Background: Dietary supplements (DS) use has increased in the U.S. in the past 20 years. More than half of the U.S. population reported using DS. There are few studies to our knowledge that have assessed DS use specifically for older adults. In this study we purposed to evaluate the trend of using DS among older adults and to test the association between using DS and several demographics, socioeconomics and health characteristics. The second objective was to evaluate the reasons behind using DS among older adults using a nationally representative database. Methods: This is a cross sectional study using the most recent National Health and Nutrition Examination Survey (NHANES) database 2009-2012. It is a nationally representative sample of noninstitutionalized adults in the U.S. Frequency and weighted percentage (standard error) were reported for dichotomous variables. Multiple logistic regressions model analyses were used to evaluate the predictors of DS use after testing model assumptions, multicollinearity, and outliers. P values 0.05 were considered significant. All the statistical analyses were conducted using SAS software version 9.4. Results: Out of 2625 older adult participants (65 years and older) 70.5% of them reported using DS in the past 30 days. Female, non-hispanic white, obese, overweight and excellent and very good self-reported health status participants were more likely to use DS. Multivitamin-multiminerals (MVMM), calcium and vitamin D were the most commonly reported supplements among older adults. 71% of oldest old (80≥ years) reported taking DS and prescription medication in the past 30 days concomitantly and 73% of polypharmacy users reported using DS. To stay healthy, to improve overall health and for bone health were the most commonly reported reasons behind using DS. Conclusion: majority of older adult participants reported using DS in the past 30 days. Health care professionals need to evaluate the dietary supplement information from older adults in order to improve health care.

Title: Guest dimensions of health status in patients with spondylarthritis ankylopoetica using the SF-36th Objectives: The major aim of the diploma thesis was the study and the evaluation of the quality of life of patients with the spondylarthritis ankylopoetica in the Czech Republic. Methods: The own research was conducted using the survey method by means of the standardized questionnaire Short Form 36 (SF-36), which deals with the Health Related Quality of Life . The Czech version of the SF-36 survey translated by MUDr. Petr, Ph.D. (2000) was applied. In order to reach the main aim of the thesis the research was conducted in a group of patients with spondylarthritis ankylopoetica (n=101) and among the same number of the general Czech population members. The achieved results were divided into particular age categories in the both groups. The statistically significant differences between the two analysed samples were subsequently verified. Results: The mean age of the patients with spondylarthritis ankylopoetica was 51,6±14,9 years, whereas it reached 52,3±15,5 years in the sample of the general population. In the majority of the dimensions of the SF-36 questionnaire related to the physical health (physical functioning, role physical, bodily pain and general health) achieved the patients...

O envelhecimento populacional vem ocorrendo de forma extremamente rápida nos países em desenvolvimento, implicando em maior prevalência de doenças crônico-degenerativas. Dentre estas, destaca-se o diabetes mellitus, síndrome caracterizada por estado crônico de hiperglicemia e distúrbios no metabolismo de carboidratos, lipídios e proteínas, associada à deficiência absoluta ou relativa de insulina e/ou à sua ação no organismo. A prevalência de diabetes vem aumentando em proporções epidêmicas, principalmente entre os idosos, e suas complicações são altamente incapacitantes e onerosas para o Sistema de Saúde. Assim, os objetivos do presente estudo foram: traçar o perfil das condições de vida e saúde da população idosa (60 anos e mais), residente no município de São Paulo, portadora de diabetes mellitus e verificar a associação da doença à ocorrência de óbito nesta população em um período de seis anos. Para isso foram utilizados dados do Estudo SABE– Saúde, Bem-Estar e Envelhecimento, inquérito multicêntrico desenvolvido em países da América Latina e Caribe. Este estudo caracteriza-se, no primeiro momento, como uma pesquisa exploratória, descritiva, retrospectiva e com abordagem quantitativa, e no segundo momento, como um estudo longitudinal. A prevalência de diabetes mellitus encontrada foi de 17,9%, comparável à de países desenvolvidos; esta prevalência decrescia com a idade, levando à suposição de que estes idosos estariam tendo uma mortalidade precoce. Mulheres apresentaram maior prevalência em todas as faixas etárias. Quanto às condições sócio-demográficas, verificou-se que os diabéticos, sobretudo as mulheres, possuíam baixa escolaridade e referiram renda insuficiente para suas despesas; uma parcela importante destes idosos ainda trabalhava, justificando a necessidade de aumentar sua fonte de renda. A maioria dos homens vivia em casais ou em arranjos bigeracionais, enquanto as mulheres viviam em arranjos bi e trigeracionais, refletindo maior dependência destas com relação à ajuda de filhos e/ou netos. Verificou-se com grande freqüência inadequação do tratamento da doença nestes idosos, com 16% em monoterapia com dieta e 17,4% sem tratamento