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The intent of my project is to recognize the importance of the residential care home administrator by providing him or her with a training curriculum in order to have additional knowledge upon which to base program planning. Perhaps, someday, a unique type of care outside as well as inside California.

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No / BACKGROUND: Alopecia causes widespread psychological distress, but is relatively poorly controlled. The development of new treatments is hampered by the lack of suitable human hair follicle models. Although intermediate and vellus hair follicles are the main clinical targets for pharmacological therapy, terminal hair follicles are more frequently studied as smaller hair follicles are more difficult to obtain. OBJECTIVES: This investigation was designed to quantify in vivo morphological and in vitro behavioural differences in organ culture between matched intermediate and terminal hair follicles, in order to develop a new clinically relevant model system. METHODS: Microdissected terminal and intermediate hair follicles, from the same individuals, were analysed morphometrically (250 follicles; five individuals), or observed and measured over 9 days of organ culture (210 follicles; six individuals). RESULTS: Intermediate hair follicles were less pigmented and smaller, penetrating less below the skin surface (mean +/- SEM) (2.59 +/- 0.07 vs. 3.52 +/- 0.10 mm; P = 0.02), with smaller fibre (0.03 +/- 0.002 vs. 0.07 +/- 0.002 mm), connective tissue sheath (0.24 +/- 0.01 mm vs. 0.33 +/- 0.01 mm), bulb (0.19 +/- 0.01 vs. 0.31 +/- 0.01 mm) and dermal papilla (0.06 +/- 0.002 vs. 0.12 +/- 0.01 mm) diameters (P < 0.001). Intermediate hair follicle bulbs appeared 'tubular', unlike their 'bulbous' terminal follicle counterparts. In organ culture they also grew more slowly (0.044 +/- 0.002 vs. 0.067 +/- 0.003 mm per day; P < 0.001), remained in anagen longer (84 +/- 0.03% vs. 74 +/- 0.03% at day 9; P = 0.012) and produced less hair fibre (0.36 +/- 0.02 vs. 0.50 +/- 0.03 mm; P < 0.001) than terminal follicles. CONCLUSIONS: Smaller intermediate hair follicles showed major morphological differences from terminal follicles in vivo and retained significant, biologically relevant differences in vitro in organ culture. Therefore, intermediate hair follicles offer a novel, exciting, more clinically relevant, albeit technically difficult, model for future investigations into hair growth. This should be particularly important for developing new therapies.

This study compares financially optimal uneven-aged and even-aged silvicultural regimes of loblolly pine (Pinus Taeda). Uneven-aged regimes which maximize net present value (NPV) are found by quantifying the effects of diameter distribution (Q factor), maximum diameter, cutting cycle, and residual basal area on NPV. For the benchmark inputs, the regime yielding the highest NPV had a maximum diameter of 12 inches, residual basal area of 45 ft²/acre, and a cutting cycle of 11 years. Financially optimal even-aged regimes are taken from published literature of even-aged silviculture. Even-aged and uneven-aged silvicultural regimes are simulated starting from, 1) bare land, 2) a balanced uneven-aged loblolly pine stand, and 3) a mature even-aged loblolly pine stand. For the three starting conditions and selected benchmark variable values, simulation of even-aged silviculture yields NPVs of $877, $2,152 and $3,400 per acre and simulation of uneven-aged silviculture yields NPVs of $644, $2,084, and $2,569 per acre. Sensitivity analysis shows, for the levels of the variables tested, that even-aged silviculture yields higher NPVs than uneven-aged silviculture when starting from bare land or from a mature even-aged stand. When starting from an uneven-aged stand, for the variable values tested, uneven and even-aged silviculture are financially very competitive. Aside from the aesthetic benefits of avoiding clearcutting under uneven-aged silviculture, non-timber considerations between loblolly pine silvicultural systems are not well documented. Resource professionals hold opinions often in direct conflict with each other regarding the non-timber costs and benefits of even-aged and uneven-aged silviculture when considering wildlife, soil and water, and catastrophic damage events. / Master of Science

