; Campbell, Mark R; Jane, Jay-Lin; White, Pamela J; Hendrich, Suzanne

    2015-09-01

    An in vitro semi-continuous long-term (3 wk) anaerobic incubation system simulating lower gut fermentation was used to determine variability in gut microbial metabolism between 4 predigested high amylose-resistant starch residues (SR): SRV, SRVI, SRVII, and SRGEMS in human fecal samples. Subjects participated twice, 5 mo apart: 30 in Phase I (15 lean, 9 overweight and 6 obese), 29 in Phase II (15 lean, 9 overweight, 5 obese); 13 of 15 lean subjects participated in both phases. Of the 4 SRs, SRV displayed the highest gelatinization temperature, peak temperature, enthalpy changes, and the least digestibility compared with the other SRs. In both phases, compared with blank controls, all SRs increased butyrate ∼2-fold which stabilized at week 2 and only SRV caused greater propionate concentration (∼30%) after 3 wk which might have been partly mediated by its lesser digestibility. Fecal samples from lean and overweight/obese subjects incubated with SRs showed similar short-chain fatty acid production across both time points, which suggests that resistant starch may benefit individuals across BMIs. © 2015 Institute of Food Technologists®

  4. Long term pharmacotherapy for obesity and overweight: updated meta-analysis

    Science.gov (United States)

    2007-01-01

    Objective To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status. Design Updated meta-analysis of randomised trials. Data sources Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006. Studies reviewed Double blind randomised placebo controlled trials of approved anti-obesity dugs used in adults (age over 18) for one year or longer. Results 30 trials of one to four years’ duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine lowered concentrations of high density lipoprotein cholesterol and triglycerides but raised blood pressure and pulse rate. Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders. Conclusions Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects. PMID:18006966

  5. Long-term potentiation and long-term depression: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Timothy V.P. Bliss

    2011-01-01

    Full Text Available Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

  6. Systematic Review of the Mediterranean Diet for Long-Term Weight Loss.

    Science.gov (United States)

    Mancini, Joseph G; Filion, Kristian B; Atallah, Renée; Eisenberg, Mark J

    2016-04-01

    Although the long-term health benefits of the Mediterranean diet are well established, its efficacy for weight loss at ≥12 months in overweight or obese individuals is unclear. We therefore conducted a systematic review of randomized controlled trials (RCTs) to determine the effect of the Mediterranean diet on weight loss and cardiovascular risk factor levels after ≥12 months. We systematically searched MEDLINE, EMBASE, and the Cochrane Library of Clinical Trials for RCTs published in English or French and with follow-up ≥12 months that examined the effect of the Mediterranean diet on weight loss and cardiovascular risk factor levels in overweight or obese individuals trying to lose weight. Five RCTs (n = 998) met our inclusion criteria. Trials compared the Mediterranean diet to a low-fat diet (4 treatment arms), a low-carbohydrate diet (2 treatment arms), and the American Diabetes Association diet (1 treatment arm). The Mediterranean diet resulted in greater weight loss than the low-fat diet at ≥12 months (range of mean values: -4.1 to -10.1 kg vs 2.9 to -5.0 kg), but produced similar weight loss as other comparator diets (range of mean values: -4.1 to -10.1 kg vs -4.7 to -7.7 kg). Moreover, the Mediterranean diet was generally similar to comparator diets at improving other cardiovascular risk factor levels, including blood pressure and lipid levels. Our findings suggest that the Mediterranean diet results in similar weight loss and cardiovascular risk factor level reduction as comparator diets in overweight or obese individuals trying to lose weight. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme

    2012-01-01

    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  8. Long-term survival of adult trauma patients.

    Science.gov (United States)

    Davidson, Giana H; Hamlat, Christian A; Rivara, Frederick P; Koepsell, Thomas D; Jurkovich, Gregory J; Arbabi, Saman

    2011-03-09

    Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition. Retrospective cohort study of 124,421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Kaplan-Meier and Cox proportional hazards models were used to evaluate long-term mortality following hospital admission for trauma. Of the 124,421 trauma patients, 7243 died before hospital discharge and 21,045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16% (95% confidence interval [CI], 15.8%-16.2%) compared with the expected population cumulative mortality of 5.9% (95% CI, 5.9%-5.9%). In-hospital mortality improved during the 14-year study period from 8% (n = 362) to 4.9% (n = 600), whereas long-term cumulative mortality increased from 4.7% (95% CI, 4.1%-5.4%) to 7.4% (95% CI, 6.8%-8.1%). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. The adjusted hazard ratios (HRs) for death after discharge to a skilled nursing facility compared with that after discharge home were 1.41 (95% CI, 0.72-2.76) for patients aged 18 to 30 years, 1.92 (95% CI, 1.36-2.73) for patients aged 31 to 45 years, 2.02 (95% CI, 1.39-2.93) for patients aged 46 to 55 years, 1.93 (95% CI, 1.40-2.64) for patients aged 56 to 65 years, 1.49 (95% CI, 1.14-1.94) for patients aged 66 to 75 years, 1.54 (95% CI, 1.27-1.87) for patients aged 76 to 80 years, and 1.38 (95% CI, 1.09-1.74) for patients older than 80 years. Other significant predictors of mortality

  9. Cross-cultural comparison of long-term care in the United States and Finland: Research done through a short-term study-abroad experience.

    Science.gov (United States)

    Kruger, Tina M; Gilland, Sarah; Frank, Jacquelyn B; Murphy, Bridget C; English, Courtney; Meade, Jana; Morrow, Kaylee; Rush, Evan

    2017-01-01

    In May 2014, a short-term study-abroad experience was conducted in Finland through a course offered at Indiana State University (ISU). Students and faculty from ISU and Eastern Illinois University participated in the experience, which was created to facilitate a cross-cultural comparison of long-term-care settings in the United States and Finland. With its outstanding system of caring for the health and social needs of its aging populace, Finland is a logical model to examine when considering ways to improve the quality of life for older adults who require care in the United States . Those participating in the course visited a series of long-term-care facilities in the region surrounding Terre Haute, Indiana, then travelled to Lappeenranta, Finland to visit parallel sites. Through limited-participation observation and semistructured interviews, similarities and differences in experiences, educations, and policies affecting long-term care workers in the United States and Finland were identified and are described here.

  10. Heart transplantation from older donors

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2017-01-01

    Full Text Available In the current situation of the shortage of suitable donor organs, heart transplantation from older donors is one of the ways to increase the performance of more heart transplants, particularly, in patients with urgent need of transplantation. While planning a heart transplantation from older donor one should consider increased risk of early cardiac allograft dysfunction, preexisting coronary artery disease, accelerated transplant vasculopathy which may adversely affect early and long-term survival of recipients. Subject to careful selection of donor–recipient pairs, effective prevention and treatment of early cardiac allograft dysfunction, pre-existing atherosclerosis and transplant vasculopathy the early and long-term survival of heart transplant recipients from older donors is comparable to heart transplantation from young donors.

  11. Economic Downturns, Retirement and Long-Term Cognitive Function Among Older Americans.

    Science.gov (United States)

    Hessel, Philipp; Riumallo-Herl, Carlos J; Leist, Anja K; Berkman, Lisa F; Avendano, Mauricio

    2018-04-16

    Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life. Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised. Longer exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline. Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life.

  12. Long-Term Symbolic Learning

    National Research Council Canada - National Science Library

    Kennedy, William G; Trafton, J. G

    2007-01-01

    What are the characteristics of long-term learning? We investigated the characteristics of long-term, symbolic learning using the Soar and ACT-R cognitive architectures running cognitive models of two simple tasks...

  13. Long-term reliability of the visual EEG Poffenberger paradigm.

    Science.gov (United States)

    Friedrich, Patrick; Ocklenburg, Sebastian; Mochalski, Lisa; Schlüter, Caroline; Güntürkün, Onur; Genc, Erhan

    2017-07-14

    The Poffenberger paradigm is a simple perception task that is used to estimate the speed of information transfer between the two hemispheres, the so-called interhemispheric transfer time (IHTT). Although the original paradigm is a behavioral task, it can be combined with electroencephalography (EEG) to assess the underlying neurophysiological processes during task execution. While older studies have supported the validity of both paradigms for investigating interhemispheric interactions, their long-term reliability has not been assessed systematically before. The present study aims to fill this gap by determining both internal consistency and long-term test-retest reliability of IHTTs produced by using the two different versions of the Poffenberger paradigm in a sample of 26 healthy subjects. The results show high reliability for the EEG Poffenberger paradigm. In contrast, reliability measures for the behavioral Poffenberger paradigm were low. Hence, our results indicate that electrophysiological measures of interhemispheric transfer are more reliable than behavioral measures; the later should be used with caution in research investigating inter-individual differences of neurocognitive measures. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Detection of delirium by nurses among long-term care residents with dementia

    OpenAIRE

    Voyer, Philippe; Richard, Sylvie; Doucet, Lise; Danjou, Christine; Carmichael, Pierre-Hugues

    2008-01-01

    Abstract Background Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected...

  15. Pediatric polytrauma : Short-term and long-term outcomes

    NARCIS (Netherlands)

    vanderSluis, CK; Kingma, J; Eisma, WH; tenDuis, HJ

    Objective: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. Materials and Methods: Ail pediatric polytrauma patients (Injury Severity Score of greater than or equal to 16, less than

  16. Suicide risk in long-term care facilities: a systematic review.

    Science.gov (United States)

    Mezuk, Briana; Rock, Andrew; Lohman, Matthew C; Choi, Moon

    2014-12-01

    Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Long-term competence restoration.

    Science.gov (United States)

    Morris, Douglas R; DeYoung, Nathaniel J

    2014-01-01

    While the United States Supreme Court's Jackson v. Indiana decision and most state statutes mandate determinations of incompetent defendants' restoration probabilities, courts and forensic clinicians continue to lack empirical evidence to guide these determinations and do not yet have a consensus regarding whether and under what circumstances incompetent defendants are restorable. The evidence base concerning the restoration likelihood of those defendants who fail initial restoration efforts is even further diminished and has largely gone unstudied. In this study, we examined the disposition of a cohort of defendants who underwent long-term competence restoration efforts (greater than six months) and identified factors related to whether these defendants were able to attain restoration and adjudicative success. Approximately two-thirds (n = 52) of the 81 individuals undergoing extended restoration efforts were eventually deemed restored to competence. Lengths of hospitalization until successful restoration are presented with implications for the reasonable length of time that restoration efforts should persist. Older individuals were less likely to be restored and successfully adjudicated, and individuals with more severe charges and greater factual legal understanding were more likely to be restored and adjudicated. The significance of these findings for courts and forensic clinicians is discussed.

  18. Long-term Impact of Weight Loss Intervention on Changes in Cognitive Function: Exploratory Analyses from the Action for Health in Diabetes Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Espeland, Mark A; Carmichael, Owen; Hayden, Kathleen; Neiberg, Rebecca H; Newman, Anne B; Keller, Jeffery N; Wadden, Thomas A; Rapp, Stephen R; Hill, James O; Horton, Edward S; Johnson, Karen C; Wagenknecht, Lynne; Wing, Rena R

    2018-03-14

    Diabetes adversely impacts cognition. Lifestyle change can improve diabetes control and potentially improve cognition. We examined whether weight loss through reduced caloric intake and increased physical activity was associated with slower cognitive aging in older adults with type 2 diabetes mellitus. The Look AHEAD randomized controlled clinical trial delivered 10 years of intensive lifestyle intervention (ILI) that yielded long-term weight losses. During 5 years spanning the end of intervention and postintervention follow-up, repeated cognitive assessments were obtained in 1,091 individuals who had been assigned to ILI or a control condition of diabetes support and education (DSE). We compared the means and slopes of scores on cognitive testing over these repeated assessments. Compared with DSE, assignment to ILI was associated with a -0.082 SD deficit in mean global cognitive function across repeated assessments (p = .010). However, overweight (body mass index [BMI] memory. The behavioral weight loss intervention was associated with small relative deficits in cognitive function among individuals who were obese and marginally greater cognitive decline overall compared to control. ClinicalTrials.gov Identifier: NCT00017953.

  19. New Zealand: long-term care in a decade of change.

    Science.gov (United States)

    Ashton, T

    2000-01-01

    Long-term care in New Zealand incorporates a mix of public and private funding and provision. After a decade of structural change, the purchasing of almost all publicly funded health and social care is now the responsibility of one central agency. Services for older persons are poorly integrated, and there are problems of access to and quality of some services. Efforts are being made to address these problems. The challenge now is to ensure that this groundwork is not lost amid the turmoil of yet another round of restructuring by an enthusiastic, newly elected government.

  20. Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains.

    Science.gov (United States)

    Slaug, Björn; Chiatti, Carlos; Oswald, Frank; Kaspar, Roman; Schmidt, Steven M

    2017-08-26

    The physical housing environment is important to facilitate activities of daily living (ADL) for older people. A hindering environment may lead to ADL dependence and thus increase the need for home services, which is individually restricting and a growing societal burden. This study presents simulations of policy changes with regard to housing accessibility that estimates the potential impact specifically on instrumental activities of daily living (I-ADL), usage of home services, and related costs. The models integrate empirical data to test the hypothesis that a policy providing funding to remove the five most severe environmental barriers in the homes of older people who are at risk of developing dependence in I-ADL, can maintain independence and reduce the need for home services. In addition to official statistics from state agencies in Sweden and Germany, we utilized published results from the ENABLE-AGE and other scientific studies to generate the simulations. The simulations predicted that new policies that remove potentially hindering housing features would improve I-ADL performance among older people and reduce the need for home services. Our findings suggest that a policy change can contribute to positive effects with regard to I-ADL independence among older people and to a reduction of societal burden.

  1. Long-term and baseline recreational physical activity and risk of endometrial cancer: the California Teachers Study.

    Science.gov (United States)

    Dieli-Conwright, C M; Ma, H; Lacey, J V; Henderson, K D; Neuhausen, S; Horn-Ross, P L; Deapen, D; Sullivan-Halley, J; Bernstein, L

    2013-08-06

    Physical activity may be associated with decreasing endometrial cancer risk; it remains unclear whether the association is modified by body size. Among 93 888 eligible California Teachers Study participants, 976 were diagnosed with incident endometrial cancer between 1995-1996 and 2007. Cox proportional hazards regression methods were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for endometrial cancer associated with long-term (high school through age 54 years) and baseline (3 years prior to joining the cohort) strenuous and moderate recreational physical activity, overall and by body size. Increased baseline strenuous recreational physical activity was associated with decreased endometrial cancer risk (Ptrend=0.006) with approximately 25% lower risk among women exercising >3 h per week per year than among those exercising activity was associated with lower risk among overweight/obese women. Increasing physical activity, particularly strenuous activity, may be a lifestyle change that overweight and obese women can implement to reduce their endometrial cancer risk.

  2. Long-Term Effect of Mediterranean-Style Diet and Calorie Restriction on Biomarkers of Longevity and Oxidative Stress in Overweight Men

    Directory of Open Access Journals (Sweden)

    Katherine Esposito

    2011-01-01

    Full Text Available We report the effects of a Mediterranean-style diet, with or without calorie restriction, on biomarkers of aging and oxidative stress in overweight men. 192 men were randomly assigned to either a Mediterranean-style diet or a conventional diet. The intervention program was based on implementation of a Mediterranean dietary pattern in the overweight group (MED diet group, associated with calorie restriction and increased physical activity in the obese group (lifestyle group. Both groups were compared with participants in two matched control groups (advice groups. After 2 years, there was a significant difference in weight loss between groups, which was −14 kg (95% CI −20 to −8 in lifestyle groups and −2.0 kg (−4.4 to 0 in the advice groups, with a difference of −11.9 kg (CI −19 to −4.7 kg, <.001; moreover, there was a significant difference between groups at 2 years for insulin (=.04, 8-iso-PGF2α (=.037, glucose (=.04, and adiponectin (=.01. Prolonged adherence to a Mediterranean-style diet, with or without caloric restriction, in overweight or obese men is associated with significant amelioration of multiple risk factors, including a better cardiovascular risk profile, reduced oxidative stress, and improved insulin sensitivity.

  3. Tracking of childhood overweight into adulthood: a systematic review of the literature.

    Science.gov (United States)

    Singh, A S; Mulder, C; Twisk, J W R; van Mechelen, W; Chinapaw, M J M

    2008-09-01

    Overweight and obesity in youth are important public health concerns and are of particular interest because of possible long-term associations with adult weight status and morbidity. The aim of this study was to systematically review the literature and update evidence concerning persistence of childhood overweight. A computerized bibliographical search--restricted to studies with a prospective or retrospective longitudinal design--was conducted. Two authors independently extracted data and assessed the methodological quality of the included studies in four dimensions (i) study population and participation rate; (ii) study attrition; (iii) data collection and (iv) data analysis. Conclusions were based on a rating system of three levels of evidence. A total of 25 publications were selected for inclusion in this review. According to a methodological quality assessment, 13 studies were considered to be of high quality. The majority of these high-quality studies were published after 2001, indicating that recently published data, in particular, provide us with reliable information. All included studies consistently report an increased risk of overweight and obese youth becoming overweight adults, suggesting that the likelihood of persistence of overweight into adulthood is moderate for overweight and obese youth. However, predictive values varied considerably. Limiting aspects with respect to generalizability and methodological issues are discussed.

  4. A randomised controlled intervention study investigating the efficacy of carotenoid-rich fruits and vegetables and extra-virgin olive oil on attenuating sarcopenic symptomology in overweight and obese older adults during energy intake restriction: protocol paper.

    Science.gov (United States)

    Villani, Anthony; Wright, Hattie; Slater, Gary; Buckley, Jonathan

    2018-01-05

    Weight loss interventions have not been advocated for overweight/obese older adults due to potential loss of skeletal muscle and strength impacting on physical function with potential loss of independence. Carotenoids and polyphenols are inversely associated with sarcopenic symptomology. This paper reports the protocol of a study evaluating the efficacy of a high-protein, energy restricted diet rich in carotenoids and polyphenols on body composition, muscle strength, physical performance and quality of life in overweight and obese older adults. This randomised controlled clinical trial will recruit community-dwelling, healthy overweight and obese older adults (≥60 years) for a 12-week weight loss intervention. Seventy-three participants will be recruited and randomized to an energy restricted (~30% restriction), isocaloric diet (30% protein; 30% carbohydrate; 40% fat) enriched with either: a) 375 g/d of high carotenoid vegetables, 300 g/d high carotenoid fruit, and 40-60 ml extra-virgin olive oil (EVOO); or b) 375 g/d of lower carotenoid vegetables, 300 g/d lower carotenoid fruit, and 40-60 ml Polyunsaturated fatty acid (PUFA) based oil. All participants will receive individual dietary counselling each fortnight for the duration of the study and will be asked to maintain their habitual level of physical activity throughout the study. The primary outcome will be appendicular skeletal muscle (ASM) assessed by dual energy X-ray absorptiometry (DXA). Secondary outcomes will include body weight, fat-free mass (FFM), fat mass (FM), muscle strength (Isometric hand-grip strength), physical performance (Short Physical Performance Battery), physical activity (International Physical Activity Questionnaire) and health related quality of life (SF-36). Outcomes will be measured at baseline and at week 12. The results of this study will provide a novel insight relating to the potential influence of high carotenoid and polyphenol intakes on attenuation of ASM during

  5. Notation of Depression in Case Records of Older Adults in Community Long-Term Care

    Science.gov (United States)

    Proctor, Enola K.

    2008-01-01

    Although significant numbers of social service clients experience mental health problems, virtually no research has examined the responsiveness of social service agencies to mental disorder. This article examines the extent to which client depression is reflected in records of a public social service agency, community long-term care (CLTC).…

  6. Academic skills in the long term after epilepsy surgery in childhood.

    Science.gov (United States)

    Puka, Klajdi; Smith, Mary Lou

    2016-09-01

    We evaluated the progression of academic skills in a cohort of patients who underwent, or were considered for, epilepsy surgery in childhood, four to eleven years before. The few existing studies that have evaluated cognitive function in the long term after surgery have examined intelligence and memory. Participants were 97 patients with childhood-onset intractable epilepsy; 61 had undergone resective epilepsy surgery. Participants completed standardized tests of reading, spelling, arithmetic, and intelligence at baseline and, on average, 7years after. Surgical patients were additionally assessed one year postsurgery. At baseline and long-term follow-up, 61% and 69% of patients, respectively, scored at least one standard deviation below normative data in at least one academic domain. Evaluation of change over time while controlling for IQ showed that arithmetic scores were lower at long-term follow-up in comparison with those at baseline among all patient groups, whereas reading and spelling scores remained unchanged. Few advantages were associated with seizure control. Multiple regression analyses found that older age at surgery, cessation of antiepileptic medications, improved IQ, and low baseline scores were independently associated with improvement in some academic domains among all patient groups. We found that arithmetic scores were lower at long-term follow-up, suggesting a lack of ongoing development or deterioration in skills. Reading and spelling scores remained stable suggesting that patients made gains in abilities at a rate expected for their increase in age; this finding contrasts with recent short-term outcome studies identifying significantly lower scores over time in these areas. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Near-Term Actions to Address Long-Term Climate Risk

    Science.gov (United States)

    Lempert, R. J.

    2014-12-01

    Addressing climate change requires effective long-term policy making, which occurs when reflecting on potential events decades or more in the future causes policy makers to choose near-term actions different than those they would otherwise pursue. Contrary to some expectations, policy makers do sometimes make such long-term decisions, but not as commonly and successfully as climate change may require. In recent years however, the new capabilities of analytic decision support tools, combined with improved understanding of cognitive and organizational behaviors, has significantly improved the methods available for organizations to manage longer-term climate risks. In particular, these tools allow decision makers to understand what near-term actions consistently contribute to achieving both short- and long-term societal goals, even in the face of deep uncertainty regarding the long-term future. This talk will describe applications of these approaches for infrastructure, water, and flood risk management planning, as well as studies of how near-term choices about policy architectures can affect long-term greenhouse gas emission reduction pathways.

  8. Children With Morbid Obesity Benefit Equally as Children With Overweight and Obesity From an Ongoing Care Program.

    Science.gov (United States)

    Rijks, J M; Plat, J; Mensink, R P; Dorenbos, E; Buurman, W A; Vreugdenhil, A C E

    2015-09-01

    Despite stabilization of childhood overweight and obesity prevalence, there is a shift toward more severe degrees of obesity, which results in an increasing prevalence of children with morbid obesity. Prior studies demonstrated that lifestyle modification without ongoing treatment has only a modest and not sustainable effect in children with morbid obesity. This suggests that a chronic care model is necessary for long-term effects on weight management and health. This study aimed to evaluate the effect of an ongoing lifestyle intervention in children with morbid obesity in comparison with children with overweight and obesity. This was a nonrandomized prospective intervention study with 12- and 24-month followup at the Centre for Overweight Adolescent and Children's Healthcare. Children and adolescents (n = 100 females and 72 males) with overweight, obesity, or morbid obesity were given long-term, outpatient, tailored lifestyle intervention. Body mass index (BMI) z score was measured. In children with morbid obesity, 12- and 24-month interventions resulted in a decrease of BMI z score of -0.13 ± 0.25 (P = .001) and -0.23 ± 0.32 (P = .01) respectively, whereas weight status category improved to obese in 21% and 25% of the children. Cardiovascular risk parameters including serum total cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin (HbA1c), and diastolic blood pressure significantly improved after 1-year intervention in the complete group. Most important, BMI z score as well as cardiovascular risk parameters improved to a similar degree in children with overweight, obesity, and morbid obesity. Children with overweight, obesity, and morbid obesity benefit equally from an ongoing, outpatient, tailored lifestyle intervention, and demonstrate significant weight loss and improvement of cardiovascular risk parameters.

  9. Long Term Financing of Infrastructure

    OpenAIRE

    Sinha, Sidharth

    2014-01-01

    Infrastructure projects, given their long life, require long term financing. The main sources of long term financings are insurance and pension funds who seek long term investments with low credit risk. However, in India household financial savings are mainly invested in bank deposits. Insurance and pension funds account for only a small percentage of household financial savings. In addition most infrastructure projects do not qualify for investment by insurance and pension funds because of t...

  10. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P; Gao, B [Powertech Labs. Inc., Surrey, BC (Canada)

    1994-12-31

    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  11. Occupational sitting time and overweight and obesity in Australian workers.

    Science.gov (United States)

    Mummery, W Kerry; Schofield, Grant M; Steele, Rebekah; Eakin, Elizabeth G; Brown, Wendy J

    2005-08-01

    One of the major immediate and long-term health issues in modern society is the problem of overweight and obesity. This paper examines the role of the workplace in the problem by studying the association between occupational sitting time and overweight and obesity (body mass index [BMI] > or =25) in a sample of adult Australians in full-time employment. Data on age, gender, occupation, physical activity, occupational sitting time, and BMI were collected in September 2003 from a sample of 1579 adult men and women in full-time employment at the time of the survey. Logistic regression was used to examine the association between occupational sitting time and overweight and obesity. Mean occupational sitting time was >3 hours/day, and significantly higher in men (209 minutes) than in women (189 minutes, p=0.026). Univariate analyses showed significant associations between occupational sitting time and BMI of > or =25 in men but not in women. After adjusting for age, occupation, and physical activity, the odds ratio for BMI > or =25 was 1.92 (confidence interval: 1.17-3.17) in men who reported sitting for >6 hours/day, compared with those who sat for workplace may play an important role in the growing problem of overweight and obesity. Further research is needed to clearly understand the association between sitting time at work and overweight and obesity in women.

  12. Percutaneous transluminal angioplasty of malfunctioning Brescia-Cimino arteriovenous fistula: analysis of factors adversely affecting long-term patency

    International Nuclear Information System (INIS)

    Sugimoto, Koji; Hirota, Shozo; Sugimura, Kazuro; Higashino, Takanori; Kuwata, Yoichiro; Imanaka, Kazufumi

    2003-01-01

    Our objective was to identify the factors adversely affecting long-term patency after percutaneous transluminal angioplasty (PTA) for hemodialysis Brescia-Cimino arteriovenous fistulas. Between November 1995 and March 2000, 91 PTA procedures were performed on 50 patients with 57 Brescia-Cimino fistulas. A retrospective study based on the chart review was performed. The initial technical success rate for all procedures and the primary and secondary patency rates for all fistulas were calculated. Regarding fistulas successfully maintained by the primary PTA, the primary and secondary patency rates were compared using the Kaplan-Meier method between two patient groups. They were classified on the basis of several factors, including age (older, over 70 years, and younger group), age of the fistulas (older, over 6 months, and younger group), with or without diabetes mellitus (DM), solitary or multiple lesions, long or short segment lesion, stenosis or occlusion, and with or without arterial and/or anastomotic lesions. Initial technical success rates for all procedures and fistulas were 91.2 and 89.5%, respectively. Cumulative primary and secondary patency rates at 1 year were 47.3 and 67.3%, respectively. In the comparative study, the secondary patency rate for the older group was lower than that of the younger group with statistical significance (p =0.029). The higher age is the only factor that reduces the long-term patency rate after PTA. (orig.)

  13. Patient function, long-term survival, and use of surgery in patients with kidney cancer.

    Science.gov (United States)

    Tan, Hung-Jui; Chamie, Karim; Daskivich, Timothy J; Litwin, Mark S; Hu, Jim C

    2016-12-15

    Beyond age and comorbidity, functionality can shape the long-term survival potential of patients with cancer. Accordingly, herein the authors compared mortality and receipt of cancer-directed surgery according to patient function among older adults with kidney cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 through 2009, the authors studied 28,326 elderly subjects with primary kidney cancer. Patient function was quantified using function-related indicators, claims indicative of dysfunction and disability. Adjusting for patient and cancer characteristics, competing risk regression was used to assess the relationship between function-related indicator count and cause-specific mortality and then generalized estimating equations were used to quantify the probability of surgery. A total of 13,619 adult patients (48.1%) with at least 1 function-related indicator were identified. A higher indicator category was associated with older age, greater comorbidity, female sex, unmarried status, lower socioeconomic status, and higher stage of disease (Pkidney cancer mortality varied minimally with patient function. Patients with ≥ 2 indicators received cancer-directed surgery less often than those without disability (odds ratio, 0.61; 95% CI, 0.56-0.66), although treatment probabilities remained high for patients with locoregional disease and low for those with metastatic cancer. Among older adults with kidney cancer, functional health stands as a significant predictor of long-term survival. However, receipt of cancer-directed surgery appears largely determined by cancer stage. Patient function should be considered more heavily when determining treatment for older adults with kidney cancer. Cancer 2016;122:3776-3784. © 2016 American Cancer Society. © 2016 American Cancer Society.

  14. Productivity loss due to overweight and obesity: a systematic review of indirect costs.

    Science.gov (United States)

    Goettler, Andrea; Grosse, Anna; Sonntag, Diana

    2017-10-05

    The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity. A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality. Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies. The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial.

    Science.gov (United States)

    Anton, Stephen D; Manini, Todd M; Milsom, Vanessa A; Dubyak, Pamela; Cesari, Matteo; Cheng, Jing; Daniels, Michael J; Marsiske, Michael; Pahor, Marco; Leeuwenburgh, Christiaan; Perri, Michael G

    2011-01-01

    Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults. Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight, sedentary, older adults. This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese, older adult women. Participants (N = 34) were generally healthy, obese, older adult women (age range 55-79 years) with mild to moderate physical impairments (ie, functional limitations). Participants were randomly assigned to one of two groups for 24 weeks: (i) weight loss plus exercise (WL+E; n = 17; mean age = 63.7 years [4.5]) or (ii) educational control (n = 17; mean age = 63.7 [6.7]). In the WL+E group, participants attended a group-based weight management session plus three supervised exercise sessions within their community each week. During exercise sessions, participants engaged in brisk walking and lower-body resistance training of moderate intensity. Participants in the educational control group attended monthly health education lectures on topics relevant to older adults. Outcomes were: (i) body weight, (ii) walking speed (assessed by 400-meter walk test), (iii) the Short Physical Performance Battery (SPPB), and (iv) knee extension isokinetic strength. Participants randomized to the WL+E group lost significantly more weight than participants in the educational control group (5.95 [0.992] vs 0.23 [0.99] kg; P meter walk test = 44 seconds; P < 0.05). Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test (P < 0.05), with significant differences between groups (P = 0.02). Knee extension strength was maintained in both groups. Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle

  16. Association between Obesity and Serum 25(OH)D Concentrations in Older Mexican Adults.

    Science.gov (United States)

    Rontoyanni, Victoria G; Avila, Jaqueline C; Kaul, Sapna; Wong, Rebeca; Veeranki, Sreenivas P

    2017-01-31

    Vitamin D is essential for maintaining bone mineralization and calcium homeostasis, and prevents falls and fractures in older adults. Mexico is undergoing an epidemiologic and demographic transition with increasing obesity rates. The study's aim was to determine the association of obesity with serum 25-hydroxyvitamin D [25(OH)D] concentrations in older Mexican adults. Data from 1772 Mexicans, aged ≥50 years, enrolled in a sub-sample of the 3rd wave of the Mexican Health and Aging Study, were included. Serum 25(OH)D concentrations were used to define vitamin D status, and were categorized into tertiles. Body mass index measures were used to categorize older adults into under/normal weight, overweight, and obese groups. Multinomial logistic regression models were used to assess the relationship, adjusting for potential confounders. Approximately 40% and 37% of older Mexican adults were either overweight or obese, respectively. Compared to under/normal weight older Mexicans, obese adults were 1.78 times (95% Confidence Interval (CI) 1.27-2.48) and 1.94 times (95% CI 1.40-2.68) more associated with the first and second tertile concentrations of serum 25(OH)D, respectively. Overweight adults were 1.52 times (95% CI 1.12-2.06) more associated with the second tertile of serum 25(OH)D concentration than under/normal weight adults. Overweight/Obesity was found to be significantly associated with low concentrations of serum 25(OH) in older Mexican adults.

  17. Regulatory components for treating persistent pain in long-term care.

    Science.gov (United States)

    Planton, Jonathan; Edlund, Barbara J

    2010-04-01

    Persistent or chronic pain is frequently reported by older adults and has the potential to dramatically influence quality of life. Estimates indicate that 25% to 50% of community-dwelling older adults experience this kind of pain. This rate is even higher in long-term care facilities, where 50% to 75% of residents have chronic pain syndromes that are untreated or undertreated. To promote optimal pain management and enumerate the responsibilities of skilled nursing facilities to effectively treat and prevent pain, the Centers for Medicare & Medicaid Services released a new pain management surveyor guidance, F-Tag 309, which endorses the presence of an interdisciplinary team approach to pain management that involves the resident. The guidance delineates pain management principles, the need for ongoing professional education in all components of pain management, and emphasizes the important role of appropriate pharmacological treatment in conjunction with nonpharmacological interventions to aggressively manage pain. This directive will help skilled nursing facilities achieve optimal pain management for their residents. Copyright 2010, SLACK Incorporated.

  18. Number of siblings, birth order, and childhood overweight: a population-based cross-sectional study in Japan

    Directory of Open Access Journals (Sweden)

    Ochiai Hirotaka

    2012-09-01

    Full Text Available Abstract Background Although several studies have investigated the relationship between the number of siblings or birth order and childhood overweight, the results are inconsistent. In addition, little is known about the impact of having older or younger siblings on overweight among elementary schoolchildren. The present population-based study investigated the relationship of the number of siblings and birth order with childhood overweight and evaluated the impact of having younger or older siblings on childhood overweight among elementary schoolchildren in Japan. Methods Subjects comprised fourth-grade schoolchildren (age, 9–10 years in Ina Town during 1999–2009. Information about subjects’ sex, age, birth weight, birth order, number of siblings, lifestyle, and parents’ age, height, and weight was collected by a self-administered questionnaire, while measurements of subjects’ height and weight were done at school. Childhood overweight was defined according to age- and sex-specific cut-off points proposed by the International Obesity Task Force. A logistic regression model was used to calculate the odds ratio (OR and 95% confidence intervals (95% CI of "number of siblings" or "birth order" for overweight. Results Data from 4026 children were analyzed. Only children (OR: 2.13, 95% CI: 1.45-3.14 and youngest children (1.56, 1.13-2.16 significantly increased ORs for overweight compared with middle children. A larger number of siblings decreased the OR for overweight (P for trend P for trend  Conclusions Being an only or youngest child was associated with childhood overweight, and having a larger number of younger siblings was negatively associated with overweight. The present study suggests that public health interventions to prevent childhood overweight need to focus on children from these family backgrounds.

  19. The Low Fall as a Surrogate Marker of Frailty Predicts Long-Term Mortality in Older Trauma Patients.

    Directory of Open Access Journals (Sweden)

    Ting Hway Wong

    Full Text Available Frailty is associated with adverse outcomes including disability, mortality and risk of falls. Trauma registries capture a broad range of injuries. However, frail patients who fall comprise a large proportion of the injuries occurring in ageing populations and are likely to have different outcomes compared to non-frail injured patients. The effect of frail fallers on mortality is under-explored but potentially significant. Currently, many trauma registries define low falls as less than three metres, a height that is likely to include non-frailty falls. We hypothesized that the low fall from less than 0.5 metres, including same-level falls, is a surrogate marker of frailty and predicts long-term mortality in older trauma patients.Using data from the Singapore National Trauma Registry, 2011-2013, matched till September 2014 to the death registry, we analysed adults aged over 45 admitted via the emergency department in public hospitals sustaining blunt injuries with an injury severity score (ISS of 9 or more, excluding isolated hip fractures from same-level falls in the over 65. Patients injured by a low fall were compared to patients injured by high fall and other blunt mechanisms. Logistic regression was used to analyze 12-month mortality, controlling for mechanism of injury, ISS, revised trauma score (RTS, co-morbidities, gender, age and age-gender interaction. Different low fall height definitions, adjusting for injury regions, and analyzing the entire adult cohort were used in sensitivity analyses and did not change our findings.Of the 8111 adults in our cohort, patients who suffered low falls were more likely to die of causes unrelated to their injuries (p<0.001, compared to other blunt trauma and higher fall heights. They were at higher risk of 12-month mortality (OR 1.75, 95% CI 1.18-2.58, p = 0.005, independent of ISS, RTS, age, gender, age-gender interaction and co-morbidities. Falls that were higher than 0.5m did not show this pattern

  20. Local variability in long-term care services: local autonomy, exogenous influences and policy spillovers.

    Science.gov (United States)

    Fernandez, José-Luis; Forder, Julien

    2015-03-01

    In many countries, public responsibility over the funding and provision of long-term care services is held at the local level. In such systems, long-term care provision is often characterised by significant local variability. Using a panel dataset of local authorities over the period 2002-2012, the paper investigates the underlying causes of variation in gross social care expenditure for older people in England. The analysis distinguishes between factors outside the direct control of policy makers, local preferences and local policy spillovers. The results indicate that local demand and supply factors, and to a much lesser extent local political preferences and spatial policy spillovers, explain a large majority of the observed variation in expenditure. Copyright © 2015 John Wiley & Sons, Ltd.

  1. Long-term urethral catheterisation.

    Science.gov (United States)

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  2. A Diffusion Model Analysis of Adult Age Differences in Episodic and Semantic Long-Term Memory Retrieval

    Science.gov (United States)

    Spaniol, Julia; Madden, David J.; Voss, Andreas

    2006-01-01

    Two experiments investigated adult age differences in episodic and semantic long-term memory tasks, as a test of the hypothesis of specific age-related decline in context memory. Older adults were slower and exhibited lower episodic accuracy than younger adults. Fits of the diffusion model (R. Ratcliff, 1978) revealed age-related increases in…

  3. Long term mortality study of chromate pigment workers who suffered lead poisoning

    Energy Technology Data Exchange (ETDEWEB)

    Davies, J.M.

    1984-05-01

    Long term mortality was studied in a group of 57 chromate pigment workers who suffered clinical lead poisoning, mostly between 1930 and 1945. One death was attributed to lead poisoning and there were significant excesses of deaths from nephritis (observed/expected 3/0.24) and cerebrovascular disease (9/2.20), as well as non-significant excesses for respiratory diseases (7/3.59) and accidents and violence (3/1.13). The deaths from nephritis followed long spells of service exceeding 10 years. Poisoning appeared to have more adverse long term effects on older workers: 15 men aged 40 or over at the time of acute poisoning experienced generally high mortality, and 30 years later or by the end of 1981 only two survived instead of the seven expected. The risk of cerebrovascular disease appeared to be unrelated to duration of exposure and affected even men employed for under one year. Excluding the 57 lead poisoned men, other contemporary workers at the factories showed no excess mortality from cerebrovascular disease.

  4. A self-efficacy education programme on foot self-care behaviour among older patients with diabetes in a public long-term care institution, Malaysia: a Quasi-experimental Pilot Study.