algum; apesar disto, a maioria acreditava ter bom controle da doença. Encontrou-se entre os diabéticos maiores prevalências de obesidade, sedentarismo, hipertensão, doenças cardíacas, artrite, acidente vascular cerebral, amputações de membros inferiores, quedas, incontinência urinária e intestinal, dificuldade nas atividades de vida diária, declínio cognitivo e depressão. A procura por atendimento médico e internações hospitalares também foram mais freqüentes entre os portadores da doença, que também apresentaram internações mais prolongadas, refletindo o impacto da doença no Sistema de Saúde. Por fim, verificou-se através de regressão logística a grande influência do diabetes mellitus no desfecho óbito, multiplicando este risco em 2,55 vezes quando associado a outras enfermidades. Estes resultados reforçam a necessidade do estabelecimento de políticas públicas voltadas para a detecção precoce da doença e prevenção de suas complicações, principalmente nas faixas etárias mais elevadas / Population ageing has been occurring extremely fast in developing countries, leading to high rates of chronic diseases. Diabetes mellitus, a syndrome characterized by chronic hyperglycemia and disturbances of carbohydrate, fat and protein metabolism associated with absolute or relative deficiencies of insulin and/or in its action, is one of the most important of these conditions. Prevalence of diabetes is increasing in epidemic proportions, especially among older people, and the burden of its complications constitutes a serious health problem. The purposes of this study were: to describe social and health conditions of elderly diabetic subjects living in the city of São Paulo and to investigate the association between diabetes and mortality in a period of six years. This study is part of the project entitled SABE – Health, Ageing and Well-Being, a multicenter survey conducted in Latin America and The Caribbean. Prevalence of diabetes in people aged ≥ 60 years was 17,9%, as high as in most developed countries; this prevalence decreased with age, leading to the supposition that these elders are dying sooner than non diabetic subjects. Women had higher prevalences in every age group. It was found that diabetic elders, especially women, were low-income and had poor educational level; most of those subjects were still working at the time of the survey. Men tended to live with their wives or with sons/daughters, while women tended to live with sons/daughters and/or grandchildren, reflecting higher need of care. It was verified that treatment of diabetes was far from ideal in this population, 16% were under monotherapy with diet and 17,4% were not receiving any treatment; despite that, most of the patients believed having good control of diabetes. Prevalences of obesity, physical inactivity, hypertension, cardiac diseases, arthritis, stroke, lower limb amputations, falls, urinary and fecal incontinences, functional and cognitive impairment and depression were higher in diabetic than in non diabetic elders. Frequencies of physician visits and hospitalizations were also higher among elderly diabetic patients, and hospitalizations tended to be longer in this population, reflecting its burden on health system. The impact of diabetes on mortality was verified through logistic regression model. It was found that diabetes associated with at least one comorbid condition increased mortality risk (odds ratio) in 2,55 (p=0,000). These findings show that public health policies are necessary to get earlier diagnosis and prevent the complications of diabetes, especially among elderly people

The diploma thesis is focused on the legal nature assessments of medical assessment service. The medical assesment service has seen many changes over the course of history, and its competence is constantly changing and evolving. Unfortunately, the nature of the assesment service is sometimes ambiguous for the non-professional public and is thus viewed very skeptically. Nowadays, only a few experts are dedicated to this topic, so I decided to unify the information and summarize the main objectives of the medical assessment service. In order to better understand and illustrate the rights and duties of this service, I also looked into history. Given the nature of the work, I decided to work on theoretical work, which points out not only the historical development in the Czech Republic, but also in Slovak Republic, further it focuses on the current state and definition of terms necessary for understanding the work of the medical assessment service. The objective of the work is to map the system of medical assessment service and work is thus a summary of information not only for the non-professional public, but also for study purposes and awareness of social workers who meet daily with many questions on this topic. The medical assessment service affects many human life stages, so it is not only about assessing health status for pension insurance, but also for health insurance or ensure the social services. Since many authors are not concerned with the topic, it is sometimes quite difficult to find a clear definition of the legal nature of individual assessments. However, the legal nature of the assessments is enshrined in the law, and also affects other life stages of the person that being assessed and claims not only for financial but also for social security, and it is therefore important to deal with this topic and its changes and submit new and comprehensive information.