No / OBJECTIVES: Performance on neuropsychological tests can be influenced by non-cognitive factors, including deliberate underperformance, stress, the need to fulfil a sick role, depression, un-cooperativeness, fatigue and unhappiness with the evaluative situation. Tests to detect suboptimal effort are becoming widely used in clinical practice and are based on their reported insensitivity to cognitive dysfunction. A diagnosis of dementia has life-changing implications for an individual of working age. It is therefore crucial that clinicians can be confident they have obtained a valid estimate of current cognitive functioning. This study aimed to establish whether mood or cognitive functioning adversely influenced performance on symptom validity tests (SVTs) in individuals with working age dementia, who were judged to be using full effort. METHOD: Forty-two participants with dementia diagnosed before the age of 65 completed measures of emotional and cognitive functioning and six SVTs. RESULTS: There were no significant correlations between emotional functioning and measures of effort. However, cognitive functioning, in particular new learning, was significantly related to SVT performance. Participants with mild dementia performed significantly better on all six SVTs than those with moderate/severe dementia. The results also suggest that the SVTs are not equally sensitive to cognitive dysfunction. Rey's Dot Counting Test (DCT) (times criterion) achieved 100% specificity, and was the only test passed by every participant. CONCLUSION: Rey's DCT is the only SVT that can be recommended for use in those under 65 years with possible dementia at this time until further validation studies are undertaken.

No / Dementia is a common illness that is increasing in frequency and set to challenge the resources and expertise of health and social care services over the coming years. Increasingly, there has been interest in the management of behavioural and psychological symptoms of dementia (BPSD), as they are both common and associated with a range of negative outcomes. BPSD are associated with the admission of people with dementia to care homes. Limited resources and lack of knowledge in permanent care settings often lead to BPSD being managed with antipsychotic medications, which are associated with significant morbidity and mortality. There is evidence for the benefits of exercise within care home settings, although only a few studies include those with cognitive impairment. Tai Chi is a mind-body exercise combining relaxed physical movement and meditation, and has been suggested to have many health benefits. This article discusses the rationale and available options for treating BPSD and the current practice and reviews the literature regarding the benefits of exercise and, in particular, Tai Chi in the management of BPSD.