    Science.gov (United States)

    Sharoni, Siti Khuzaimah Ahmad; Abdul Rahman, Hejar; Minhat, Halimatus Sakdiah; Shariff Ghazali, Sazlina; Azman Ong, Mohd Hanafi

    2017-06-08

    A pilot self-efficacy education programme was conducted to assess the feasibility, acceptability and potential impact of the self-efficacy education programme on improving foot self-care behaviour among older patients with diabetes in a public long-term care institution. A prequasi-experimental and postquasi-experimental study was conducted in a public long-term care institution in Selangor, Malaysia. Patients with diabetes aged 60 years and above who fulfilled the selection criteria were invited to participate in this programme. Four self-efficacy information sources; performance accomplishments, vicarious experience, verbal persuasion and physiological information were translated into programme interventions. The programme consisted of four visits over a 12-week period. The first visit included screening and baseline assessment and the second visit involved 30 min of group seminar presentation. The third and fourth visits entailed a 20-min one-to-one follow-up discussion and evaluation. A series of visits to the respondents was conducted throughout the programme. The primary outcome was foot self-care behaviour. Foot self-efficacy (efficacy-expectation), foot care outcome expectation, knowledge of foot care, quality of life, fasting blood glucose and foot condition were secondary outcomes. Data were analysed with descriptive and inferential statistics (McNemar's test and Wilcoxon signed-rank test) using the Statistical Package for the Social Sciences V.20.0. Fifty-two residents were recruited but only 31 met the inclusion criteria and were included in the analysis at baseline and at 12 weeks postintervention. The acceptability rate was moderately high. At postintervention, foot self-care behaviour (p<0.001), foot self-efficacy (efficacy-expectation), (p<0.001), foot care outcome expectation (p<0.001), knowledge of foot care (p<0.001), quality of life (physical symptoms) (p=0.003), fasting blood glucose (p=0.010), foot hygiene (p=0.030) and anhydrosis (p=0

  5. Clinical Risk Factors for Head Impact During Falls in Older Adults: A Prospective Cohort Study in Long-Term Care.

    Science.gov (United States)

    Yang, Yijian; Mackey, Dawn C; Liu-Ambrose, Teresa; Leung, Pet-Ming; Feldman, Fabio; Robinovitch, Stephen N

    To examine risk factors associated with head impact during falls in older adults in long-term care (LTC). Two LTC facilities in British Columbia, Canada. 160 LTC residents. Prospective cohort study. Between 2007 and 2014, we video captured 520 falls experienced by participants. Each fall video was analyzed to determine whether impact occurred to the head. Using generalized estimating equation models, we examined how head impact was associated with other fall characteristics and health status prior to the fall. Head impact occurred in 33% of falls. Individuals with mild cognitive impairment were at higher risk for head impact (odds ratio = 2.8; 95% confidence interval, 1.5-5.0) than those with more severe cognitive impairment. Impaired vision was associated with 2.0-fold (1.3-3.0) higher odds of head impact. Women were 2.2 times (1.4-3.3) more likely than men to impact their head during a fall. Head impact is common during falls in LTC, with less cognitively impaired, female residents who suffered from visual impairment, being most likely to impact their head. Future research should focus on improving our ability to detect neural consequences of head impact and evaluating the effect of interventions for reducing the risk for fall-related head injuries in LTC.

  6. Association of long-term patterns of depressive symptoms and attention/executive function among older men with and without human immunodeficiency virus.

    Science.gov (United States)

    Armstrong, Nicole M; Surkan, Pamela J; Treisman, Glenn J; Sacktor, Ned C; Irwin, Michael R; Teplin, Linda A; Stall, Ron; Martin, Eileen M; Becker, James T; Munro, Cynthia; Levine, Andrew J; Jacobson, Lisa P; Abraham, Alison G

    2017-08-01

    Older HIV-infected men are at higher risk for both depression and cognitive impairments, compared to HIV-uninfected men. We evaluated the association between longitudinal patterns of depressive symptoms and attention/executive function in HIV-infected and HIV-uninfected men aged 50+ years to understand whether HIV infection influenced the long-term effect of depression on attention/executive function. Responses to the Center for Epidemiologic Studies-Depression scale and attention/executive function tests (Trail Making Test Part B and Symbol Digit Modalities Test) were collected semiannually from May 1986 to April 2015 in 1611 men. Group-based trajectory models, stratified by HIV status, were used to identify latent patterns of depressive symptoms and attention/executive function across 12 years of follow-up. We identified three depression patterns for HIV-infected and HIV-uninfected men (rare/never 50.0 vs. 60.6%, periodically depressed 29.6 vs. 24.5%, chronic high 20.5 vs.15.0%, respectively) and three patterns of attention/executive function for HIV-infected and HIV-uninfected men (worst-performing 47.4 vs. 45.1%; average 41.9 vs. 47.0%; best-performing 10.7 vs. 8.0%, respectively). Multivariable logistic regression models were used to assess associations between depression patterns and worst-performing attention/executive function. Among HIV-uninfected men, those in the periodically depressed and chronic high depressed groups had higher odds of membership in the worst-performing attention/executive function group (adjusted odds ratio [AOR] = 1.45, 95% CI 1.04, 2.03; AOR = 2.25, 95% CI 1.49, 3.39, respectively). Among HIV-infected men, patterns of depression symptoms were not associated with patterns of attention/executive function. Results suggest that HIV-uninfected, but not HIV-infected, men with chronic high depression are more likely to experience a long-term pattern of attention/executive dysfunction.

  7. Survey of prevalence of overweight body condition in laboratory-housed cynomolgus macaques (Macaca fascicularis).

    Science.gov (United States)

    Bauer, Sharon A; Leslie, Ken E; Pearl, David L; Fournier, Jocelyn; Turner, Patricia V

    2010-07-01

    Excessive weight gain has been reported to occur in captive cynomolgus macaques with little to no change in diet. Overweight body condition can result in development of hyperglycemia and type 2 diabetes and should be avoided. The purpose of this survey was to assess the prevalence of overweight cynomolgus macaques in North American research facilities, including breeding colonies and short-term and long-term facilities, and to describe current methods used to assess body condition. The survey consisted of 51 questions covering animal population demographics, body weight and body condition scoring, feeding, and behavior. Voluntary participants included veterinarians and animal care managers. Respondents from 13 facilities completed the survey, and information was collected on 17,500 cynomolgus macaques. The majority of surveyed facilities housed juvenile and young adult macaques. The reported prevalence of overweight (greater than 10% of ideal body weight) animals ranged between 0% and 20% and reportedly was more frequent in animals younger than 10 y. Most facilities had weight reduction strategies in place. Despite these programs, a significant proportion of animals were reported as being overweight. The results of this survey demonstrate that most North American facilities housing cynomolgus macaques recognize the importance of tracking body condition regularly. However, implementing effective weight reduction programs may be difficult in captive housing environments. Because of the potential for adverse health effects, facilities should have a means of regularly tracking body weight as well as an action plan for managing overweight animals.

  8. Long-term associative learning predicts verbal short-term memory performance.

    Science.gov (United States)

    Jones, Gary; Macken, Bill

    2018-02-01

    Studies using tests such as digit span and nonword repetition have implicated short-term memory across a range of developmental domains. Such tests ostensibly assess specialized processes for the short-term manipulation and maintenance of information that are often argued to enable long-term learning. However, there is considerable evidence for an influence of long-term linguistic learning on performance in short-term memory tasks that brings into question the role of a specialized short-term memory system separate from long-term knowledge. Using natural language corpora, we show experimentally and computationally that performance on three widely used measures of short-term memory (digit span, nonword repetition, and sentence recall) can be predicted from simple associative learning operating on the linguistic environment to which a typical child may have been exposed. The findings support the broad view that short-term verbal memory performance reflects the application of long-term language knowledge to the experimental setting.

  9. Older patients with inoperable non-small cell lung cancer. Long-term survival after concurrent chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Semrau, Sabine; Fietkau, Rainer [Friedrich-Alexander-University Erlangen-Nuernberg, Department of Radiation Oncology, Erlangen (Germany); Zettl, Heike [Rostock Cancer Registry University of Rostock, Rostock (Germany); Hildebrandt, Guido [University of Rostock, Department of Radiation Therapy, Rostock (Germany); Klautke, Gunther [Klinikum Chemnitz, Department of Radiation Therapy, Chemnitz (Germany)

    2014-12-15

    Considering the various comorbidities associated with aging, the feasibility and usefulness of concurrent chemoradiotherapy (CRT) in older patients with inoperable non-small cell lung cancer (NSCLC) is a controversial issue. Here, we compared the feasibility of CRT and the effects of various comorbidities on the prognosis of a minimally selected population of inoperable NSCLC patients aged 60-77 years. The study comprised 161 patients with inoperable NSCLC who received CRT with a target radiation dose greater than 60 Gy and platinum-based chemotherapy from 1998 to 2007. The total population included 69 patients aged 60-69 years and 53 aged 70-77 years. These two age cohorts were included in the study with a follow-up of a median 14.5 months. The two groups showed no differences in long-term survival, as reflected by the 5-year survival rates of 13.0 ± 4.1 % (60- to 69-year-olds) and 14.4 ± 4.9 % (70- to 77-year-olds). During the treatment phase, the groups were comparable in terms of toxicity and the feasibility of chemotherapy. Compared to patients in their 60s, the septuagenarians had more pulmonary comorbidities (p = 0.02), diabetes mellitus (p = 0.04), cardiac comorbidities (p = 0.08), and previous cancer disease (p = 0.08) that exerted a negative effect on survival. In patients without comorbidities, there were no differences between the age groups. Age is not a contraindication for concurrent CRT per se, because elderly patients do not have a worse long-term prognosis than younger seniors. However, ''elderly patients'' (≥ 70-77 years) have more concomitant diseases associated with shorter survival than ''moderately aged patients'' (≥ 60-69 years). (orig.) [German] Hinsichtlich der verschiedenen altersbedingten Komorbiditaeten werden die Durchfuehrbarkeit und der Nutzen einer simultanen Chemoradiotherapie (''concurrent chemoradiotherapy'', CRT) bei alten Patienten mit einem inoperablen nicht

  10. Altered methylation and expression of ER-associated degradation factors in long-term alcohol and constitutive ER stress-induced murine hepatic tumors

    Directory of Open Access Journals (Sweden)

    Hui eHan

    2013-10-01

    Full Text Available Mortality from liver cancer in humans is increasingly attributable to heavy or long-term alcohol consumption. The mechanisms by which alcohol exerts its carcinogenic effect are not well understood. In this study, the role of alcohol-induced endoplasmic reticulum (ER stress response in liver cancer development was investigated using an animal model with a liver knockout of the chaperone BiP and under constitutive hepatic ER stress. Long-term alcohol and high fat diet (HFD feeding resulted in higher levels of serum alanine aminotransferase (ALT, impaired ER stress response, and higher incidence of liver tumor in older (aged 16 months knockout females than in either middle-aged (6 months knockouts or older (aged 16 months wild type females. In the older knockout females, stronger effects of the alcohol on methylation of CpG islands at promoter regions of genes involved in the ER associated degradation (ERAD were also detected. Altered expression of ERAD factors including derlin 3, Creld2 (cysteine-rich with EGF-like domains 2, Herpud1 (ubiquitin-like domain member, Wfs1 (wolfram syndrome gene, and Yod1 (deubiquinating enzyme 1 was co-present with decreased proteasome activities, increased estrogen receptor alpha variant (ERa36, and enhanced phosphorylations of ERK1/2 (extracellular signal-regulated protein kinases 1 and 2 and STAT3 (the signal transducers and activators of transcription in the older knockout female fed alcohol. Our results suggest that long-term alcohol consumption and ageing may promote liver tumorigenesis in females through interfering with DNA methylation and expression of genes involved in the ER associated degradation.

  11. Long-term glucocorticoid concentrations as a risk factor for childhood obesity and adverse body-fat distribution.

    Science.gov (United States)

    Noppe, G; van den Akker, E L T; de Rijke, Y B; Koper, J W; Jaddoe, V W; van Rossum, E F C

    2016-10-01

    Childhood obesity is an important risk factor for premature development of the metabolic syndrome (MetS) at adulthood. There is need for understanding of the mechanisms underlying the MetS and obesity. Patients with Cushing's disease suffer from similar metabolic complications, leading to the hypothesis that inter-individual cortisol variation may contribute to the onset of obesity. In addition, glucocorticoid receptor (GR)-gene polymorphisms resulting in differential glucocorticoid (GC) sensitivity, have been associated with an adverse metabolic profile. To study associations of GC levels in scalp hair, as a marker of long-term systemic GC concentrations, and genetically determined GC sensitivity with obesity and body-fat distribution in children. We performed a cross-sectional study of cortisol and cortisone concentrations over a 3-month period, measured by LC-MS/MS (Liquid Chromatography Tandem Mass Spectrometry) in hair of 3019 6-year-old children participating in the Generation R study. Genotyping of GR-gene polymorphisms was performed. Of all children, 4.3% was obese and 13.4% overweight. Cortisol was significantly associated with risk of obesity (odd ratio (OR): 9.4 (3.3-26.9)) and overweight (OR: 1.4 (1.0-2.0)). Cortisone was associated with risk of obesity (OR: 1.9 (1.0-3.5)). Cortisol and cortisone were significantly positively associated with body mass index, fat mass (FM) index and android/gynecoid FM ratio. GR polymorphisms were not associated with adiposity parameters. Long-term cortisol concentrations are strongly associated with an increased risk of childhood obesity and adverse body-fat distribution. Future research may reveal whether these are causal relations and may be a target for therapy.

  12. Associations of moderate and severe overweight with self-reported illness and medical care in Dutch adults

    NARCIS (Netherlands)

    Seidell, J C; de Groot, L.C.; van Sonsbeek, J L; Deurenberg, P.; Hautvast, J.G.A.J.

    Data on height, weight, illness, medical care consumption, and demographic variables for 19,126 Dutch adults aged 20 years or older were obtained from three annual Health Interview Surveys. Data on severely overweight (Body Mass Index 30.0-40.0 kg/m2) and moderately overweight (BMI 25.0-29.9 kg/m2)

  13. Drivers for successful long-term lifestyle change, the role of e-health

    DEFF Research Database (Denmark)

    Brandt, Carl Joakim; Clemensen, Jane; Nielsen, Jesper Bo

    2018-01-01

    Objectives Assisting patients in lifestyle change using collaborative e-health tools can be an efficient treatment for non-communicable diseases like diabetes, cardiovascular disease and chronic obstructive lung disease that are caused or aggravated by unhealthy living in the form of unhealthy diet......, physical inactivity or tobacco smoking. In a prospective pilot study, we tested an online collaborative e-health tool in general practice. The aim of this study was to identify drivers of importance for long-term personal lifestyle changes from a patient perspective when using a collaborative e-health tool......, including the support of peers and healthcare professionals. Setting General practice clinics in the Region of Southern Denmark. Participants 10 overweight patients who had previously successfully used a hybrid online collaborative e-health tool with both face-to-face and online consultations to lose weight...

  14. Unemployment and Long-Term Unemployment of Immigrants in Croatia

    Directory of Open Access Journals (Sweden)

    Valerija Botrić

    2016-04-01

    older than 55 (in comparison to 35‒44 negative predictors: skilled agricultural, forestry and fishery workers and male persons. The analysis for the 2012 (crisis year has identified the following significant predictors of unemployment status for immigrants in Croatia, listed in the decreasing marginal effects order: positive predictors: elementary occupations, plant and machine operators, persons aged 15‒24 (in comparison to the reference age cohort 35‒44, craft and related trade workers, service and sales workers, persons older than 55 (in comparison to the reference age cohort; negative predictors: skilled agricultural, forestry and fishery workers and persons living in urban areas. The analysis has revealed that traditional predictors of labour market outcome status have also been significant for the immigrant population in Croatia. It also reveals that they change over time. The occupation of the immigrant is more important in the crisis, which is probably related to the adverse demand effects of specific economic activities. Additionally, age has gained increased importance in the crisis, which is similar to the experiences of the domicile population. The second segment of the analysis was focused on long-term unemployment. Unemployment is considered to be short-term if the person is in that status for less than a year (in accordance with the long-term unemployment definition used by the Eurostat and very long-term if the person is in that status for more than two years. Descriptive statistics reveals that there is a higher share of persons with lower secondary education in the long-term unemployment sample, while the highest share, regardless of the duration of the unemployment, is reserved for upper secondary education. The data also reveal that the share of unemployed immigrants registered as unemployed at the public employment service increased in the crisis year, regardless of the duration of the unemployment. It is also interesting to note that the

  15. Relationship Between Depressive Symptoms and Social Cognitive Processing in Partners of Long-Term Breast Cancer Survivors.

    Science.gov (United States)

    Cohee, Andrea A; Adams, Rebecca N; Fife, Betsy L; Von Ah, Diane M; Monahan, Patrick O; Zoppi, Kathleen A; Cella, David; Champion, Victoria L

    2017-01-01

    To determine (a) if depressive symptoms in partners of long-term breast cancer survivors (BCSs) could be predicted by social cognitive processing theory and (b) if partners of younger and older BCSs were differentially affected by the cancer experience.
. A cross-sectional, descriptive study using self-report questionnaires.
. Indiana University in Bloomington and 97 ECOG-ACRIN Cancer Research Group sites in the United States.
. 508 partners of BCSs diagnosed three to eight years prior to the study. 
. Secondary data mediation analyses were conducted to determine if cognitive processing mediated the relationship between social constraints and depressive symptoms. Age-related differences on all scales were tested.
. Depressive symptoms; secondary variables included social constraints, cognitive processing (avoidance and intrusive thoughts), and potentially confounding variables.
. Cognitive processing mediated the relationship between social constraints and depressive symptoms for partners. Partners of younger BCSs reported worse outcomes on all measures than partners of older BCSs.
. As predicted by the social cognitive processing theory, cognitive processing mediated the relationship between social constraints and depressive symptoms. In addition, partners of younger BCSs fared worse on social constraints, intrusive thoughts, and depressive symptoms than partners of older BCSs. 
. Results provide support for using the social cognitive processing theory in an intervention design with partners of long-term BCSs to decrease depressive symptoms.

  16. Heat production and body temperature during cooling and rewarming in overweight and lean men.

    Science.gov (United States)

    Claessens-van Ooijen, Anne M J; Westerterp, Klaas R; Wouters, Loek; Schoffelen, Paul F M; van Steenhoven, Anton A; van Marken Lichtenbelt, Wouter D

    2006-11-01

    To compare overweight and lean subjects with respect to thermogenesis and physiological insulation in response to mild cold and rewarming. Ten overweight men (mean BMI, 29.2 +/- 2.8 kg/m(2)) and 10 lean men (mean BMI, 21.1 +/- 2.0 kg/m(2)) were exposed to cold air for 1 hour, followed by 1 hour of rewarming. Body composition was determined by hydrodensitometry and deuterium dilution. Heat production and body temperatures were measured continuously by indirect calorimetry and thermistors, respectively. Muscle activity was recorded using electromyography. In both groups, heat production increased significantly during cooling (lean, p = 0.004; overweight, p = 0.006). The increase was larger in the lean group compared with the overweight group (p = 0.04). During rewarming, heat production returned to baseline in the overweight group and stayed higher compared with baseline in the lean group (p = 0.003). The difference in heat production between rewarming and baseline was larger in the lean (p = 0.01) than in the overweight subjects. Weighted body temperature of both groups decreased during cold exposure (lean, p = 0.002; overweight, p < 0.001) and did not return to baseline during rewarming. Overweight subjects showed a blunted mild cold-induced thermogenesis. The insulative cold response was not different among the groups. The energy-efficient response of the overweight subjects can have consequences for energy balance in the long term. The results support the concept of a dynamic heat regulation model instead of temperature regulation around a fixed set point.

  17. Effectiveness of interventions on physical activity in overweight or obese children: a systematic review and meta-analysis including studies with objectively measured outcomes.

    Science.gov (United States)

    Nooijen, C F J; Galanti, M R; Engström, K; Möller, J; Forsell, Y

    2017-02-01

    There is no consensus on interventions to be recommended in order to promote physical activity among overweight or obese children. The objective of this review was to assess the effects on objectively measured physical activity, of interventions promoting physical activity among overweight or obese children or adolescents, compared to no intervention or to interventions without a physical activity component. Publications up to December 2015 were located through electronic searches for randomized controlled trials resulting in inclusion of 33 studies. Standardized mean differences from baseline to post-intervention and to long-term follow-up were determined for intervention and control groups and meta-analysed using random effects models. The meta-analysis showed that interventions had no effect on total physical activity of overweight and obese children, neither directly post-intervention (-0.02 [-0.15, 0.11]) nor at long-term follow-up (0.07 [-0.27, 0.40]). Separate analyses by typology of intervention (with or without physical fitness, behavioural or environmental components) showed similar results (no effect). In conclusion, there is no evidence that currently available interventions are able to increase physical activity among overweight or obese children. This questions the contribution of physical activity to the treatment of overweight and obesity in children in the studied interventions and calls for other treatment strategies. © 2017 World Obesity Federation.

  18. Motivational Interviewing to Treat Overweight Children: 24-Month Follow-Up of a Randomized Controlled Trial.

    Science.gov (United States)

    Broccoli, Serena; Davoli, Anna Maria; Bonvicini, Laura; Fabbri, Alessandra; Ferrari, Elena; Montagna, Gino; Panza, Costantino; Pinotti, Mirco; Storani, Simone; Tamelli, Marco; Candela, Silvia; Bellocchio, Eletta; Giorgi Rossi, Paolo

    2016-01-01

    Pediatrician-led motivational interviewing can be an effective way of controlling BMI in overweight children in the short term. Its long-term efficacy is unknown. The primary aim was to determine whether the short-term (12-month) impact of family pediatrician-led motivational interviews on the BMI of overweight children could be sustained in the long term (24 months), in the absence of any other intervention. Children were recruited in 2011 by family pediatricians working in the province of Reggio Emilia, Italy, and randomly allocated to receive either 5 interviews delivered over a 12-month period or usual care. Eligible participants were all 4- to 7-year-old overweight children resident in the province of Reggio Emilia who had been receiving care from the pediatrician for ≥ 12 months. The primary outcome of this study was individual variation in BMI between the baseline visit and the 24-month follow-up, assessed by pediatricians not blinded to treatment group allocation. Of 419 eligible families, 372 (89%) participated; 187 children were randomized to receive intervention and 185 to usual care. Ninety-five percent of the children attended the 12-month follow-up, and 91% attended the 24-month follow-up. After the 12-month intervention period, BMI in the intervention group increased less than in the control group (0.46 and 0.78, respectively; difference -0.32; P = .005). At the 24-month follow-up, the difference had disappeared (1.52 and 1.56, respectively; difference -0.04; P = .986). The intervention lost its effectiveness within 1 year of cessation. Sustainable boosters are required for weight control and obesity prevention. Copyright © 2016 by the American Academy of Pediatrics.

  19. Long-term Effects on Cognitive Trajectories of Postmenopausal Hormone Therapy in Two Age Groups.

    Science.gov (United States)

    Espeland, Mark A; Rapp, Stephen R; Manson, JoAnn E; Goveas, Joseph S; Shumaker, Sally A; Hayden, Kathleen M; Weitlauf, Julie C; Gaussoin, Sarah A; Baker, Laura D; Padula, Claudia B; Hou, Lifang; Resnick, Susan M

    2017-06-01

    Postmenopausal hormone therapy may have long-term effects on cognitive function depending on women's age. Postintervention follow-up was conducted with annual cognitive assessments of two randomized controlled clinical trial cohorts, beginning an average of 6-7 years after study medications were terminated: 1,376 women who had enrolled in the Women's Health Initiative when aged 50-54 years and 2,880 who had enrolled when aged 65-79 years. Women had been randomly assigned to 0.625mg/d conjugated equine estrogens (CEE) for those with prior hysterectomy (mean 7.1 years), CEE with 2.5mg/d medroxyprogesterone acetate for those without prior hysterectomy (mean 5.4 years), or matching placebos. Hormone therapy, when prescribed to women aged 50-54 years, had no significant long-term posttreatment effects on cognitive function and on changes in cognitive function. When prescribed to older women, it was associated with long-term mean (SE) relative decrements (standard deviation units) in global cognitive function of 0.081 (0.029), working memory of 0.070 (0.025), and executive function of 0.054 (0.023), all p therapy regimen, prior use, or years from last menstrual period. Mean intervention effects were small; however, the largest were comparable in magnitude to those seen during the trial's active intervention phase. CEE-based hormone therapy delivered near the time of menopause provides neither cognitive benefit nor detriment. If administered in older women, it results in small decrements in several cognitive domains that remain for many years. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Obese older adults suffer foot pain and foot-related functional limitation.

    Science.gov (United States)

    Mickle, Karen J; Steele, Julie R

    2015-10-01

    There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Prevalence of overweight and obesity in a large clinical sample of children with autism.

    Science.gov (United States)

    Broder-Fingert, Sarabeth; Brazauskas, Karissa; Lindgren, Kristen; Iannuzzi, Dorothea; Van Cleave, Jeanne

    2014-01-01

    Overweight and obesity are major pediatric public health problems in the United States; however, limited data exist on the prevalence and correlates of overnutrition in children with autism. Through a large integrated health care system's patient database, we identified 6672 children ages 2 to 20 years with an assigned ICD-9 code of autism (299.0), Asperger syndrome (299.8), and control subjects from 2008 to 2011 who had at least 1 weight and height recorded in the same visit. We calculated age-adjusted, sex-adjusted body mass index and classified children as overweight (body mass index 85th to 95th percentile) or obese (≥ 95th percentile). We used multinomial logistic regression to compare the odds of overweight and obesity between groups. We then used logistic regression to evaluate factors associated with overweight and obesity in children with autism, including demographic and clinical characteristics. Compared to control subjects, children with autism and Asperger syndrome had significantly higher odds of overweight (odds ratio, 95% confidence interval: autism 2.24, 1.74-2.88; Asperger syndrome 1.49, 1.12-1.97) and obesity (autism 4.83, 3.85-6.06; Asperger syndrome 5.69, 4.50-7.21). Among children with autism, we found a higher odds of obesity in older children (aged 12-15 years 1.87, 1.33-2.63; aged 16-20 years 1.94, 1.39-2.71) compared to children aged 6 to 11 years. We also found higher odds of overweight and obesity in those with public insurance (overweight 1.54, 1.25-1.89; obese 1.16, 1.02-1.40) and with co-occurring sleep disorder (obese 1.23, 1.00-1.53). Children with autism and Asperger syndrome had significantly higher odds of overweight and obesity than control subjects. Older age, public insurance, and co-occurring sleep disorder were associated with overweight or obesity in this population. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  2. Long-term weight loss after colorectal cancer diagnosis is associated with lower survival: The Colon Cancer Family Registry.

    Science.gov (United States)

    Kocarnik, Jonathan M; Hua, Xinwei; Hardikar, Sheetal; Robinson, Jamaica; Lindor, Noralane M; Win, Aung Ko; Hopper, John L; Figueiredo, Jane C; Potter, John D; Campbell, Peter T; Gallinger, Steven; Cotterchio, Michelle; Adams, Scott V; Cohen, Stacey A; Phipps, Amanda I; Newcomb, Polly A

    2017-12-01

    Body weight is associated with colorectal cancer (CRC) risk and survival, but to the authors' knowledge, the impact of long-term postdiagnostic weight change is unclear. Herein, the authors investigated whether weight change over the 5 years after a diagnosis of CRC is associated with survival. CRC cases diagnosed from 1997 to 2008 were identified through 4 population-based cancer registry sites. Participants enrolled within 2 years of diagnosis and reported their height and weight 2 years prior. Follow-up questionnaires were administered approximately 5 years after diagnosis. Associations between change in weight (in kg) or body mass index (BMI) with overall and CRC-specific survival were estimated using Cox regression analysis adjusted for age, sex, American Joint Committee on Cancer stage of disease, baseline BMI, nonsteroidal anti-inflammatory drug use, smoking, time between diagnosis and enrollment, and study site. At the 5-year postdiagnostic survey, 2049 participants reported higher (53%; median plus 5 kg), unchanged (12%), or lower (35%; median -4 kg) weight. Over a median of 5.1 years of subsequent follow-up (range, 0.3-9.9 years), 344 participants died (91 of CRC). Long-term weight loss (per 5 kg) was found to be associated with poorer overall survival (hazard ratio, 1.13; 95% confidence interval, 1.07-1.21) and CRC-specific survival (hazard ratio, 1.25; 95% confidence interval, 1.13-1.39). Significantly lower survival was similarly observed for relative weight loss (>5% vs ≤5% change), BMI reduction (per 1 unit), or BMI category change (overweight to normal vs remaining overweight). Weight loss 5 years after a diagnosis of CRC was found to be significantly associated with decreased long-term survival, suggesting the importance of avoiding weight loss in survivors of CRC. Future research should attempt to further evaluate this association, accounting for whether this weight change was intentional or represents a marker of declining health. Cancer 2017

  3. Short and long-term mortality of patients presenting with bleeding events to the Emergency Department.

    Science.gov (United States)

    Conti, Alberto; Renzi, Noemi; Molesti, Daniele; Bianchi, Simone; Bogazzi, Irene; Bongini, Giada; Pepe, Giuseppe; Frosini, Fabiana; Bertini, Alessio; Santini, Massimo

    2017-12-01

    Death of patients presenting with bleeding events to the Emergency Department still represent a major problem. We sought to analyze clinical characteristics associated with worse outcomes including short- and long-term death, beyond antithombotic treatment strategy. Patients presenting with any bleeding events during 2016-2017years were enrolled. Clinical parameters, site of bleeding, major bleeding, ongoing anti-thrombotic treatment strategy and death were collected. Hard 5:1 propensity score matching was performed to adjust dead patients in baseline characteristics. Endpoints were one-month and one-year death. Out of 166,000 visits to the Emergency Department, 3.050 patients (1.8%) were enrolled and eventually 429 were analyzed after propensity. Overall, anticoagulants or antiplatelets were given to 234(54%). Major bleeding account for 111(26%) patients, without differences between those taking anticoagulants or antiplatelets versus others. Death at one-month and one-year was 26(6%) and 72(17%), respectively. Independent predictors of one-month death were major bleeding (Odds Ratio, OR 26, pbleeding (OR 7, pbleeding where higher than others (pbleeding and age (0.75 and 0.72, respectively) over others; pbleeding events, death rate was driven by major bleeding on short-term and older age on long-term. Among dead patients mortality was approximately 40% on one-month; 60% in older patients, and 80% in female gender. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. [Perioperative adverse respiratory events in overweight and obese children].

    Science.gov (United States)

    Ulrici, J; Hempel, G; Sasse, M; Vollrath, J; Höhne, C

    2016-12-01

    Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18 years, ASA I-III, undergoing elective procedures (ENT and pediatric surgery), were observed. With the aid of special data sheets, the following parameters were determined: Mallampati Score, difficult mask ventilation and intubation, use of a Guedel/Wendl tube, Cormack-Lehane Score, number of intubation attempts, airway obstructions (broncho- and laryngospasms), coughing as a sign of airway irritation, and decreases in oxygen saturation >10 %. Overweight and obese children had a significantly higher Mallampati Score and a significantly higher prevalence of coughing (p overweight children and 6.3 % in children of normal weight, and that of airway obstructions was 4.1 vs 2.7 %. This study demonstrated a very low incidence of respiratory problems, which may be caused by the low proportion of morbidly obese children and the older age of overweight children in comparison with other studies.

  5. Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults: a randomized controlled trial.

    Science.gov (United States)

    Verreijen, Amely M; Engberink, Mariëlle F; Memelink, Robert G; van der Plas, Suzanne E; Visser, Marjolein; Weijs, Peter J M

    2017-02-06

    Intentional weight loss in obese older adults is a risk factor for accelerated muscle mass loss. We investigated whether a high protein diet and/or resistance exercise preserves fat free mass (FFM) during weight loss in overweight and obese older adults. We included 100 overweight and obese adults (55-80 year) in a randomized controlled trial (RCT) with a 2 × 2 factorial design and intention-to-treat analysis. During a 10-week weight loss program all subjects followed a hypocaloric diet. Subjects were randomly allocated to either a high protein (1.3 g/kg body weight) or normal protein diet (0.8 g/kg), with or without a resistance exercise program 3 times/week. FFM was assessed by air displacement plethysmography. At baseline, mean (±SD) BMI was 32 ± 4 kg/m 2 . During intervention, protein intake was 1.13 ± 0.35 g/kg in the high protein groups vs. 0.98 ± 0.29 in the normal protein groups, which reflects a 16.3 ± 5.2 g/d higher protein intake in the high protein groups. Both high protein diet and exercise did not significantly affect change in body weight, FFM and fat mass (FM). No significant protein*exercise interaction effect was observed for FFM. However, within-group analysis showed that high protein in combination with exercise significantly increased FFM (+0.6 ± 1.3 kg, p = 0.011). A high protein diet, though lower than targeted, did not significantly affect changes in FFM during modest weight loss in older overweight and obese adults. There was no significant interaction between the high protein diet and resistance exercise for change in FFM. However, only the group with the combined intervention of high protein diet and resistance exercise significantly increased in FFM. Dutch Trial Register, number NTR4556, date 05-01-2014.

  6. Successful long-term weight loss maintenance in a rural population.

    Science.gov (United States)

    Milsom, Vanessa A; Middleton, Kathryn M Ross; Perri, Michael G

    2011-01-01

    Few investigations of successful long-term weight loss beyond two years have been conducted, and none has examined weight changes in medically underserved rural populations of older adults. The purpose of this study was to assess long-term weight loss maintenance 3.5 years after the completion of an initial six-month lifestyle intervention for obesity among women aged 50-75 years residing in rural communities. One hundred and ten obese women with a mean (± standard deviation) age of 60.08 ± 6.17 years and mean body mass index of 36.76 ± 5.10 kg/m(2) completed an in-person assessment during which their weight and adherence to behavioral weight management strategies were evaluated. Participants showed a mean weight reduction of 10.17% ± 5.0% during the initial six- month intervention and regained 6.95% ± 9.44% from the completion of treatment to follow-up assessment 3.5 years later. A substantial proportion of participants (41.80%) were able to maintain weight reductions of 5% or greater from baseline to follow-up. "Successful" participants (those who maintained losses of 5% or greater at follow-up) reported weighing themselves, self-monitoring their intake and calories, planning meals in advance, and choosing lower calorie foods with greater frequency than "unsuccessful" participants (those who lost less than 5%). Collectively, these findings indicate that a large proportion of participants were able to maintain clinically significant weight losses for multiple years after treatment, and that self-monitoring was a key component of successful long-term weight management.

  7. Evaluation of risk of falls and orthostatic hypotension in older, long-term topical beta-blocker users

    NARCIS (Netherlands)

    W.D. Ramdas (Wishal); N. van der Velde (Nathalie); T.J.M. van der Cammen (Tischa); R.C.W. Wolfs (Roger)

    2009-01-01

    textabstractBackground: Falls are a serious problem in the elderly, and have recently been described as cardiovascular-mediated side effects of beta-blocker eye drops. Therefore, we investigated the possible association between the long-term use of beta-blockers, prostaglandins and their

  8. Physical activity after commitment lotteries: examining long-term results in a cluster randomized trial.

    Science.gov (United States)

    van der Swaluw, Koen; Lambooij, Mattijs S; Mathijssen, Jolanda J P; Schipper, Maarten; Zeelenberg, Marcel; Berkhout, Stef; Polder, Johan J; Prast, Henriëtte M

    2018-02-26

    To overcome self-control difficulties, people can commit to their health goals by voluntarily accepting deadlines with consequences. In a commitment lottery, the winners are drawn from all participants, but can only claim their prize if they also attained their gym-attendance goals. In a 52-week, three-arm trial across six company gyms, we tested if commitment lotteries with behavioral economic underpinnings would promote physical activity among overweight adults. In previous work, we presented an effective 26-week intervention. In the present paper we analyzed maintenance of goal attainment at 52-week follow-up and the development of weight over time. We compared weight and goal attainment (gym attendance ≥ 2 per week) between three arms that-in the intervention period- consisted of (I) weekly short-term lotteries for 13 weeks; (II) the same short-term lotteries in combination with an additional long-term lottery after 26 weeks; and (III) a control arm without lottery-deadlines. After a successful 26-week intervention, goal attainment declined between weeks 27 and 52 in the long-term lottery arm, but remained higher than in the control group. Goal attainment did not differ between the short-term lottery arm and control arm. Weight declined slightly in all arms in the first 13 weeks of the trial and remained stable from there on. Commitment lotteries can support regular gym attendance up to 52 weeks, but more research is needed to achieve higher levels of maintenance and weight loss.

  9. Risk Factors for Overweight and Obesity among Thai Adults: Results of the National Thai Food Consumption Survey

    Directory of Open Access Journals (Sweden)

    Walker S.C. Poston

    2010-01-01

    Full Text Available We evaluated the associations between overweight and obesity and socio-economic status (SES, behavioral factors, and dietary intake in Thai adults. A nationally representative sample of 6,445 Thais adults (18–70 years was surveyed during 2004–2005. Information including demographics, SES characteristics, dietary intake, and anthropometrics were obtained. Overall, 35.0% of men, and 44.9% of women were overweight or obese (BMI ≥ 23 kg/m2 using the Asian cut-points. Regression models demonstrated that age was positively associated with being overweight in both genders. In gender-stratified analyses, male respondents who were older, lived in urban areas, had higher annual household income, and did not smoke were more likely to be classified as overweight and obese. Women who were older, had higher education, were not in a marriage-like relationship and were in semi-professional occupation were at greater risk for being overweight and obese. High carbohydrate and protein intake were found to be positively associated with BMI whereas the frequent use of dairy foods was found to be negatively associated with BMI among men. The present study found that SES factors are associated with being classified as overweight and obese in Thai adults, but associations were different between genders. Health promotion strategies regarding obesity and its related co-morbidity are necessary.

  10. Reforming Long-Term Care Funding in Alberta.

    Science.gov (United States)

    Crump, R Trafford; Repin, Nadya; Sutherland, Jason M

    2015-01-01

    Like many provinces across Canada, Alberta is facing growing demand for long-term care. Issues with the mixed funding model used to pay long-term care providers had Alberta Health Services concerned that it was not efficiently meeting the demand for long-term care. Consequently, in 2010, Alberta Health Services introduced the patient/care-based funding (PCBF) model. PCBF is similar to activity-based funding in that it directly ties the complexity and care needs of long-term care residents to the payment received by long-term care providers. This review describes PCBF and discusses some of its strengths and weaknesses. In doing so, this review is intended to inform other provinces faced with similar long-term care challenges and contemplating their own funding reforms.

  11. Characteristics associated with the use of complementary health approaches among long-term cancer survivors.

    Science.gov (United States)

    Sohl, Stephanie J; Weaver, Kathryn E; Birdee, Gurjeet; Kent, Erin E; Danhauer, Suzanne C; Hamilton, Ann S

    2014-04-01

    This study aims to identify the prevalence and characteristics of long-term adult cancer survivors who use complementary health approaches (CHA). Participants completed the Follow-up Care Use Among Survivors (FOCUS) Survey, a cross-sectional investigation of long-term cancer survivors. The use of CHA and reasons for use were assessed. A multivariable logistic regression model was applied to identify if predisposing, enabling, and need characteristics described in the Complementary and Alternative Medicine Healthcare Model were associated with CHA use in the past year. Long-term cancer survivors in the study (N = 1,666) were predominately female (62%) and older (mean age = 69.5), with breast, prostate, colorectal, ovarian, and endometrial cancers. Thirty-three percent of survivors used CHA in the past year. Common reasons for CHA use were to relieve stress (28%), treat or prevent cancer (21%), relieve cancer-related symptoms (18%), and deal with another condition (18%). Predisposing (i.e., higher optimism) and need factors (i.e., experienced cancer-related symptoms, ever had depression/anxiety) were significantly associated with CHA (p-values financial resources) were not. Cancer survivors continue to report a high prevalence of recent CHA use more than 5 years after initial diagnosis. Healthcare providers should be aware of increased use of CHA among subgroups of long-term cancer survivors in order to guide safe and optimal use.

  12. Barriers to and facilitators of long term weight loss maintenance in adult UK people: A thematic analysis

    Directory of Open Access Journals (Sweden)

    Himanshu Gupta

    2014-01-01

    Full Text Available Adult obesity and overweight is affecting every region of the world and is described as one of today′s most significant and neglected public health problems. The problem has taken the shape of an epidemic not only because the prevalence of obesity has witnessed a dramatic progress in a short period of time, but also because obesity has paved the way for increased risks for morbidity and mortality associated with it. It has been predicted that about half of the adult men and more than a quarter of adult women would be obese by 2030 in the UK and this figure could rise up to 50% in 2050 for whole of the adult UK population. Although a modest 5-10% weight loss maintained in the long term can significantly decrease health risk, few people engage in weight loss activities. Against this background, this review paper aims to investigate the reasons helping and/or hindering adults in the UK maintain weight loss in the long term; using online and organizational data sources and thematically analyzing the data. Self-body perception, enhanced self-confidence, social support, self-motivation, incentives and rewards, increased physical activity levels and healthy eating habits facilitated people in maintaining weight loss in the long term and overall quality of life. Extreme weather conditions, natural phenomena such as accidents, injuries and ill-health, work commitments, inability for time management and to resist the temptation for food constrained the successful long-term weight loss maintenance.