Objetivo: Discutir criticamente, descrever e analisar os dados de óbitos infantis disponibilizados pelos serviços públicos da província de Cabinda-Angola. Método: Foram estudados nascimentos vivos em hospitais da província de Cabinda, e óbitos de menores de um ano de idade, nos anos 2007 e 2008. Como fonte de dados foram utilizados os registrados nos livros de registro dos hospitais municipais, d o hospital provincial e do escritório provincial da OMS de Cabinda. Os dados são contextualizados pela experiência do autor como habitante da região. Resultados: Os resultados deste trabalho mostram que em 2008 morreram mais crianças no primeiro dia de vida (109) que nos 11 meses restantes (97). Contudo, evidencia-se que 200 óbitos (54,64 por cento ) ocorreram em menores de 28 dias de idade em 2007 enquanto que para o mesmo período em 2008 morreram 178 crianças, Quanto às causas básicas de mortes infantis, a malária é destacada como principal causa. Isoladamente a malária responde aproximadamente por uma morte a cada três crianças falecidas. Dentre as doenças evitáveis por vacinação, o tétano responde por cerca de 5 por cento das mortes. Entre as doenças controláveis por saneamento básico, as diarréias ocupam posição de destaque 9,83 por cento em 2007 e 3,27 por cento em 2008. A redução de 65 para 40 óbitos por pneumonia entre as crianças inscreve-a como segunda ou terceira causa mais importante de óbito entre as crianças cabindenses, partilhando espaço com a asfixia neonatal (17,75 por cento em 2007 e 26,90 por cento em 2008). Apesar das dificuldades e limitantes da qualidade das informações encontradas durante a coleta de dados, buscou-se valorizar as existentes e que foram analisa das neste trabalho. Conclusões: Os resultados obtidos indicam que em Cabinda, melhorias na qualidade de assistência pré-natal, ao parto e ao recém-nascido de risco, poderiam reduzir ainda que parcialmente a Mortalidade Infantil. Fatores como condições inadequadas de abastecimento de água, falta de saneamento básico, dentre outros, revelaram ter papel importante como condicionantes da elevada Mortalidade Infantil observada em Cabinda. Apesar de ser atraente priorizar investimentos dos recursos em ações curativas, este trabalho reforça a perspectiva revisitar as políticas locais de Saúde e priorizar as atividades preventivas nos municípios da grande Cabinda. Assim, sugere-se a implantação de uma rede primária de assistência à saúde e um investimento permanente na melhoria da qualidade das informações de Saúde / Objective: To critically discuss, describe and analyze the infant deaths data available for public services in the province of Cabinda-Angola. Method: A total of live births in hospitals in the province of Cabinda, and deaths of children under one year of age, in years 2007 and 2008. The data source were used those recorded on the records of municipal hospitals, the provincial hospital and the provincial office of WHO in Cabinda. The data are contextualized by the author\'s experience as an inhabitant of the region. Results: The results of this study suggested that in 2008 more children died in the first days of life (109) than in the remaining 11 months (97). However, it is clear that 200 deaths (54.64 per cent ) occurred in children younger than 28 day- old in 2007 while for the same period in 2008 died 178 children. As the root causes of child deaths, malaria is highlighted as the main cause. Malaria alone accounts for approximately one death every three children who die. Among the vaccinepreventable diseases, tetanus accounts for about 5 per cent of deaths. Among the diseases controlled by sanitation, diarrhea, occupy a prominent position in 2007, 