Introdução: A presença de limitações funcionais entre os idosos determina a necessidade de cuidado. Essa necessidade aponta demandas desafiadoras para a família e para os serviços de saúde por ser um grupo complexo. Objetivo: Analisar a necessidade de cuidado, a utilização dos serviços de saúde de idosos residentes no município de São Paulo e as mudanças associadas a essa necessidade ao longo do tempo. Método: Trata-se de um estudo longitudinal e analítico, de base domiciliar, e utilizou a base de dados do Estudo SABE (Saúde, Bem estar e Envelhecimento) nos anos de 2006 e 2010. A amostra foi constituída por 1413 idosos ( 60 anos). Considerou-se como necessidade de cuidado, a dificuldade do idoso no desempenho das atividades básicas e instrumentais de vida diária de acordo com demandas de auxílio nessas atividades. Para identificar os níveis de necessidade de cuidado, utilizou-se o Escalonamento de Guttman. Para avaliar os fatores associados à necessidade de cuidados e os determinantes da mudança utilizaram-se as análises de Regressão Logística e Multinomial Múltiplas. Resultados: Quanto à hierarquia das atividades de vida diária, encontraram boa consistência interna (=0,92), coeficiente de reprodutibilidade igual a 98%, uma probabilidade de erro de 2%, um coeficiente de escalabilidade de 0,84 e reprodutibilidade mínima marginal de 0,87. Em relação à classificação da necessidade de cuidados, 53,3% eram independentes para o cuidado, 26,7% apresentavam necessidade mínima, 10,5% necessidade moderada e 9,4% necessidade máxima. Entre os idosos com necessidade de cuidado, 73,0% referiram ajuda de alguém para as suas demandas. Maiores proporções de idosos com necessidade máxima foram encontradas entre aqueles que utilizaram os serviços de saúde como consulta médica, urgência/emergência e internação (43,8%) e naqueles que usaram somente serviço de urgência/emergência e internação (54,1%). Entre os idosos independentes, os fatores determinantes para necessidade mínima foram sexo feminino (RRR=1,81; IC 95%:1,05-3,13), ter 80 anos e mais (RRR=2,84; IC 95%: 1,17-6,86), mobilidade física prejudicada (RRR=2,94; IC 95%: 1,02-8,43); para necessidade moderada, idosos com 80 anos e mais 5,58 [1,55-20,00] e declínio cognitivo (RRR=7,83; IC 95%:1,60-38,24); e, necessidade máxima, ter entre 70 a 79 anos (RRR= 2,60; IC 95%: 1,13-5,96), ter 80 anos e mais (RRR=5,59; IC 95%: 1,87-16,62) e multimorbidade (RRR= 3,50; IC 95%: 1,32-9,30). Processo de fragilização (OR=2,12; IC 95%: 1,05-4,27) e mobilidade física prejudicada (OR=1,77; IC 95%: 1,01-3,12) foram determinantes para a piora da necessidade de cuidado entre os idosos. Conclusão: A classificação da necessidade de cuidados possibilita a identificação de idosos demandantes de auxílio nas atividades cotidianas e, direcionará os profissionais de saúde na elaboração de uma linha de cuidados. Políticas públicas devem ser elaboradas aos cuidadores, considerando os serviços de saúde e sociais como suporte aos provedores de cuidado / Introduction: The presence of functional limitations in the elderly determines the need for care. This necessity represents challenging demands for the family and the health services as it presents a complex group. Objective: To analyze the need for care, utilization of health care services of elderly residents in the city of São Paulo and the changes associated with this need over time. Method: This was a longitudinal and analytical home-based study, which used the database of the SABE study (Health, Well-being and Aging) in the years 2006 and 2010. The sample consisted of 1.413 elderly individuals ( 60 years). It was considered as the need for care, the difficulty of the elderly in the performance of basic and instrumental activities of daily living according to aid demands in these activities. To identify the care need levels, we used the Guttman Scaling. To evaluate factors associated with the need for care and determinants of change, the analysis of Multiple Logistic and Multiple Multinomial regression were used. Results: Regarding the hierarchy of activities of daily living, good internal consistency was found (=0.92), a coefficient of reproducibility of 98%, an error probability of 2%, a scalability factor of 0.84 and minimum marginal reproducibility of 0.87. In relation to the classification of the need for care, 53.3% were independent for care, 26.7% had minimal need, 10.5% moderate need and 9.4% maximum need. Among the elderly in need of care, 73.0% reported having someone to help with requirements. The largest proportion of elderly maximum need were found between those used those who used health services such as medical consultations, urgent/emergency and hospitalization (43.8%) and those who used only emergency service/emergency and hospitalization (54.1%). Among the independent elderly, the determining factors for minimum need were female (RRR = 1.81, CI 95%: 1.05 - 3.13), have 80 and over (RRR = 2.84, CI 95%: 1.17 - 6.86), impaired physical mobility (RRR = 2.94, CI 95%: 1.02 - 8.43); for moderate need, aged 80 years and over (RRR= 5.58; CI 95%: 1.55 - 20.00) and cognitive decline (RRR = 7.83, 95% CI: 1.60 - 38.24); and maximum need, be between 70 to 79 years (RRR = 2.60; CI 95%: 1.13 - 5.96), have 80 and over (RRR = 5.59, CI 95%: 1.87 -16.62) and multimorbidity (RRR = 3.50; CI 95%: 1.32 - 9.30). Process of frailty (OR = 2.12; 95% CI: 1.05 - 4.27) and impaired physical mobility (OR = 1.77; 95% CI: 1.01 - 3.12) Conclusion: Classifying the need for care enables identification of elderly individuals requiring help in the activities of daily living and directs health professionals when developing a range of care. Public policies should be developed for caregivers, considering the health and social services as support for the providers of care

published_or_final_version / Social Work / Master / Master of Social Sciences