  13. Evaluation of risk of falls and orthostatic hypotension in older, long-term topical beta-blocker users

    NARCIS (Netherlands)

    Ramdas, Wishal D.; van der Velde, Nathalie; van der Cammen, Tischa J. M.; Wolfs, Roger C. W.

    2009-01-01

    Falls are a serious problem in the elderly, and have recently been described as cardiovascular-mediated side effects of beta-blocker eye drops. Therefore, we investigated the possible association between the long-term use of beta-blockers, prostaglandins and their combinations in eye drops, and

  14. Mental Health Care for LGBT Older Adults in Long-Term Care Settings: Competency, Training, and Barriers for Mental Health Providers.

    Science.gov (United States)

    Smith, Ronald W; Altman, Jennifer K; Meeks, Suzanne; Hinrichs, Kate Lm

    2018-06-07

    To assess mental health providers' experience with LGBT older adults in long-term care (LTC) settings and perceived barriers to quality care. Providers (N = 57) completed an online survey on demographics and practice characteristics. They were also asked about: number of LGBT residents they've worked with, relevance of LGBT issues to their practice, preparedness, willingness to learn, hours of formal/informal training, and barriers to providing care to LGBT patients. Respondents were 63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses, most of whom practiced in LTC consulting roles. Most providers felt working with LGBT issues was relevant to their practice and felt well-prepared and willing to learn, though they were unaware of evidence based practices (EBTs), especially for LTC settings. They had little coursework on LGBT issues, and identified lack of training, stigma, and residents concealing their identity as the greatest barriers to quality care. Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care. LGBT-specific training and EBTs are needed. Facilities need to address stigma with residents and providers.

  15. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child.

    Science.gov (United States)

    Catalano, Patrick M; Shankar, Kartik

    2017-02-08

    Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates of obese women have increased body fat at birth, which increases the risk of childhood obesity. Although there is no unifying mechanism responsible for the adverse perinatal outcomes associated with maternal obesity, on the basis of the available data, increased prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation, and oxidative stress seem to contribute to early placental and fetal dysfunction. We will review the pathophysiology underlying these data and try to shed light on the specific underlying mechanisms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Nutrient adequacy and diet quality in non-overweight and overweight Hispanic children of low socioeconomic status: the Viva la Familia Study.

    Science.gov (United States)

    Wilson, Theresa A; Adolph, Anne L; Butte, Nancy F

    2009-06-01

    The role of diet quality and nutrient adequacy in the etiology of childhood obesity is poorly understood. The specific aims of these analyses were to assess overall diet quality and nutrient adequacy, and test for association between weight status and diet in children from low socioeconomic status (SES) Hispanic families at high risk for obesity. A cross-sectional study design was used to assess dietary intake in low-SES Hispanic children with and without overweight who were enrolled in the Viva la Familia Study. Multiple-pass 24-hour dietary recalls were recorded on two random, weekday occasions. Diet quality was evaluated according to the Dietary Guidelines for Americans. Nutrient adequacy was assessed using z scores based on estimated average requirement or adequate intake. The study included 1,030 Hispanic children and adolescents, aged 4 to 19 years, in Houston, TX, who participated between November 2000 and August 2004. STATA software (version 9.1, 2006, STATA Corp, College Station, TX) was used for generalized estimating equations and random effects regression. Diet quality did not adhere to the Dietary Guidelines for Americans for fat, cholesterol, saturated fatty acids, fiber, added sugar, and sodium. Although energy intake was significantly higher in children with overweight, food sources, diet quality, macro- and micronutrient composition were similar between non-overweight and overweight children. Relative to estimated average requirements or adequate intake levels, mean nutrient intakes were adequate (70% to 98% probability) in the children without and with overweight, except for vitamins D and E, pantothenic acid, calcium, and potassium, for which z scores cannot be interpreted given the uncertainty of their adequate intake levels. Whereas the diets of low-SES Hispanic children with and without overweight were adequate in most essential nutrients, other components of a healthful diet, which promote long-term health, were suboptimal. Knowledge of the

  17. Industrial Foundations as Long-Term Owners

    DEFF Research Database (Denmark)

    Thomsen, Steen; Poulsen, Thomas; Børsting, Christa Winther

    Short-termism has become a serious concern for corporate governance, and this has inspired a search for institutional arrangements to promote long-term decision-making. In this paper, we call attention to long-term ownership by industrial foundations, which is common in Northern Europe but little...... known in the rest of the world. We use a unique Danish data set to document that industrial foundations are long-term owners that practice long-term governance. We show that foundation ownership is highly stable compared to other ownership structures. Foundation-owned companies replace managers less...... frequently. They have conservative capital structures with low financial leverage. They score higher on an index of long-termism in finance, investment, and employment. They survive longer. Overall, our paper supports the hypothesis that corporate time horizons are influenced by ownership structures...

  18. Long-term associative learning predicts verbal short-term memory performance

    OpenAIRE

    Jones, Gary; Macken, Bill

    2017-01-01

    Studies using tests such as digit span and nonword repetition have implicated short-term memory across a range of developmental domains. Such tests ostensibly assess specialized processes for the short-term manipulation and maintenance of information that are often argued to enable long-term learning. However, there is considerable evidence for an influence of long-term linguistic learning on performance in short-term memory tasks that brings into question the role of a specialized short-term...

  19. Long-Term Air Pollution and Traffic Noise Exposures and Mild Cognitive Impairment in Older Adults: A Cross-Sectional Analysis of the Heinz Nixdorf Recall Study.

    Science.gov (United States)

    Tzivian, Lilian; Dlugaj, Martha; Winkler, Angela; Weinmayr, Gudrun; Hennig, Frauke; Fuks, Kateryna B; Vossoughi, Mohammad; Schikowski, Tamara; Weimar, Christian; Erbel, Raimund; Jöckel, Karl-Heinz; Moebus, Susanne; Hoffmann, Barbara

    2016-09-01

    Investigative Group. 2016. Long-term air pollution and traffic noise exposures and mild cognitive impairment in older adults: a cross-sectional analysis of the Heinz Nixdorf Recall Study. Environ Health Perspect 124:1361-1368; http://dx.doi.org/10.1289/ehp.1509824.

  20. Long-Term Body Weight Maintenance among StrongWomen–Healthy Hearts Program Participants

    Directory of Open Access Journals (Sweden)

    Rebecca A. Seguin

    2017-01-01

    Full Text Available Background. The repeated loss and regain of body weight, referred to as weight cycling, may be associated with negative health complications. Given today’s obesity epidemic and related interventions to address obesity, it is increasingly important to understand contexts and factors associated with weight loss maintenance. This study examined BMI among individuals who had previously participated in a 12-week, evidence-based, nationally disseminated nutrition and physical activity program designed for overweight and obese middle-aged and older women. Methods. Data were collected using follow-up surveys. Complete height and weight data were available for baseline, 12-week program completion (post-program and follow-up (approximately 3 years later for 154 women (response rate = 27.5%; BMI characteristics did not differ between responders and nonresponders. Results. Mean BMI decreased significantly from baseline to post-program (−0.5, P<0.001 and post-program to follow-up (−0.7, P<0.001. Seventy-five percent of survey respondents maintained or decreased BMI post-program to follow-up. Self-efficacy and social support for healthy eating behaviors (but not physical activity were associated with BMI maintenance or additional weight loss. Conclusions. These findings support the durability of weight loss following participation in a relatively short-term intervention.

  1. The impact of oral health on body image and social interactions among elders in long-term care.

    Science.gov (United States)

    Donnelly, Leeann R; Clarke, Laura Hurd; Phinney, Alison; MacEntee, Michael I

    2016-12-01

    The objective of this study was to explore how social interactions and body image are influenced by perceived oral health among older people who live in long-term care facilities. Social interactions among frail elders in long-term care (LTC) facilities are limited, but to what extent body image and oral health influence their social relations is poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health and well-being irrespective of age. However, as frailty increases, it is unclear whether appearance and oral health priorities remain stable. Open-ended interviews were conducted with a purposefully selected group of cognitively intact, older men and women who exhibited varying degrees of frailty, social engagement and oral health conditions and lived in one of seven long-term care facilities. The interviews were analysed using a constant comparative technique, and a second interview with participants checked the trustworthiness of the analysis. Three major categories were expressed by the participants: (1) My mouth is fine; (2) It depends; and (3) Not that important. Within each category, there were several contributing and influencing factors. Social interactions among residents in LTC may be negatively impacted by poor oral health, but only if other personal and social issues are less bothersome than conditions with the mouth. © 2015 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  2. [Overweight and obesity in children treated for congentital heart disease].

    Science.gov (United States)

    Perin, Francesca; Carreras Blesa, Carmen; Rodríguez Vázquez Del Rey, Maria Del Mar; Cobo, Inmaculada; Maldonado, José

    2018-04-21

    The negative impact of overweight and obesity is potentially greater in children affected by a congenital heart disease (CHD). The aim of this study is to calculate the proportion of overweight and obesity in children who underwent an intervention for CHD, and to investigate systolic arterial hypertension as a possible early cardiovascular complication. A retrospective study was conducted on patients aged 6 to 17 years treated for CHD, and healthy control subjects, followed-up in a Paediatric Cardiology Clinic. Body mass index percentiles were calculated according to the criteria of WHO. A review was performed on the anthropometric and clinical data, as well as the systolic blood pressure (SBP). A total of 440 patients were included, of which 220 had CHD. The proportion of combined obesity and overweight (body mass index percentile≥85) was 36.4% (37.3% in healthy subjects and 35.4% in patients with CHD, P=.738). A higher prevalence of obesity (body mass index percentile≥97) was found in CHD patients (22.7%) compared to 15.5% in healthy subjects (P=.015). SBP percentiles were higher in overweight compared to normal-weight patients (P<.001). The prevalence of SBP readings≥the 95th percentile was greater in overweight than in normal weight CHD patients (29.5% versus 7.7%, P<.001) and also in the overweight healthy controls compared to those of normal weight (12.2% versus 0.7%, P<.001). The proportion of obesity is high in treated CHD children and is associated with high SBP levels. The risk of long-term complications needs to be reduced by means of prevention and treatment of obesity in this very vulnerable population. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  3. Implications of teen birth for overweight and obesity in adulthood.

    Science.gov (United States)

    Chang, Tammy; Choi, HwaJung; Richardson, Caroline R; Davis, Matthew M

    2013-08-01

    The objective of this study was to examine whether teen birth was independently associated with overweight and obesity in a US cohort. We examined whether teen birth is independently associated with overweight and obesity in a multiyear US cohort using the 2001-2010 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey of the US civilian, noninstitutionalized population. We performed multinomial logistic regression adjusting for survey cohort, age at survey, race, education, and parity. We included women 20-59 years old at the time of survey, with at least 1 live birth, not currently or recently pregnant (unweighted, n = 5220; weighted, n = 48.4 million). Our outcome measure was the effect of teen birth on subsequent overweight and obesity. In bivariate analyses, women with a teen birth were significantly more likely than women without a teen birth to be overweight (relative risk ratios [RRRs], 1.61; 95% confidence interval [CI], 1.37-1.90) or obese (RRR, 1.84; 95% CI, 1.56-2.16) at the time of the survey. In multivariate models, women with a teen birth remained significantly more likely to be overweight (adjusted RRR, 1.33; 95% CI, 1.10-1.62) or obese (adjusted RRR, 1.32; 95% CI, 1.09-1.61) than women without a teen birth. For women in the United States, giving birth as a teen is associated with subsequent overweight/obese status later in life. To inform clinical and policy interventions with the goal to improve the long-term health of teenage mothers, future studies must examine modifiable physiological and sociomedical reasons for early child-bearing and later risk of obesity. Copyright © 2013 Mosby, Inc. All rights reserved.

  4. Impact of Simulated Ostracism on Overweight and Normal-Weight Youths’ Motivation to Eat and Food Intake

    Science.gov (United States)

    Salvy, Sarah-Jeanne; Bowker, Julie C.; Nitecki, Lauren A.; Kluczynski, Melissa A.; Germeroth, Lisa J.; Roemmich, James N.

    2010-01-01

    There is growing evidence that the experience of being ostracized can impair individuals abilities to self-regulate, which in turn, leads to negative health behaviors, such as increased unhealthy eating. Research has focused on adults, but deficits in eating regulation in response to ostracism may be particularly detrimental for overweight or obese youth. This study examines the effects of a brief episode of ostracism on the motivation to eat and food intake of overweight and normal-weight young adolescents (M age = 13.6 years). A computerized ball-tossing game (Cyberball) was used to induce ostracism or inclusion. Following the inclusion/ostracism manipulation, all participants completed an operant computer task to earn points exchangeable for portions of food or for time socializing with an unfamiliar peer. Participants’ responses for food and their subsequent energy intake were recorded. As hypothesized, ostracized overweight participants responded more for food and had a greater energy intake than overweight participants in the inclusion/control condition; whereas this was not the case for normal-weight participants. These results are important as studies indicate that overweight and obese youth may be at risk of social isolation and peer difficulties. Social adversity, if left unchanged, may increase the difficulty of promoting long-term changes in overweight youths’ health behaviors. PMID:21094193

  5. The psychosocial burden of childhood overweight and obesity: evidence for persisting difficulties in boys and girls.

    Science.gov (United States)

    Gibson, Lisa Y; Allen, Karina L; Davis, Elizabeth; Blair, Eve; Zubrick, Stephen R; Byrne, Susan M

    2017-07-01

    There is evidence that overweight and obese children tend to remain overweight or obese into adolescence and adulthood. However, little is known about the long-term psychosocial outcomes of childhood overweight and obesity. This study aimed to investigate the course of psychosocial difficulties over a 2-year period for children who were overweight or obese at baseline, and a sample of children who were a healthy weight at baseline. Participants were 212 children aged 8 to 13 years at baseline, who were participating in the Childhood Growth and Development (GAD) Study. Questionnaire and interview measures were used to assess children's self-esteem, depressive symptoms, body image, eating disorder symptoms, experiences with bullying, family satisfaction and quality of life. Linear mixed models were used to consider longitudinal changes in psychosocial variables. Overweight and obese children reported greater psychosocial distress than healthy weight children, and these differences were more pronounced for girls than boys. Weight and psychosocial impairment showed stability from baseline to 2-year follow-up. The results of this study suggest that psychosocial difficulties show considerable stability in childhood, for overweight/obese and healthy weight children. What is Known: • Childhood obesity tracks into adolescence and adulthood. • Physical health problems associated with childhood obesity also persist to adulthood. What is New: • Overweight and obese children are at risk of ongoing psychosocial distress from childhood into early adolescence.

  6. Efficacy and safety of liraglutide for overweight adult patients with type 1 diabetes and insufficient glycaemic control (Lira-1)

    DEFF Research Database (Denmark)

    Dejgaard, Thomas Fremming; Frandsen, Christian Seerup; Hansen, Tanja Stenbæk

    2016-01-01

    to insulin for overweight adult patients with type 1 diabetes. Methods We did a randomised, double-blind, placebo-controlled trial at Steno Diabetes Center (Gentofte, Denmark). Patients aged 18 years or older with type 1 diabetes, insufficient glycaemic control (HbA1c >8% [64 mmol/mol]), and overweight (BMI...

  7. Long-term collections

    CERN Multimedia

    Collectes à long terme

    2007-01-01

    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  8. Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Bedi, Prabhjot K; Castro-Codesal, Maria Luisa; Featherstone, Robin; AlBalawi, Mohammed M; Alkhaledi, Bashar; Kozyrskyj, Anita L; Flores-Mir, Carlos; MacLean, Joanna E

    2018-01-01

    The use of long-term non-invasive ventilation (NIV) to treat sleep and breathing disorders in children has increased substantially in the last decade; however, less data exist about its use in infants. Given that infants have distinct sleep and breathing patterns when compared to older children, the outcomes of infants on long-term NIV may differ as well. The aim of this study is to systematically review the use and outcomes of long-term NIV in infants. Ovid Medline, Ovid Embase, CINAHL (via EbscoHOST), PubMed, and Wiley Cochrane Library were systematically searched from January 1990 to July 2017. Studies on infants using long-term NIV outside of an acute care setting were included. Data were extracted on study design, population characteristics, and NIV outcomes. A total of 327 studies were full-text reviewed, with final inclusion of 60. Studies were distributed across airway (40%), neuromuscular (28%), central nervous system (10%), cardio-respiratory (2%), and multiple (20%) disease categories. Of the 18 airway studies reporting on NIV outcomes, 13 (72%) reported improvements in respiratory parameters. Of the 12 neuromuscular studies exclusively on spinal muscular atrophy type 1 (SMA1), six (50%) reported decreased hospitalizations and nine (75%) reported on mortality outcomes. Risk of bias was moderate to serious, and quality of the evidence was low to very low for all studies. Most studies had an observational design with no control group, limiting the potential for a meta-analysis. The outcomes reported in studies differed by the disease category being studied. Studies on airway conditions showed improvements in respiratory parameters for infants using NIV. Studies on neuromuscular disorder, which were almost exclusively on SMA1, reported decreased hospitalizations and prolonged survival. Overall, it appears that NIV is an effective long-term therapy for infants. However, the high risk of bias and low quality of the available evidence limited strong

  9. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities

    NARCIS (Netherlands)

    Chin A Paw, M.J.M.; M.N. Poppel, van; Twisk, J.W.; van Mechelen, W.

    2006-01-01

    Objective: To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations. Methods: Subjects (N = 224) were randomised to 6 months of twice weekly (1) resistance

  10. Understanding Adult Overweight and Obesity

    Science.gov (United States)

    ... Step in the Right Direction Understanding Adult Overweight & Obesity View or Print All Sections Definition & Facts The terms “overweight” and “obesity” refer to body weight that is greater than ...

  11. Compensation for PKMζ in long-term potentiation and spatial long-term memory in mutant mice.

    Science.gov (United States)

    Tsokas, Panayiotis; Hsieh, Changchi; Yao, Yudong; Lesburguères, Edith; Wallace, Emma Jane Claire; Tcherepanov, Andrew; Jothianandan, Desingarao; Hartley, Benjamin Rush; Pan, Ling; Rivard, Bruno; Farese, Robert V; Sajan, Mini P; Bergold, Peter John; Hernández, Alejandro Iván; Cottrell, James E; Shouval, Harel Z; Fenton, André Antonio; Sacktor, Todd Charlton

    2016-05-17

    PKMζ is a persistently active PKC isoform proposed to maintain late-LTP and long-term memory. But late-LTP and memory are maintained without PKMζ in PKMζ-null mice. Two hypotheses can account for these findings. First, PKMζ is unimportant for LTP or memory. Second, PKMζ is essential for late-LTP and long-term memory in wild-type mice, and PKMζ-null mice recruit compensatory mechanisms. We find that whereas PKMζ persistently increases in LTP maintenance in wild-type mice, PKCι/λ, a gene-product closely related to PKMζ, persistently increases in LTP maintenance in PKMζ-null mice. Using a pharmacogenetic approach, we find PKMζ-antisense in hippocampus blocks late-LTP and spatial long-term memory in wild-type mice, but not in PKMζ-null mice without the target mRNA. Conversely, a PKCι/λ-antagonist disrupts late-LTP and spatial memory in PKMζ-null mice but not in wild-type mice. Thus, whereas PKMζ is essential for wild-type LTP and long-term memory, persistent PKCι/λ activation compensates for PKMζ loss in PKMζ-null mice.

  12. Long-term effects of an inpatient weight-loss program in obese children and the role of genetic predisposition-rationale and design of the LOGIC-trial.

    Science.gov (United States)

    Rank, Melanie; Siegrist, Monika; Wilks, Désirée C; Haller, Bernhard; Wolfarth, Bernd; Langhof, Helmut; Halle, Martin

    2012-03-19

    The prevalence of childhood obesity has increased worldwide, which is a serious concern as obesity is associated with many negative immediate and long-term health consequences. Therefore, the treatment of overweight and obesity in children and adolescents is strongly recommended. Inpatient weight-loss programs have shown to be effective particularly regarding short-term weight-loss, whilst little is known both on the long-term effects of this treatment and the determinants of successful weight-loss and subsequent weight maintenance.The purpose of this study is to evaluate the short, middle and long-term effects of an inpatient weight-loss program for children and adolescents and to investigate the likely determinants of weight changes, whereby the primary focus lies on the potential role of differences in polymorphisms of adiposity-relevant genes. The study involves overweight and obese children and adolescents aged 6 to 19 years, who participate in an inpatient weight-loss program for 4 to 6 weeks. It started in 2006 and it is planned to include 1,500 participants by 2013. The intervention focuses on diet, physical activity and behavior therapy. Measurements are taken at the start and the end of the intervention and comprise blood analyses (DNA, lipid and glucose metabolism, adipokines and inflammatory markers), anthropometry (body weight, height and waist circumference), blood pressure, pubertal stage, and exercise capacity. Physical activity, dietary habits, quality of life, and family background are assessed by questionnaires. Follow-up assessments are performed 6 months, 1, 2, 5 and 10 years after the intervention: Children will complete the same questionnaires at all time points and visit their general practitioner for examination of anthropometric parameters, blood pressure and assessment of pubertal stage. At the 5 and 10 year follow-ups, blood parameters and exercise capacity will be additionally measured. Apart from illustrating the short, middle and long-term

  13. Overweight or obese BMI is associated with earlier, but not later survival after common acute illnesses.

    Science.gov (United States)

    Prescott, Hallie C; Chang, Virginia W

    2018-02-06

    Obesity has been associated with improved short-term mortality following common acute illness, but its relationship with longer-term mortality is unknown. Observational study of U.S. Health and Retirement Study (HRS) participants with federal health insurance (fee-for-service Medicare) coverage, hospitalized with congestive heart failure (N = 4287), pneumonia (N = 4182), or acute myocardial infarction (N = 2001), 1996-2012. Using cox proportional hazards models, we examined the association between overweight or obese BMI (BMI ≥ 25.0 kg/m 2 ) and mortality to 5 years after hospital admission, adjusted for potential confounders measured at the same time as BMI, including age, race, sex, education, partnership status, income, wealth, and smoking status. Body mass index (BMI) was calculated from self-reported height and weight collected at the HRS survey prior to hospitalization (a median 1.1 year prior to hospitalization). The referent group was patients with a normal BMI (18.5 to BMI was associated with lower mortality at 1 year after hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction-with adjusted hazard ratios of 0.68 (95% CI 0.59-0.79), 0.74 (95% CI: 0.64-0.84), and 0.65 (95%CI: 0.53-0.80), respectively. Among participants who lived to one year, however, subsequent survival was similar between patients with normal versus overweight/obese BMI. In older Americans, overweight or obese BMI was associated with improved survival following hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction. This association, however, is limited to the shorter-term. Conditional on surviving to one year, we did not observe a survival advantage associated with excess weight.

  14. Diet Quality and Nutrient Intake of Urban Overweight and Obese Primarily African American Older Adults with Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Sevasti Vergis

    2018-04-01

    Full Text Available Diet quality may be a unique target for preventing and managing obesity-related osteoarthritis (OA. Using the Healthy Eating Index-2010 (HEI-2010, this study examined the nutrient intake and diet quality of 400 urban overweight and obese primarily African American older adults with self-reported lower extremity OA. Associations between sociodemographic and health-related factors and diet quality were explored. Participants (mean age 67.8 years, SD 5.9 were included. Habitual dietary intake was assessed using a food frequency questionnaire (FFQ. Nutrient intake and diet quality were calculated from the FFQ. Results indicated that diet quality needs improvement (HEI-2010: 66.3 (SD 10.5. Age, body mass index, employment (multivariable model only, and OA severity (bivariate model only were significant predictors of HEI-2010 total score in linear models. Mean intakes for fiber, calcium, and vitamin D were below recommendations, while percentage of calories as total fat exceeded recommendations. These findings can inform future dietary intervention trials and public health messaging for a sub-population at a high risk for obesity-related OA.

  15. Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

    Directory of Open Access Journals (Sweden)

    Renate Kruschitz

    2017-04-01

    Full Text Available Objective: Structured obesity treatment programs at primary care level are becoming increasingly important. However, evidence from current treatment approaches in the long term is lacking. In view of this fact we evaluated a standardized, meal replacement-based weight loss program (myLINE®; AENGUS, Graz, Austria according to the currently applicable guidelines. Methods: Data of overweight and obese individuals (n = 70 who participated at least 36 months in the program were analyzed. Data were collected at baseline (T0 as well as after 1, 3, 6, 12, 24, and 36 (T1-T36 months. Body composition was measured by conventional anthropometry and bioelectrical impedance analysis. Results: Compared to T0, a maximum weight, BMI, fat mass, absolute body cell mass (BCM reduction and an increase of relative BCM could be seen at T6. Subsequently, the findings reveal a significant reduction of body weight and body fat and a satisfying development of body cell mass during the observation period of 36 months. Conclusion: The evaluated program complies with national and international guidelines for the therapy of obesity in adults and is efficient and meaningful for a long-term therapeutic use in primary care..

  16. Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam.

    Science.gov (United States)

    Carrillo-Larco, Rodrigo M; Miranda, J Jaime; Bernabé-Ortiz, Antonio

    2016-05-01

    To estimate the incidence and risk of childhood overweight and obesity according to socioeconomic status in Peruvian and Vietnamese school-aged children. Longitudinal data from the Young Lives study were analyzed. Exposure was wealth index in tertiles. Outcome was overweight and obesity. Cumulative incidence per 100 children-years, relative risks (RR), and 95 % confidence intervals (95 % CI) were calculated. A hierarchical approach, including child- and family-related variables, was followed to construct multivariable models. The cumulative incidence of overweight and obesity was 4.8 (95 % CI 4.1-5.5) and 1.7 (95 % CI 1.3-2.2) in the younger and older Peruvian cohort, respectively; and in Vietnam 1.5 (95 % CI 1.2-1.8) and 0.3 (95 % CI 0.2-0.5), respectively. The incidence of overweight and obesity was higher at the top wealth index tertile in all samples. In the older cohorts, comparing highest versus bottom wealth index tertile, RR of overweight and obesity was four to nine times higher: 4.25 in Peru (95 % CI 2.21-8.18) and 9.11 in Vietnam (95 % CI 1.07-77.42). The results provide important information for childhood obesity prevention in countries moving ahead with economic, epidemiological and nutritional transitions.

  17. Differences in health status between long-term and short-term benzodiazepine users.

    NARCIS (Netherlands)

    Zandstra, S.M.; Furer, J.W.; Lisdonk, E.H. van de; Bor, J.H.J.; Zitman, F.G.; Weel, C. van

    2002-01-01

    BACKGROUND: Despite generally accepted advice to keep treatment short, benzodiazepines are often prescibed for more than six months. Prevention of long-term benzodiazepine use could be facilitated by the utilisation of risk indicators for long-term use. However, the characteristics of long-term

  18. Scientific Understanding from Long Term Observations: Insights from the Long Term Ecological Research (LTER) Program

    Science.gov (United States)

    Gosz, J.

    2001-12-01

    The network dedicated to Long Term Ecological Research (LTER) in the United States has grown to 24 sites since it was formed in 1980. Long-term research and monitoring are performed on parameters thatare basic to all ecosystems and are required to understand patterns, processes, and relationship to change. Collectively, the sites in the LTER Network provide opportunities to contrast marine, coastal, and continental regions, the full range of climatic gradients existing in North America, and aquatic and terrestrial habitats in a range of ecosystem types. The combination of common core areas and long-term research and monitoring in many habitats have allowed unprecedented abilities to understand and compare complex temporal and spatial dynamics associated with issues like climate change, effects of pollution, biodiversity and landuse. For example, McMurdo Dry Valley in the Antarctic has demonstrated an increase in glacier mass since 1993 which coincides with a period of cooler than normal summers and more than average snowfall. In contrast, the Bonanza Creek and Toolik Lake sites in Alaska have recorded a warming period unprecedented in the past 200 years. Nitrogen deposition effects have been identified through long-term watershed studies on biogeochemical cycles, especially at Coweeta Hydrological Lab, Harvard Forest, and the Hubbard Brook Experimental Forest. In aquatic systems, such as the Northern Temperate Lakes site, long-term data revealed time lags in effects of invaders and disturbance on lake communities. Biological recovery from an effect such as lake acidification was shown to lag behind chemical recovery. The long-term changes documented over 2 decades have been instrumental in influencing management practices in many of the LTER areas. In Puerto Rico, the Luquillo LTER demonstrated that dams obstruct migrations of fish and freshwater shrimp and water abstraction at low flows can completely obliterate downstream migration of juveniles and damage

  19. Patient empowerment in long-term conditions: development and preliminary testing of a new measure

    Science.gov (United States)

    2013-01-01

    Background Patient empowerment is viewed by policy makers and health care practitioners as a mechanism to help patients with long-term conditions better manage their health and achieve better outcomes. However, assessing the role of empowerment is dependent on effective measures of empowerment. Although many measures of empowerment exist, no measure has been developed specifically for patients with long-term conditions in the primary care setting. This study presents preliminary data on the development and validation of such a measure. Methods We conducted two empirical studies. Study one was an interview study to understand empowerment from the perspective of patients living with long-term conditions. Qualitative analysis identified dimensions of empowerment, and the qualitative data were used to generate items relating to these dimensions. Study two was a cross-sectional postal study involving patients with different types of long-term conditions recruited from general practices. The survey was conducted to test and validate our new measure of empowerment. Factor analysis and regression were performed to test scale structure, internal consistency and construct validity. Results Sixteen predominately elderly patients with different types of long-term conditions described empowerment in terms of 5 dimensions (identity, knowledge and understanding, personal control, personal decision-making, and enabling other patients). One hundred and ninety seven survey responses were received from mainly older white females, with relatively low levels of formal education, with the majority retired from paid work. Almost half of the sample reported cardiovascular, joint or diabetes long-term conditions. Factor analysis identified a three factor solution (positive attitude and sense of control, knowledge and confidence in decision making and enabling others), although the structure lacked clarity. A total empowerment score across all items showed acceptable levels of internal

  20. Telomere length and long-term endurance exercise: does exercise training affect biological age? A pilot study.

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    Ida Beate Ø Østhus

    Full Text Available BACKGROUND: Telomeres are potential markers of mitotic cellular age and are associated with physical ageing process. Long-term endurance training and higher aerobic exercise capacity (VO(2max are associated with improved survival, and dynamic effects of exercise are evident with ageing. However, the association of telomere length with exercise training and VO(2max has so far been inconsistent. Our aim was to assess whether muscle telomere length is associated with endurance exercise training and VO(2max in younger and older people. METHODS: Twenty men; 10 young (22-27 years and 10 old (66-77 years, were studied in this cross-sectional study. Five out of 10 young adults and 5 out of 10 older were endurance athletes, while other halves were exercising at a medium level of activity. Mean telomere length was measured as telomere/single copy gene-ratio (T/S-ratio using quantitative real time polymerase chain reaction. VO(2max was measured directly running on a treadmill. RESULTS: Older endurance trained athletes had longer telomere length compared with older people with medium activity levels (T/S ratio 1.12±0.1 vs. 0.92±0.2, p = 0.04. Telomere length of young endurance trained athletes was not different than young non-athletes (1.47±0.2 vs. 1.33±0.1, p = 0.12. Overall, there was a positive association between T/S ratio and VO(2max (r = 0.70, p = 0.001. Among endurance trained athletes, we found a strong correlation between VO(2max and T/S ratio (r = 0.78, p = 0.02. However, corresponding association among non-athlete participants was relatively weak (r = 0.58, p = 0.09. CONCLUSION: Our data suggest that VO(2max is positively associated with telomere length, and we found that long-term endurance exercise training may provide a protective effect on muscle telomere length in older people.

  1. Very long-term sequelae of craniopharyngioma.

    Science.gov (United States)

    Wijnen, Mark; van den Heuvel-Eibrink, Marry M; Janssen, Joseph A M J L; Catsman-Berrevoets, Coriene E; Michiels, Erna M C; van Veelen-Vincent, Marie-Lise C; Dallenga, Alof H G; van den Berge, J Herbert; van Rij, Carolien M; van der Lely, Aart-Jan; Neggers, Sebastian J C M M

    2017-06-01

    Studies investigating long-term health conditions in patients with craniopharyngioma are limited by short follow-up durations and generally do not compare long-term health effects according to initial craniopharyngioma treatment approach. In addition, studies comparing long-term health conditions between patients with childhood- and adult-onset craniopharyngioma report conflicting results. The objective of this study was to analyse a full spectrum of long-term health effects in patients with craniopharyngioma according to initial treatment approach and age group at craniopharyngioma presentation. Cross-sectional study based on retrospective data. We studied a single-centre cohort of 128 patients with craniopharyngioma treated from 1980 onwards (63 patients with childhood-onset disease). Median follow-up since craniopharyngioma presentation was 13 years (interquartile range: 5-23 years). Initial craniopharyngioma treatment approaches included gross total resection ( n  = 25), subtotal resection without radiotherapy ( n  = 44), subtotal resection with radiotherapy ( n  = 25), cyst aspiration without radiotherapy ( n  = 8), and 90 Yttrium brachytherapy ( n  = 21). Pituitary hormone deficiencies (98%), visual disturbances (75%) and obesity (56%) were the most common long-term health conditions observed. Different initial craniopharyngioma treatment approaches resulted in similar long-term health effects. Patients with childhood-onset craniopharyngioma experienced significantly more growth hormone deficiency, diabetes insipidus, panhypopituitarism, morbid obesity, epilepsy and psychiatric conditions compared with patients with adult-onset disease. Recurrence-/progression-free survival was significantly lower after initial craniopharyngioma treatment with cyst aspiration compared with other therapeutic approaches. Survival was similar between patients with childhood- and adult-onset craniopharyngioma. Long-term health conditions were comparable after

  2. Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: a large-scale population-based study in Japan.

    Science.gov (United States)

    Arai, Yumiko; Kumamoto, Keigo; Mizuno, Yoko; Washio, Masakazu

    2014-01-01

    To identify predictors for depression among family caregivers of community-dwelling older people under the Long Term Care Insurance (LTCI) program in Japan through a large-scale population-based survey. All 5938 older people with disabilities, using domiciliary services under the LTCI in the city of Toyama, and their family caregivers participated in this study. Caregiver depression was defined as scores of ≥16 on the Center for Epidemiological Studies Depression Scale (CES-D). Other caregiver measures included age, sex, hours spent caregiving, relationship to the care recipient, income adequacy, living arrangement, self-rated health, and work status. Care recipient measures included age, sex, level of functional disability, and severity of dementia. The data from 4128 pairs of the care recipients and their family caregivers were eligible for further analyses. A multiple logistic regression analysis was used to examine the predictors associated with being at risk of clinical depression (CES-D of ≥16). Overall, 34.2% of caregivers scored ≥16 on the CES-D. The independent predictors for depression by logistic regression analysis were six caregiver characteristics (female, income inadequacy, longer hours spent caregiving, worse subjective health, and co-residence with the care recipient) and one care-recipient characteristic (moderate dementia). This is one of the first population-based examinations of caregivers of older people who are enrolled in a national service system that provides affordable access to services. The results highlighted the importance of monitoring caregivers who manifest the identified predictors to attenuate caregiver depression at the population level under the LTCI.

  3. Long-term prisoner in prison isolation

    Directory of Open Access Journals (Sweden)

    Karolina Grudzińska

    2013-06-01

    Full Text Available Long-term prisoner belongs to a particular category of people who are imprisoned in prisons. On the one hand in this group are often heavily demoralized people who committed the most serious crimes, on the other hand it is a group of prisoners, who should be well thought out and programmed the impact of rehabilitation. The situation of man trapped for years poses in a complicated situation not only the prisoners, but also the entire prison staff. They have to take care of the fact that the prison isolation did not cause the state in which convicts form itself in learned helplessness and lack of skills for self-planning and decision-making. In addition, planning the rehabilitation impact of long-term prisoners should not be forgotten that these prisoners in the short or the long term will return to the libertarian environment therefore, should prevent any negative effects of long-term imprisonment. This article presents the main issues related to the execution of imprisonment against long-term prisoners. It is an attempt to systematize the knowledge of this category of people living in prison isolation.

  4. The Benefits of Continuous Leisure Participation in Relocation Adjustment Among Residents of Long-Term Care Facilities.

    Science.gov (United States)

    Lin, Li-Jung; Yen, Hsin-Yen

    2018-03-19

    The rising population of older adults is transforming Taiwan society. Although many long-term care facilities now operate for older adults, the transition from the home environment to long-term facilities may cause multiple issues, including relocation stress syndrome, for new residents. Autonomy is a critical element of the human experience. Leisure, as an expression of autonomy, has been shown to enhance self-image and promote feelings of competence and mastery. The aim of this study was to assess the relationship between participation in leisure activities and adjustment to residential care using the continuity theory. One hundred sixty-three qualified individuals from 11 long-term care institutions were recruited and completed the questionnaire. The sampling criteria for the study were age (55+ years), appropriate cognitive skills, and residency (less than 5 years). Interviews conducted by trained interviewers were used to collect data. Measured outcomes included leisure participation; physical, psychological, and social adjustments; and background information. Cluster analysis, descriptive analysis, multivariate analysis of variance, and least significant difference test were used in analysis. Type of admission (voluntary/mandated) and type of leisure participation significantly affected the level of relocation adjustment success. Four leisure behavior categories were identified, including reduced participation, expanded participation, active participation, and continuing participation. The participants in the active and continuing participation categories had significantly higher psychological adjustment than their peers in the reduced participation category. Moreover, the continuing participation category had a significantly better level of social adjustment than their expanded participation category peers. Continuous and active participation categories had a beneficial outcome in relocation adjustment. The findings support that, in general, residents of

  5. Long-term adherence to exercise: the relationship with functional fitness and personal motivation among community-dwelling independent-living older women

    Directory of Open Access Journals (Sweden)

    Philipe de Souto BarretoI

    2011-03-01

    Full Text Available OBJECTIVE: The aim of this study were to examine the relationships between functional fitness, self-esteem, aesthetic body care and long-term adherence to dance, and to identify other characteristics related to dance adherence in the elderly. METHODS: Seventeen women, aged 59-86 years-old, who practised a type of dance labeled "bodily expression". RESULTS: Functional fitness was correlated to dance adherence and was the only factor related to this variable in a linear regression analysis. Self-esteem and aesthetic body care seemed to play an indirect role on adherence. Functional fitness, specially upper-body flexibility and lower-body muscular function, and interest in dance (qualitative data were related to long-term adherence to dance. CONCLUSIONS: Functional fitness and interest in exercising were the main aspects related to participants' long-term adherence to dance.

  6. Competitive short-term and long-term memory processes in spatial habituation.

    Science.gov (United States)

    Sanderson, David J; Bannerman, David M

    2011-04-01

    Exposure to a spatial location leads to habituation of exploration such that, in a novelty preference test, rodents subsequently prefer exploring a novel location to the familiar location. According to Wagner's (1981) theory of memory, short-term and long-term habituation are caused by separate and sometimes opponent processes. In the present study, this dual-process account of memory was tested. Mice received a series of exposure training trials to a location before receiving a novelty preference test. The novelty preference was greater when tested after a short, rather than a long, interval. In contrast, the novelty preference was weaker when exposure training trials were separated by a short, rather than a long interval. Furthermore, it was found that long-term habituation was determined by the independent effects of the amount of exposure training and the number of exposure training trials when factors such as the intertrial interval and the cumulative intertrial interval were controlled. A final experiment demonstrated that a long-term reduction of exploration could be caused by a negative priming effect due to associations formed during exploration. These results provide evidence against a single-process account of habituation and suggest that spatial habituation is determined by both short-term, recency-based memory and long-term, incrementally strengthened memory.