9.83 per cent and 3.27 per cent in 2008. The reduction from 65 to 40 deaths from pneumonia among children falls as the second or third most important cause of death among children Cabinda, sharing space with neonatal asphyxia (17.75 per cent in 2007 and 26.90 per cent in 2008). Despite the difficulties, limiting the quality of information found during the data collection, we sought to enhance existing ones, which were analyzed in this work. Conclusions: The results indicate that in Cabinda, improvements in quality of prenatal care, childbirth and the newborn at risk, even partially could reduce infant mortality. Factors such as inadequate water supply, poor sanitation, among others, were found to have important role as determinants of high infant mortality observed in Cabinda. Despite being attractive investments prioritize resources on curative actions, this work reinforces the perspective of revisit policies and prioritize local health preventive activities in the great area of Cabinda. Thus, we suggest the establishment of a network of primary health care and an ongoing investment to improve the quality of information on Health

The complex relationship between human societies and the environment has become a thriving field of research over the past three decades. The contribution of human osteoarchaeology to exploring this relationship, however, has been rather limited. Two unpublished late medieval skeletal assemblages unearthed in the historical centres of Bucharest and Braşov (located in southern and north-central Romania respectively) seemed ideal choices for investigating the impact of substantial climatic and environmental changes that took place worldwide between the 14th and the 18th century AD. As witnessed by medieval artistic and documentary sources, this unsettled climate was mirrored by human populations with social and political instability, epidemics, famine, but also through the rise of new cultural movements. The analysis of over 600 individuals (a minimum number of 421 individuals from Bucharest and 206 from Braşov) was carried out to: 1) Provide a thorough osteological analysis, and compare and test statistically the collected data to reconstruct demographic and pathological patterning; 2) Identify ‘skeletal environmental markers’, i.e. possible indicators of the effect of climatic shifts on the human body; 3) Cross-reference osteological, archaeological, historical and climatological data in order to present a robust biocultural assessment of the impact of environmental and historical events on the Romanian population during the Middle Ages. The identification of low life-expectancy, higher mortality rates for children and young adults and general high morbidity levels were in line with other studies on medieval populations. However, evidence for a high prevalence of specific physiological and psychological stress markers was observed in these two geographically, culturally and economically different urban communities. As a strong mortality- and morbidity-shaping factor, the detrimental effect of climate anomalies is one of the main explanations for such findings, and is supported by medieval historical sources and recent advances in Romanian climatological studies. Despite some limitations (i.e. incomplete chronological information for most of the burial contexts, minimal local historical sources, lack of funding for isotopic analyses, and time constraints), the results of the present study have offered a new perspective on the relationship between Romanian medieval populations and their living environment, and have shown the enormous potential of interdisciplinary bioarchaeological research in Romania.