  7. Anthropometry in Long-Term Survivors of Acute Lymphoblastic Leukemia in Childhood and Adolescence.

    Science.gov (United States)

    Collins, Laura; Beaumont, Lesley; Cranston, Amy; Savoie, Stefanie; Nayiager, Trishana; Barr, Ronald

    2017-06-01

    Body mass index (BMI) is an inadequate measure of nutritional status in children and adolescents with cancer as it does not distinguish muscle from adipose tissue. However, arm anthropometry offers simple assessments of fat mass and lean body mass; especially valuable in low- and middle-income countries where the great majority of young people with cancer live and access to sophisticated expensive measures of body composition is markedly limited. The nutritional status of 75 long-term survivors of acute lymphoblastic leukemia was assessed by arm anthropometry, in addition to BMI, in a cross-sectional cohort study. Normal ranges for triceps skin fold thickness (TSFT, a surrogate for fat mass) and mid-upper arm circumference (MUAC, a surrogate for lean body mass) were between the 15th and 85th percentiles for age and sex. Overweight/obesity was classified as a TSFT >85th percentile and sarcopenia as an MUAC obesity was identified in 1/3 of subjects by a BMI >25 and by TSFT; and 20% of the subjects had a TSFT >95th percentile. Only two subjects were sarcopenic. None met the combined criteria for sarcopenic obesity. TSFT and MUAC/height indices did not add sensitivity to identification of sarcopenia or obesity. TSFT is a useful measure of overweight/obesity in this population, but MUAC does not identify a notable proportion with sarcopenia. Further resolution may be provided by more sophisticated measures of body composition.

  8. Long term liquidity analysis of the firm

    Directory of Open Access Journals (Sweden)

    Jaroslav Gonos

    2009-09-01

    Full Text Available Liquidity control is a very difficult and important function. If the business is not liquid in the long term, it is under threatof bankruptcy, and on the other hand surplus of the cash in hand threaten its future efficiency, because the cash in hand is a sourceof only limited profitability. Long term liquidity is related to the ability of the short term and long term liabilities payment. Articleis trying to point out to the monitoring and analyzing of the long term liquidity in the concrete business, in this case the printing industrycompany. Hereby at the end of the article mentioned monitored and analyzed liquidity is evaluated in the five years time period.

  9. Dental Implants in the Elderly Population: A Long-Term Follow-up.

    Science.gov (United States)

    Compton, Sharon M; Clark, Danielle; Chan, Stephanie; Kuc, Iris; Wubie, Berhanu A; Levin, Liran

    The objectives of this study were to evaluate implant survival and success in the elderly population and to assess indicators and risk factors for success or failure of dental implants in older adults (aged 60 years and older). This historical prospective study was developed from a cohort of patients born prior to 1950 who received dental implants in a single private dental office. Implant survival and marginal bone levels were recorded and analyzed with regard to different patient- and implant-related factors. The study examined 245 patient charts and 1,256 implants from one dental clinic. The mean age at the time of implant placement was 62.18 ± 8.6 years. Smoking was reported by 9.4% of the cohort studied. The overall survival rate of the implants was 92.9%; 7.1% of the implants had failed. Marginal bone loss depicted by exposed threads was evident in 23.3% of the implants. Presenting with generalized periodontal disease and/or severe periodontal disease negatively influenced the survival probability of the implant. Implants placed in areas where bone augmentation was performed prior to or during implant surgery did not have the same longevity compared with those that did not have augmentation prior to implantation. The overall findings concluded that implants can be successfully placed in older adults. A variety of factors are involved in the long-term success of the implant, and special consideration should be taken prior to placing implants in older adults to limit the influence of those risk factors.

  10. Growing older with post-traumatic stress disorder.

    Science.gov (United States)

    Curran, B; Collier, E

    2016-04-01

    WHAT IS KNOWN ON THE SUBJECT?: The needs of older people with long-term mental illness are not very well addressed in policy and research. Older people are not a homogenous group and people ageing with long-term mental illness have potentially unique or specific needs. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A unique example of the idiosyncratic and contextual nature of individual strengths and the abilities in managing personal recovery when experiencing long-term mental illness. Emotional exhaustion experienced after long-term mental health compromises the ability to manage feelings, potentially a special feature of life time mental ill health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Recognition that the hard work involved in successfully managing long-term personal recovery may be important in preventing suicide in later life. The need to understand a person's life story to make sense of their experience of mental illness and to recognize long-term mental illness to later life as part of a persons' established identity. The importance of appreciating the place of early memories for understanding older person's mental health in their present. Introduction Ageing with mental illness is a neglected area of research and policy. People who grow older to later life with ongoing mental health problems may not have their needs well understood. This understanding is important if mental health services are to ensure direct or indirect age discrimination is avoided. Aim This paper aims to explore issues relating to later life and ageing with mental illness focused on the story of Bernard (who was 84 years of age at the time of writing) who lived with a diagnosis of post-traumatic stress disorder (PTSD). Method The paper is co-authored by Bernard and the researcher he originally told his story to as a participant in a biographical research study exploring mental ill health through the life course. In the original research study, Bernard completed a curriculum vitae

  11. Chewing ability of the long-term hospitalized elderly.

    Science.gov (United States)

    Peltola, Petteri; Vehkalahti, Miira M

    2005-01-01

    We investigated the chewing ability of 260 (25 percent men) long-term hospitalized elderly patients 60 years of age and older in Laakso hospital, Helsinki, Finland, in relation to their mastication capacity, sore mouth and degree of dependence. The subjects' (mean age 83.3 years, SD = 8.1 years) mastication capacity was determined by a specialist dentist by means of: (a) number of functioning teeth and dentures; (b) modified Eichner Index; and (c) the Eichner Score, based on the index. Based on the information given by the nursing staff, an indicator of chewing ability was created. The chewing ability was poor for 55 percent, limited for 17 percent, moderate for 14 percent and excellent for 14 percent. Excellent or moderate ability to chew was related to a subject's lesser degree of dependence (OR = 1.5; p = 0.02) and higher Eichner Score (OR = 1.3; p = 0.000). More attention should be focused on mastication capacity of the hospitalized elderly.

  12. Reduced fertility among overweight and obese men.

    Science.gov (United States)

    Sallmén, Markku; Sandler, Dale P; Hoppin, Jane A; Blair, Aaron; Baird, Donna Day

    2006-09-01

    Overweight and obese men have been reported to have lower sperm counts and hormonal changes, but data are lacking regarding effects on couple fertility. We examined the relationship between male body mass index (BMI) and infertility in couples enrolled in the Agricultural Health Study in the United States. The analysis sample was limited to couples (wife conceiving a pregnancy after at least 12 months of unprotected intercourse regardless of whether or not a pregnancy ultimately occurred. Self-reported weight and height were used to calculate BMI (kg/m). Adjusted odds ratios (aORs) for infertility associated with increases in male BMI were calculated with logistic regression. Adjusting for potential confounders, a 3-unit increase in male BMI was associated with infertility (aOR = 1.12; 95% confidence interval = 1.01-1.25; n = 1329). There was a dose-response relationship, and the BMI effect was stronger when the data were limited to couples with the highest-quality infertility data. The association between BMI and infertility was similar for older and younger men, suggesting that erectile dysfunction in older men does not explain the association. This report of lower fertility in overweight and obese men needs replication. If the findings are robust, programs to prevent obesity may improve men's reproductive health and save medical costs for infertility treatment.

  13. Impact of simulated ostracism on overweight and normal-weight youths' motivation to eat and food intake.

    Science.gov (United States)

    Salvy, Sarah-Jeanne; Bowker, Julie C; Nitecki, Lauren A; Kluczynski, Melissa A; Germeroth, Lisa J; Roemmich, James N

    2011-02-01

    There is growing evidence that the experience of being ostracized can impair individuals' abilities to self-regulate, which in turn, leads to negative health behaviors, such as increased unhealthy eating. Research has focused on adults, but deficits in eating regulation in response to ostracism may be particularly detrimental for overweight or obese youth. This study examines the effects of a brief episode of ostracism on the motivation to eat and food intake of overweight and normal-weight young adolescents (M age=13.6 years). A computerized ball-tossing game (Cyberball) was used to induce ostracism or inclusion. Following the inclusion/ostracism manipulation, all participants completed an operant computer task to earn points exchangeable for portions of food or for time socializing with an unfamiliar peer. Participants' responses for food and their subsequent energy intake were recorded. As hypothesized, ostracized overweight participants responded more for food and had a greater energy intake than overweight participants in the inclusion/control condition; whereas this was not the case for normal-weight participants. These results are important as studies indicate that overweight and obese youth may be at risk of social isolation and peer difficulties. Social adversity, if left unchanged, may increase the difficulty of promoting long-term changes in overweight youths' health behaviors. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Bulimia nervosa in overweight and normal-weight women.

    Science.gov (United States)

    Masheb, Robin; White, Marney A

    2012-02-01

    The aim of the present study was to examine overweight bulimia nervosa (BN) in a community sample of women. Volunteers (n = 1964) completed self-report questionnaires of weight, binge eating, purging, and cognitive features. Participants were classified as overweight (body mass index ≥25) or normal weight (body mass index <25). Rates of BN within the overweight and normal-weight classes did not differ (6.4% vs 7.9%). Of the 131 participants identified as BN, 64% (n = 84) were classified as overweight BN and 36% (n = 47) as normal-weight BN. The overweight BN group had a greater proportion of ethnic minorities and reported significantly less restraint than the normal-weight BN group. Otherwise, the 2 groups reported similarly, even in terms of purging and depression. In summary, rates of BN did not differ between overweight and normal-weight women. Among BN participants, the majority (two thirds) were overweight. Differences in ethnicity and restraint, but little else, were found between overweight and normal-weight BN. Findings from the present study should serve to increase awareness of the weight range and ethnic diversity of BN, and highlight the need to address weight and cultural sensitivity in the identification and treatment of eating disorders. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Underweight and overweight among children and adolescents in Tuscany (Italy). Prevalence and short-term trends.

    Science.gov (United States)

    Lazzeri, G; Rossi, S; Pammolli, A; Pilato, V; Pozzi, T; Giacchi, M V

    2008-03-01

    The recent increase in both childhood obesity and adolescent anorexia nervosa in developed countries has underlined the important consequences that these trends may have on public health, as there is an increased risk that these conditions may become chronic diseases in adulthood. Therefore, it is necessary to monitor prevalence rates and trends in thinness and overweight (including obesity) among children and adolescents at different levels: international, national and sub-national. Since 2001/2002, a nutritional surveillance system has been implemented in the Tuscany Region to estimate the nutritional status and lifestyles of children and adolescents. The main objectives were to assess the prevalence of thinness, overweight and obesity among Tuscan children and adolescents and to provide baseline information on the prevalence of thinness, for the first time calculated according to the new international definitions, for geographical comparisons and descriptions of time trends. Independent cross-sectional sample surveys were conducted in 2002, 2004 and 2006 in Tuscany, North-Central Italy. Data were collected from stratified two-stage cluster samples of children aged 9 years (n = 3,048 in 2002 and n = 1,430 in 2006) and of adolescents aged 11-13-15 years (n = 1,066, n = 1185 and n = 1,160 in 2004 and n = 1,189, n = 1,211 and n = 1,178 in 2006, respectively). Weights and heights of primary school children were measured by means of standardized methods, while those of adolescents were self-reported. Decimal age was calculated from the date of birth to the date of measurement. Body Mass Index classes were calculated according to the International Obesity Task Force standards. Instead of the term underweight in children, we used the term thinness, which the World Health Organization uses to mean low Body Mass Index for age in adults and adolescents. According to Cole's recently published cut-offs for thinness, we divided our Body Mass Index values below 18.5 into three

  16. Rural-urban differences in the long-term care of the disabled elderly in China.

    Science.gov (United States)

    Li, Mei; Zhang, Yang; Zhang, Zhenyu; Zhang, Ying; Zhou, Litao; Chen, Kun

    2013-01-01

    In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively), but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

  17. Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women.

    Science.gov (United States)

    Nagl, Michaela; Steinig, Jana; Klinitzke, Grit; Stepan, Holger; Kersting, Anette

    2016-04-01

    Pre-pregnancy overweight and obesity is associated with poor health outcomes for the mother and the child. General population studies suggest that childhood maltreatment is associated with obesity in adulthood. The aim of our study was to examine the association between pre-pregnancy overweight and obesity and a history of childhood abuse or neglect including different stages of severity of abuse and neglect. Three hundred twenty-six normal weight, overweight, or obese pregnant women reported demographic data, height and weight, and general psychological distress at 18-22 weeks of gestation. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Associations were examined using logistic regression analyses and a reference group of normal weight women. Fifty percent reported a history of abuse or neglect. After adjusting for age, education, income, marital status, and the number of previous children, pre-pregnancy overweight and obesity were strongly associated with severe physical abuse (overweight: OR = 8.33, 95% CI 1.48-47.03; obesity: OR = 6.31, 95% CI 1.06-37.60). Women with severe physical neglect (OR = 4.25, 95% CI 1.23-14.74) were at increased risk of pregnancy overweight. We found a dose-response relationship between physical abuse and pre-pregnancy overweight and obesity. Whereas other studies report an association between childhood maltreatment and pre-pregnancy obesity, this is the first study that found an association between childhood maltreatment and pre-pregnancy overweight. Considering the severe health risks of pre-pregnancy overweight and obesity and the long-term consequences of childhood maltreatment, affected women constitute a subgroup with special needs in prenatal care. Further research is needed to improve the understanding of the underlying mechanisms.

  18. A humanbecoming qualitative descriptive study on quality of life with older adults.

    Science.gov (United States)

    Ma, Lina

    2014-04-01

    Quality of life is a universal living experience and is significant for older adults living in long-term residential care facilities. The purposes of this research study were to: explicate the experience of quality of life for older adults, contribute to the understanding of quality of life for older adults and to nursing's extant body of knowledge by enhancing humanbecoming. Humanbecoming was selected as the theoretical perspective for the qualitative descriptive exploratory method study with 10 volunteers living in the same long-term residential care facility in Singapore. Findings showed that: quality of life is fortifying tranquillity amid potential turbulence with the gratifying engagements of diverse affiliations, as envisioning possibilities arise with discordant constraints. The findings of this study have made a significant contribution to the phenomenon - quality of life both in terms of older adults living in nursing homes and from a Singaporean context.

  19. Long-term contracts vs. short-term trade of natural gas - a European perspective

    International Nuclear Information System (INIS)

    Neuhoff, Karsten; Hirschhausen, Christian von

    2005-01-01

    This paper analyses the economics of long-term gas contracts under changing institutional conditions, mainly gas sector liberalisation. The paper is motivated by the increasingly tense debate in continental Europe, UK and the US on the security of long-term gas supply. We discuss the main issues regarding long-term contracts, i.e. the changing role of the flexibility clause, the effect of abandoning the destination clause, and the strategic behaviour of producers between long-term sales and spot-sales. The literature suggests consumers and producers benefit from risk hedging through long-term contracts. Furthermore long-term contracts may reduce exercise of market power. Our analysis adds an additional benefit if the long-run demand elasticity is significantly lower than the short-run elasticity, both strategic producers and consumers benefit from lower prices and larger market volume. Some policy implications of the findings are also discussed. (Author)

  20. The uranium industry: long-term planning for short-term competition

    International Nuclear Information System (INIS)

    Vottero, X.; Georges Capus, G.

    2001-01-01

    Long term planning for short term competition Today, uranium producers face new challenges in terms of both production (new regulatory, environmental and social constraints) and market conditions (new sources of uranium supply, very low prices and tough competition). In such a context, long-term planning is not just a prerequisite to survive in the nuclear fuel cycle industry. In fact, it also contributes to sustaining nuclear electricity generation facing fierce competition from other energy sources in increasingly deregulated markets. Firstly, the risk of investing in new mining projects in western countries is growing because, on the one hand, of very erratic market conditions and, on the other hand, of increasingly lengthy, complex and unpredictable regulatory conditions. Secondly, the supply of other sources of uranium (uranium derived from nuclear weapons, uranium produced in CIS countries, ...) involve other risks, mainly related to politics and commercial restrictions. Consequently, competitive uranium supply requires not only technical competence but also financial strength and good marketing capabilities in order to anticipate long-term market trends, in terms of both demand and supply. It also requires taking into account new parameters such as politics, environment, regulations, etc. Today, a supplier dedicated to the sustainable production of nuclear electricity must manage a broad range of long-term risks inherent to the procurement of uranium. Taking into account all these parameters in a context of short-term, fast-changing market is a great challenge for the future generation. World Uranium Civilian Supply and Demand. (authors)

  1. Long-term biodosimetry Redux

    International Nuclear Information System (INIS)

    Simon, Steven L.; Bouville, Andre

    2016-01-01

    This paper revisits and reiterates the needs, purposes and requirements of bio-dosimetric assays for long-term dose and health risk assessments. While the most crucial need for bio-dosimetric assays is to guide medical response for radiation accidents, the value of such techniques for improving our understanding of radiation health risk by supporting epidemiological (long-term health risk) studies is significant. As new cohorts of exposed persons are identified and new health risk studies are undertaken with the hopes that studying the exposed will result in a deeper understanding of radiation risk, the value of reliable dose reconstruction is underscored. The ultimate application of biodosimetry in long-term health risk studies would be to completely replace model-based dose reconstruction-a complex suite of methods for retrospectively estimating dose that is commonly fraught with large uncertainties due to the absence of important exposure-related information, as well as imperfect models. While biodosimetry could potentially supplant model-based doses, there are numerous limitations of presently available techniques that constrain their widespread application in health risk research, including limited ability to assess doses received far in the past, high cost, great inter-individual variability, invasiveness, higher than preferred detection limits and the inability to assess internal dose (for the most part). These limitations prevent the extensive application of biodosimetry to large cohorts and should be considered a challenge to researchers to develop new and more flexible techniques that meet the demands of long-term health risk research. Events in recent years, e.g. the Fukushima reactor accident and the increased threat of nuclear terrorism, underscore that any event that results in significant radiation exposures of a group of people will also produce a much larger population, exposed at lower levels, but that likewise needs (or demands) an exposure

  2. Comparison of quality of sleep, depression, and life satisfaction between older adults in nursing homes and long-term care hospitals in Korea.

    Science.gov (United States)

    Kim, Kon Hee; Hwang, Eun Hee

    2017-01-01

    The purpose of the present study was to identify the sleep quality, depression, and life satisfaction between nursing home and long-term care hospital residents. Data was collected through a structured questionnaire survey of 61 nursing home residents and 74 long-term care hospital residents. Descriptive statistics, t-test, χ 2 -test, anova, Pearson's correlation were used to analyze the data. The residents living in a nursing home showed higher subjective health status and sleep quality than long-term care hospital residents. Depression did not show a significant difference between them. However, there was a significant difference in depression score by subjective health status. Sleep quality and depression showed a significant negative correlation for both residents. In terms of depression and life satisfaction, nursing home residents showed a significant negative correlation, and long-term care hospital residents showed a significant positive correlation. These results show that environmental management is essential to enhance sleep quality, thus depression and subjective health status will be improved. Geriatr Gerontol Int 2017; 17: 142-149. © 2015 Japan Geriatrics Society.

  3. Long term radioactive waste management

    International Nuclear Information System (INIS)

    Lavie, J.M.

    1984-01-01

    In France, waste management, a sensitive issue in term of public opinion, is developing quickly, and due to twenty years of experience, is now reaching maturity. With the launching of the French nuclear programme, the use of radioactive sources in radiotherapy and industry, waste management has become an industrial activity. Waste management is an integrated system dealing with the wastes from their production to the long term disposal, including their identification, sortage, treatment, packaging, collection and transport. This system aims at guaranteing the protection of present and future populations with an available technology. In regard to their long term management, and the design of disposals, radioactive wastes are divided in three categories. This classification takes into account the different radioisotopes contained, their half life and their total activity. Presently short-lived wastes are stored in the shallowland disposal of the ''Centre de la Manche''. Set up within the French Atomic Energy Commission (CEA), the National Agency for waste management (ANDRA) is responsible within the framework of legislative and regulatory provisions for long term waste management in France [fr

  4. Modeling long-term dynamics of electricity markets

    International Nuclear Information System (INIS)

    Olsina, Fernando; Garces, Francisco; Haubrich, H.-J.

    2006-01-01

    In the last decade, many countries have restructured their electricity industries by introducing competition in their power generation sectors. Although some restructuring has been regarded as successful, the short experience accumulated with liberalized power markets does not allow making any founded assertion about their long-term behavior. Long-term prices and long-term supply reliability are now center of interest. This concerns firms considering investments in generation capacity and regulatory authorities interested in assuring the long-term supply adequacy and the stability of power markets. In order to gain significant insight into the long-term behavior of liberalized power markets, in this paper, a simulation model based on system dynamics is proposed and the underlying mathematical formulations extensively discussed. Unlike classical market models based on the assumption that market outcomes replicate the results of a centrally made optimization, the approach presented here focuses on replicating the system structure of power markets and the logic of relationships among system components in order to derive its dynamical response. The simulations suggest that there might be serious problems to adjust early enough the generation capacity necessary to maintain stable reserve margins, and consequently, stable long-term price levels. Because of feedback loops embedded in the structure of power markets and the existence of some time lags, the long-term market development might exhibit a quite volatile behavior. By varying some exogenous inputs, a sensitivity analysis is carried out to assess the influence of these factors on the long-run market dynamics

  5. Short-term memory and long-term memory are still different.

    Science.gov (United States)

    Norris, Dennis

    2017-09-01

    A commonly expressed view is that short-term memory (STM) is nothing more than activated long-term memory. If true, this would overturn a central tenet of cognitive psychology-the idea that there are functionally and neurobiologically distinct short- and long-term stores. Here I present an updated case for a separation between short- and long-term stores, focusing on the computational demands placed on any STM system. STM must support memory for previously unencountered information, the storage of multiple tokens of the same type, and variable binding. None of these can be achieved simply by activating long-term memory. For example, even a simple sequence of digits such as "1, 3, 1" where there are 2 tokens of the digit "1" cannot be stored in the correct order simply by activating the representations of the digits "1" and "3" in LTM. I also review recent neuroimaging data that has been presented as evidence that STM is activated LTM and show that these data are exactly what one would expect to see based on a conventional 2-store view. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  6. Dynamics of Hippocampal Protein Expression During Long-term Spatial Memory Formation*

    Science.gov (United States)

    Borovok, Natalia; Nesher, Elimelech; Levin, Yishai; Reichenstein, Michal; Pinhasov, Albert

    2016-01-01

    Spatial memory depends on the hippocampus, which is particularly vulnerable to aging. This vulnerability has implications for the impairment of navigation capacities in older people, who may show a marked drop in performance of spatial tasks with advancing age. Contemporary understanding of long-term memory formation relies on molecular mechanisms underlying long-term synaptic plasticity. With memory acquisition, activity-dependent changes occurring in synapses initiate multiple signal transduction pathways enhancing protein turnover. This enhancement facilitates de novo synthesis of plasticity related proteins, crucial factors for establishing persistent long-term synaptic plasticity and forming memory engrams. Extensive studies have been performed to elucidate molecular mechanisms of memory traces formation; however, the identity of plasticity related proteins is still evasive. In this study, we investigated protein turnover in mouse hippocampus during long-term spatial memory formation using the reference memory version of radial arm maze (RAM) paradigm. We identified 1592 proteins, which exhibited a complex picture of expression changes during spatial memory formation. Variable linear decomposition reduced significantly data dimensionality and enriched three principal factors responsible for variance of memory-related protein levels at (1) the initial phase of memory acquisition (165 proteins), (2) during the steep learning improvement (148 proteins), and (3) the final phase of the learning curve (123 proteins). Gene ontology and signaling pathways analysis revealed a clear correlation between memory improvement and learning phase-curbed expression profiles of proteins belonging to specific functional categories. We found differential enrichment of (1) neurotrophic factors signaling pathways, proteins regulating synaptic transmission, and actin microfilament during the first day of the learning curve; (2) transcription and translation machinery, protein

  7. Dynamics of Hippocampal Protein Expression During Long-term Spatial Memory Formation.

    Science.gov (United States)

    Borovok, Natalia; Nesher, Elimelech; Levin, Yishai; Reichenstein, Michal; Pinhasov, Albert; Michaelevski, Izhak

    2016-02-01

    Spatial memory depends on the hippocampus, which is particularly vulnerable to aging. This vulnerability has implications for the impairment of navigation capacities in older people, who may show a marked drop in performance of spatial tasks with advancing age. Contemporary understanding of long-term memory formation relies on molecular mechanisms underlying long-term synaptic plasticity. With memory acquisition, activity-dependent changes occurring in synapses initiate multiple signal transduction pathways enhancing protein turnover. This enhancement facilitates de novo synthesis of plasticity related proteins, crucial factors for establishing persistent long-term synaptic plasticity and forming memory engrams. Extensive studies have been performed to elucidate molecular mechanisms of memory traces formation; however, the identity of plasticity related proteins is still evasive. In this study, we investigated protein turnover in mouse hippocampus during long-term spatial memory formation using the reference memory version of radial arm maze (RAM) paradigm. We identified 1592 proteins, which exhibited a complex picture of expression changes during spatial memory formation. Variable linear decomposition reduced significantly data dimensionality and enriched three principal factors responsible for variance of memory-related protein levels at (1) the initial phase of memory acquisition (165 proteins), (2) during the steep learning improvement (148 proteins), and (3) the final phase of the learning curve (123 proteins). Gene ontology and signaling pathways analysis revealed a clear correlation between memory improvement and learning phase-curbed expression profiles of proteins belonging to specific functional categories. We found differential enrichment of (1) neurotrophic factors signaling pathways, proteins regulating synaptic transmission, and actin microfilament during the first day of the learning curve; (2) transcription and translation machinery, protein

  8. Effect of short-term carbohydrate overfeeding and long-term weight loss on liver fat in overweight humans.

    Science.gov (United States)

    Sevastianova, Ksenia; Santos, Alexandre; Kotronen, Anna; Hakkarainen, Antti; Makkonen, Janne; Silander, Kaisa; Peltonen, Markku; Romeo, Stefano; Lundbom, Jesper; Lundbom, Nina; Olkkonen, Vesa M; Gylling, Helena; Fielding, Barbara A; Rissanen, Aila; Yki-Järvinen, Hannele

    2012-10-01

    Cross-sectional studies have identified a high intake of simple sugars as an important dietary factor predicting nonalcoholic fatty liver disease (NAFLD). We examined whether overfeeding overweight subjects with simple sugars increases liver fat and de novo lipogenesis (DNL) and whether this is reversible by weight loss. Sixteen subjects [BMI (kg/m²): 30.6 ± 1.2] were placed on a hypercaloric diet (>1000 kcal simple carbohydrates/d) for 3 wk and, thereafter, on a hypocaloric diet for 6 mo. The subjects were genotyped for rs739409 in the PNPLA3 gene. Before and after overfeeding and after hypocaloric diet, metabolic variables and liver fat (measured by proton magnetic resonance spectroscopy) were measured. The ratio of palmitate (16:0) to linoleate (18:2n-6) in serum and VLDL triglycerides was used as an index of DNL. Carbohydrate overfeeding increased weight (±SEM) by 2% (1.8 ± 0.3 kg; P fat by 27% from 9.2 ± 1.9% to 11.7 ± 1.9% (P = 0.005). DNL increased in proportion to the increase in liver fat and serum triglycerides in subjects with PNPLA3-148IIbut not PNPLA3-148MM. During the hypocaloric diet, the subjects lost 4% of their weight (3.2 ± 0.6 kg; P fat content (from 11.7 ± 1.9% to 8.8 ± 1.8%; P Carbohydrate overfeeding for 3 wk induced a >10-fold greater relative change in liver fat (27%) than in body weight (2%). The increase in liver fat was proportional to that in DNL. Weight loss restores liver fat to normal. These data indicate that the human fatty liver avidly accumulates fat during carbohydrate overfeeding and support a role for DNL in the pathogenesis of NAFLD. This trial was registered at www.hus.fi as 235780.

  9. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme

    2011-01-01

    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  10. The role of polyunsaturated fatty acid metabolism in overweight and obese children and adolescents

    Directory of Open Access Journals (Sweden)

    A. A. Glazyrina

    2014-01-01

    Full Text Available The problem of obesity is currently being widely discussed by various specialists. The literature dealing with this problem places a considerable emphasis on investigations of lipid metabolism disorders that occupy a prominent place in the genesis of cardiovascular diseases in the populations of most countries. The special role of long chain polyunsaturated fatty acids that are major functional components of brain membrane structure phospholipids, retinal photoreceptors is emphasized. Pediatricians pay great attention to the nutrition of infants, by adjusting adapted milk-based formulas for their adequate growth and development. At the same time, no consideration is given to the possibility of correcting obesity-associated problems with appropriate adapted milk-based formulas in older infants. However, dietary recommendations for older infants with obesity and overweight should be developed not only in the context of optimization of a qualitative and quantitative diet that ensures the needs of the growing organism at the present moment, but should take into account the prevention of cardiovascular diseases and other complications of obesity in the future.

  11. Expanding the Andersen model: the role of psychosocial factors in long-term care use.

    Science.gov (United States)

    Bradley, Elizabeth H; McGraw, Sarah A; Curry, Leslie; Buckser, Alison; King, Kinda L; Kasl, Stanislav V; Andersen, Ronald

    2002-10-01

    To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long-term care. Twelve focus groups of African-American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000. Using qualitative analysis, data were coded and analyzed in NUD-IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African-American and white focus groups. Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation. Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African-American and white focus group members differed in their reported accessibility of information about long-term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self-determination. More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long-term care use as well as the effectiveness of policies and programs designed to address disparities in long-term care service use among minority and nonminority groups.

  12. Association of TSH With Cardiovascular Disease Risk in Overweight and Obese Children During Lifestyle Intervention.

    Science.gov (United States)

    Rijks, Jesse M; Plat, Jogchum; Dorenbos, Elke; Penders, Bas; Gerver, Willem-Jan M; Vreugdenhil, Anita C E

    2017-06-01

    Overweight and obese children have an increased risk to develop cardiovascular diseases (CVDs) in which thyroid-stimulating hormone (TSH) has been suggested as an intermediary factor. However, results of cross-sectional studies are inconclusive, and intervention studies investigating changes in TSH concentrations in association with changes in cardiovascular risk parameters in overweight and obese children are scarce. To gain insight in associations of circulating TSH concentrations and cardiovascular risk parameters in overweight and obese children. Nonrandomized lifestyle intervention. Centre for Overweight Adolescent and Children's Healthcare. Three hundred thirty euthyroid overweight and obese children. Long-term lifestyle intervention. TSH concentrations, pituitary TSH release in response to thyrotropin-releasing hormone (TRH), and cardiovascular risk parameters. At baseline, serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triacylglycerol (TAG), and monocyte chemotactic protein 1 concentrations were significantly associated with serum TSH concentrations. TSH release by the pituitary in response to exogenous TRH was not associated with cardiovascular risk parameters. During lifestyle intervention, several cardiovascular risk parameters significantly improved. In children whose body mass index z score improved, changes in TSH concentrations were significantly associated with changes in TC, LDL-C, and TAG concentrations. In euthyroid overweight and obese children, circulating TSH concentrations are positively associated with markers representing increased CVD risk. Changes in TSH concentrations are also associated with changes in lipid concentrations in children with successful weight loss, which is consistent with TSH being an intermediary factor in modulating lipid and lipoprotein metabolism. Copyright © 2017 Endocrine Society

  13. The long-term impact of war on health and wellbeing in Northern Vietnam: some glimpses from a recent survey.

    Science.gov (United States)

    Teerawichitchainan, Bussarawan; Korinek, Kim

    2012-06-01

    War is deemed a major threat to public health; yet, the long-term effects of war on individual health have rarely been examined in the context of developing countries. Based on data collected as a pilot follow-up to the Vietnam Longitudinal Survey, this study examines current health profiles of northern Vietnamese war survivors who entered early adulthood during the Vietnam War and now represent Vietnam's older adult population. To ascertain how war and military service in the early life course may have had long-term impacts on health status of Vietnam's current older adults, we compare multi-dimensional measures of health among veterans and nonveterans, and within these groups, regardless of their military service, between combatants and noncombatants. Multivariate results suggest that despite prolonged exposure to war, veterans and those who served in combat roles are not significantly different from their civilian and noncombatant counterparts on most health outcomes later in life. This is in contrast to American veterans who fought on the opposing side of the war. The near absence of differences in older adult health among northern Vietnamese with varying degrees of war involvement might be explained by the encompassing extent of war; the notion that time heals; and the hardiness and resilience against ill health that are by-products of shared struggle in war and a victorious outcome. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Occurrence and correlates of overweight and obesity among island Puerto Rican youth.

    Science.gov (United States)

    Garza, Jeremiah R; Pérez, Edna Acosta; Prelip, Michael; McCarthy, William J; Feldman, Jonathan M; Canino, Glorisa; Ortega, Alexander N

    2011-01-01

    OBJECTIVE AND MAIN OUTCOME MEASURES: This article provides 2005-2008 population-based prevalence data on obesity and overweight among youth residing in Puerto Rico. Data for this report are from the Asthma, Depression, and Anxiety in Puerto Rican Youth (ADA) study. Measures included height and weight level data on youth in Puerto Rico aged 10 to 19 years with and without asthma as well as body mass index data on their caregivers. A total of 436 youth-caregiver dyads were selected and weighted to represent the general population of youth in Puerto Rico using 2008 US Census data. Household surveys demonstrated that 40% of youth aged 10 to 19 were overweight or obese. Twenty-five percent met moderate-to-vigorous-intensity physical activity guidelines, however, physical activity was not associated with overweight or obesity in this sample. In multivariate analyses, females were 50% less likely than males to be overweight or obese. Older youth were 73% less likely to be overweight or obese than younger youth. Youth whose parents were obese were more than two times more likely to be overweight or obese than those whose parents were at a desirable weight. Youth in Puerto Rico have higher rates of overweight and obesity and lower compliance to moderate-to-vigorous-intensity physical activity guidelines than rates reported for youth on the mainland. More population-based research is needed to understand the epidemiology of obesity and overweight among island Puerto Rican youth and the contribution of physical activity to the phenomenon.

  15. Long-Term Memory Performance in Adult ADHD.

    Science.gov (United States)

    Skodzik, Timo; Holling, Heinz; Pedersen, Anya

    2017-02-01

    Memory problems are a frequently reported symptom in adult ADHD, and it is well-documented that adults with ADHD perform poorly on long-term memory tests. However, the cause of this effect is still controversial. The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD. We performed separate meta-analyses of measures of memory acquisition and long-term memory using both verbal and visual memory tests. In addition, the influence of potential moderator variables was examined. Adults with ADHD performed significantly worse than controls on verbal but not on visual long-term memory and memory acquisition subtests. The long-term memory deficit was strongly statistically related to the memory acquisition deficit. In contrast, no retrieval problems were observable. Our results suggest that memory deficits in adult ADHD reflect a learning deficit induced at the stage of encoding. Implications for clinical and research settings are presented.

  16. Prevention of fall-related injuries in long-term care: a randomized controlled trial of staff education.

    Science.gov (United States)

    Ray, Wayne A; Taylor, Jo A; Brown, Anne K; Gideon, Patricia; Hall, Kathi; Arbogast, Patrick; Meredith, Sarah

    2005-10-24

    Fall-related injuries, a major public health problem in long-term care, may be reduced by interventions that improve safety practices. Previous studies have shown that safety practice interventions can reduce falls; however, in long-term care these have relied heavily on external funding and staff. The aim of this study was to test whether a training program in safety practices for staff could reduce fall-related injuries in long-term care facilities. A cluster randomization clinical trial with 112 qualifying facilities and 10,558 study residents 65 years or older and not bedridden. The intervention was an intensive 2-day safety training program with 12-month follow-up. The training program targeted living space and personal safety; wheelchairs, canes, and walkers; psychotropic medication use; and transferring and ambulation. The main outcome measure was serious fall-related injuries during the follow-up period. There was no difference in injury occurrence between the intervention and control facilities (adjusted rate ratio, 0.98; 95% confidence interval, 0.83-1.16). For residents with a prior fall in facilities with the best program compliance, there was a nonsignificant trend toward fewer injuries in the intervention group (adjusted rate ratio, 0.79; 95% confidence interval, 0.57-1.10). More intensive interventions are required to prevent fall-related injuries in long-term care facilities.

  17. Preoperative sclerotherapy of facial venous malformations: impact on surgical parameters and long-term follow-up.

    Science.gov (United States)

    James, Charles A; Braswell, Leah E; Wright, Lonnie B; Roberson, Paula K; Moore, Mary B; Waner, Milton; Buckmiller, Lisa M

    2011-07-01

    To analyze the operative benefit of preoperative sclerotherapy of facial venous malformations and assess long-term patient outcome. Preoperative sclerotherapy was performed in 24 consecutive patients referred before resection of facial venous malformation. Pretreatment imaging was reviewed for malformation dimensions (length, width, and height), and volumes were estimated. Sclerotherapy was performed with 3% sodium tetradecyl in the first 15 patients and 98% dehydrated alcohol in the remaining 9 patients. Operative blood loss, operative time, transfusion requirement, and hospital stay were recorded. Operative time per lesion volume and operative blood loss per lesion volume were calculated. Results were compared with 15 historical control patients who underwent resection of facial venous malformations without preoperative sclerotherapy. Long-term follow-up of study and control patients was performed. Compared with controls, patients undergoing preoperative venous sclerotherapy were significantly older (P = .0206) and had larger lesions in all three dimensions (height, P = .0002; length, P = .0010; width, P = .0004). Patients receiving sclerotherapy had shorter operative time per lesion volume (P lesion volume (P nerve paresis occurred in 8.3% of cases. Long-term follow-up revealed retreatment was required in 2 of 24 patients (8.3%). Preoperative sclerotherapy of venous malformations was associated with less operative time per lesion volume and less operative blood loss per lesion volume. Long-term follow-up revealed a low need for retreatment. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  18. A Long-term Plan for Kalk

    DEFF Research Database (Denmark)

    2017-01-01

    In this case, the author demonstrates together with the owner-manager of KALK A/S, Mr Rasmus Jorgensen, how to use the Family Business Map to frame a constructive discussion about long-term planning. The Family Business Map is a tool for long-term planning in family firms developed by Professor...

  19. Virtual Models of Long-Term Care

    Science.gov (United States)

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  20. Sleep facilitates long-term face adaptation

    OpenAIRE

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent

    2013-01-01

    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted imag...

  1. The impact of non-alcoholic fatty liver disease on incident type 2 diabetes mellitus in non-overweight individuals.

    Science.gov (United States)

    Fukuda, Takuya; Hamaguchi, Masahide; Kojima, Takao; Hashimoto, Yoshitaka; Ohbora, Akihiro; Kato, Takahiro; Nakamura, Naoto; Fukui, Michiaki

    2016-02-01

    The aim of this study was to evaluate the impact of non-alcoholic fatty liver disease (NAFLD) on incident type 2 diabetes mellitus (T2DM) in non-overweight individuals with NAFLD. A population-based retrospective cohort study of 4629 participants who were enrolled in a health check-up programme for more than 10 years. A standardized questionnaire and abdominal ultrasonography were used to diagnose NAFLD. A cut-off point of BMI 23 kg/m(2) was used to define overweight (≥23.0 kg/m(2)) or non-overweight (<23.0 kg/m(2)). The primary outcome was incident T2DM. Over a mean follow-up of 12.8 years, 351 participants (7.6%) developed T2DM. The incidence rate of T2DM was 3.2% in the non-overweight without NAFLD group, 14.4% in the non-overweight with NAFLD group, 8.0% in the overweight without NAFLD group and 26.4% in the overweight with NAFLD group. The adjusted hazard ratios for incident T2DM compared with the non-overweight without NAFLD group were as follows: 3.59 (95% CI: 2.14-5.76) in the non-overweight with NAFLD group, 1.99 (95% CI: 1.47-2.69) in the overweight without NAFLD group and 6.77 (95% CI: 5.17-8.91) in the overweight with NAFLD group. The adjusted hazard ratio in the non-overweight with NAFLD group was significantly higher than that in the overweight without NAFLD group or that in the non-overweight without NAFLD group. Non-overweight individuals with NAFLD had a high risk of incident T2DM. Diagnosis of NAFLD is important in non-overweight individuals, and therefore it might be necessary to follow their health conditions on a long-term basis after detection of NAFLD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Comparison of sensory-specific satiety between normal weight and overweight children.