abstract: Advances in health care have resulted in an increase in life expectancy causing a rapid growth in the number of older adults at a global level. At the same time, socioeconomic development is transitioning family structures and social relationships. With reduced family engagement, many older adults are more at risk for physical and psychological health issues including loneliness, which is considered a public health issue affecting their quality of life and well-being. This descriptive, exploratory study aims to describe the significance of loneliness in three northern regions of the Sultanate of Oman. The purpose of this study is to examine the prevalence and correlates of loneliness and the relationship of loneliness to health statuses among older Omani adults aged 60 years and above. A demographic data questionnaire, the UCLA loneliness scale, and SF-12-v-1 health status instruments were used for data collection. The sample includes 113 Omani older adults, male (n = 36) and female (n = 77), who experienced a mixture from low to high and severe levels of loneliness. Among these older adults, 34.5% perceived low level, 34.5% moderate level, 22.1% high, and 8.8% were severely lonely. The main demographic factors that were associated with the older adults level of loneliness were female gender, older age 80 years and above, living with others who were not a family member, and being unemployed. When controlling for demographic and environmental factors loneliness was a significant predictor (p < .001) for lower mental health status but not for physical health status (p > .05). / Dissertation/Thesis / Doctoral Dissertation Nursing 2019

Diabetes is an epidemic that has started to capture political attention in the United States because of the devastating health care costs associated with the disease. Researchers in other studies have concluded that additional education face-to-face (FTF) and FTF with alternative forms of diabetes communication (FTF plus) have been beneficial. However, there is very little information on the comparison of the two groups as mentioned above when comparing chronic limitations, self-perception, health status, and healthcare satisfaction as circumscribed by specific demographic population. This study was an investigation of the above variables and explored how specific demographic characteristics (age, gender, educational level, and race/ethnic background) may have an identifiable association with each diabetes education type, either FTF or FTF plus. This research involved the use of the social cognitive theory and the health belief model to help explain self-care behavior changes. This quantitative, cross-sectional study used secondary data from the 2016 National Health Interview Survey for analysis. A simple linear regression was used to understand health status and healthcare satisfaction. A logistical regression was used for chronic limitations, while controlling for demographics for all the variables. The study revealed FTF plus had an association with chronic limitations with race and education level, but age was not significant. After controlling for demographics, a person who has FTF plus has decreased odds of having chronic limitations, in comparison to someone who receives only FTF. The results from this study may aid formulation of future healthcare policies that focus on how to refer patients to multiple forums of diabetes education, while reducing healthcare costs.

Thesis (M.SC. (Aquaculture)) --University of Limpopo, 2011 / The present MSc dissertation emanates from seasonal surveys conducted by the fish parasitological group of the Department of Biodiversity and Aquaculture Research Unit of the University of Limpopo, Turfloop Campus. The first part of the present study was aimed at investigating the metazoan parasites of three cyprinids occurring in the Nwanedi-Luphephe Dams. The main purpose of it was to determine temporal changes in the intensity of infestation in terms of prevalence, mean intensity and abundance of parasite species parasitizing the cyprinids studied over a two year period. Ecological parameters including species host-specificity, seasonality, and gender preference and host size versus species intensity are discussed for each parasite. Altogether 152 specimens were examined for parasites and a total of 2 432 metazoan parasites of ten species were recorded. At the sampling site, all three hosts co-occurred, however, a substantial proportion of Barbus radiatus was collected from the perennial stream feeding one of the twindams. Fish were sampled by means of gill nets and electrofishing or seine netting in accordance with the habitat conditions. Hosts were killed and organs investigated for metazoan parasites. After collection of parasites, standard methods for processing individual parasites were followed. The results obtained revealed the following groups of parasites; monogeneans (ectoparasites) included Dactylogyrus spinicirrus, D. afrolongicornis afrolongicornis, D. afrolongicornis alberti, Afrodiplozoon polycotyleus, Gyrodactylus sp., and Dogielius sp. (all recorded from the gills); Crustacea, Dolops ranarum was found from the mouth cavity, gills and skin of Labeobarbus marequensis. Of these, only two specialists, both monogeneans, were found on Barbus trimaculatus namely, D. afrolongicornis afrolongicornis and D. afrolongicornis alberti. Based on morphology of the haptoral hard parts, these two species were almost similar to each other than to D. spinicirrus. The appreciable difference between D. afrolongicornis afrolongicornis and D. afrolongicornis alberti was mainly in the shape of the marginal bar. Both D. spinicirrus and A. polycotyleus were widely distributed and recorded on the gills of all hosts during all seasons. Both