    Science.gov (United States)

    Rischel, Helene Egebjerg; Nielsen, Louise Aas; Gamborg, Michael; Møller, Per; Holm, Jens-Christian

    2016-12-01

    Sensory properties of some foods may be of importance to energy consumption and thus the development and maintenance of childhood obesity. This study compares selected food related qualities in overweight and normal weight children. Ninety-two participants were included; 55 were overweight with a mean age of 11.6 years (range 6-18 years) and a mean BMI z-score of 2.71 (range 1.29-4.60). The 37 normal weight children had a mean age of 13.0 years (range 6-19 years) and a mean BMI z-score of 0.16 (range -1.71 to 1.24). All children completed a half-hour long meal test consisting of alternation between consumption of foods and answering of questionnaires. Compared to the normal weight, the overweight children displayed lower self-reported intake paces (χ 2 (2) = 6.3, p = 0.04), higher changes in liking for mozzarella (F(1,63) = 9.55, p = 0.003) and pretzels (F(1,87) = 5.27, p = 0.024), and declines in wanting for something fat, of which the normal weight children displayed an increase (F(1,83) = 4,10, p = 0.046). No differences were found for sensory-specific satiety, wanting for the main food yoghurt, hunger, or satiety. In conclusion, overweight children did not differ from normal weight children in terms of sensory-specific satiety, hunger, or satiety. However, overweight children had lower intake paces and appeared to differ from normal weight children regarding foods with a fatty taste. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Meaning making in long-term care: what do certified nursing assistants think?

    Science.gov (United States)

    Gray, Michelle; Shadden, Barbara; Henry, Jean; Di Brezzo, Ro; Ferguson, Alishia; Fort, Inza

    2016-09-01

    Certified nursing assistants (CNAs) provide up to 80% of the direct care to older adults in long-term care facilities. CNAs are perceived as being at the bottom of the hierarchy among healthcare professionals often negatively affecting their job satisfaction. However, many CNAs persevere in providing quality care and even reporting high levels of job satisfaction. The aim of the present investigation was to identify primary themes that may help CNAs make meaning of their chosen career; thus potentially partially explaining increases in job satisfaction among this group. Focus groups were conducted with CNAs at three long-term care facilities. Four themes emerged from the data: CNA work is good or special; CNA as relationship builder; CNA as expert; CNA as team member. These themes reflect the perceptions that these CNAs held in regard to themselves and their relationships to others in the work environment and, when present, can contribute to intrinsic job satisfaction. Our meaning-making themes support the premise that CNAs do not passively accept the evaluations of others but instead actively frame identities that validate their importance to residents and the institution. © 2016 John Wiley & Sons Ltd.

  4. WOMEN'S AGE AT FIRST MARRIAGE AND LONG-TERM ECONOMIC EMPOWERMENT IN EGYPT.

    Science.gov (United States)

    Yount, Kathryn M; Crandall, AliceAnn; Cheong, Yuk Fai

    2018-02-01

    Sustainable Development Goal (SDG) 5 calls on nations to promote gender equality and to empower women and girls. SDG5 also recognizes the value of women's economic empowerment, entailing equal rights to economic resources and full participation at all levels in economic decisions. Also according to SDG5, eliminating harmful practices-such as child marriage before age 18-is a prerequisite for women's economic empowerment. Using national data for 4,129 married women 15-43 years who took part in the Egypt Labor Market Panel Survey (ELMPS 1998-2012), we performed autoregressive, cross-lagged panel analyses to assess whether women's first marriage in adulthood (at 18 years or older, as reported in 2006), was positively associated with their long-term post-marital economic empowerment, measured as their engagement in market work and latent family economic agency in 2012. Women's first marriage in adulthood had positive unadjusted associations with their market work and family economic agency in 2012. These associations persisted after accounting for market work and family economic agency in 2006, pre-marital resources for empowerment, and cumulative fertility. Policies to discourage child marriage may show promise to enhance women's long-term post-marital economic empowerment.

  5. Characteristics associated with being overweight among the population of Ukraine, results of 2000 survey

    Directory of Open Access Journals (Sweden)

    Chagarna, Natalia

    2011-05-01

    Full Text Available BACKGROUND. Being overweight is considered among major risk factors of chronic non-communicable diseases. The goal of this study was to investigate main determinants associated with being overweight and obese among the population of Ukraine in transitional period.METHODS. Data from the survey “Health and Well-being in the Transitions” (2000 were used. Body mass index (BMI was used to estimate the level of overweight. Binary dependent variable was computed by setting BMI of 25 as the borderline between normal weight and overweight. Risk of being overweight was compared by educational groups, demographic characteristics, occupation, level of physical activity, and behavioral and eating habits, after adjustment for age and stratification by gender.RESULTS. Among men, those overweight were less likely to smoke (adjusted odds ratio 2,5, while more likely to eat meat more often (AOR=2,3 and to consume more vegetable oil. However, among women being overweight was associated with eating more potatoes (AOR = 0,4 and with frequent vodka intake (AOR = 1,7. Those women who drank beer were less likely to be overweight (AOR = 0,3. Risk of being overweight was related to occupation: those unemployed, housekeepers, and self-employed people were less likely to be overweight than those employed with salaries. Obesity risk was greater in those older than 30. Education and physical activity did not show significant associations with risk of being overweight.CONCLUSION. Eating habits, occupational status, and unhealthy habits were associated with obesity among men and women in different ways. Age was found to be an important factor of being overweight both for males and females. Some of the associated characteristics may be considered causes of being overweight and the others as consequences.

  6. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after facility cleanup is complete. As the Department of Energy’s (DOE) lead laboratory for environmental management programs, the Idaho National Engineering and Environmental Laboratory (INEEL) administers DOE’s long-term stewardship science and technology efforts. The INEEL provides DOE with technical, and scientific expertise needed to oversee its long-term environmental management obligations complexwide. Long-term stewardship is administered and overseen by the Environmental Management Office of Science and Technology. The INEEL Long-Term Stewardship Program is currently developing the management structures and plans to complete INEEL-specific, long-term stewardship obligations. This guidance document (1) assists in ensuring that the program leads transition planning for the INEEL with respect to facility and site areas and (2) describes the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete. Additionally, this document summarizes current information on INEEL facilities, structures, and release sites likely to enter long-term stewardship at the completion of DOE’s cleanup mission. This document is not intended to function as a discrete checklist or local procedure to determine readiness to transition. It is an overarching document meant as guidance in implementing specific transition procedures. Several documents formed the foundation upon which this guidance was developed. Principal among these documents was the Long-Term Stewardship Draft Technical Baseline; A Report to Congress on Long-Term Stewardship, Volumes I and II; Infrastructure Long-Range Plan; Comprehensive Facility Land Use Plan; INEEL End-State Plan; and INEEL Institutional Plan.

  7. Improving food and fluid intake for older adults living in long-term care

    DEFF Research Database (Denmark)

    Keller, Heather; Beck, Anne Marie; Namasivayam, Ashwini

    2015-01-01

    intake for persons living in LTC. Top determinants to address with intervention research included social interactions of residents at mealtime; self-feeding ability; the dining environment; the attitudes, knowledge, and skills of staff; adequate time to eat/availability of staff to provide assistance...... for the development and testing of interventions to improve food and fluid intake of older adults living in LTC....

  8. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years

    NARCIS (Netherlands)

    Mead, Emma; Brown, Tamara; Rees, Karen; Azevedo, Liane B; Whittaker, Victoria; Jones, Dan; Olajide, Joan; Mainardi, Giulia M; Corpeleijn, Eva; O'Malley, Claire; Beardsmore, Elizabeth; Al-Khudairy, Lena; Baur, Louise; Metzendorf, Maria-Inti; Demaio, Alessandro; Ells, Louisa J

    2017-01-01

    BACKGROUND: Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into

  9. Neighborhood walking among overweight and obese adults: age variations in barriers and motivators.

    Science.gov (United States)

    Lee, Chanam; Ory, Marcia G; Yoon, Jeongjae; Forjuoh, Samuel N

    2013-02-01

    Walking is a popular form of physical activity that can bring many public health benefits. It can be even more beneficial to those who are currently obese or overweight. However, many barriers discourage people from walking, ranging from lack of motivation to unsafe neighborhood environments, and such barriers vary with age. This study addresses barriers and motivators to walking among overweight and obese adults, and examines their age variations. Particular emphasis was given to modifiable environmental factors as the priority intervention targets. A survey of 161 overweight and obese adults recruited from a large integrated healthcare system in central Texas provided data on walking, demographics, motivators and barriers. Descriptive statistics and correlation analysis were conducted. The respondents had a mean age of 48.4 (20-86), and were predominantly female (80.8%), non-Hispanic White (86.0%), and obese (mean BMI = 32.5). Popular environmental barriers to walking were: bad weather, inadequate lighting, no shade, unattended dogs, disconnected sidewalks, poor walking surfaces, no interesting places to walk nearby, and no benches (74.5-38.5%). Even and smooth walking surfaces and benches were more frequently reported by older adults as motivators. Proximity to recreational facilities was a stronger motivator for younger adults. Two safety related barriers, fear of injury (older adults) and traffic safety concerns (younger adults), also showed significant age differences. Overweight and obese adults experience substantial environmental barriers to walking, but many of them are modifiable. Observed age variations suggest that future interventions may be more effective if tailored to address age-specific barriers.

  10. Long-term cumulative depressive symptom burden and risk of cognitive decline and dementia among very old women.

    Science.gov (United States)

    Zeki Al Hazzouri, Adina; Vittinghoff, Eric; Byers, Amy; Covinsky, Ken; Blazer, Dan; Diem, Susan; Ensrud, Kristine E; Yaffe, Kristine

    2014-05-01

    Depressive symptoms and cognitive outcomes are strongly interrelated. Despite that rates of depressive symptoms fluctuate during late life, little is known about the impact of long-term cumulative depressive symptom burden on cognitive decline and dementia in older adults. This study examines the association of nearly 20 years of cumulative depressive symptoms with cognitive outcomes in a cohort of older women. We assessed depressive symptoms in 7,240 women using the Geriatric Depression scale (GDS) at serial visits. We used a Poisson model with random slopes to estimate GDS trajectories for each participant from baseline to death or end of follow-up, and then characterized depressive symptom burden by quartile of the area under the curve. We assessed cognitive outcomes using repeated measures of the Mini-Mental State Examination (MMSE) and Trails B score over 20 years, Year-20 neuropsychological test battery, and adjudicated dementia and mild cognitive impairment (MCI). Adjusting for potential confounders, compared with women in the lowest quartile of cumulative depressive symptoms burden, women in the highest quartile had 21% more MMSE errors over time (95% CI = 17%, 26%), 20% worse Trails B score over time (95% CI = 17%, 23%), worse scores on most of the Year-20 cognitive tests, and a twofold greater likelihood of developing dementia or MCI (95% CI = 1.48, 3.11). Long-term cumulative depressive symptom burden was associated with cognitive decline and risk of dementia or MCI. Older adults with a history of depression should be closely monitored for recurrent episodes or unresolved depressive symptoms as well as any cognitive deficits.

  11. Nutritional interventions for optimizing healthy body composition in older adults in the community: an umbrella review of systematic reviews.

    Science.gov (United States)

    Schultz, Timothy J; Roupas, Peter; Wiechula, Richard; Krause, Debra; Gravier, Susan; Tuckett, Anthony; Hines, Sonia; Kitson, Alison

    2016-08-01

    data extraction tool. Only quantitative studies of effectiveness were included. The strength of evidence assessing the effectiveness of interventionswas graded using a traffic light system (green, amber, red). An overall assessment of the quality of the evidence for each comparison was undertaken. More systematic reviews investigating weight gain than those investigating weight loss were included. Studies onweight gain showed improved body composition for oral nutritional supplements on its own, for oral nutritional supplements in combination with resistance exercise training, and for oral nutritional supplements in combination with nutrition counselling. Studies on weight loss showed that diet in combination with exercise, diet in combination with exercise and nutrition counselling, and nutrition counselling on its own all can lead to reduced weight in older people. The outcomes of lean mass and weight/BMI were responsive to nutritional interventions, but fat mass did not vary. There were no qualitative reviews identified. Although effective interventions for weight gain and weight loss to optimize body composition of older people in the community were identified,making long term, clinically relevant changes in body composition is difficult. Multiple interventions are more effective than single interventions.

  12. Prevalent Long-Term Trends of Hypertension in Austria: The Impact of Obesity and Socio-Demography.

    Directory of Open Access Journals (Sweden)

    Franziska Großschädl

    Full Text Available Globally there are only less long-term-studies on hypertension available to provide reliable estimates and identify risk groups. This study aims to analyse the prevalence and long-term-trend of hypertension in Austria, recognize affected subpopulations and investigate social inequalities.This representative population-based study is based on self-reported data of adults (mean age: 47.7 ± 17.5; n = 178,818 that were taken from five health surveys between 1973 and 2007. An adjustment of self-reported BMI was performed based on a preliminary validation study. Absolute changes (AC and aetiologic fractions (AF were calculated from logistic regressions in order to measure trends. To quantify the extent of social inequality, a relative index of inequality (RII was computed.During the study period the age-standardized hypertension prevalence increased from 1.0% to 18.8%, with a considerable rise from 1991 onwards. There was a positive trend in all subpopulations, with the highest AC among obese women (+50.2% and obese subjects aged 75 years and older (+54.4%, whereas the highest risk was observed among the youngest obese adults (AF: 99.4%. The RII for hypertension was higher for women than men, but in general unstable during the investigation period.Obesity and older age are significant factors for increased morbidity of hypertension. The most undesirable trends occurred in obese women and obese subjects aged 75 years and older. These risk groups should be given special attention when planning hypertension prevention programs. The high increase in the prevalence of hypertension is due to different aspects, e.g. a demographic change and a change in the definition of hypertension. These findings help to understand why hypertension is becoming more common in the Austrian population.

  13. Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care.

    Science.gov (United States)

    Kruschitz, Renate; Wallner-Liebmann, Sandra; Lothaller, Harald; Luger, Maria; Ludvik, Bernhard

    2017-01-01

    Structured obesity treatment programs at primary care level are becoming increasingly important. However, evidence from current treatment approaches in the long term is lacking. In view of this fact we evaluated a standardized, meal replacement-based weight loss program (myLINE®; AENGUS, Graz, Austria) according to the currently applicable guidelines. Data of overweight and obese individuals (n = 70) who participated at least 36 months in the program were analyzed. Data were collected at baseline (T0) as well as after 1, 3, 6, 12, 24, and 36 (T1-T36) months. Body composition was measured by conventional anthropometry and bioelectrical impedance analysis. Compared to T0, a maximum weight, BMI, fat mass, absolute body cell mass (BCM) reduction and an increase of relative BCM could be seen at T6. Subsequently, the findings reveal a significant reduction of body weight and body fat and a satisfying development of body cell mass during the observation period of 36 months. The evaluated program complies with national and international guidelines for the therapy of obesity in adults and is efficient and meaningful for a long-term therapeutic use in primary care.. © 2017 The Author(s) Published by S. Karger GmbH, Freiburg.

  14. Going outdoors daily predicts long-term functional and health benefits among ambulatory older people.

    Science.gov (United States)

    Jacobs, Jeremy M; Cohen, Aaron; Hammerman-Rozenberg, Robert; Azoulay, Daniel; Maaravi, Yoram; Stessman, Jochanan

    2008-04-01

    This article examines the association between frequency of going out of the house and health and functional status among older people. A randomly chosen cohort of ambulatory participants born in 1920 or 1921 from the Jerusalem Longitudinal Study underwent assessments for health, functional, and psychosocial variables at ages 70 and 77. Twelve-year mortality data were collected. Women went out daily less than did men. Participants going out daily at age 70 reported significantly fewer new complaints at age 77 of musculoskeletal pain, sleep problems, urinary incontinence, and decline in activities of daily living (ADLs). Logistic regression analysis indicated that not going out daily at age 70 was predictive of subsequent dependence in ADL, poor self-rated health, and urinary incontinence at age 77. Going out daily is beneficial among independent older people, correlating with reduced functional decline and improved health measures.

  15. Long-Term Prognosis of Plantar Fasciitis

    DEFF Research Database (Denmark)

    Hansen, Liselotte; Krogh, Thøger Persson; Ellingsen, Torkell

    2018-01-01

    , exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad. Study....... The risk was significantly greater for women (P heel...... regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us...

  16. Long-term dependence in exchange rates

    Directory of Open Access Journals (Sweden)

    A. Karytinos

    2000-01-01

    Full Text Available The extent to which exchange rates of four major currencies against the Greek Drachma exhibit long-term dependence is investigated using a R/S analysis testing framework. We show that both classic R/S analysis and the modified R/S statistic if enhanced by bootstrapping techniques can be proven very reliable tools to this end. Our findings support persistence and long-term dependence with non-periodic cycles for the Deutsche Mark and the French Franc series. In addition a noisy chaos explanation is favored over fractional Brownian motion. On the contrary, the US Dollar and British Pound were found to exhibit a much more random behavior and lack of any long-term structure.

  17. Short-term versus long-term contracting for uranium enrichment services

    International Nuclear Information System (INIS)

    Rudy, G.P.

    1990-01-01

    The US Department of Energy (US DOE) is the world's largest and most experienced supplier of uranium enrichment services. Through the late 1970s and early 1980s, emerging market forces transformed what was once a monopoly into a highly competitive industry. In the early 1980's the DOE lost market share. But as we enter the 1990s, new market forces have emerged. The US DOE believes a responsible balance between long-term and short-term contracting will be the key to success and the key to assuring the long-term health and reliability of the nuclear fuel industry. The US DOE intends to be in this nuclear business for a long time and will continue to offer reliable and responsive services second to none

  18. Long-Term Dynamics of Autonomous Fractional Differential Equations

    Science.gov (United States)

    Liu, Tao; Xu, Wei; Xu, Yong; Han, Qun

    This paper aims to investigate long-term dynamic behaviors of autonomous fractional differential equations with effective numerical method. The long-term dynamic behaviors predict where systems are heading after long-term evolution. We make some modification and transplant cell mapping methods to autonomous fractional differential equations. The mapping time duration of cell mapping is enlarged to deal with the long memory effect. Three illustrative examples, i.e. fractional Lotka-Volterra equation, fractional van der Pol oscillator and fractional Duffing equation, are studied with our revised generalized cell mapping method. We obtain long-term dynamics, such as attractors, basins of attraction, and saddles. Compared with some existing stability and numerical results, the validity of our method is verified. Furthermore, we find that the fractional order has its effect on the long-term dynamics of autonomous fractional differential equations.

  19. Long-term effects of an inpatient weight-loss program in obese children and the role of genetic predisposition-rationale and design of the LOGIC-trial

    Directory of Open Access Journals (Sweden)

    Rank Melanie

    2012-03-01

    Full Text Available Abstract Background The prevalence of childhood obesity has increased worldwide, which is a serious concern as obesity is associated with many negative immediate and long-term health consequences. Therefore, the treatment of overweight and obesity in children and adolescents is strongly recommended. Inpatient weight-loss programs have shown to be effective particularly regarding short-term weight-loss, whilst little is known both on the long-term effects of this treatment and the determinants of successful weight-loss and subsequent weight maintenance. The purpose of this study is to evaluate the short, middle and long-term effects of an inpatient weight-loss program for children and adolescents and to investigate the likely determinants of weight changes, whereby the primary focus lies on the potential role of differences in polymorphisms of adiposity-relevant genes. Methods/Design The study involves overweight and obese children and adolescents aged 6 to 19 years, who participate in an inpatient weight-loss program for 4 to 6 weeks. It started in 2006 and it is planned to include 1,500 participants by 2013. The intervention focuses on diet, physical activity and behavior therapy. Measurements are taken at the start and the end of the intervention and comprise blood analyses (DNA, lipid and glucose metabolism, adipokines and inflammatory markers, anthropometry (body weight, height and waist circumference, blood pressure, pubertal stage, and exercise capacity. Physical activity, dietary habits, quality of life, and family background are assessed by questionnaires. Follow-up assessments are performed 6 months, 1, 2, 5 and 10 years after the intervention: Children will complete the same questionnaires at all time points and visit their general practitioner for examination of anthropometric parameters, blood pressure and assessment of pubertal stage. At the 5 and 10 year follow-ups, blood parameters and exercise capacity will be additionally

  20. Analysis of the overweight and obesity trend in the Peruvian population

    Directory of Open Access Journals (Sweden)

    Carolina Tarqui-Mamani

    2017-07-01

    Full Text Available Introduction: Overweight and obesity constitute a public health problem worldwide and also in Peru, and its study is necessary. The aim was to analyze the tendency of overweight and obesity according to age, sex and poverty. Material and methods: A trend study that analyzed overweight and obesity in 175,984 Peruvians surveyed between 2007 and 2014. The samples were representative and probabilistic of Peruvian households. Results: The trend of overweight and obesity was increased in all age groups studied (p<0.001, except for the group under 5 years of age. In men, the tendency of overweight was to increase (p<0.001 except in children. In women, the tendency was to increase in all groups (p<0.001 except the under 5 years of age and the group between 20-29 years of age. In people living in extreme poverty, the tendency of overweight was to increase in the young, adult and elderly (p<0.001. In people living in poverty, the tendency of the overweight was to increase (p<0.01, except in children of 5-9 years of age. The trend of obesity in men and women was increased (p<0.001, except in children under 5 years of age. In women, the exception was also in older adults. Analyzing poverty it was observed that in people living in extreme poverty the tendency of obesity was to increase in young people and adults (p<0.01. In people living in poverty, the tendency of obesity was to increase in adolescents, youth and adults (p<0.01. Conclusions: The trend of overweight and obesity was increased, except in children under 5 years of age, with predominance in men and people living in poverty.

  1. Competitive versus Cooperative Exergame Play for African American Adolescents' Executive Function Skills: Short-Term Effects in a Long-Term Training Intervention

    Science.gov (United States)

    Staiano, Amanda E.; Abraham, Anisha A.; Calvert, Sandra L.

    2012-01-01

    Exergames are videogames that require gross motor activity, thereby combining gaming with physical activity. This study examined the role of competitive versus cooperative exergame play on short-term changes in executive function skills, following a 10-week exergame training intervention. Fifty-four low-income overweight and obese African American…

  2. The Womanly World of Long Term Care: The Plight of the Long Term Care Worker. Gray Paper.

    Science.gov (United States)

    Older Women's League, Washington, DC.

    Long-term care workers (those who are paid to provide custodial care for long-term patients in nursing homes or at home) must care for a growing number of increasingly disabled or dependent persons. They are working for agencies and institutions under growing pressure to increase productivity. They face new training and competency requirements,…

  3. Long term wet spent nuclear fuel storage

    International Nuclear Information System (INIS)

    1987-04-01

    The meeting showed that there is continuing confidence in the use of wet storage for spent nuclear fuel and that long-term wet storage of fuel clad in zirconium alloys can be readily achieved. The importance of maintaining good water chemistry has been identified. The long-term wet storage behaviour of sensitized stainless steel clad fuel involves, as yet, some uncertainties. However, great reliance will be placed on long-term wet storage of spent fuel into the future. The following topics were treated to some extent: Oxidation of the external surface of fuel clad, rod consolidation, radiation protection, optimum methods of treating spent fuel storage water, physical radiation effects, and the behaviour of spent fuel assemblies of long-term wet storage conditions. A number of papers on national experience are included

  4. Long-Term Collections

    CERN Multimedia

    Staff Association

    2016-01-01

    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  5. Long-Term Collection

    CERN Multimedia

    Staff Association

    2016-01-01

    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  6. A research note on the relationship between long working hours and weight gain for older workers in the United States.

    Science.gov (United States)

    Mercan, Murat Anil

    2014-09-01

    Working long hours may be related to obesity in older adults. No studies have focused on older workers and long work hours, although the risk of obesity is high among this population group. This study is the first attempt to investigate the relationship between obesity and the older workforce. Panel data from the Health and Retirement Study are examined using Cox regression techniques. We found that older workers who work more than 59 hr a week are more likely to gain weight than older workers who work less than 59 hr per week. © The Author(s) 2013.

  7. Musculoskeletal pain in overweight and obese children

    Science.gov (United States)

    Smith, S M; Sumar, B; Dixon, K A

    2014-01-01

    This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005

  8. Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents.

    Science.gov (United States)

    Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Belzile, Eric; Vu, Minh

    2014-07-01

    The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents. The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM - defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations. Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia. CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.

  9. Changing incentives for long-term gas contracts

    International Nuclear Information System (INIS)

    Bohi, D.R.

    1992-01-01

    There is much concern about the absence of long-term gas contracts with fixed price and quantity conditions, which until recent years was the standard way of doing business in the gas industry. These types of contracts performed a valuable service in the development of the gas industry, and there comparative absence today is sometimes thought to be one reason for the current malaise in the industry. One hears the argument that there must be some kind of 'market failure' that prevents buyers and sellers from entering into these long term arrangements, and recent changes in state and federal regulations are often cited as the cause of the problem. The purpose of the author's remarks is to argue that what is taken as a breakdown in the market may be simply a reaction to a decline in economic incentives to enter into long-term contracts with rigid price and quantity terms. This is, in other words, simply one more aspect of change in the gas business that Frank Heintz referred to in his opening remarks this morning. The author starts by giving a brief description of the motives for engaging in long-term contracts, and then describes how incentives to use long-term contracts have declined for both gas buyers and gas sellers. He concludes that the decline in the use of long-term contracts is not cause for regulatory concern, but a result of the continuing transformation of the gas business to one that more closely resembles other commodity markets

  10. Energy in 2010 - 2020. Long term challenges; Energie 2010-2020. Les defis du long terme

    Energy Technology Data Exchange (ETDEWEB)

    Dessus, Benjamin [ed.] [Centre National de la Recherche Scientifique (CNRS), 75 - Paris (France)

    2000-02-02

    This report presents the results of a workshop intending to anticipate the long term challenges, to guide better the short term power options, to understand the available political, economical and technical assumptions for the prospective world situation, to give some strategic hints on the necessary transition. Indeed, the difficult issue which the workshop tried to tackle was how should we prepare to reveal the energetic challenge of the development of the eight to ten billion inhabitants of our Planet in the next century without jeopardizing its existence. The energetic problems, a hardcore of the international preoccupation of both growth and environment, as it was recently evidenced by the climatic conference in Kyoto, have ever been the object of a particular attention on the part of General Commissariat of Plan. Thus, the commission 'Energy in 2010 - 2020' has been instituted in April 1996 in order to update the works done in 1990 - 1991 by the commission 'Energy 2010'. Soon it occurred to this new commission the task of illuminating its works by a long term (2050 - 2100) world prospective analysis of the challenges and problems linked to energy, growth and environment. In conclusion, this document tried to find answers to questions like: - which are the risks the energy consumption augmentation entail? - can we control them by appropriate urbanism and transport policies or technological innovation?. Four options for immediate action are suggested: - the energy efficiency should become a priority objective of policies; -coping with the long term challenges requires acting at present; - building the transition between governmental leadership and market; - taking profit of all the possible synergies between short and long term planning.

  11. Location, Location, Location: Characteristics and Services of Long-Stay Home Care Recipients in Retirement Homes Compared to Others in Private Homes and Long-Term Care Homes.

    Science.gov (United States)

    Poss, Jeffrey W; Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John

    2017-02-01

    We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. Copyright © 2017 Longwoods Publishing.

  12. Opening remarks for a panel discussion on short-term vs long-term procurement

    International Nuclear Information System (INIS)

    Courtenay, R.H.

    1990-01-01

    Long-term contracting in the late 1970's and early 1980's is blamed for some of the inequities that plague the uranium industry today. Utilities are obliged to pay prices far above prevailing levels and relatively low cost producers are forced to shut down while watching less efficient suppliers stay in business thanks to their long term supply agreements. Furthermore, it is argued that long-term contracts have contributed to supply instability by forcing the buildup of surplus inventories and by supporting excess incremental production by suppliers who have a baseload of long-term contracts. The depressed prices resulting from this oversupply are in turn jeopardizing future resource development and damaging supply reliability. In summary, the author's argument is that supply reliability will be greatly enhanced by the assurance of adequate primary supply from traditional sources such as Canada. This will not happen without long-term contracts. This conclusion may not be expected coming from a representative of Canada's largest uranium producer. But the final comment is less self serving. Many of the critics of long term contracts apparently expect a continuing and plentiful supply of East Bloc uranium to the spot market. A further question is to what extent East Bloc suppliers will eventually require long-term contracts in order to maintain production facilitates in economies that are no longer centrally planned, and where there is open competition for capital. Ultimately, reliability of supply from the non-traditional suppliers may also depend on long-term contracts

  13. Age at treatment and long-term performance results in medulloblastoma

    International Nuclear Information System (INIS)

    Chin, H.W.; Maruyama, Y.

    1984-01-01

    Medulloblastoma is highly radioresponsive, and recent treatment results have improved greatly since the introduction of megavoltage machine in 1960s. There is increasing evidence for the potential cure of medulloblastoma if properly treated in its early stages. The curable group represents approximately 75% of diagnosed patients. Long-term treatment effects were examined in this study. The study reveals age-dependent late effects in learning ability; the patients less than 4-years-old at treatment had major learning problems; patients of 5 to 7 years old performed at satisfactory-to-low passing levels in school work; patients older than 8 years old had no major intellectual impairment. Short stature was common when growth potential was present at the time of therapy, but endocrine tests were generally negative. These observations indicate special educational requirement needs, especially for children treated at a young age

  14. The development in body mass index, overweight and obesity in three regions in Denmark

    DEFF Research Database (Denmark)

    Toft, Ulla; Vinding, Anker Lund; Larsen, Finn Breinholt

    2015-01-01

    /2007 and 2010. A random sample of citizens aged more than or equal to 25 years was invited to participate. The overall response rate was 57.5% (n = 177 076). Data from questionnaire and central registers were included. RESULTS: In 2006/2007, the prevalence of overweight, including obesity, was 54.3% and 36.......8% among men and women, respectively. Of the overweight men 12.8% were obese and 11.8% women were obese. The prevalence was highest in the Northern region and among those who were older, had short education, was outside labour market, had low income and residents in rural areas. In 2010, the prevalence...... retired or above 60 years, and with high income. CONCLUSION: The prevalence of overweight and obesity was high and increased. The development, however, was heterogenic....

  15. Long-term risks of kidney living donation

    DEFF Research Database (Denmark)

    Maggiore, Umberto; Budde, Klemens; Heemann, Uwe

    2017-01-01

    Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science...... and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information...... to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing ‘de novo’ kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors...

  16. Epidemic Use of Benzodiazepines among Older Adults in Israel: Epidemiology and Leverage Points for Improvement.

    Science.gov (United States)

    Steinman, Michael A; Low, Marcelo; Balicer, Ran D; Shadmi, Efrat

    2017-08-01

    Benzodiazepines and benzodiazepine-receptor agonists (BDZRAs, often known as "Z-drugs") are commonly used in older adults despite well-documented harms. To evaluate patterns of benzodiazepine and BDZRA use in Israel, focusing on potential leverage points where quality improvement initiatives might effectively curtail new use or the transition from intermittent to chronic use. We used national electronic medical data to assess a 10% random sample of adults receiving care in Clalit Health Services, which serves half of Israel's population. The sample included 267,221 adults, of whom 56,808 (21%) were age 65 and older. Medication use from 2013 to 2015 was ascertained using pharmacy dispensing data. In 2014, 7% of adults age 21-64 and 32% of adults age 65 and older received at least one benzodiazepine/BDZRA, including 49% of adults age 85 and older (P older users (59%) were long-term users of the drugs, and 21% of older adults who were short-term users in 2014 transitioned to medium- or long-term use in 2015. Older Arab Israelis were much less likely to receive benzodiazepine/BDZRAs than older Jewish Israelis (adjusted OR 0.28, 95% 0.25-0.31), but within each community there was no major variation in prescribing rates across clinics. Depression diagnosis was associated with particularly high rates of benzodiazepine/BDZRA use: 17% of older adults with depression received a benzodiazepine/BDZRA but no antidepressant, and 42% received both. Recent hospitalization increased the risk of new benzodiazepine/BDZRA use (adjusted OR 1.41, 95% CI 1.01-1.96), but the absolute risk increase was only 3%. Benzodiazepines/BDZRAs are used at exceptionally high rates by older Israeli adults, especially the oldest old. Important leverage points for quality improvement efforts include curtailing the transition from short-term to long-term use, reducing use in older adults with depression, and identifying reasons that explain large differences in benzodiazepine/BDZRA prescribing between

  17. Long-term effects of radiation

    International Nuclear Information System (INIS)

    Smith, J.; Smith, T.

    1981-01-01

    It is pointed out that sources of long-term damage from radiation are two-fold. People who have been exposed to doses of radiation from initial early fallout but have recovered from the acute effects may still suffer long-term damage from their exposure. Those who have not been exposed to early fallout may be exposed to delayed fallout, the hazards from which are almost exclusively from ingesting strontium, caesium and carbon isotopes present in food; the damage caused is relatively unimportant compared with that caused by the brief doses from initial radiation and early fallout. A brief discussion is presented of the distribution of delayed long-lived isotope fallout, and an outline is sketched of late biological effects, such as malignant disease, cataracts, retarded development, infertility and genetic effects. (U.K.)

  18. [Strength, flexibility, balance, resistance and flexibility assessment according to body mass index in active older women].

    Science.gov (United States)

    Vaquero-Cristóbal, Raquel; Martínez González-Moro, Ignacio; Alacid Cárceles, Fernando; Ros Simón, Esperanza

    2013-01-01

    Overweight and obesity are increasing at an alarming rate among older people. This is mainly because this population is predominantly sedentary. The aim of this study was to classify, according to the body mass index (BMI), a group of older active women and to evaluate the different basic physical abilities as a function of this. The BMI and fitness were evaluated in 60 elderly active women (mean age: 66.14 ± 6.59 years) using the 2-minute step test, arm curl test, chair stand test, back scratch test, chair-sit and reach-test, flamenco test, and 8-foot up-and-go test. It was found that 52.23% of the women studied had a normal BMI and 47.76% were slightly overweight. There were no cases of obesity or underweight. Women with normal BMI had better values in all tests than overweight women. Significant differences were found in the flamenco test (P<.05), and 8-foot up-and-go test (P<.01). Older women who usually do physical activity had a normal or slightly overweight BMI. It was also found that women with lower BMI have better resistance, flexibility, balance and strength. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  19. Long-term psychosocial outcomes among bereaved siblings of children with cancer.

    Science.gov (United States)

    Rosenberg, Abby R; Postier, Andrea; Osenga, Kaci; Kreicbergs, Ulrika; Neville, Bridget; Dussel, Veronica; Wolfe, Joanne

    2015-01-01

    The death of a child from cancer affects the entire family. Little is known about the long-term psychosocial outcomes of bereaved siblings. To describe 1) the prevalence of risky health behaviors, psychological distress, and social support among bereaved siblings and 2) potentially modifiable factors associated with poor outcomes. Bereaved siblings were eligible for this dual-center, cross-sectional, survey-based study if they were 16 years or older and their parents had enrolled in one of three prior studies about caring for children with cancer at the end of life. Linear regression models identified associations between personal perspectives before, during, and after the family's cancer experience and outcomes (health behaviors, psychological distress, and social support). Fifty-eight siblings completed surveys (62% response rate). They were approximately 12 years bereaved, with a mean age of 26 years at the time of the survey (SD 7.8). Anxiety, depression, and illicit substance use increased during the year after their brother/sister's death but then returned to baseline. Siblings who reported dissatisfaction with communication, poor preparation for death, missed opportunities to say goodbye, and/or a perceived negative impact of the cancer experience on relationships tended to have higher distress and lower social support scores (P siblings reported that their loss still affected them; half stated that the experience impacted current educational and career goals. How siblings experience the death of a child with cancer may impact their long-term psychosocial well-being. Sibling-directed communication and concurrent supportive care during the cancer experience and the year after the sibling death may mitigate poor long-term outcomes. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  20. Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors.

    Science.gov (United States)

    Gewa, Constance A

    2010-04-01

    To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors. Demographic Health Survey data, multistage stratified cluster sampling methodology. Rural and urban areas of Kenya. A total of 1495 children between the ages of 3 and 5 years in Kenya. Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children. The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

  1. Television-viewing characteristics of adults: correlations to eating practices and overweight and health status.

    Science.gov (United States)

    Bowman, Shanthy A

    2006-04-01

    The purpose of this study was to examine the associations among television viewing, eating practices, and overweight and health status of a nationally representative sample of adults in the United States. Data on adults aged 20 years or older from the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals 1994-1996 were used for the study. Participants' socioeconomic and demographic characteristics, macronutrient intakes, weight status, prevalence of health conditions, television viewing, and overweight status were analyzed. Survey design effects were used in the analyses. More than 2 hours of television viewing per day was associated with a high mean body mass index and overweight or obesity in both men and women. Other characteristics associated with watching more than 2 hours of television per day were being 50 years of age or older, having a high school education or less, living in a household with income below 131% of the federal poverty level, and not being employed. Adults who watched more than 2 hours of television per day had high intakes of energy and macronutrients and were more likely to be overweight. They also obtained more energy from snacks and supper. A higher percentage of adults with health conditions watched more than 2 hours of television per day compared with adults without health conditions. Obesity intervention programs, especially those aimed at adults who are retired or not employed, should emphasize reducing time spent viewing television or videos or participating in similar sedentary activities and discourage snacking or eating while watching television.

  2. Long-term outcome of pediatric patients with intracranial germinomas

    International Nuclear Information System (INIS)

    Jinguji, Shinya; Yoshimura, Junichi; Aoki, Hiroshi; Natsumeda, Manabu; Yoneoka, Yuichiro; Nishiyama, Kenichi; Fujii, Yukihiko; Nagasaki, Keisuke

    2012-01-01

    Intracranial germinomas are sensitive to both chemotherapy and radiotherapy. For this reason, long-term survival or cure rate is excellent. It is therefore important for such patients, especially for younger children, to keep a high quality of life (QOL) after the treatment. Recently, whole ventricle radiotherapy with chemotherapy has been the treatment of choice for these tumors. However, in our institute, we perform radiotherapy alone as a standard treatment, using prophylactic craniospinal irradiation (CSI) or whole brain irradiation (WBI) with local tumor booster. The purpose of this study is to assess the long-term outcome of pediatric patients with intracranial germinomas in our institute. Twenty-three young patients (17 males and 6 females) ranging from 5 to 15 years were treated between 1990 and 2009 at University of Niigata. Mean age at the time of diagnosis was 10.7 years. Tumor locations were as follows: pineal regions in 6, suprasellar in 6, basal ganglia in 4, ventricles in 1, bifocal regions (pineal and suprasellar) in 2, and dissemination in 4 patients. Twenty (88%) patients had received radiotherapy alone: 15 (66%) with CSI, and 5 (22%) with WBI. Median doses for the whole brain, spine, and primary site were 26.6 Gy (range, 23.8-35.0), 25.9 Gy (range, 23.8-30.6), 49.8 Gy (range, 44.7-52.8), respectively. Three (12%) received chemotherapy with or without radiotherapy. We analyzed the survival and long-term QOL including hormonal sequel after the above treatments. The median follow-up period was 126 months (26 to 235 months). None of the 20 patients with radiotherapy alone suffered tumor recurrence, while 2 of the 3 with chemotherapy developed recurrences. Eleven (48%), including 9 with supurasellar region required hormone replacement therapy. Two (9%) were short stature compared with normal (mean-2 standard deviation). One (4%) developed a possible radiation-induced menigioma. In 15 patients aged 19 years or older, 13 (87%) graduated from senior high

  3. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  4. Analysing long term discursive processes

    DEFF Research Database (Denmark)

    Horsbøl, Anders

    which extend beyond the single interaction, for instance negotiations or planning processes, seems to have played a less important role, with studies such as Iedema 2001 and Wodak 2000 as exceptions. These long term processes, however, are central to the constitution and workings of organizations......What do timescales - the notion that processes take place or can be viewed within a shorter or longer temporal range (Lemke 2005) - mean for the analysis of discourse? What are the methodological consequences of analyzing discourse at different timescales? It may be argued that discourse analysis...... in general has favored either the analysis of short term processes such as interviews, discussions, and lessons, or the analysis of non-processual entities such as (multimodal) texts, arguments, discursive repertoires, and discourses (in a Foucaultian sense). In contrast, analysis of long term processes...