species were recorded for the first time on B. radiatus. Also, D. spinicirrus was recorded for the first time on the gills of B. trimaculatus. Based on comparison with the original material, the species could be identified to species level. These analyses provided sufficient evidence for restoration of Afrodiplozoon polycotyleus as a valid taxon. The existence of two species, Gyrodactylus sp. and Dogielius sp. were recorded for the first time on B. radiatus in South Africa, and this possibly represents new species. The endoparasites included the following groups: digeneans- Diplostomulum metacercariae from the eyes of Lb. marequensis, Ornithodiplostomum sp. and black spot (grubs) were recorded from B. trimaculatus. The latter was also recorded in the muscle of B. radiatus. Unidentified digenean cysts were recovered from the gills and in the body cavity of both Lb. marequensis and B. trimaculatus; nematodes were represented by Contracaecum larvae in the body cavity of both Lb. marequensis and B. trimaculatus; cestodes were represented by gryporynchid larvae from the intestine of B. radiatus. The general high prevalence and intensities of ectoparasites recorded is an indication that the Nwanedi-Luphephe Dams has a biotic mechanism which might have enabled it to sustain the growth rate of ectoparasite intra-population. There was no correlation between either fish length or condition factor and the number of parasites. The study indicated that the abundance of monogeneans is partly influenced by season and that of endoparasites was principally governed by the presence of intermediate hosts and definitive hosts. The second part of this dissertation dealt with the health status of Lb. marequensis. Fish health was assessed using condition-related indices including condition factor and a modified Health Assessment Index (HAI) and the associated Parasite Index (PI). The HAI was performed to determine and examine any macroscopic abnormalities regarding external features and internal organs. The purpose of combining the two indices was to use the infestation of the metazoan parasites found on and/or in Lb. marequensis to determine whether or not the environment they live in was healthy. Both indices together with the condition factor provided relatively simple and rapid indications of how well fish were coping in their environment. The HAI score varied amongst the four sampling seasons. The highest individual mean value was 63 in winter, followed by a score of 50 in autumn, while the lowest were 42 and 33 in summer and spring respectively. To authenticate the HAI and PI data, certain water quality variables were measured and are discussed in detail in this dissertation. The Nwanedi-Luphephe Dams are generally believed to have good water quality. This was supported in this study; conditions assessed in fish using the aforementioned indices did not differ greatly between seasons, nor did the conditions deviate appreciably from normality. The HAI values were low overall which signifies a healthy fish profile for the system. The present investigation showed the existence of differences in the occurrence of individual parasite to be linked to water temperature changes. Thus, seasonal changes do influence parasite developmental stages to a certain degree. Tested heavy and trace metals were within the permissible limits as provided by the Department of Water Affairs and Tourism (DWAF, 1996).

Most health professionals are aware of the amazing diversity of the Australian population, which is made up of people from over 140 different countries. Of these, an increasing number have arrived as refugees under Australia's humanitarian resettlement program. Research indicates that at least 30% of the 12,000 or so people arriving in Australia under the humanitarian assistance programmes each year have been exposed to physical and emotional torture and trauma. They also have well documented health deficits relating to the health standards in their countries of origin, the level of deprivation experienced prior to arrival in Australia, and the time they have spent in transit before arriving in Australia. The purpose of this study was to review the health status of refugees from the former Yugoslavia, and to identify the perceived needs of this group, which represents one of Canberra's largest communities of recently arrived refugees. Utilising both qualitative and quantitative methodologies, findings showed that the cohort had significantly lower levels of both physical and mental health than the wider ACT and Australian population. The difficulties of socialisation of the refugees into the Australian lifestyle are highlighted. In particular, findings from the study have demonstrated the lack of appropriate information given to some refugees on arrival, and the struggles experienced by most of the group with learning a new language, and coping with unemployment and inadequate housing. The problem of covert political harassment in Canberra was also described during the interview process. Recommendations for improving the situation for these refugees were that information for refugees prior to, and following arrival in Australia needs to be consistent and readily available, and there needs to be provision of a formalised support system from the time of arrival, including a review of language facilities. The study also recommended that culturally sensitive health promotion and treatment programs should be incorporated into current health service provision. Nurses are identified as the appropriate health providers to take a leading role in developing such programs for refugees, although findings from this study indicate that current nurse education programs need to place more emphasis on a transcultural framework for the provision of care.