  5. Nuclear Energy, Long Term Requirements

    International Nuclear Information System (INIS)

    Knapp, V.

    2006-01-01

    There are serious warnings about depletion of oil and gas and even more serious warnings about dangers of climate change caused by emission of carbon dioxide. Should developed countries be called to replace CO2 emitting energy sources as soon as possible, and the time available may not be longer then few decades, can nuclear energy answer the call and what are the requirements? Assuming optimistic contribution of renewable energy sources, can nuclear energy expand to several times present level in order to replace large part of fossil fuels use? Paper considers intermediate and long-term requirements. Future of nuclear power depends on satisfactory answers on several questions. First group of questions are those important for near and intermediate future. They deal with economics and safety of nuclear power stations in the first place. On the same time scale a generally accepted concept for radioactive waste disposal is also required. All these issues are in the focus of present research and development. Safer and more economical reactors are targets of international efforts in Generation IV and INPRO projects, but aiming further ahead these innovative projects are also addressing issues such as waste reduction and proliferation resistance. However, even assuming successful technical development of these projects, and there is no reason to doubt it, long term and large-scale nuclear power use is thereby not yet secured. If nuclear power is to play an essential role in the long-term future energy production and in reduction of CO2 emission, than several additional questions must be replied. These questions will deal with long-term nuclear fuel sufficiency, with necessary contribution of nuclear power in sectors of transport and industrial processes and with nuclear proliferation safety. This last issue is more political then technical, thus sometimes neglected by nuclear engineers, yet it will have essential role for the long-term prospects of nuclear power. The

  6. What are the differences between long-term, short-term, and working memory?

    OpenAIRE

    Cowan, Nelson

    2008-01-01

    In the recent literature there has been considerable confusion about the three types of memory: long-term, short-term, and working memory. This chapter strives to reduce that confusion and makes up-to-date assessments of these types of memory. Long- and short-term memory could differ in two fundamental ways, with only short-term memory demonstrating (1) temporal decay and (2) chunk capacity limits. Both properties of short-term memory are still controversial but the current literature is rath...

  7. Rural-urban differences in the long-term care of the disabled elderly in China.

    Directory of Open Access Journals (Sweden)

    Mei Li

    Full Text Available BACKGROUND: In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. METHODS: This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. RESULTS: Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively, but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. CONCLUSIONS: The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

  8. Systematic Review and Meta-Analysis: The Impact of Multicomponent Weight Management Interventions on Self-Esteem in Overweight and Obese Adolescents.

    Science.gov (United States)

    Murray, Margaret; Dordevic, Aimee L; Bonham, Maxine P

    2017-05-01

    Building self-esteem in overweight adolescents is key to long-term weight management; yet, self-esteem is rarely a key outcome of adolescent weight management interventions. This systematic review investigates the impact of multicomponent weight management interventions on self-esteem in overweight and obese adolescents. Six databases were searched in December 2014. Eligible studies met the following criteria: (1) randomized controlled trial, (2) overweight or obese participants, (3) adolescents (10-19 years), (4) multicomponent weight management intervention, (5) reported self-esteem and weight changes. Thirteen studies with 1,157 overweight or obese adolescents, aged 10-19 years, were included. Meta-analyses showed no significant change in self-esteem (0.27 [-0.04, 0.59]), but body mass index z -score reduced following intervention (-0.17 [-0.22, -0.11]). The lack of change in self-esteem suggests weight loss alone is insufficient to improve self-esteem. Multicomponent weight management interventions require a specific focus on self-esteem to improve this outcome in overweight and obese adolescents. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. Long-term hearing preservation in vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Thomsen, Jens; Tos, Mirko

    2010-01-01

    The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas.......The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas....

  10. Age and CD4 count at initiation of antiretroviral therapy in HIV-infected children: effects on long-term T-cell reconstitution.

    Science.gov (United States)

    Lewis, Joanna; Walker, A Sarah; Castro, Hannah; De Rossi, Anita; Gibb, Diana M; Giaquinto, Carlo; Klein, Nigel; Callard, Robin

    2012-02-15

    Effective therapies and reduced AIDS-related morbidity and mortality have shifted the focus in pediatric human immunodeficiency virus (HIV) from minimizing short-term disease progression to maintaining optimal long-term health. We describe the effects of children's age and pre-antiretroviral therapy (ART) CD4 count on long-term CD4 T-cell reconstitution. CD4 counts in perinatally HIV-infected, therapy-naive children in the Paediatric European Network for the Treatment of AIDS 5 trial were monitored following initiation of ART for a median 5.7 years. In a substudy, naive and memory CD4 counts were recorded. Age-standardized measurements were analyzed using monophasic, asymptotic nonlinear mixed-effects models. One hundred twenty-seven children were studied. Older children had lower age-adjusted CD4 counts in the long term and at treatment initiation (P memory CD4 counts increased less, albeit on a faster timescale. It appears the immature immune system can recover well from HIV infection via the naive pool. However, this potential is progressively damaged with age and/or duration of infection. Current guidelines may therefore not optimize long-term immunological health.

  11. Handgrip strength, quadriceps muscle power, and optimal shortening velocity roles in maintaining functional abilities in older adults living in a long-term care home: a 1-year follow-up study

    Directory of Open Access Journals (Sweden)

    Kozicka I

    2016-05-01

    Full Text Available Izabela Kozicka, Tomasz Kostka Department of Geriatrics, Medical University of Lodz, Lodz, Poland Purpose: To assess the relative role of handgrip strength (HGS, quadriceps muscle power (Pmax, and optimal shortening velocity (υopt in maintaining functional abilities (FAs in older adults living in a long-term care home over a 1-year follow-up. Subjects and methods: Forty-one inactive older institutionalized adults aged 69.8±9.0 years participated in this study. HGS, Pmax, υopt, cognitive function using the Mini-Mental State Examination, depressive symptoms using the Geriatric Depression Scale, nutritional status using the Mini Nutritional Assessment (MNA, and physical activity (PA using the Seven-Day Physical Activity Recall Questionnaire were assessed at baseline and at 1-year follow-up. FAs were assessed with activities of daily living (ADL, instrumental ADL, and Timed Up & Go test. Results: Both at baseline and at follow-up, FAs were related to age, HGS, Pmax/kg, υopt, MNA, and PA. These associations were generally similar in both sexes. As revealed in multiple regression analysis, υopt was the strongest predictor of FA, followed by Pmax/kg, PA, and MNA. FA deteriorated after 1 year as measured by ADL and Timed Up & Go test. Pmax and υopt, but not HGS, also decreased significantly after 1 year. Nevertheless, 1-year changes in FAs were not related to changes in HGS, Pmax, υopt, or PA. Conclusion: The 1-year period of physical inactivity among older institutionalized adults was found to have a negative effect on their FAs, Pmax, and υopt. The present study demonstrates that Pmax and, especially, υopt correlated with FAs of older adults more than HGS, both at baseline and at follow-up. Despite this, 1-year natural fluctuations of PA, Pmax, and υopt are not significant enough to influence FAs in inactive institutionalized older adults. Keywords: aging, handgrip strength, institutionalization, functional status, physical activity

  12. Long-Term Patency of Lymphovenous Anastomoses: A Systematic Review.

    Science.gov (United States)

    Tourani, Saam S; Taylor, G Ian; Ashton, Mark W

    2016-08-01

    With advancements in technology and microsurgical techniques, lymphovenous anastomosis has become a popular reconstructive procedure in the treatment of chronic lymphedema. However, the long-term patency of these anastomoses is not clear in the literature. A systematic review of the MEDLINE and EMBASE databases was performed to assess the reported long-term patency of lymphovenous anastomoses. A total of eight studies satisfied the inclusion criteria. Pooled data from four similar experiments in normal dogs showed an average long-term (≥5 months) patency of 52 percent. The only experiment in dogs with chronic lymphedema failed to show any long-term patency. The creation of peripheral lymphovenous anastomoses with a moderate long-term patency rate has become technically possible. However, the long-term results in chronic lymphedema are limited.

  13. Long-term incidence of depression and predictors of depressive symptoms in older stroke survivors.

    Science.gov (United States)

    Allan, Louise M; Rowan, Elise N; Thomas, Alan J; Polvikoski, Tuomo M; O'Brien, John T; Kalaria, Raj N

    2013-12-01

    Depression is common and an important consequence of stroke but there is limited information on the longer-term relationship between these conditions. To identify the prevalence, incidence and predictors of depression in a secondary-care-based cohort of stroke survivors aged over 75 years, from 3 months to up to 10 years post-stroke. Depression was assessed annually by three methods: major depression by DSM-IV criteria, the self-rated Geriatric Depression Scale (GDS) and the observer-rated Cornell scale. We found the highest rates, 31.7% baseline prevalence, of depressive symptoms with the GDS compared with 9.7% using the Cornell scale and 1.2% using DSM-IV criteria. Incidence rates were 36.9, 5.90 and 4.18 episodes per 100 person years respectively. Baseline GDS score was the most consistent predictor of depressive symptoms at all time points in both univariate and multivariate analyses. Other predictors included cognitive impairment, impaired activities of daily living and in the early period, vascular risk factor burden and dementia. Our results emphasise the importance of psychiatric follow-up for those with early-onset post-stroke depression and long-term monitoring of mood in people who have had a stroke and remain at high risk of depression.

  14. Long-Term Orientation in Trade

    NARCIS (Netherlands)

    Hofstede, G.J.; Jonker, C.M.; Verwaart, D.

    2008-01-01

    Trust does not work in the same way across cultures. This paper presents an agent model of behavior in trade across Hofstedes cultural dimension of long-term vs. short-term orientation. The situation is based on a gaming simulation, the Trust and Tracing game. The paper investigates the

  15. Long-term weight changes in obese young adult men and subsequent all-cause mortality

    DEFF Research Database (Denmark)

    Zimmermann, E; Berentzen, T L; Ängquist, Lars Henrik

    2013-01-01

    change and all-cause mortality in a broad range of body mass index (BMI) in young men.METHODS:Among 362200 Danish draftees, examined between 1943 and 1977, all obese (BMI 31.0 kg m(-2); n=1930), and a random 1% sample of the others (n=3601) were identified at a mean age of 20 years (range: 18-25 years......BACKGROUND:Although the expectation is that weight gain increases mortality and weight loss among those overweight reduces mortality, results on weight gain and mortality in young adults are conflicting, and weight loss is less explored. We investigated the association between long-term weight......). All the obese and half the controls were re-examined between 4 and 40 years later (mean age 35 years). Weight changes were defined as: weight loss 0.1 kg m(-2) per year. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression.RESULTS:Among the 908 obese and 1073...

  16. Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Anton SD

    2011-06-01

    Full Text Available Stephen D Anton1,2, Todd M Manini1, Vanessa A Milsom2, Pamela Dubyak2, Matteo Cesari3, Jing Cheng4, Michael J Daniels5, Michael Marsiske2, Marco Pahor1, Christiaan Leeuwenburgh1, Michael G Perri21Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA; 2Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; 3Area di Geriatria, Università Campus Bio-Medico, Rome, Italy; 4Division of Oral Epidemiology and Dental Public Health, San Francisco, CA, USA; 5Department of Statistics, University of Florida, Gainesville, FL, USABackground: Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults. Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight, sedentary, older adults. This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese, older adult women.Methods: Participants (n = 34 were generally healthy, obese, older adult women (age range 55–79 years with mild to moderate physical impairments (ie, functional limitations. Participants were randomly assigned to one of two groups for 24 weeks: (i weight loss plus exercise (WL+E; n = 17; mean age = 63.7 years [4.5] or (ii educational control (n = 17; mean age = 63.7 [6.7]. In the WL+E group, participants attended a group-based weight management session plus three supervised exercise sessions within their community each week. During exercise sessions, participants engaged in brisk walking and lower-body resistance training of moderate intensity. Participants in the educational control group attended monthly health education lectures on topics relevant to older adults. Outcomes were: (i body weight, (ii walking speed (assessed by 400-meter walk test, (iii the Short Physical Performance Battery (SPPB, and (iv knee extension isokinetic strength.Results: Participants randomized

  17. Long-term effects of childbirth in MS

    NARCIS (Netherlands)

    D'hooghe, M.B.; Nagels, G.; Uitdehaag, B.M.J.

    2010-01-01

    Background: The uncertainty about long-term effects of childbirth presents MS patients with dilemmas. Methods: Based on clinical data of 330 female MS patients, the long-term effects of childbirth were analysed, using a cross-sectional study design. Four groups of patients were distinguished: (1)

  18. Differences in Physical Activity between Non-overweight, Overweight and Obese Children

    OpenAIRE

    Planinšec, Jurij; Matejek, Črtomir

    2004-01-01

    The purpose of the study was to find out differences in moderate to vigorous physical activity among non-overweight, overweight and obese children, and between boys and girls. The sample included 364 children (179 boys and 185 girls), aged 6.4 years (±0.3 SD). Physical activity was assessed by 7-day questionnaire. Age adapted BMI was used as overweight and obesity indicator. The children were divided into non-overweight, overweight and obese groups. It was found out, that there are significan...

  19. Exclusively breastfed overweight infants are at the same risk of childhood overweight as formula fed overweight infants

    NARCIS (Netherlands)

    Van der Willik, E.M.; Vrijkotte, T.G.M.; Altenburg, T.M.; Gademan, M.G.J.; van Holthe, J.E.

    2015-01-01

    Background and objective Several early life determinants play a role in childhood obesity. Rapid weight gain and overweight in infancy increases the risk while breast feeding seems to protect against childhood overweight. However, should we worry about exclusively breastfed overweight infants? The

  20. Nurses' Experiences of End-of-life Care in Long-term Care Hospitals in Japan: Balancing Improving the Quality of Life and Sustaining the Lives of Patients Dying at Hospitals

    Directory of Open Access Journals (Sweden)

    Ryo Odachi, RN, MA

    2017-09-01

    Full Text Available Summary: Purpose: In Japan, about 80% of deaths occur in hospitals, especially long-term care beds. The purpose of this study was to clarify the nursing practices used for such older patients at the end-of-life stage in long-termcare wards via the modified grounded theory approach (M-GTA. Methods: Data were obtained through semi-structured interviews of nineteen nurses working in cooperating long-term care wards, acute care wards, or hospice services (to allow for constant comparison between these types of wards in western Japan in 2014. We analyzed the transcribed data using M-GTA. Results: The core category that emerged from the analysis was “Balancing enhancement of patients' daily life quality and life-sustaining care in the face of uncertainty about the patients' character.” Eleven categories emerged, such as Seeking older patients' character with their family, Supporting families' decision making, Rebuilding patients' daily life in the ward, and Sustaining patients' life span through medical care. Conclusions: Nurses experienced uncertainty about the care needs of older patients, the ethical problems of Enhancing the patients' QOL by using risky care, and the evaluation criteria used to judge their own nursing care after the patients' death. All nurses had the goal of ensuring a natural death for all patients. Nurses' acceptance and evaluation of their own care was critically influenced by the patient's family's responses to their care after patients' death. Further research is necessary to develop evaluation criteria and educational programs for end-of-life nursing care of older adults. Keywords: terminal care, aged, long-term care, qualitative research

  1. Successful long-term weight loss maintenance in a rural population

    Directory of Open Access Journals (Sweden)

    Milsom VA

    2011-11-01

    Full Text Available Vanessa A Milsom1,2, Kathryn M Ross Middleton2, Michael G Perri21Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 2Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USABackground: Few investigations of successful long-term weight loss beyond two years have been conducted, and none has examined weight changes in medically underserved rural populations of older adults. The purpose of this study was to assess long-term weight loss maintenance 3.5 years after the completion of an initial six-month lifestyle intervention for obesity among women aged 50–75 years residing in rural communities.Methods: One hundred and ten obese women with a mean (± standard deviation age of 60.08 ± 6.17 years and mean body mass index of 36.76 ± 5.10 kg/m2 completed an in-person assessment during which their weight and adherence to behavioral weight management strategies were evaluated.Results: Participants showed a mean weight reduction of 10.17% ± 5.0% during the initial six-month intervention and regained 6.95% ± 9.44% from the completion of treatment to follow-up assessment 3.5 years later. A substantial proportion of participants (41.80% were able to maintain weight reductions of 5% or greater from baseline to follow-up. "Successful" participants (those who maintained losses of 5% or greater at follow-up reported weighing themselves, self-monitoring their intake and calories, planning meals in advance, and choosing lower calorie foods with greater frequency than "unsuccessful" participants (those who lost less than 5%.Conclusion: Collectively, these findings indicate that a large proportion of participants were able to maintain clinically significant weight losses for multiple years after treatment, and that self-monitoring was a key component of successful long-term weight management.Keywords: obesity, weight loss, weight maintenance, lifestyle intervention, rural, health disparities

  2. A randomised controlled intervention study investigating the efficacy of carotenoid-rich fruits and vegetables and extra-virgin olive oil on attenuating sarcopenic symptomology in overweight and obese older adults during energy intake restriction: protocol paper

    OpenAIRE

    Villani, Anthony; Wright, Hattie; Slater, Gary; Buckley, Jonathan

    2018-01-01

    Background Weight loss interventions have not been advocated for overweight/obese older adults due to potential loss of skeletal muscle and strength impacting on physical function with potential loss of independence. Carotenoids and polyphenols are inversely associated with sarcopenic symptomology. This paper reports the protocol of a study evaluating the efficacy of a high-protein, energy restricted diet rich in carotenoids and polyphenols on body composition, muscle strength, physical perfo...

  3. The role of overweight and obesity in urinary tract infection in children.

    Science.gov (United States)

    Mahyar, Abolfazl; Ayazi, Parviz; Gholmohammadi, Parisa; Moshiri, Seyed Alireza; Oveisi, Sonia; Esmaeily, Shiva

    2016-01-01

    This study was conducted to determine the relationship between overweight/obesity and UTI in children. A comparison was made, in terms of overweight and obesity, between 135 children with UTI (case group) and 135 healthy children (control group). UTI was diagnosed through urine culture. Dimercaptosuccinic acid renal scanning (DMSA) was also used to distinguish between lower UTI and acute pyelonephritis. Overweight and obesity were determined based on standard body mass index (BMI) curves. There were 12 (8.8%) overweight and 26 (19.2%) obese children in the case group. Four (3.0%) overweight and five (3.7%) obese children were found in the control group. There was a significant difference between the two groups regarding overweight and obesity frequencies. However, no such difference existed between children with cystitis and acute pyelonephritis. This study showed a significant relationship between overweight/obesity and UTI. Therefore, overweight and obesity may play a role in the pathogenesis of UTI in children.

  4. Hippocampal Focal Knockout of CBP Affects Specific Histone Modifications, Long-Term Potentiation, and Long-Term Memory

    Science.gov (United States)

    Barrett, Ruth M; Malvaez, Melissa; Kramar, Eniko; Matheos, Dina P; Arrizon, Abraham; Cabrera, Sara M; Lynch, Gary; Greene, Robert W; Wood, Marcelo A

    2011-01-01

    To identify the role of the histone acetyltransferase (HAT) CREB-binding protein (CBP) in neurons of the CA1 region of the hippocampus during memory formation, we examine the effects of a focal homozygous knockout of CBP on histone modifications, gene expression, synaptic plasticity, and long-term memory. We show that CBP is critical for the in vivo acetylation of lysines on histones H2B, H3, and H4. CBP's homolog p300 was unable to compensate for the loss of CBP. Neurons lacking CBP maintained phosphorylation of the transcription factor CREB, yet failed to activate CREB:CBP-mediated gene expression. Loss of CBP in dorsal CA1 of the hippocampus resulted in selective impairments to long-term potentiation and long-term memory for contextual fear and object recognition. Together, these results suggest a necessary role for specific chromatin modifications, selectively mediated by CBP in the consolidation of memories. PMID:21508930

  5. Long-term lifestyle intervention with optimized high-intensity interval training improves body composition, cardiometabolic risk, and exercise parameters in patients with abdominal obesity.

    Science.gov (United States)

    Gremeaux, Vincent; Drigny, Joffrey; Nigam, Anil; Juneau, Martin; Guilbeault, Valérie; Latour, Elise; Gayda, Mathieu

    2012-11-01

    The aim of this study was to study the impact of a combined long-term lifestyle and high-intensity interval training intervention on body composition, cardiometabolic risk, and exercise tolerance in overweight and obese subjects. Sixty-two overweight and obese subjects (53.3 ± 9.7 yrs; mean body mass index, 35.8 ± 5 kg/m(2)) were retrospectively identified at their entry into a 9-mo program consisting of individualized nutritional counselling, optimized high-intensity interval exercise, and resistance training two to three times a week. Anthropometric measurements, cardiometabolic risk factors, and exercise tolerance were measured at baseline and program completion. Adherence rate was 97%, and no adverse events occurred with high-intensity interval exercise training. Exercise training was associated with a weekly energy expenditure of 1582 ± 284 kcal. Clinically and statistically significant improvements were observed for body mass (-5.3 ± 5.2 kg), body mass index (-1.9 ± 1.9 kg/m(2)), waist circumference (-5.8 ± 5.4 cm), and maximal exercise capacity (+1.26 ± 0.84 metabolic equivalents) (P high-density lipoprotein ratio were also significantly improved (P body mass and waist circumference loss were baseline body mass index and resting metabolic rate; those for body mass index decrease were baseline waist circumference and triglyceride/high-density lipoprotein cholesterol ratio. A long-term lifestyle intervention with optimized high-intensity interval exercise improves body composition, cardiometabolic risk, and exercise tolerance in obese subjects. This intervention seems safe, efficient, and well tolerated and could improve adherence to exercise training in this population.

  6. [Psychosocial issues of long-term cancer survivors].

    Science.gov (United States)

    Weis, J; Faller, H

    2012-04-01

    Although cancer incidence rates are increasing, recent statistical studies suggest that cancer patients are showing higher cure rates as well as improved overall survival rates for most cancer locations. These advances are explained by improved strategies in early diagnoses as well as improved cancer therapies. Therefore, the number of long-term cancer survivors has also increased, but only few studies, especially within the last years, have focused on psychosocial issues of this subgroup. Some studies show that overall quality of life of long-term cancer survivors is quite high and comparable to that of the normal population. Nevertheless, a substantial percentage of former patients shows reduced quality of life and suffers from various sequelae of cancer and its treatment. This review focuses on the most common psychosocial issue of long-term survivors such as reduced psychological wellbeing, neuropsychological deficits and cancer-related fatigue syndrome. Finally, recommendations for problem-oriented interventions as well as improvement of psychosocial care of long-term survivors are given.

  7. Are long-term bisphosphonate users a reality?

    DEFF Research Database (Denmark)

    Abrahamsen, B

    2012-01-01

    The prevalence of long-term bisphosphonate use may be low due to low refill compliance and gaps in treatment. An analysis of the prescription history of 58,674 bisphosphonate users in Denmark found that only 2.8 % had received ten dose years of treatment or above. INTRODUCTION: This study aims...... to describe the demographics of present bisphosphonate (BP) users, to determine the prevalence of long-term BP use, and to establish if long-term use (a 10-year history of osteoporosis treatment) translated to ten dose years of bisphosphonate prescriptions filled, given the propensity for treatment gaps...... more than ten dose years of a BP. For any osteoporosis drug, 3.0 % had received ten dose years or more, while 23.2 % had received between 5 and 10 years of treatment. CONCLUSION: Long-term users with ten dose years or more of a BP are rare due to periods of low compliance and gaps, with a discrepancy...

  8. A security/safety survey of long term care facilities.

    Science.gov (United States)

    Acorn, Jonathan R

    2010-01-01

    What are the major security/safety problems of long term care facilities? What steps are being taken by some facilities to mitigate such problems? Answers to these questions can be found in a survey of IAHSS members involved in long term care security conducted for the IAHSS Long Term Care Security Task Force. The survey, the author points out, focuses primarily on long term care facilities operated by hospitals and health systems. However, he believes, it does accurately reflect the security problems most long term facilities face, and presents valuable information on security systems and practices which should be also considered by independent and chain operated facilities.

  9. Differences in bone mineral density between normal-weight children and children with overweight and obesity: a systematic review and meta-analysis.

    Science.gov (United States)

    van Leeuwen, J; Koes, B W; Paulis, W D; van Middelkoop, M

    2017-05-01

    This study examines the differences in bone mineral density between normal-weight children and children with overweight or obesity. A systematic review and meta-analysis of observational studies (published up to 22 June 2016) on the differences in bone mineral density between normal-weight children and overweight and obese children was performed. Results were pooled when possible and mean differences (MDs) were calculated between normal-weight and overweight and normal-weight and obese children for bone content and density measures at different body sites. Twenty-seven studies, with a total of 5,958 children, were included. There was moderate and high quality of evidence that overweight (MD 213 g; 95% confidence interval [CI] 166, 261) and obese children (MD 329 g; 95%CI [229, 430]) have a significantly higher whole body bone mineral content than normal-weight children. Similar results were found for whole body bone mineral density. Sensitivity analysis showed that the association was stronger in girls. Overweight and obese children have a significantly higher bone mineral density compared with normal-weight children. Because there was only one study included with a longitudinal design, the long-term impact of childhood overweight and obesity on bone health at adulthood is not clear. © 2017 World Obesity Federation.

  10. The Structure and Content of Long-Term and Short-Term Mate Preferences

    Directory of Open Access Journals (Sweden)

    Peter K. Jonason

    2013-12-01

    Full Text Available This study addresses two limitations in the mate preferences literature. First, research all-too-often relies on single-item assessments of mate preferences precluding more advanced statistical techniques like factor analysis. Second, when factor analysis could be done, it exclusively has done for long-term mate preferences, at the exclusion of short-term mate preferences. In this study (N = 401, we subjected 20 items designed to measure short- and long-term mate preferences to both principle components (n = 200 and confirmatory factor analysis (n = 201. In the long-term context, we replicated previous findings that there are three different categories of preferences: physical attractiveness, interpersonal warmth, and social status. In the short-term context, physical attractiveness occupied two parts of the structure, social status dropped out, and interpersonal warmth remained. Across short- and long-term contexts, there were slight changes in what defined the shared dimensions (i.e., physical attractiveness and interpersonal warmth, suggesting prior work that applies the same inventory to each context might be flawed. We also replicated sex differences and similarities in mate preferences and correlates with sociosexuality and mate value. We adopt an evolutionary paradigm to understand our results.

  11. The Cardiovascular Function Profile and Physical Fitness in Overweight Subjects

    Science.gov (United States)

    Megawati, E. R.; Lubis, L. D.; Harahap, F. Y.

    2017-03-01

    Obesity in children and young adult is associated with cardiovascular risk in short term and long term. The aim of this study was to describe the profile of the cardiovascular functions parameters and physical fitness in overweight. This is an analytical observational study with cross sectional approach. The samples of this study were 85 randomly selected subjects aged 18 to 24 years with normoweight and body mass index <40. The parameters measures were body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), cardiovascular function parameters (resting pulse, blood pressure, and peak flow meter) and physical fitness parameters (VO2max dengan McArdle step test). The mean BMI was 24,53±4,929. The WC and WHR mean were 86,7±14,10 cms and 0,89±0,073 cm respectively. The mean of resting pulses were higher in normoweight subject (p=0,0209). The mean systole were lower in normoweight subject (p=0,0026). No differences VO2 max between groups (p=0,3888). The peak flow meter was higher in normoweight (p=0,0274). The result of this study indicate that heart rate, systole and peak flow meter are signifantly different between groups. The heart rate and the peak flow meter in the overweight subjects were lower meanwhile the systole blood pressure was higher compared to normoweight subjects.

  12. Long-Term Memory and Learning

    Science.gov (United States)

    Crossland, John

    2011-01-01

    The English National Curriculum Programmes of Study emphasise the importance of knowledge, understanding and skills, and teachers are well versed in structuring learning in those terms. Research outcomes into how long-term memory is stored and retrieved provide support for structuring learning in this way. Four further messages are added to the…

  13. A least squares approach for efficient and reliable short-term versus long-term optimization

    DEFF Research Database (Denmark)

    Christiansen, Lasse Hjuler; Capolei, Andrea; Jørgensen, John Bagterp

    2017-01-01

    The uncertainties related to long-term forecasts of oil prices impose significant financial risk on ventures of oil production. To minimize risk, oil companies are inclined to maximize profit over short-term horizons ranging from months to a few years. In contrast, conventional production...... optimization maximizes long-term profits over horizons that span more than a decade. To address this challenge, the oil literature has introduced short-term versus long-term optimization. Ideally, this problem is solved by a posteriori multi-objective optimization methods that generate an approximation...... the balance between the objectives, leaving an unfulfilled potential to increase profits. To promote efficient and reliable short-term versus long-term optimization, this paper introduces a natural way to characterize desirable Pareto points and proposes a novel least squares (LS) method. Unlike hierarchical...

  14. Sacrococcygeal teratoma: Clinical characteristics and long-term ...

    African Journals Online (AJOL)

    Background/Purpose : The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods : Between January 1990 and ...

  15. Managerial Long-Term Responsibility in Family-Controlled Firms

    Directory of Open Access Journals (Sweden)

    Dietmar Sternad

    2013-01-01

    Full Text Available Evidence suggests that long-term orientation (LTO as a dominantstrategic logic contributes to the sustainable performance offamily-controlled firms (FCFS. Combining a review of the literatureon lto with stewardship theory and upper echelons theoryreasoning, this article presents a typology of managerial responsibilityand introduces the concept of long-term responsibility as amanagerial characteristic constituting a major driving force behindcreating lto. The antecedents of long-term responsibilityunder family firm-specific conditions (stemming from the familysystem, the governance system, and family-firm managers’ personalcharacteristics are also identified and presented in an integratedmodel. The paper contributes to a more comprehensiveunderstanding of intertemporal choice in fcfs and explains whythey tend to be more long-term oriented than other types of firms.

  16. The effect of the addition of resistance training to a dietary education intervention on apolipoproteins and diet quality in overweight and obese older adults

    Directory of Open Access Journals (Sweden)

    Valente EA

    2011-09-01

    Full Text Available Elizabeth A Valente1, Megan E Sheehy1, Joshua J Avila2, Julie A Gutierres2, Matthew J Delmonico2, Ingrid E Lofgren11Department of Nutrition and Food Sciences, 2Department of Kinesiology, University of Rhode Island, Kingston, RI, USAObjectives: The aim of the study was to examine the additive effect of resistance training (RT to a dietary education (DE intervention on emerging coronary heart disease (CHD risk factors, concentration of apolipoproteins B (apoB and A-I (apoA-I, and Dietary Approaches to Stop Hypertension (DASH Diet Index scores in overweight and obese older adults.Patients and methods: This was an ancillary study of a randomized clinical trial held in the Fall of 2008 at the University of Rhode Island. Participants were overweight or obese subjects (mean body mass index [BMI] of 31.7 kg/m2 randomized into two groups, one participating in DE only (n = 12 and the other participating in DE plus RT (DERT (n = 15. The intervention involved all subjects participating in 30 minutes of DE per week for 10 weeks. Subjects in the DERT group participated in an additional 40 minutes of RT three times per week for 10 weeks. Measurements taken were anthropometric (height, weight, waist circumference, and body composition using the BOD POD® [Body Composition System, v 2.14; Life Measurement Instruments, Concord, CA], clinical (blood pressure, and biochemical (lipid profile and apoB and apoA-I concentrations, and the DASH Diet Index was used to measure diet quality.Results: 27 subjects (11 males, 16 females, with a mean age of 66.6 ± 4.3 years, were included in analyses. The DERT subjects had significantly better triacylglycerol and apoB concentrations and DASH Diet Index scores than the DE subjects post-intervention. Improvements were seen within the DE group in energy intake, fat-free mass, and systolic blood pressure and within the DERT group in body weight, percentage of body fat, BMI, diastolic blood pressure, and oxidized low

  17. Which Frail Older People Are Dehydrated? The UK DRIE Study.

    Science.gov (United States)

    Hooper, Lee; Bunn, Diane K; Downing, Alice; Jimoh, Florence O; Groves, Joyce; Free, Carol; Cowap, Vicky; Potter, John F; Hunter, Paul R; Shepstone, Lee

    2016-10-01

    Water-loss dehydration in older people is associated with increased mortality and disability. We aimed to assess the prevalence of dehydration in older people living in UK long-term care and associated cognitive, functional, and health characteristics. The Dehydration Recognition In our Elders (DRIE) cohort study included people aged 65 or older living in long-term care without heart or renal failure. In a cross-sectional baseline analysis, we assessed serum osmolality, previously suggested dehydration risk factors, general health, markers of continence, cognitive and functional health, nutrition status, and medications. Univariate linear regression was used to assess relationships between participant characteristics and serum osmolality, then associated characteristics entered into stepwise backwards multivariate linear regression. DRIE included 188 residents (mean age 86 years, 66% women) of whom 20% were dehydrated (serum osmolality >300 mOsm/kg). Linear and logistic regression suggested that renal, cognitive, and diabetic status were consistently associated with serum osmolality and odds of dehydration, while potassium-sparing diuretics, sex, number of recent health contacts, and bladder incontinence were sometimes associated. Thirst was not associated with hydration status. DRIE found high prevalence of dehydration in older people living in UK long-term care, reinforcing the proposed association between cognitive and renal function and hydration. Dehydration is associated with increased mortality and disability in older people, but trials to assess effects of interventions to support healthy fluid intakes in older people living in residential care are needed to enable us to formally assess causal direction and any health benefits of increasing fluid intakes. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Collectes à long terme

    CERN Multimedia

    Collectes à long terme

    2014-01-01

    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  19. Long-term effects of tetanus toxoid inoculation on the demography and life expectancy of the Cayo Santiago rhesus macaques.

    Science.gov (United States)

    Kessler, Matthew J; Hernández Pacheco, Raisa; Rawlins, Richard G; Ruiz-Lambrides, Angelina; Delgado, Diana L; Sabat, Alberto M

    2015-02-01

    Tetanus was a major cause of mortality in the free-ranging population of rhesus monkeys on Cayo Santiago prior to 1985 when the entire colony was given its first dose of tetanus toxoid. The immediate reduction in mortality that followed tetanus toxoid inoculation (TTI) has been documented, but the long-term demographic effects of eliminating tetanus infections have not. This study uses the Cayo Santiago demographic database to construct comparative life tables 12 years before, and 12 years after, TTI. Life tables and matrix projection models are used to test for differences in: (i) survival among all individuals as well as among social groups, (ii) long-term fitness of the population, (iii) age distribution, (iv) reproductive value, and (v) life expectancy. A retrospective life table response experiment (LTRE) was performed to determine which life cycle transition contributed most to observed changes in long-term fitness of the population post-TTI. Elimination of clinical tetanus infections through mass inoculation improved the health and well-being of the monkeys. It also profoundly affected the population by increasing survivorship and long-term fitness, decreasing the differences in survival rates among social groups, shifting the population's age distribution towards older individuals, and increasing reproductive value and life expectancy. These findings are significant because they demonstrate the long-term effects of eradicating a major cause of mortality at a single point in time on survival, reproduction, and overall demography of a naturalistic population of primates. © 2014 Wiley Periodicals, Inc.

  20. Higher Intake of Fruit, but Not Vegetables or Fiber, at Baseline Is Associated with Lower Risk of Becoming Overweight or Obese in Middle-Aged and Older Women of Normal BMI at Baseline.

    Science.gov (United States)

    Rautiainen, Susanne; Wang, Lu; Lee, I-Min; Manson, JoAnn E; Buring, Julie E; Sesso, Howard D

    2015-05-01

    Fruit, vegetable, and dietary fiber intake have been associated with lower risk of cardiovascular disease (CVD); however, little is known about their role in obesity prevention. Our goal was to investigate whether intake of fruits, vegetables, and dietary fiber is associated with weight change and the risk of becoming overweight and obese. We studied 18,146 women aged ≥45 y from the Women's Health Study free of CVD and cancer with an initial body mass index (BMI) of 18.5 to Fruit, vegetable, and dietary fiber intakes were assessed at baseline through a 131-item food-frequency questionnaire, along with obesity-related risk factors. Women self-reported body weight on annual questionnaires. During a mean follow-up of 15.9 y, 8125 women became overweight or obese (BMI ≥25 kg/m²). Intakes of total fruits and vegetables, fruits, and dietary fiber were not associated with the longitudinal changes in body weight, whereas higher vegetable intake was associated with greater weight gain (P-trend: 0.02). In multivariable analyses, controlling for total energy intake and physical activity along with other lifestyle, clinical, and dietary factors, women in the highest vs. lowest quintile of fruit intake had an HR of 0.87 (95% CI: 0.80, 0.94; P-trend: 0.01) of becoming overweight or obese. No association was observed for vegetable or dietary fiber intake. The association between fruit intake and risk of becoming overweight or obese was modified by baseline BMI (P-interaction: fruit, but not vegetables or fiber, by middle-aged and older women with a normal BMI at baseline is associated with lower risk of becoming overweight or obese. © 2015 American Society for Nutrition.

  1. CLIMATE CHANGE: LONG-TERM TRENDS AND SHORT-TERM OSCILLATIONS

    Institute of Scientific and Technical Information of China (English)

    GAO Xin-quan; ZHANG Xin; QIAN Wei-hong

    2006-01-01

    Identifying the Northern Hemisphere (NH) temperature reconstruction and instrumental data for the past 1000 years shows that climate change in the last millennium includes long-term trends and various oscillations. Two long-term trends and the quasi-70-year oscillation were detected in the global temperature series for the last 140 years and the NH millennium series. One important feature was emphasized that temperature decreases slowly but it increases rapidly based on the analysis of different series. Benefits can be obtained of climate change from understanding various long-term trends and oscillations. Millennial temperature proxies from the natural climate system and time series of nonlinear model system are used in understanding the natural climate change and recognizing potential benefits by using the method of wavelet transform analysis. The results from numerical modeling show that major oscillations contained in numerical solutions on the interdecadal timescale are consistent with that of natural proxies. It seems that these oscillations in the climate change are not directly linked with the solar radiation as an external forcing. This investigation may conclude that the climate variability at the interdecadal timescale strongly depends on the internal nonlinear effects in the climate system.

  2. Impact of long-term and short-term therapies on seminal parameters

    Directory of Open Access Journals (Sweden)

    Jlenia Elia

    2013-04-01

    Full Text Available Aim: The aim of this work was: i to evaluate the prevalence of male partners of subfertile couples being treated with long/short term therapies for non andrological diseases; ii to study their seminal profile for the possible effects of their treatments on spermatogenesis and/or epididymal maturation. Methods: The study group was made up of 723 subjects, aged between 25 and 47 years. Semen analysis was performed according to World Health Organization (WHO guidelines (1999. The Superimposed Image Analysis System (SIAS, which is based on the computerized superimposition of spermatozoa images, was used to assess sperm motility parameters. Results: The prevalence of subjects taking pharmacological treatments was 22.7% (164/723. The prevalence was 3.7% (27/723 for the Short-Term Group and 18.9% (137/723 for the Long-Term Group. The subjects of each group were also subdivided into subgroups according to the treatments being received. Regarding the seminal profile, we did not observe a significant difference between the Long-Term, Short-Term or the Control Group. However, regarding the subgroups, we found a significant decrease in sperm number and progressive motility percentage in the subjects receiving treatment with antihypertensive drugs compared with the other subgroups and the Control Group. Conclusions: In the management of infertile couples, the potential negative impact on seminal parameters of any drugs being taken as Long-Term Therapy should be considered. The pathogenic mechanism needs to be clarified.

  3. A cost of long-term memory in Drosophila

    OpenAIRE

    Mery, Frederic; Kawecki, Tadeusz J.

    2005-01-01

    Two distinct forms of consolidated associative memory are known in Drosophila: long-term memory and so-called anesthesia-resistant memory. Long-term memory is more stable, but unlike anesthesia-resistant memory, its formation requires protein synthesis. We show that flies induced to form long-term memory become more susceptible to extreme stress (such as desiccation). In contrast, induction of anesthesia-resistant memory had no detectable effect on desiccation resistance. This finding may hel...

  4. A study of the long-term effect of malar fat repositioning in face lift surgery: short-term success but long-term failure.

    Science.gov (United States)

    Hamra, Sam T

    2002-09-01

    In 1990, the author reported on a series of 403 cases of deep plane face lifts, the first published technique describing the repositioning of the cheek fat, known as malar fat, in face lift surgery. This study examines the long-term results of 20 of the original series in an attempt to determine what areas of the rejuvenated face (specifically, the malar fat) showed long-term improvement. The results were judged by comparing the preoperative and long-term postoperative views in a half-and-half same-side hemiface photograph. The anatomy of the jawline (superficial musculoaponeurotic system [SMAS]), the nasolabial fold (malar fat), and the periorbital diameter were evaluated. The results confirmed that repositioning of the SMAS remained for longer than improvement in the nasolabial fold and that the vertical diameter of the periorbit did not change at all. The early results of malar fat repositioning shown at 1 to 2 years were successful, but the long-term results showed failure of the early improvement, manifested by recurrence of the nasolabial folds. There was, however, continuation of the improved results of the forehead lift and SMAS maneuvers of the original procedure. The conclusion is that only a direct excision will produce a permanent correction of the aging nasolabial fold.

  5. The Trochanteric Localization is a Mediator of Slower Short-Term Functional Recovery in Overweight and Obese Elderly Women with Recent Hip Fracture: The BREAK Study.

    Science.gov (United States)

    Gonnelli, Stefano; Caffarelli, Carla; Rossi, Stefania; Siviero, Paola; Maggi, Stefania; Crepaldi, Gaetano; Nuti, Ranuccio

    2015-12-01

    The hypothesis tested in this study, carried out on elderly Italian women with recent hip fracture, was to assess the extent to which the effect of a condition of being overweight/obese on short-term functional recovery as evaluated by the "time to permitted load" could be explained by a mediator variable (type of hip fracture). We studied 727 women aged 60 years or over with a recent low trauma surgically treated hip fracture and for whom an information on post-surgery complications and on the time to permitted load was available. To assess for mediation, the statistical analyses were carried out following the procedure described by Baron and Kenny. In this study, 46 % of women with hip fracture presented a time to permitted load of ≥ 10 days. The women with a post-surgery time to permitted load of ≥ 10 days showed a significantly higher proportion of trochanteric fracture localization (72.1 vs 42 %), of total overweight/obesity (46.5 vs 36.8 %) and of post-surgery complications (38.8 vs 18.8 %). The mediating effect of hip fracture localization on the association between overweight/obesity and the time of permitted load was demonstrated and confirmed in a multivariate logistic regression model. This study, carried out using a "mediator" statistical analysis, suggests that in elderly women with hip fracture being overweight/obese is associated with a slower short-term functional recovery as evaluated by the time to permitted load and that this association is mediated by the trochanteric localization of hip fracture.

  6. Developmental Dyslexia and Explicit Long-Term Memory

    Science.gov (United States)

    Menghini, Deny; Carlesimo, Giovanni Augusto; Marotta, Luigi; Finzi, Alessandra; Vicari, Stefano

    2010-01-01

    The reduced verbal long-term memory capacities often reported in dyslexics are generally interpreted as a consequence of their deficit in phonological coding. The present study was aimed at evaluating whether the learning deficit exhibited by dyslexics was restricted only to the verbal component of the long-term memory abilities or also involved…

  7. On Lok: a pioneering long-term care organization for the elderly (1971-2008).

    Science.gov (United States)

    Lehning, Amanda J; Austin, Michael J

    2011-01-01

    On Lok is a pioneering nonprofit organization that has delivered services to the frail and elderly since its founding in 1971. The agency began as a grassroots effort focused on improving the health care available to older adults living independently in the community. Over its 40-year history, On Lok has evolved into a $70 million nonprofit human service organization with a national reputation for innovation as a leading provider of care to frail elderly. The agency has developed its own model of care that has been replicated in cities around the country. The history of On Lok represents the important impact that donor and community support plays in an organization's long-term success.

  8. Should children with overweight or obesity be excluded from height references?

    Science.gov (United States)

    Júlíusson, Pétur B; Brannsether, Bente; Kristiansen, Hege; Hoppenbrouwers, Karel; Bjerknes, Robert; Roelants, Mathieu

    2015-11-01

    Growth reference charts are usually based on measurements of children free from a medical condition that affects growth. However, samples collected during the past decades often contain a large proportion of overweight or obese children. Because obesity increases linear growth, the question arises to what extent the percentiles curves for length/height are affected by the presence of children with overweight or obesity. Data from two cross-sectional samples of 2-year-old to 18-year-old children were analysed: 12,252 Belgian children, measured in 2002-2004, and 6159 Norwegian children, measured in 2003-2006. The LMS method was used to estimate height-for-age curves with and without children considered overweight or obese according to the International Obesity Task Force thresholds. The prevalence of overweight (including obesity) and obesity was 13.0% and 2.8% in the Belgian and 13.8% and 2.3% in the Norwegian sample. Children were taller when overweight (+0.49 and 0.43 SD, in the Belgian and Norwegian sample, respectively) or obese (+0.73 and 0.72 SD in the Belgian and Norwegian sample, respectively). Effect sizes were smaller in younger and older children, which points to an advanced age of maturation as a possible cause. Excluding overweight and obese children had only a minor impact on the growth curves with largest difference in mean height SD scores -0.09 in the Belgian and -0.12 in the Norwegian sample with a corresponding increase of up to 0.5% and 1.2% in number of children >+2 SD. Current Belgian and Norwegian growth references for length/height were found to be largely unaffected by the current proportion of overweight and obese children. There is, therefore, no need for revised height charts that exclude overweight or obese children. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Advancing an ethical framework for long-term care.

    Science.gov (United States)

    Carter, Mary Whelan

    2002-02-01

    This article represents an effort to formulate an ethical framework for long-term care with the explicit purpose of providing a catalyst to promote further discourse and expand consideration of what an ethic of long-term care might entail. Grounding the discussion, an introduction to traditional ethical philosophy is presented, focusing mainly on the fundamentals of deontological and teleological ethical theories. Attention then shifts to a review of the more frequently cited principles found in the long-term care ethics literature, followed by a critique of the current reliance upon principlism to resolve ethical dilemmas in long-term care. In response to this criticism, an agent-driven ethical framework stressing dignity and respect for personhood, drawn from the philosophy of Immanuel Kant, is advanced.

  10. Long-term memory, sleep, and the spacing effect.

    Science.gov (United States)

    Bell, Matthew C; Kawadri, Nader; Simone, Patricia M; Wiseheart, Melody

    2014-01-01

    Many studies have shown that memory is enhanced when study sessions are spaced apart rather than massed. This spacing effect has been shown to have a lasting benefit to long-term memory when the study phase session follows the encoding session by 24 hours. Using a spacing paradigm we examined the impact of sleep and spacing gaps on long-term declarative memory for Swahili-English word pairs by including four spacing delay gaps (massed, 12 hours same-day, 12 hours overnight, and 24 hours). Results showed that a 12-hour spacing gap that includes sleep promotes long-term memory retention similar to the 24-hour gap. The findings support the importance of sleep to the long-term benefit of the spacing effect.

  11. Long-term course of opioid addiction.

    Science.gov (United States)

    Hser, Yih-Ing; Evans, Elizabeth; Grella, Christine; Ling, Walter; Anglin, Douglas

    2015-01-01

    Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

  12. Cesarean section may increase the risk of both overweight and obesity in preschool children.

    Science.gov (United States)

    Rutayisire, Erigene; Wu, Xiaoyan; Huang, Kun; Tao, Shuman; Chen, Yunxiao; Tao, Fangbiao

    2016-11-03

    The increase rates of cesarean section (CS) occurred at the same period as the dramatic increase of childhood overweight/obesity. In China, cesarean section rates have exponentially increased in the last 20 years and they now exceed World Health Organization (WHO) recommendation. Such high rates demand an understanding to the long-term consequences on child health. We aim to examine the association between CS and risk of overweight and obesity among preschool children. We recruited 9103 children from 35 kindergartens in 4 cities located in East China. Children anthropometric measurements were taken in person by trained personnel. The mode of delivery was classified as vaginal or CS, in sub-analyses we divided cesarean delivery into elective or non-elective. The mode of delivery and other parental information were self-reported by parents. Multivariate logistic regression analysis was used to examine the associations. In our cross-sectional study of 8900 preschool children aged 3-6 years, 67.3 % were born via CS, of whom 15.7 % were obese. Cesarean delivery was significantly associated with the risk of overweight [OR 1.24; (95 % CI 1.07-1.44); p = 0.003], and the risk of obesity [OR 1.29; (95 % CI 1.13-1.49); p children. After adjusted for child characteristics, parental factors and family income, the odd of overweight was 1.35 and of obesity was 1.25 in children delivered by elective CS. The associations between CS and overweight/obesity in preschool children are influenced by potential confounders. Both children delivered by elective or non-elective CS are at increased risk of overweight/obesity. Potential consequences of CS on the health of the children should be discussed among both health care professionals and childbearing women.

  13. Prevalence of malnutrition and its correlates in older adults living in long stay institutions situated in Beirut, Lebanon.

    Science.gov (United States)

    El Zoghbi, Mohamad; Boulos, Christa; Awada, Sanaa; Rachidi, Samar; Al-Hajje, Amal; Bawab, Wafaa; Saleh, Nadine; Salameh, Pascale

    2014-01-01

    Malnutrition represents an important issue in older adults; unfortunately, there is lack of data concerning this topic in Lebanon. This paper aims to provide a description of nutritional status and its correlates in older adults living in long stay institutions situated in Beirut. This cross-sectional study was conducted in three long stay institutions in Beirut in 2012. The study population was composed of people aged 65 years and above, having a score of Folstein Mini Mental State Examination (MMSE) greater than 14 and without renal failure requiring dialysis. Subjects meeting inclusion criteria filled out a questionnaire consisting of nutritional status scale (Mini Nutritional Assessment: MNA) and several other parts (demographic, self-assessment of the state health, smoking and alcohol, physical dependence, quality of life, frailty, depression, social isolation and loneliness). Data were entered and analyzed using the statistical software SPSS (Statistical Package for Social Sciences), version 17.0 (Chicago, IL, USA). Among 111 older adults (55 men and 56 women), 14 (12.6%) were malnourished, 54 (48.7%) were at risk of malnutrition and 43 (38.7%) had an adequate nutritional status. Multivariate analysis showed that physical exercise, depression, frailty and cognitive function were independent correlates of nutritional status of older adults. This model explained 42.2% (adjusted R2 = 0.422) of the older adults nutritional status variability. We found a moderate percentage of malnutrition in older adults living in long stay institutions situated in Beirut, and the correlates of malnutrition in older adults were low physical exercise, depression, frailty and low cognitive function.

  14. When the private sphere goes public: exploring the issues facing family caregiver organizations in the development of long-term care policies.

    Science.gov (United States)

    Rozario, Philip A; Palley, Elizabeth

    2008-01-01

    Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the "private spheres." In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.

  15. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People's Republic of China.

    Science.gov (United States)

    Zhang, Zhenyu; Wang, Jianbing; Jin, Mingjuan; Li, Mei; Zhou, Litao; Jing, Fangyuan; Chen, Kun

    2014-01-01

    The People's Republic of China's population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People's Republic of China. To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People's Republic of China. We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People's Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services.

  16. Essays on long-term mortality and interest rate risk

    NARCIS (Netherlands)

    de Kort, J.P.

    2017-01-01

    This dissertation comprises a study of long-term risks which play a major role in actuarial science. In Part I we analyse long-term mortality risk and its impact on consumption and investment decisions of economic agents, while Part II focuses on the mathematical modelling of long-term interest

  17. ERDA's long-term waste management goals and programs

    International Nuclear Information System (INIS)

    Perge, A.F.; Trice, V.G. Jr.; Walton, R.D. Jr.

    1976-01-01

    This paper presents an overview of the ERDA's major program for the long-term waste management of radioactive waste and provides a perspective for symposium participants with regard to the interrelationship of specific components of the program that are discussed in detail in other ERDA-sponsored papers. Needs, goals, and plans are reviewed for ERDA's management of the commercially generated wastes which are expected to be delivered to ERDA in accordance with Federal regulations. At present, ERDA responsibilities include long-term management of commercial-level wastes. Possible future regulations may give ERDA responsibility for the long-term management of commercial low-level solid wastes contaminated with transuranic nuclides. Primary planning goals and programs for the development of terminal storage facilities and waste processing technology to produce acceptable waste forms for long-term management are reviewed for each of the waste types identified above. The status of development programs for the long-term management of airborne radionuclides, which may be required at some time in the future, is also reviewed. (author)

  18. [Ophthalmologic healthcare utilization of people in need of long-term care : Analyses of health insurance data of the AOK Baden-Württemberg].

    Science.gov (United States)

    Schuster, Alexander K; Pick, Julia; Saalmann, Frauke; Pfeiffer, Norbert

    2018-04-10

    Eye diseases causing visual impairment increase with age. Thus, seeking eye care has a higher probability in older people. In this study, the rate of utilization of outpatient eye care services in Germany was analyzed. The analyses focused on older persons and persons in need of either home-based or facility-based long-term care. A descriptive secondary data analysis of health insurance data of the AOK Baden-Württemberg from 2016 was conducted. The study population comprised all insured persons on 1 January 2016. The cohort of older persons (60 years+) was further stratified by the type of care (home-based/facility-based) and the level of care (0-3). The utilization of outpatient eye care services was defined by the reimbursement for an ophthalmologist's provision of service. While 39.3% of the study population 60+ years old sought eye care, the utilization rate was lower among people in need of home-based (33.0%) and facility-based care (19.3%). The utilization rates showed comparable age-dependent patterns, except for persons in need of facility-based care where rates were similar for all age groups. Utilization rates were negatively associated with increasing care levels. Only people with care level 0 showed lower utilization rates than people with care level 1. Utilization rates of eye healthcare services among older persons are considerably influenced by the need of long-term care, by the form of care as well as by the level of care.

  19. Long-Term Clock Behavior of GPS IIR Satellites

    National Research Council Canada - National Science Library

    Epstein, Marvin; Dass, Todd; Rajan, John; Gilmour, Paul

    2007-01-01

    .... Rubidium clocks, as opposed to cesium clocks, have significant long-term drift. The current literature describes an initial model of drift aging for rubidium atomic clocks followed by a long-term characteristic...

  20. Long-term properties of bituminized waste products

    International Nuclear Information System (INIS)

    Snellman, M.; Valkiainen, M.

    1985-10-01

    This study is a survey of the factors of importance for the long term behaviour of bituminized ion exchange resins. Phenomena occurring in bituminized waste products affected by the treatment, storage and disposal are identified. Test methods have been developed for characterizing product properties, which are important for the long-term behaviour. The long-term properties of bituminized ion-exchange resins are studied in a repository environment with access of water equilibrated with concrete. In these circumstances the most important properties are related to the interactions of bituminized waste with the surrounding barriers. The most important phenomena are water uptake due to rehydration of the resins and subsequent swelling of the product

  1. Long-term properties of bituminized waste products

    International Nuclear Information System (INIS)

    Snellman, M.; Valkiainen, M.

    1985-10-01

    This study is a survey of the factors of importance for long term behaviour of bituminized ion exchange resins. Phenomena occurring in bituminized waste products affected by the treatment, storage and disposal are identified. Test methods have been developed for characterizing product properties, which are important for the long-term behaviour. The long-term properties of bituminized ion-exchange resins are studied in a repository environment with access of water equilibrated with concrete. In these circumstances the most important properties are ralated to the interactions of bituminized waste with the surrounding barriers. The most important phenomena are water uptake due to rehydration of the resins and subsequent swelling of the product. (author)

  2. Space ventures and society long-term perspectives

    Science.gov (United States)

    Brown, W. M.

    1985-01-01

    A futuristic evaluation of mankind's potential long term future in space is presented. Progress in space will not be inhibited by shortages of the Earth's physical resources, since long term economic growth will be focused on ways to constrain industrial productivity by changing social values, management styles, or government competence. Future technological progress is likely to accelerate with an emphasis on international cooperation, making possible such large joint projects as lunar colonies or space stations on Mars. The long term future in space looks exceedingly bright even in relatively pessimistic scenarios. The principal driving forces will be technological progress, commercial and public-oriented satellites, space industrialization, space travel, and eventually space colonization.

  3. Societal consequences of falls in the older population: Injuries, healthcare costs, and long-term reduced quality of life

    NARCIS (Netherlands)

    K.A. Hartholt (Klaas); E.F. van Beeck (Ed); S. Polinder (Suzanne); N. van der Velde (Nathalie); E.M.M. van Lieshout (Esther); M.J.M. Panneman (Martien); T.J.M. van der Cammen (Tischa); P. Patka (Peter)

    2011-01-01

    textabstractBACKGROUND:: Fall incidents are a major cause of morbidity and mortality in older adults. The aim of this cohort study was to determine the incidence, costs, and quality of life for fall-related injuries in the older Dutch population presenting at the emergency department. METHODS:: Data

  4. BMI and obesity incidence in relation to food patterns of Polish older people

    DEFF Research Database (Denmark)

    Wadolowska, L.; Danowska-Oziewicz, M.; Niedzwiedzka, E.

    2006-01-01

    BMI differentiation and obesity incidence in relation to food patterns of Polish older people were analysed. The research included 422 people aged 65+ years. 21 food patterns were separated by the factor analysis. On the basis of the self-reported body mass and height, the BMI and percentages...... of overweight or obese people were calculated. The increase of the BMI and overweight and obesity incidence for both sexes was unequivocally connected with eating rye. The increase of the BMI and overweight and obesity incidence depended among women on consuming pork meat and alcoholic beverages. For men...

  5. Effect of a low fat versus a low carbohydrate weight loss dietary intervention on biomarkers of long term survival in breast cancer patients ('CHOICE'): study protocol.

    Science.gov (United States)

    Sedlacek, Scot M; Playdon, Mary C; Wolfe, Pamela; McGinley, John N; Wisthoff, Mark R; Daeninck, Elizabeth A; Jiang, Weiqin; Zhu, Zongjian; Thompson, Henry J

    2011-07-06

    Weight loss in overweight or obese breast cancer patients is associated with an improved prognosis for long term survival. However, it is not clear whether the macronutrient composition of the chosen weight loss dietary plan imparts further prognostic benefit. A study protocol is presented for a dietary intervention to investigate the effects of weight loss dietary patterns that vary markedly in fat and carbohydrate contents on biomarkers of exposure to metabolic processes that may promote tumorigenesis and that are predictive of long term survival. The study will also determine how much weight must be lost for biomarkers to change in a favorable direction. Approximately 370 overweight or obese postmenopausal breast cancer survivors (body mass index: 25.0 to 34.9 kg/m²) will be accrued and assigned to one of two weight loss intervention programs or a non-intervention control group. The dietary intervention is implemented in a free living population to test the two extremes of popular weight loss dietary patterns: a high carbohydrate, low fat diet versus a low carbohydrate, high fat diet. The effects of these dietary patterns on biomarkers for glucose homeostasis, chronic inflammation, cellular oxidation, and steroid sex hormone metabolism will be measured. Participants will attend 3 screening and dietary education visits, and 7 monthly one-on-one dietary counseling and clinical data measurement visits in addition to 5 group visits in the intervention arms. Participants in the control arm will attend two clinical data measurement visits at baseline and 6 months. The primary outcome is high sensitivity C-reactive protein. Secondary outcomes include interleukin-6, tumor necrosis factor-α, insulin-like growth factor-1 (IGF), IGF binding protein-3, 8-isoprostane-F2-alpha, estrone, estradiol, progesterone, sex hormone binding globulin, adiponectin, and leptin. While clinical data indicate that excess weight for height is associated with poor prognosis for long term

  6. Effect of a low fat versus a low carbohydrate weight loss dietary intervention on biomarkers of long term survival in breast cancer patients ('CHOICE': study protocol

    Directory of Open Access Journals (Sweden)

    Daeninck Elizabeth A

    2011-07-01

    Full Text Available Abstract Background Weight loss in overweight or obese breast cancer patients is associated with an improved prognosis for long term survival. However, it is not clear whether the macronutrient composition of the chosen weight loss dietary plan imparts further prognostic benefit. A study protocol is presented for a dietary intervention to investigate the effects of weight loss dietary patterns that vary markedly in fat and carbohydrate contents on biomarkers of exposure to metabolic processes that may promote tumorigenesis and that are predictive of long term survival. The study will also determine how much weight must be lost for biomarkers to change in a favorable direction. Methods/Design Approximately 370 overweight or obese postmenopausal breast cancer survivors (body mass index: 25.0 to 34.9 kg/m2 will be accrued and assigned to one of two weight loss intervention programs or a non-intervention control group. The dietary intervention is implemented in a free living population to test the two extremes of popular weight loss dietary patterns: a high carbohydrate, low fat diet versus a low carbohydrate, high fat diet. The effects of these dietary patterns on biomarkers for glucose homeostasis, chronic inflammation, cellular oxidation, and steroid sex hormone metabolism will be measured. Participants will attend 3 screening and dietary education visits, and 7 monthly one-on-one dietary counseling and clinical data measurement visits in addition to 5 group visits in the intervention arms. Participants in the control arm will attend two clinical data measurement visits at baseline and 6 months. The primary outcome is high sensitivity C-reactive protein. Secondary outcomes include interleukin-6, tumor necrosis factor-α, insulin-like growth factor-1 (IGF, IGF binding protein-3, 8-isoprostane-F2-alpha, estrone, estradiol, progesterone, sex hormone binding globulin, adiponectin, and leptin. Discussion While clinical data indicate that excess weight

  7. Short-term and long-term sick-leave in Sweden

    DEFF Research Database (Denmark)

    Blank, N; Diderichsen, Finn

    1995-01-01

    The primary aim of the study was to analyse similarities and differences between repeated spells of short-term sick-leave (more than 3 spells of less than 7 days' duration in a 12-month period) and long-term absence through sickness (at least 1 spell of more than 59 days' duration in a 12-month p...

  8. Long-term dietary intervention trials: critical issues and challenges

    Directory of Open Access Journals (Sweden)

    Crichton Georgina E

    2012-07-01

    Full Text Available Abstract Background There are many challenges involved in running randomised controlled dietary intervention trials that investigate health outcomes. The aim of this paper was to evaluate the recruitment process, retention of participants and challenges faced in our dairy intervention trial, and to provide strategies to combat the difficulties of running long-term dietary intervention trials. Methods A 12-month, randomised, two-way crossover study was conducted in overweight adults with habitually low dairy food consumption to assess the effects of a high dairy intake (4 servings of reduced-fat dairy per day compared with a low dairy intake (1 serving of reduced-fat dairy per day on measures of cardiometabolic and cognitive health. On completion of the high dairy intake phase, each participant was interviewed about their experience in the trial and responses were used to evaluate the key issues for study participants. Results Although the recruitment target was achieved, high rates of attrition (49.3% and difficulties maintaining participant compliance (reported by 37.8% of participants were major threats to the viability of the study. Factors that contributed to the high attrition included inability to comply with the dietary requirements of the study protocol (27.0%, health problems or medication changes (24.3% and time commitment (10.8%. Conclusion Attrition and adherence to study requirements present challenges to trials requiring longer-term dietary change. Including a run-in period to further assess the motivation, commitment and availability of participants, maintaining regular contact with participants during control phases, minimising time commitment, providing flexibility with dietary requirements, facilitating positive experiences, and stringent monitoring of diet are some key recommendations for future dietary intervention trials. Trial registration Australia and New Zealand Clinical Trials Registry (ACTRN 12608000538347

  9. Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults

    NARCIS (Netherlands)

    Neelemaat, Floor; Lips, Paul; Bosmans, Judith E; Thijs, Abel; Seidell, Jaap C; van Bokhorst-de van der Schueren, Marian A E

    OBJECTIVES: To evaluate the effects of a short-term nutritional intervention with protein and vitamin D on falls in malnourished older adults. DESIGN: Randomized controlled trial. SETTING: From hospital admission until 3 months after discharge. PARTICIPANTS: Malnourished older adults (≥ 60) newly

  10. Long-Term Effects of Repeated Prefrontal Cortex Transcranial Direct Current Stimulation (tDCS) on Food Craving in Normal and Overweight Young Adults.

    Science.gov (United States)

    Ljubisavljevic, M; Maxood, K; Bjekic, J; Oommen, J; Nagelkerke, N

    The dorsolateral prefrontal cortex (DLPFC) plays an important role in the regulation of food intake. Several previous studies demonstrated that a single session of transcranial direct current stimulation (tDCS) of the DLPFC reduces food craving and caloric intake. We hypothesized that repeated tDCS of the right DLPFC cortex may exert long-term changes in food craving in young, healthy adults and that these changes may differ between normal and overweight subjects. Thirty healthy individuals who reported frequent food cravings without a prior history of eating disorders were initially recruited. Subjects were randomized into an ACTIVE group who received 5 days of real tDCS (20 minutes, anode right-cathode left montage, 2 mA with current density kept at 0.06 mA/cm2, 1 min ramp-up/ramp-down), and a SHAM group, who received one day of real tDCS, on the first day (same parameters), followed by 4 days of sham tDCS. Food craving intensity was examined by Food Craving Questionnaires State and Trait and Food Craving Inventory before, during, (5-days) and one month (30-days) after tDCS. Single session of tDCS significantly reduced the intensity of current food craving (FCQ-S). Five days of active tDCS significantly reduced habitual experiences of food craving (FCQ-T), when compared to baseline pre-stimulation levels. Furthermore, both current (FCQ-S) and habitual craving (FCQ-T) were significantly reduced 30 days after active tDCS, while sham tDCS, i.e. a single tDCS session did not have significant effects. Also, active tDCS significantly decreased craving for fast food and sweets, and to a lesser degree for fat, while it did not have significant effects on craving for carbohydrates (FCI). There were no significant differences between individual FCQ-T subscales (craving dimensions) after 5 or 30 days of either sham or active tDCS. Changes in craving were not significantly associated with the initial weight, or with weight changes 30 days after the stimulation in the

  11. Sensitivity analysis of weight reduction results of an observational cohort study in overweight and obese children and adolescents in Germany: the EvAKuJ Study

    Directory of Open Access Journals (Sweden)

    Thomas Böhler

    2013-10-01

    Full Text Available In the German EvAKuJ observational cohort study, changes in the body mass index standard deviation score (BMI-SDS of overweight and obese children and adolescents as primary outcome of multimodal (short, inpatient or long, outpatient weight-loss interventions are difficult to interpret. Published intention-to-treat (ITT and per protocol data obtained at the end of the intervention (T1, one year (T2, and two years (T3 after its end were used for sensitivity analysis of treatment success rates. The odds ratio and the number needed to treat (NNT for BMI-SDS reduction of at least −0.2 (successful treatment and at least −0.5 (good treatment success were related to spontaneous BMI-SDS reduction rates in a hypothetical control group (control event rate, CER. At T1, treatment seems to be effective up to a CER of 10% in inpatients and of 5% in outpatients. ITT analysis, compromised by a loss to follow-up of 81 to 90% (inpatients and 57 to 66% (outpatients, indicated that treatment may become less effective at a CER above 1% in inpatients (e.g., successful treatment at T2: NNT=106, at T3: NNT=51, and above 5% in outpatients (successful treatment at T2: NNT=7, at T3: NNT=8; good treatment success at T2 and T3: NNT=25. Positive short-term effects of inpatient treatment of overweight and obese children and adolescents may not be maintained in the long term. Long-term effectiveness of outpatient treatment may depend on age and the degree of overweight.

  12. Efficacy and safety of the trans-obturator TVT-Abbrevo device in normal weight compared to overweight patients affected by stress urinary incontinence.

    Science.gov (United States)

    Tommaselli, Giovanni A; Napolitano, Valerio; Di Carlo, Costantino; Formisano, Carmen; Fabozzi, Annamaria; Nappi, Carmine

    2016-02-01

    To investigate if TVT-Abbrevo has similar outcomes in normal weight and overweight patients. Retrospective evaluation of 205 (105 normal weight women and 100 overweight women with BMI ≥ 25 kg/m(2)) undergone TVT-Abbrevo positioning with 12 month follow-up. Primary outcomes were objective cure rate (defined as no leakage during CST) and subjective cure rate ("very much improved"/"much improved" at PGI-I), secondary outcomes were intra-operative and post-operative complications. Objective cure rates in the normal and overweight groups were 96.2% and 94%, respectively (p=.47). Subjective cure rates in the normal and overweight groups were 90.5% and 88%, respectively (p=.57). ICIQ-SF, I-QoL and PGI-S scores significantly improved in both groups with no differences between the two groups. No serious intra- or post-operative complications were observed. No differences were observed in pain VAS scores and number of analgesic vials administered. TVT-Abbrevo seems to have similar efficacy and safety in normal weight and overweight women. More studies are needed to assess the efficacy of this device in frankly obese women and long-term outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Prevalence of Overweight/Obesity and Its Associated Factors among University Students from 22 Countries

    Directory of Open Access Journals (Sweden)

    Karl Peltzer

    2014-07-01

    Full Text Available Obesity among young people increases lifetime cardiovascular risk. This study assesses the prevalence of overweight/obesity and its associated factors among a random sample of university students from 22 universities in 22 low, middle income and emerging economy countries. This cross-sectional survey comprised of a self-administered questionnaire and collected anthropometric measurements. The study population was 6773 (43.2% males and 8913 (56.8% females, aged 16 to 30 years (mean 20.8 years, SD = 2.6. Body mass index (BMI was used for weight status. Among men, the prevalence of underweight was 10.8%, normal weight 64.4%, overweight 18.9% and obesity 5.8%, while among women, the prevalence of underweight was 17.6%, normal weight 62.1%, overweight 14.1% and obesity 5.2%. Overall, 22% were overweight or obese (24.7% men and 19.3% women. In multivariate regression among men, younger age, coming from a higher income country, consciously avoiding fat and cholesterol, physically inactivity, current tobacco use and childhood physical abuse, and among women older age, coming from a higher income country, frequent organized religious activity, avoiding fat and cholesterol, posttraumatic stress symptoms and physical childhood abuse were associated overweight or obesity. Several gender specific risk factors identified can be utilized in health promotion programmes.

  14. Prevalence of overweight/obesity and its associated factors among university students from 22 countries.

    Science.gov (United States)

    Peltzer, Karl; Pengpid, Supa; Samuels, T Alafia; Özcan, Neslihan Keser; Mantilla, Carolina; Rahamefy, Onja H; Wong, Mee Lian; Gasparishvili, Alexander

    2014-07-21

    Obesity among young people increases lifetime cardiovascular risk. This study assesses the prevalence of overweight/obesity and its associated factors among a random sample of university students from 22 universities in 22 low, middle income and emerging economy countries. This cross-sectional survey comprised of a self-administered questionnaire and collected anthropometric measurements. The study population was 6773 (43.2%) males and 8913 (56.8%) females, aged 16 to 30 years (mean 20.8 years, SD = 2.6). Body mass index (BMI) was used for weight status. Among men, the prevalence of underweight was 10.8%, normal weight 64.4%, overweight 18.9% and obesity 5.8%, while among women, the prevalence of underweight was 17.6%, normal weight 62.1%, overweight 14.1% and obesity 5.2%. Overall, 22% were overweight or obese (24.7% men and 19.3% women). In multivariate regression among men, younger age, coming from a higher income country, consciously avoiding fat and cholesterol, physically inactivity, current tobacco use and childhood physical abuse, and among women older age, coming from a higher income country, frequent organized religious activity, avoiding fat and cholesterol, posttraumatic stress symptoms and physical childhood abuse were associated overweight or obesity. Several gender specific risk factors identified can be utilized in health promotion programmes.

  15. Prevalence of Overweight/Obesity and Its Associated Factors among University Students from 22 Countries

    Science.gov (United States)

    Peltzer, Karl; Pengpid, Supa; Samuels, T. Alafia; Özcan, Neslihan Keser; Mantilla, Carolina; Rahamefy, Onja H.; Wong, Mee Lian; Gasparishvili, Alexander

    2014-01-01

    Obesity among young people increases lifetime cardiovascular risk. This study assesses the prevalence of overweight/obesity and its associated factors among a random sample of university students from 22 universities in 22 low, middle income and emerging economy countries. This cross-sectional survey comprised of a self-administered questionnaire and collected anthropometric measurements. The study population was 6773 (43.2%) males and 8913 (56.8%) females, aged 16 to 30 years (mean 20.8 years, SD = 2.6). Body mass index (BMI) was used for weight status. Among men, the prevalence of underweight was 10.8%, normal weight 64.4%, overweight 18.9% and obesity 5.8%, while among women, the prevalence of underweight was 17.6%, normal weight 62.1%, overweight 14.1% and obesity 5.2%. Overall, 22% were overweight or obese (24.7% men and 19.3% women). In multivariate regression among men, younger age, coming from a higher income country, consciously avoiding fat and cholesterol, physically inactivity, current tobacco use and childhood physical abuse, and among women older age, coming from a higher income country, frequent organized religious activity, avoiding fat and cholesterol, posttraumatic stress symptoms and physical childhood abuse were associated overweight or obesity. Several gender specific risk factors identified can be utilized in health promotion programmes. PMID:25050651

  16. Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the mid- and long-term effects of screening for abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Norman, P

    2008-01-01

    Four randomised controlled trials of screening older men for abdominal aortic aneurysms (AAA) have been completed. A meta-analysis was performed to examine the pooled effects of screening on both mid- and long-term AAA-related and total mortality, and operations for AAA....

  17. Experimental Researches on Long-Term Strength of Granite Gneiss

    Directory of Open Access Journals (Sweden)

    Lin Liu

    2015-01-01

    Full Text Available It is important to confirm the long-term strength of rock materials for the purpose of evaluating the long-term stability of rock engineering. In this study, a series of triaxial creep tests were conducted on granite gneiss under different pore pressures. Based on the test data, we proposed two new quantitative methods, tangent method and intersection method, to confirm the long-term strength of rock. Meanwhile, the isochronous stress-strain curve method was adopted to make sure of the accuracy and operability of the two new methods. It is concluded that the new methods are suitable for the study of the long-term strength of rock. The effect of pore pressure on the long-term strength of rock in triaxial creep tests is also discussed.

  18. Home or foster home care versus institutional long-term care for functionally dependent older people

    NARCIS (Netherlands)

    Young, Camilla; Hall, Amanda M.; Goncalves-Bradley, Daniela C.; Quinn, Terry J.; Hooft, Lotty; van Munster, Barbara C.; Stott, David J.

    2017-01-01

    Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce

  19. Home or foster home care versus institutional long-term care for functionally dependent older people

    NARCIS (Netherlands)

    Young, Camilla; Hall, Amanda M.; Gonçalves-Bradley, Daniela C.; Quinn, Terry J.; Hooft, Lotty; van Munster, Barbara C.; Stott, David J.

    2017-01-01

    Background: Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this

  20. Long-term skeletal findings in Menkes disease

    International Nuclear Information System (INIS)

    Amador, Eva; Domene, Ruth; Fuentes, Cristian; Carreno, Juan-Carlos; Enriquez, Goya

    2010-01-01

    Skeletal findings in infants with Menkes disease, the most characteristic of which are metaphyseal spurs, long-bone fractures and wormian bones, have been widely reported. However, the changes in skeletal features over time are not well known. The long-term findings differ completely from those initially observed and consist of undertubulation and metaphyseal flaring, similar to the findings seen in some types of bone dysplasia. The initial and long-term radiological features in an 8-year-old boy with Menkes disease are illustrated. (orig.)

  1. The interaction of short-term and long-term memory in phonetic category formation

    Science.gov (United States)

    Harnsberger, James D.

    2002-05-01

    This study examined the role that short-term memory capacity plays in the relationship between novel stimuli (e.g., non-native speech sounds, native nonsense words) and phonetic categories in long-term memory. Thirty native speakers of American English were administered five tests: categorial AXB discrimination using nasal consonants from Malayalam; categorial identification, also using Malayalam nasals, which measured the influence of phonetic categories in long-term memory; digit span; nonword span, a short-term memory measure mediated by phonetic categories in long-term memory; and paired-associate word learning (word-word and word-nonword pairs). The results showed that almost all measures were significantly correlated with one another. The strongest predictor for the discrimination and word-nonword learning results was nonword (r=+0.62) and digit span (r=+0.51), respectively. When the identification test results were partialed out, only nonword span significantly correlated with discrimination. The results show a strong influence of short-term memory capacity on the encoding of phonetic detail within phonetic categories and suggest that long-term memory representations regulate the capacity of short-term memory to preserve information for subsequent encoding. The results of this study will also be discussed with regards to resolving the tension between episodic and abstract models of phonetic category structure.

  2. Higher Intake of Fruit, but Not Vegetables or Fiber, at Baseline Is Associated with Lower Risk of Becoming Overweight or Obese in Middle-Aged and Older Women of Normal BMI at Baseline123

    Science.gov (United States)

    Rautiainen, Susanne; Wang, Lu; Lee, I-Min; Manson, JoAnn E; Buring, Julie E; Sesso, Howard D

    2015-01-01

    Background: Fruit, vegetable, and dietary fiber intake have been associated with lower risk of cardiovascular disease (CVD); however, little is known about their role in obesity prevention. Objective: Our goal was to investigate whether intake of fruits, vegetables, and dietary fiber is associated with weight change and the risk of becoming overweight and obese. Methods: We studied 18,146 women aged ≥45 y from the Women’s Health Study free of CVD and cancer with an initial body mass index (BMI) of 18.5 to Fruit, vegetable, and dietary fiber intakes were assessed at baseline through a 131-item food-frequency questionnaire, along with obesity-related risk factors. Women self-reported body weight on annual questionnaires. Results: During a mean follow-up of 15.9 y, 8125 women became overweight or obese (BMI ≥25 kg/m2). Intakes of total fruits and vegetables, fruits, and dietary fiber were not associated with the longitudinal changes in body weight, whereas higher vegetable intake was associated with greater weight gain (P-trend: 0.02). In multivariable analyses, controlling for total energy intake and physical activity along with other lifestyle, clinical, and dietary factors, women in the highest vs. lowest quintile of fruit intake had an HR of 0.87 (95% CI: 0.80, 0.94; P-trend: 0.01) of becoming overweight or obese. No association was observed for vegetable or dietary fiber intake. The association between fruit intake and risk of becoming overweight or obese was modified by baseline BMI (P-interaction: fruit, but not vegetables or fiber, by middle-aged and older women with a normal BMI at baseline is associated with lower risk of becoming overweight or obese. PMID:25934663

  3. Insomnia in long-term care facilities: a comparison of seven European countries and Israel: the Services and Health for Elderly in Long TERm care study.

    Science.gov (United States)

    Gindin, Jacob; Shochat, Tamar; Chetrit, Angela; Epstein, Shulamit; Ben Israel, Yehoshua; Levi, Sarah; Onder, Graziano; Carpenter, Ian; Finne-Soveri, Harriet; van Hout, Hein; Henrard, Jean-Claude; Nikolaus, Thorsten; Topinkova, Eva; Fialová, Daniela; Bernabei, Roberto

    2014-11-01

    To assess insomnia and its correlates as part of the Services and Health for Elderly in Long TERm care (SHELTER) study, funded by the 7th Framework Programme of the European Union. Cross-cultural investigation. Long-term care facilities (LTCFs) in eight European countries (Czech Republic, France, Finland, Germany, England, the Netherlands, Italy) and one non-European country (Israel). Elderly residents (N = 4,156) of 57 LTCFs. Information on insomnia, age, sex, activities of daily living (ADLs), cognitive status, depression, major stressful life events, physical activity, fatigue, pain, and sleep medication use was extracted from the International Resident Assessment Instrument (interRAI)LTCF instrument. Rates of insomnia and its correlates were analyzed. Multivariate logistic regression was used to assess factors associated with insomnia, controlling for demographic variables. The prevalence of insomnia was 24% (range 13-30%), with significant differences between countries (P < .001). More insomnia complaints were reported in older than younger residents (P < .001). Higher rates of insomnia were associated with hypnosedatives and depression in all countries (P < .001) and with stressful life events, fatigue, and pain in most countries (P < .001). No associations were found between insomnia and ADLs, physical activity, or cognitive status. Age, depression, stressful life events, fatigue, pain and hypnosedatives were independent significant predictors of insomnia, controlling for all other variables and for country. Hypnosedatives and depression were strong predictors of insomnia beyond cultural differences. Overall, psychosocial variables were more strongly related to insomnia than functional and mental capacities. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  4. [Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency].

    Science.gov (United States)

    Nüchtern, Elisabeth; Gansweid, Barbara; Gerber, Hans; von Mittelstaedt, Gert

    2017-01-01

    Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their

  5. A new image for long-term care.

    Science.gov (United States)

    Wager, Richard; Creelman, William

    2004-04-01

    To counter widely held negative images of long-term care, managers in the industry should implement quality-improvement initiatives that include six key strategies: Manage the expectations of residents and their families. Address customers' concerns early. Build long-term customer satisfaction. Allocate resources to achieve exceptional outcomes in key areas. Respond to adverse events with compassion. Reinforce the facility's credibility.

  6. Long-term multipactor discharge in multicarrier systems

    International Nuclear Information System (INIS)

    Anza, S.; Vicente, C.; Gimeno, B.; Boria, V. E.; Armendariz, J.

    2007-01-01

    A new mechanism of long-term multipactor in multicarrier systems is studied employing both analytical and numerical methods. In particular, the investigation is focused on the impact that a realistic secondary emission yield at low energies produces on the development of long term multipactor. A novel analytical model for this interperiod charge accumulation is presented using the traditional multipactor theory for parallel plates, and approximating the multicarrier signal as a single-carrier signal modulated by a pulsed signal envelope. The analytical predictions are verified by numerical simulations for a typical rectangular waveguide. The analytical and numerical results demonstrate that the susceptibility of the system to develop a long-term multipactor discharge increases with higher values of low-energy secondary emission yield

  7. Predictors of health-related behaviour change in parents of overweight children in England.

    Science.gov (United States)

    Park, Min Hae; Falconer, Catherine L; Croker, Helen; Saxena, Sonia; Kessel, Anthony S; Viner, Russell M; Kinra, Sanjay

    2014-05-01

    Providing parents with information about their child's overweight status (feedback) could prompt them to make lifestyle changes for their children. We assessed whether parents of overweight children intend to or change behaviours following feedback, and examined predictors of these transitions. We analysed data from a cohort of parents of children aged 4-5 and 10-11 years participating in the National Child Measurement Programme in five areas of England, 2010-2011. Parents of overweight children (body mass index ≥91st centile) with data at one or six months after feedback were included (n=285). The outcomes of interest were intention to change health-related behaviours and positive behaviour change at follow-up. Associations between respondent characteristics and outcomes were assessed using logistic regression analysis. After feedback, 72.1% of parents reported an intention to change; 54.7% reported positive behaviour change. Intention was associated with recognition of child overweight status (OR 11.20, 95% CI 4.49, 27.93). Parents of older and non-white children were more likely to report behaviour changes than parents of younger or white children. Intention did not predict behaviour change. Parental recognition of child overweight predicts behavioural intentions. However, intentions do not necessarily translate into behaviours; interventions that aim to change intentions may have limited benefits. Copyright © 2014. Published by Elsevier Inc.

  8. Predictors of health-related behaviour change in parents of overweight children in England☆

    Science.gov (United States)

    Park, Min Hae; Falconer, Catherine L.; Croker, Helen; Saxena, Sonia; Kessel, Anthony S.; Viner, Russell M.; Kinra, Sanjay

    2014-01-01

    Objective Providing parents with information about their child's overweight status (feedback) could prompt them to make lifestyle changes for their children. We assessed whether parents of overweight children intend to or change behaviours following feedback, and examined predictors of these transitions. Methods We analysed data from a cohort of parents of children aged 4–5 and 10–11 years participating in the National Child Measurement Programme in five areas of England, 2010–2011. Parents of overweight children (body mass index ≥ 91st centile) with data at one or six months after feedback were included (n = 285). The outcomes of interest were intention to change health-related behaviours and positive behaviour change at follow-up. Associations between respondent characteristics and outcomes were assessed using logistic regression analysis. Results After feedback, 72.1% of parents reported an intention to change; 54.7% reported positive behaviour change. Intention was associated with recognition of child overweight status (OR 11.20, 95% CI 4.49, 27.93). Parents of older and non-white children were more likely to report behaviour changes than parents of younger or white children. Intention did not predict behaviour change. Conclusions Parental recognition of child overweight predicts behavioural intentions. However, intentions do not necessarily translate into behaviours; interventions that aim to change intentions may have limited benefits. PMID:24518007

  9. Long-term characteristics of nuclear emulsion

    International Nuclear Information System (INIS)

    Naganawa, N; Kuwabara, K

    2010-01-01

    Long-term characteristics of the nuclear emulsion so called 'OPERA film' used in the neutrino oscillation experiment, OPERA, has been studied for 8 years since its production or refreshing after it. In the results, it turned out to be excellent in sensitivity, amount of random noise, and refreshing characteristics. The retention capacity of latent image of tracks was also studied. The result will open the way to the recycling of 7,000,000 emulsion films which will remain not developed after 5 years of OPERA's run, and other long-term experiments with emulsion.

  10. Long-term characteristics of nuclear emulsion

    Science.gov (United States)

    Naganawa, N.; Kuwabara, K.

    2010-02-01

    Long-term characteristics of the nuclear emulsion so called ``OPERA film'' used in the neutrino oscillation experiment, OPERA, has been studied for 8 years since its production or refreshing after it. In the results, it turned out to be excellent in sensitivity, amount of random noise, and refreshing characteristics. The retention capacity of latent image of tracks was also studied. The result will open the way to the recycling of 7,000,000 emulsion films which will remain not developed after 5 years of OPERA's run, and other long-term experiments with emulsion.

  11. Change in Overweight from Childhood to Early Adulthood and Risk of Type 2 Diabetes.

    Science.gov (United States)

    Bjerregaard, Lise G; Jensen, Britt W; Ängquist, Lars; Osler, Merete; Sørensen, Thorkild I A; Baker, Jennifer L

    2018-04-05

    Childhood overweight is associated with an increased risk of type 2 diabetes in adulthood. We investigated whether remission of overweight before early adulthood reduces this risk. We conducted a study involving 62,565 Danish men whose weights and heights had been measured at 7 and 13 years of age and in early adulthood (17 to 26 years of age). Overweight was defined in accordance with Centers for Disease Control and Prevention criteria. Data on type 2 diabetes status (at age ≥30 years, 6710 persons) were obtained from a national health registry. Overweight at 7 years of age (3373 of 62,565 men; 5.4%), 13 years of age (3418 of 62,565; 5.5%), or early adulthood (5108 of 62,565; 8.2%) was positively associated with the risk of type 2 diabetes; associations were stronger at older ages at overweight and at younger ages at diagnosis of type 2 diabetes. Men who had had remission of overweight before the age of 13 years had a risk of having type 2 diabetes diagnosed at 30 to 60 years of age that was similar to that among men who had never been overweight (hazard ratio, 0.96; 95% confidence interval [CI], 0.75 to 1.21). As compared with men who had never been overweight, men who had been overweight at 7 and 13 years of age but not during early adulthood had a higher risk of type 2 diabetes (hazard ratio, 1.47; 95% CI, 1.10 to 1.98), but their risk was lower than that among men with persistent overweight (hazard ratio [persistently overweight vs. never overweight], 4.14; 95% CI, 3.57 to 4.79). An increase in body-mass index between 7 years of age and early adulthood was associated with an increased risk of type 2 diabetes, even among men whose weight had been normal at 7 years of age. Childhood overweight at 7 years of age was associated with increased risks of adult type 2 diabetes only if it continued until puberty or later ages. (Funded by the European Union.).

  12. Relationship between diet-related indicators and overweight and obesity in older adults in rural Japan.

    Science.gov (United States)

    Ishikawa, M; Moriya, S; Yokoyama, T

    2017-01-01

    To identify the relationship between diet-related indicators and overweight and obesity in older adults in rural Japan. Cross-sectional survey. Obira, Hokkaido, Japan. Local residents aged between 65 and 74 years, except for those with poor health, were included. A health- and diet-related questionnaire was applied to participants house-to-house by trained health professionals. The following indicators were examined: number of meals, number of balanced meals, food diversity, food group diversity, chewing ability, alcohol intake habit, smoking habit, instrumental activities of daily living scores, age, and residing alone or with family. Of 550 residents, 317 residents completely responded to the questionnaire. Of these, 41 were had low body mass index (BMI≤20) and were excluded. This resulted in a sample of 307 subjects comprising 117 men and 190 women; 37.6% and 46.8% of men and women were classified as obese (BMI≥25), respectively. Women with a normal BMI (20diet-related indicators compared with women with high BMI. The mean number of meals per day of normal men was significantly higher than of obese men. Using logistic regression analysis (stepwise), it was found that the number of meals per day was associated with obesity in men (OR=3.02; 95% CI 0.91-9.98; P=0.071), and food diversity was significantly associated with obesity in women (OR=1.95; 95% CI 1.12-3.38; P=0.018). The associations between dietary indicators and obesity differed by sex. Food diversity may be a potential indicator to measure nutritional status in women.

  13. Short- and long-term efficacy of intragastric air-filled balloon (Heliosphere® BAG) among obese patients.

    Science.gov (United States)

    Giuricin, M; Nagliati, C; Palmisano, S; Simeth, C; Urban, F; Buri, L; Balani, A; de Manzini, N

    2012-11-01

    Obesity is an increasing health problem worldwide. The intragastric balloon as a temporary endoscopic treatment of obesity can play an important role among the aforementioned group of obese individuals. It can also be used as a preoperative test before subjecting patients to restrictive bariatric surgery. Furthermore, the intragastric device may be applied to patients affected by severe obesity as a "bridge treatment" before they undergo major surgery in order to reduce chances of operation-related risks. To date, there are insufficient data in the literature on the long-term results of the intragastric balloon. Our study includes an analysis of our experience with Heliosphere® BAG from 2006 through to 2010, concerning early weight loss and weight loss maintenance over at least 18 months since the device's removal. The 32 patients who completed the 6-month treatment had recorded a mean weight loss of 12.66 kg and a mean overweight loss of 24.37 % (SD, 12.74). A total of 16 patients are subjected to an 18-month follow-up. Their pretreatment and long-term body mass index (BMI) were calculated: 6 months later, when devices were removed, they showed a mean weight of 99.75 kg (SD, 17.90; p < 0.001) and a mean weight loss of 13.62 kg and 26.14 % (SD, 12.79). 18 months after removing Heliosphere® BAG, the 16 patients' mean BMI was 37.28 kg/m² (SD, 5.41; p = 0.004), with a mean weight of 103.56 kg (SD 17.25; p = 0.0125), and a mean weight loss of 9.8 kg or 18.2 % (SD, 12.07). Heliosphere® BAG enables modest short-term weight loss with little side effects, although mid/long-term follow-up may entail partial weight gain. We believe it can be considered a useful bridge treatment in bariatric surgery in order to reduce chances of preoperative risks.

  14. In search of the elusive long-term price

    International Nuclear Information System (INIS)

    Connor, M.J.; Combs, J.

    1989-01-01

    The Uranium Institute, WNFM, and past USCEA sessions described and compared existing price reporting systems. The McGraw-Hill conference led to a rather heated discussion as to the propriety of spot prices having the influence they do on amounts paid in long-term contracts. The Ux representative proposed a future's market as a way that producers could hedge against some of the uncertainty of volatile spot market. In discussing the search for the elusive long-term price, there are two interrelated issues. The first is obvious-the search for a starting or initializing price that is representative of recently-signed or pending long-term contracts. The second is less obvious, but perhaps more important-the search for a successful mechanism for determining later delivery values in long-term contracts. This paper addresses the question of pricing mechanisms first

  15. Very-long-term and short-term chromatic adaptation: are their influences cumulative?

    Science.gov (United States)

    Belmore, Suzanne C; Shevell, Steven K

    2011-02-09

    Very-long-term (VLT) chromatic adaptation results from exposure to an altered chromatic environment for days or weeks. Color shifts from VLT adaptation are observed hours or days after leaving the altered environment. Short-term chromatic adaptation, on the other hand, results from exposure for a few minutes or less, with color shifts measured within seconds or a few minutes after the adapting light is extinguished; recovery to the pre-adapted state is complete in less than an hour. Here, both types of adaptation were combined. All adaptation was to reddish-appearing long-wavelength light. Shifts in unique yellow were measured following adaptation. Previous studies demonstrate shifts in unique yellow due to VLT chromatic adaptation, but shifts from short-term chromatic adaptation to comparable adapting light can be far greater than from VLT adaptation. The question considered here is whether the color shifts from VLT adaptation are cumulative with large shifts from short-term adaptation or, alternatively, does simultaneous short-term adaptation eliminate color shifts caused by VLT adaptation. The results show the color shifts from VLT and short-term adaptation together are cumulative, which indicates that both short-term and very-long-term chromatic adaptation affect color perception during natural viewing. Copyright © 2010 Elsevier Ltd. All rights reserved.

  16. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies

    DEFF Research Database (Denmark)

    Sorror, Mohamed L; Sandmaier, Brenda M; Storer, Barry E

    2011-01-01

    A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions.......A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions....

  17. Skipping breakfast and overweight in 2-and 5-year-old Dutch children-the GECKO Drenthe cohort

    NARCIS (Netherlands)

    Kupers, L. K.; de Pijper, J. J.; Sauer, P. J. J.; Stolk, R. P.; Corpeleijn, E.

    Skipping breakfast is associated with higher BMI in children aged 5 years and older. However, not much is known about this association in younger children. In the Dutch GECKO Drenthe birth cohort we examined the association between breakfast skipping and objectively measured overweight at the age of

  18. Long-term exposure to air pollution and mammographic density in the Danish Diet, Cancer and Health cohort

    DEFF Research Database (Denmark)

    Huynh, Stephanie; von Euler-Chelpin, My; Raaschou-Nielsen, Ole

    2015-01-01

    investigated the association between long-term exposure to traffic-related air pollution and MD in a prospective cohort of women 50 years and older. METHODS: For the 4,769 women (3,930 postmenopausal) participants in the Danish Diet, Cancer and Health cohort (1993-1997) who attended mammographic screening...... 1971 until cohort baseline (1993-97) and MD was analyzed using logistic regression, adjusting for confounders, and separately by menopause, smoking status, and obesity. RESULTS: We found inverse, statistically borderline significant associations between long-term exposure to air pollution and having...... mixed/dense MD in our fully adjusted model (OR; 95% CI: 0.96; 0.93-1.01 per 20 μg/m(3) of NOx and 0.89; 0.80- 0.98 per 10 μg/m(3) of NO2). There was no interaction with menopause, smoking, or obesity. CONCLUSION: Traffic-related air pollution exposure does not increase MD, indicating that if air...

  19. Marketing in the long-term care continuum.

    Science.gov (United States)

    Laurence, J Nathan; Kash, Bita A

    2010-04-01

    Today, long-term care facilities are composed of independent, assisted living, and skilled nursing facilities along with many variations of those themes in between. The clientele for these various types of facilities differ because of the level of care the facility provides as well as the amenities long-term care consumers are looking for. However, there many similarities and common approaches to how reaching the target audience through effective marketing activities. Knowing who the target audience is, how to reach them, and how to communicate with them will serve any facility well in this competitive market. Developing marketing strategies for long-term care settings is as important as understanding what elements of care can be marketed individually as a niche market. Determining the market base for a facility is equally crucial since the target populations differ among the three types of facilities. By reviewing current marketing articles and applying marketing practices, we have crafted some general principles for which each facility type can learn from. Finally, we will discuss the types of marketing and how they related to the spectrum of long-term care facilities.

  20. Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis.

    Directory of Open Access Journals (Sweden)

    Minyoul Baik

    Full Text Available The presence of white matter hyperintensity (WMH is related to poor long-term outcomes in stroke patients. However, the long-term outcome is unknown in patients with both large artery atherosclerosis (LAA and WMH.We investigated the impact of WMH on long-term outcome in patients with LAA. Consecutive patients in a prospective stroke registry were included. Patients were followed for a median of 7.7 years (interquartile range, 5.6-9.7. The degree of WMH was assessed by Fazekas grade on fluid-attenuated inversion recovery images. Total WMH burden was calculated by summation of Fazekas scores in periventricular and deep white matter. Severe WMH was defined as total burden score ≥ 3.Among 2529 patients, 639 patients (25.3% were classified with the LAA subtype. After applying exclusion criteria, the data from 538 patients were analyzed. The mean patient age was 65.7 ± 10.3 years. Severe WMHs were found in 243 patients (45.2%. During follow-up, 200 patients (37.2% died. Cox regression analysis showed that LAA patients with severe WMH had a 1.50-fold (95% CI, 1.12-2.00, p = 0.007 higher death rate compared to those without. In the older age group (≥65 years, Cox regression revealed that patients with severe WMH had a 1.75-fold (95% CI, 1.15-2.65, p = 0.008 higher 5-year death rate, whereas the younger age group did not have this association.The degree of WMH might be a surrogate marker for long-term outcome in patients with LAA. Atherosclerotic burdens in both small and large arteries might impact long-term prognosis in ischemic stroke patients.

  1. Designing indicators of long-term energy supply security

    International Nuclear Information System (INIS)

    Jansen, J.C.; Van Arkel, W.G.; Boots, M.G.

    2004-01-01

    To our knowledge, so far amazingly little research work has been undertaken to construct meaningful indicators of long-run energy supply security for a particular nation or region. Currently, in addressing energy supply security, policy makers tend to emphasise short-term supply disruptions. In contrast, this pre-study accords with the broader Sustainability Outlook in considering the long-term perspective. This report starts with taking stock, in a concise way, of the official EU energy outlook and issues related to the opportunities to administer changes in the energy mix at the level of major energy use categories. Then a brief survey of relevant literature is made on long-term strategies to ensure survival of systems - be it biological, social, etc. - in an environment largely characterised by high uncertainty and a lot of unchartered territory. We found the work of Andrew Stirling very inspiring in this context. Based on his work and considering the limitations of the present research activity, we retained the Shannon index as the best 'simple' indicator of diversity. In the core of the report, the Shannon index is elaborated into four indicators of long-term energy supply security. Stepwise, additional aspects of long-term energy supply security are introduced. These aspects are: Diversification of energy sources in energy supply; Diversification of imports with respect to imported energy sources; Long-term political stability in regions of origin; The resource base in regions of origin, including the home region/country itself. After small adjustments to allow for data availability, these indicators were applied to the reference year 2030 of four long-term scenarios with data of base year 1995 and projections for underlying variables provided by the Netherlands Environmental Assessment Agency (MNP). Preliminary interpretation of the results suggests the usefulness of the indicators presented in this report. A second activity undertaken in this report was

  2. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People’s Republic of China

    Science.gov (United States)

    Zhang, Zhenyu; Wang, Jianbing; Jin, Mingjuan; Li, Mei; Zhou, Litao; Jing, Fangyuan; Chen, Kun

    2014-01-01

    Background The People’s Republic of China’s population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People’s Republic of China. Objective To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People’s Republic of China. Methods We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People’s Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. Results We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. Conclusion A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services. PMID:24855346

  3. Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study.

    Science.gov (United States)

    Gaziano, Thomas A; Abrahams-Gessel, Shafika; Gomez-Olive, F Xavier; Wade, Alisha; Crowther, Nigel J; Alam, Sartaj; Manne-Goehler, Jennifer; Kabudula, Chodziwadziwa W; Wagner, Ryan; Rohr, Julia; Montana, Livia; Kahn, Kathleen; Bärnighausen, Till W; Berkman, Lisa F; Tollman, Stephen

    2017-02-17

    A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults. We recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels. Five thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 ± 13.06 years. Waist-to-hip ratio was high for men and women (0.92 ± 0.08 vs. 0.89 ± 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV - persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV + persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV + persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk

  4. Factors associated with collagen deposition in lymphoid tissue in long-term treated HIV-infected patients.

    Science.gov (United States)

    Diaz, Alba; Alós, Llúcia; León, Agathe; Mozos, Anna; Caballero, Miguel; Martinez, Antonio; Plana, Montserrat; Gallart, Teresa; Gil, Cristina; Leal, Manuel; Gatell, Jose M; García, Felipe

    2010-08-24

    The factors associated with fibrosis in lymphoid tissue in long-term treated HIV-infected patients and their correlation with immune reconstitution were assessed. Tonsillar biopsies were performed in seven antiretroviral-naive patients and 29 successfully treated patients (median time on treatment, 61 months). Twenty patients received protease inhibitors-sparing regimens and nine protease inhibitor-containing regimens. Five tonsillar resections of HIV-negative individuals were used as controls. Lymphoid tissue architecture, collagen deposition (fibrosis) and the mean interfollicular CD4(+) cell count per mum were assessed. Naive and long-term treated HIV-infected patients had a higher proportion of fibrosis than did HIV-uninfected persons (P lymphoid tissue (P = 0.03) and smaller increase in peripheral CD4(+) T cells (r = -0.40, P = 0.05). The factors independently associated with fibrosis in lymphoid tissue were age (P lymphoid tissue viral load when compared with patients with undetectable lymphoid tissue viral load (median 5 vs. 12%, respectively, P = 0.017) and patients receiving a protease inhibitor-sparing vs. a protease inhibitor-containing regimen (median 8 vs. 2.5%, respectively, P = 0.04). Fibrosis in lymphoid tissue was associated with a poor reconstitution of CD4(+) T cells and long-term antiretroviral therapy did not reverse this abnormality. HIV infection, older age, a detectable level of lymphoid tissue viral load in treated patients and protease inhibitor-sparing regimens seem to favour fibrosis in lymphoid tissue.

  5. Dietitians' views of overweight and obese people and reported management practices.

    Science.gov (United States)

    Harvey, E L; Summerbell, C D; Kirk, S F L; Hill, A J

    2002-10-01

    To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices. An independent measures survey, questioning dietitians about either overweight or obese people. One-hundred and eighty-seven members of the British Dietetic Association. A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices. Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self-esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.

  6. Managing effective partnerships in older people's services

    NARCIS (Netherlands)

    Nies, Henk

    The integration of older people's services is a challenge to all countries with an ageing population. Although it is widely acknowledged that acute care, long-term care, social care, housing, leisure, education and other services should all operate in a more 'joined-up manner', achieving this in

  7. Sleep Quality, Short-Term and Long-Term CPAP Adherence

    Science.gov (United States)

    Somiah, Manya; Taxin, Zachary; Keating, Joseph; Mooney, Anne M.; Norman, Robert G.; Rapoport, David M.; Ayappa, Indu

    2012-01-01

    Study Objectives: Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence. Methods: 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST ( 4 h) and LT adherence ( 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups. Results: There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006). Conclusions: These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence. Citation: Somiah M; Taxin Z; Keating J; Mooney AM; Norman RG; Rapoport DM; Ayappa I. Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med 2012;8(5):489-500. PMID:23066359

  8. Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness.

    Science.gov (United States)

    Muralidharan, Anjana; Klingaman, Elizabeth A; Prior, Steven J; Molinari, Victor; Goldberg, Richard W

    2016-11-01

    Older adults with serious mental illness (SMI) are an understudied population with complex care needs and high rates of obesity/overweight. Little is known about the experiences of older adults with SMI with weight management. The present study is an observational study of veterans ages 55 and over with a body mass index in the overweight or obese range, comparing Veterans with schizophrenia or bipolar disorder (n = 9044) to their same-age peers with no mental health disorders (n = 71156), on their responses to a questionnaire assessment of medical and psychosocial factors related to weight management. Responses to the questionnaire between August, 2005 and May, 2013 were used to examine the following: demographics, clinical characteristics, medical barriers to weight management, current weight loss plan, reliability of social support, reasons for being overweight, and weight loss barriers. Physical health concerns were highly prevalent in both groups. Veterans in the SMI group endorsed more medical issues and were significantly more likely to endorse experiences that indicated that their medical conditions were poorly controlled (e.g., shortness of breath). Veterans in the SMI group were more likely to endorse many barriers to healthy eating and physical activity, across medical, psychological, social, and environmental domains. Even within a sample at medically high-risk for complications related to obesity and metabolic syndrome, older veterans with SMI and overweight/obesity experience more challenges with weight management than their same-age peers with overweight/obesity and no mental health disorders. Weight management interventions for this population should take a multifaceted approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  9. Neck circumference as a discriminator of obesity in older women enrolled in a physical activity program

    Directory of Open Access Journals (Sweden)

    Daniel Rogério Petreça

    2017-12-01

    Full Text Available The aim of this study was to evaluate neck circumference (NC as a discriminator of overweight and obesity and to establish cut-off points for physically active older women. The sample consisted of 170 older women (69.5 ± 6.8 years practicing physical activity. Anthropometric measures (body weight, height, waist circumference – WC, and NC were obtained and the body mass index (BMI was calculated. Correlation analysis was performed and ROC curves were constructed. NC was significantly correlated with BMI (rho = 0.656; p<0.0001 and WC (r = 0.561; p<0.0001. Correlating BMI with NC, areas under the ROC curve of 0.819 (p=0.0001 for overweight and of 0.902 (p=0.0001 for obesity were obtained, with suggested cut-off points of 33.07 and 34.05 cm, respectively. Correlating WC with NC, areas under the ROC curve of 0.711 (p=0.0014 for moderate risk (WC and of 0.864 (p=0.0001 for high risk were obtained, with suggested cut-off points of 32.15 and 34.15 cm, respectively. NC was associated with BMI and WC. An NC ≥ 34 cm was a risk factor for obesity and abnormal body fat distribution in the older women studied. This anthropometric parameter is an alternative to discriminate overweight and obesity in physically active older women.

  10. Life-style factors associated with overweight and obesity among Spanish adults.

    Science.gov (United States)

    Rodríguez-Martín, A; Novalbos Ruiz, J P; Martínez Nieto, J M; Escobar Jiménez, L

    2009-01-01

    To assess the relationship between life styles and eating habits with the overweight and obesity prevalence in a Spanish adult population. A population-based, cross-sectional study conducted on 2640 subjects older than 15 years, in Cádiz (Spain). Surveys were conducted in subjects' homes to obtain life styles, eating habits, and anthropometric data. Logistic regression has been used to study the association between the life style variables and overweight and obesity. Prevalence of overweight and obesity in Cadiz is 37% and 17%, respectively; higher in males and increases with age. BMI has an inverse relationship with educational level (PR = 2.3, 1.57-2.38). The highest levels of obesity are associated with daily alcohol consumption (PR = 1.39, 1.29-1.50), greater consumption of television,and sedentary pursuit (PR 1.5, 1.07-1.24). A lower prevalence of obesity is observed among those with active physical activity (10.9% vs 21.6%), with differences between sex. Following a slimming diet is more frequent in the obese and in women but dedicate more hours than men to passive activities. In men is greater the consumption of alcohol, high energy foods and snacks. Overweight and obesity is associated with the male sex (OR = 3.35 2.75-4.07), high consumption of alcohol (OR = 1.38 1.03-1.86) and watching television (OR = 1.52 1.11-2.07), and foods likes bread and cereals (OR = 1.47 1.13-1.91). Exercise activities is a protective factor (OR = 0.76 0.63-0.98). Life styles factors associated with overweight and obesity present different patterns in men and women and is necessary to understand them to identify areas for behavioural intervention in overweight and obesity patients.

  11. Psychology's contribution to the well-being of older americans.

    Science.gov (United States)

    Gatz, Margaret; Smyer, Michael A; DiGilio, Deborah A

    2016-01-01

    In concert with 6 decennial White House Conferences on Aging, psychologists have considered how developments in psychological science can contribute to the well-being of older Americans. We suggest 5 illustrative areas of psychological research: Advances in neuroscience elucidate ways to promote healthy cognitive aging; associated developments in neuropsychological assessment can help in protecting older Americans with cognitive losses from financial exploitation, abuse, and neglect. Psychological research on decision making and behavioral economics has much to offer to planning for retirement security and reducing vulnerability to financial abuse. Psychological research on self-management and behavior change can contribute importantly to enhancing good health behaviors among older adults; similarly the power of context on behavior can be harnessed in long-term care settings. Psychological research on attitudes and stereotypes gives insight into age bias that can be detrimental to healthy aging. Adaptive technologies and information technologies are beginning to transform assessment in research and clinical settings; technology also holds the promise of improving long-term support for older adults in both institutional and community-based settings. Finally, with 1 in 7 Americans now ages 65 and older, compared with 1 in 11 50 years ago, the psychology workforce-including health services providers and faculty to train those providers-is insufficient to meet the challenge of the aging population. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  12. On the relationship between short- and long-term memory

    DEFF Research Database (Denmark)

    Sørensen, Thomas Alrik

    James (1890) divided memory into separate stores; primary and secondary – or short-term and long-term memory. The interaction between the two stores often assumes that information initially is represented in volatile short-term store before entering and consolidating in the more durable long-term......, accepted). Counter to popular beliefs this suggest that long-term memory precedes short-term memory and not vice versa....... memory system (e.g. Atkinson & Shiffrin, 1968). Short-term memory seems to provide a surprising processing bottleneck where only a very limited amount of information can be represented at any given moment (Miller, 1956; Cowan, 2001). A number of studies have investigated the nature of this processing...

  13. Overweight and obesity in childhood--a special challenge for public health.

    Science.gov (United States)

    Lob-Corzilius, Thomas

    2007-10-01

    The prevalence and incidence of overweight or even obese children and adolescents is significantly on the increase worldwide. According to the German Children and Adolescent Health Survey (KIGGS) conducted in 2006, 15% of all children and adolescents in Germany aged 3 through 17 years are overweight, and 6.3% of these children and adolescents are obese. On account of the long-term consequences, such as the metabolic syndrome, it can be expected that this "crisis in public health" will lead to a significantly higher expenditure of economic resources in the health care sector. Therefore it is important that public health prevention strategies analyse the key causes of overweight and obesity, and that they not only incorporate individual behaviours regarding nutrition and physical activity, but also take environmental factors, such as the residential area and traffic situation, as well as political circumstances regarding the nutrition and social aspects, into account. Even though the definition of body-mass index (BMI) has been widely accepted, the epidemiological data and the drawn percentiles are in need of a solid interpretation. There are several causes for the rising prevalence in overweight and obesity which are currently being focused on and discussed. On the individual level, the focus is on the genetic disposition and the changes in the behaviour regarding nutrition and physical exercise. Additional key influential factors like the increase in urbanisation and motorisation, the respective changes in the living environment of children and their families, and migration with its specific biosocial and cultural implications are discussed from the environmental and sociomedical, as well as the public health perspective. The article concludes with a discussion on the consequences of effective prevention strategies with reference to the Cochrane analysis from 2005. In order to be effective and successful, interventions for the prevention of overweight and obesity

  14. PSA modeling of long-term accident sequences

    International Nuclear Information System (INIS)

    Georgescu, Gabriel; Corenwinder, Francois; Lanore, Jeanne-Marie

    2014-01-01

    In the context of the extension of PSA scope to include external hazards, in France, both operator (EDF) and IRSN work for the improvement of methods to better take into account in the PSA the accident sequences induced by initiators which affect a whole site containing several nuclear units (reactors, fuel pools,...). These methodological improvements represent an essential prerequisite for the development of external hazards PSA. However, it has to be noted that in French PSA, even before Fukushima, long term accident sequences were taken into account: many insight were therefore used, as complementary information, to enhance the safety level of the plants. IRSN proposed an external events PSA development program. One of the first steps of the program is the development of methods to model in the PSA the long term accident sequences, based on the experience gained. At short term IRSN intends to enhance the modeling of the 'long term' accident sequences induced by the loss of the heat sink or/and the loss of external power supply. The experience gained by IRSN and EDF from the development of several probabilistic studies treating long term accident sequences shows that the simple extension of the mission time of the mitigation systems from 24 hours to longer times is not sufficient to realistically quantify the risk and to obtain a correct ranking of the risk contributions and that treatment of recoveries is also necessary. IRSN intends to develop a generic study which can be used as a general methodology for the assessment of the long term accident sequences, mainly generated by external hazards and their combinations. This first attempt to develop this generic study allowed identifying some aspects, which may be hazard (or combinations of hazards) or related to initial boundary conditions, which should be taken into account for further developments. (authors)

  15. Long-term survival in patients hospitalized for chronic obstructive pulmonary disease: a prospective observational study in the Nordic countries

    Directory of Open Access Journals (Sweden)

    Gudmundsson G

    2012-09-01

    Full Text Available Gunnar Gudmundsson,1,2 Charlotte Suppli Ulrik,3 Thorarinn Gislason,1,2 Eva Lindberg,4 Eva Brøndum,3 Per Bakke,5 Christer Janson31Department of Respiratory Medicine, Allergy and Sleep, National University Hospital, Reykjavik, Iceland; 2Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 3Department of Respiratory Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; 4Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden; 5Haukeland University Hospital, Bergen, NorwayBackground and aim: Mortality rate is high in patients with chronic obstructive pulmonary disease (COPD. Our aim was to investigate long-term mortality and associated risk factors in COPD patients previously hospitalized for a COPD exacerbation.Methods: A total of 256 patients from the Nordic countries were followed for 8.7 ± 0.4 years after the index hospitalization in 2000–2001. Prior to discharge, the St George’s Respiratory Questionnaire was administered and data on therapy and comorbidities were obtained. Information on long-term mortality was obtained from national registries in each of the Nordic countries.Results: In total, 202 patients (79% died during the follow up period, whereas 54 (21% were still alive. Primary cause of death was respiratory (n = 116, cardiovascular (n = 43, malignancy (n = 28, other (n = 10, or unknown (n = 5. Mortality was related to older age, with a hazard risk ratio (HRR of 1.75 per 10 years, lower forced expiratory volume in 1 second (FEV1 (HRR 0.80, body mass index (BMI <20 kg/m2 (HRR 3.21, and diabetes (HRR 3.02. Older age, lower BMI, and diabetes were related to both respiratory and cardiovascular mortality. An association was also found between lower FEV1 and respiratory mortality, whereas mortality was not significantly associated with therapy, anxiety, or depression.Conclusion: Almost four out of five patients died within 9 years following an admission

  16. What Legislators Need to Know about Long-Term Care Insurance.

    Science.gov (United States)

    Landes, David

    This booklet discusses the potential importance to states of long-term care insurance, describes general policy characteristics, and summarizes state actions to both regulate and promote long-term care insurance. It is intended as a resource for legislators and others involved in long-term care financing and public policy formulation. Long-term…

  17. Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities.

    Science.gov (United States)

    Kataoka-Yahiro, Merle R; McFarlane, Sandra; Koijane, Jeannette; Li, Dongmei

    2017-05-01

    Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

  18. Private long-term care insurance and state tax incentives.

    Science.gov (United States)

    Stevenson, David G; Frank, Richard G; Tau, Jocelyn

    2009-01-01

    To increase the role of private insurance in financing long-term care, tax incentives for long-term care insurance have been implemented at both the federal and state levels. To date, there has been surprisingly little study of these initiatives. Using a panel of national data, we find that market take-up for long-term care insurance increased over the last decade, but state tax incentives were responsible for only a small portion of this growth. Ultimately, the modest ability of state tax incentives to lower premiums implies that they should be viewed as a small piece of the long-term care financing puzzle.

  19. Differences in impact of long term caregiving for mentally ill older adults on the daily life of informal caregivers: a qualitative study.

    Science.gov (United States)

    Zegwaard, Marian I; Aartsen, Marja J; Grypdonck, Mieke Hf; Cuijpers, Pim

    2013-03-27

    Owing to the policy of extramuralization of care in most Western countries older people with severe mental illness have to rely more and more on informal caregivers for daily care. Caregivers themselves are often aged, and although caregiving implies an impact on daily life that exceeds the boundaries of usual informal care, the impact differs across caregivers. Some caregivers seem to suffer more than others, and the differences cannot be fully understood by factors currently known to exacerbate the burden of caregiving. In order to help caregivers reduce the impact of caregiving it is important to gain a deeper understanding of factors influencing the burden and its impact on the caregiver's life. With this in mind, the aim of the study is to explore and understand differences in the impact of long-term caregiving on the quality of life of caregivers who look after older adults with severe mental illness. A qualitative, associative, inductive strategy and continuous simultaneous coding were used to interpret the data of 19 semi-structured interviews. We identified an underlying psychological factor "perceived freedom of choice" which explains the gross differences in impact, leading to a definition of two main types of caregivers. Depending on how people perceive freedom of choice to provide care, the consequences of caregiving can be characterized as a process of gain (type 1) or loss (type 2). Four influential factors deepen the impact of caregiving for the type 2 caregivers, and two subtypes are identified for this category. Consequences of caregiving are most readily seen in a deteriorating quality of the relationship with the care recipient and in the psychosocial well-being of the caregiver. The concept of freedom of choice adds to our understanding of the differences and explains the variation in impact on the caregivers' life. The type 1 caregiver generally experiences gain whereas type 2 generally experiences loss, which puts the latter group typically

  20. The Long-Term Conditions Questionnaire: conceptual framework and item development.

    Science.gov (United States)

    Peters, Michele; Potter, Caroline M; Kelly, Laura; Hunter, Cheryl; Gibbons, Elizabeth; Jenkinson, Crispin; Coulter, Angela; Forder, Julien; Towers, Ann-Marie; A'Court, Christine; Fitzpatrick, Ray

    2016-01-01

    To identify the main issues of importance when living with long-term conditions to refine a conceptual framework for informing the item development of a patient-reported outcome measure for long-term conditions. Semi-structured qualitative interviews (n=48) were conducted with people living with at least one long-term condition. Participants were recruited through primary care. The interviews were transcribed verbatim and analyzed by thematic analysis. The analysis served to refine the conceptual framework, based on reviews of the literature and stakeholder consultations, for developing candidate items for a new measure for long-term conditions. Three main organizing concepts were identified: impact of long-term conditions, experience of services and support, and self-care. The findings helped to refine a conceptual framework, leading to the development of 23 items that represent issues of importance in long-term conditions. The 23 candidate items formed the first draft of the measure, currently named the Long-Term Conditions Questionnaire. The aim of this study was to refine the conceptual framework and develop items for a patient-reported outcome measure for long-term conditions, including single and multiple morbidities and physical and mental health conditions. Qualitative interviews identified the key themes for assessing outcomes in long-term conditions, and these underpinned the development of the initial draft of the measure. These initial items will undergo cognitive testing to refine the items prior to further validation in a survey.