Objetivos: o objetivo do presente estudo é avaliar a resposta molares e não molares a dois protocolos de atenção periodontal na fase de manutenção periódica preventiva (MPP). Métodos: Sessenta e dois pacientes com periodontite moderada ou avançada (idade média 50.97 ± 9.26 anos, 40 mulheres, 24 fumantes) foram tratados de acordo com um protocolo não-cirúrgico. Finalizada a fase terapêutica, os pacientes iniciaram a fase de MPP e foram randomicamente alocados para receber controle supragengival isolado (SPG) ou combinado ao subgengival (SPG+SBG). Exames periodontais, instruções de higiene bucal e as respectivas intervenções experimentais foram realizados em consultas trimestrais. Resultados: não foram observadas diferenças significativas nas variáveis demográficas, número médio de dentes e distribuição média de dentes não-molares/molares e de sítios livres/proximais entre os dois grupos experimentais. Quando do baseline, os dentes molares apresentaram um maior número de sítios positivos para IPV, ISG, SS e maiores valores médios de PS e PI quando comparados aos não-molares (p<0.001). Ao longo da fase de MPP, foi demonstrado que independente da terapia aplicada, tanto para molares e não molares, a resposta para ambos os grupos dentários não foi diferente. Da mesma forma, a perda dentária entre molares e não molares não diferiu ao longo de 24 meses. Conclusões: Molares apresentam semelhante resposta durante a fase de MPP quando comparados a dentes não molares, independente do protocolo de intervenção clínica aportado. / Aim: The objective of the present study was to evaluate the response of molar teeth and non-molar teeth to two periodontal care protocols in the periodic preventive maintenance phase (PMP). METHODS: Sixty-two patients with moderate or advanced periodontitis (mean age 50.97 ± 9.26 years, 40 women, 24 smokers) were treated according to a non-surgical protocol. After the therapeutic phase, the patients started the PMP and were randomly assigned to receive supragingival (SPG) or combined subgengival (SPG + SBG) control. Periodontal examinations, oral hygiene instructions and the respective experimental interventions were performed in quarterly consultations. Results: There were no significant differences in demographic variables, mean number of teeth and mean distribution of non-molar / molar teeth and free / proximal sites between the two experimental groups. At the baseline, molar teeth had a higher number of positive sites for VPI, GBI, BOP and higher mean values of PPD and CAL when compared to non-molars (p <0.001). Throughout the MPP phase, it was demonstrated that regardless of the applied therapy, for both molars and non-molars, the response for both dental groups was not different. Likewise, tooth loss between molars and non-molars did not differ over 24 months. Conclusions: Molars presented a similar response during the PMP when compared to non-molar teeth, independent of the protocol of clinical intervention provided.

Objetivos: Comparar o efeito do controle estrito do biofilme supragengival (SUPRA), em comparação ao controle combinado dos biofilmes supra e subgengival (SUPRA+SUB), na microbiota subgengival de pacientes durante a fase de manutenção periódica preventiva (MPP), ao longo de 1 ano. Materiais e métodos: Sessenta e dois pacientes com periodontite moderada ou avançada (idade média 50.97 ± 9.26 anos, 40 mulheres, 24 fumantes) foram tratados de acordo com um protocolo não-cirúrgico. Finalizada a fase terapêutica, os pacientes iniciaram a fase de MPP e foram randomicamente alocados para receber a intervenção SUPRA ou SUPRA+SUB. Exames periodontais, instruções de higiene bucal, e as respectivas intervenções (SUPRA ou SUPRA+SUB) foram realizados em consultas trimestrais. Biofilme subgengival foi coletado ao baseline, 3, 6 e 12 meses. Técnica de PCR em Tempo Real foi utilizada para quantificar as espécies bacterianas Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), e o domínio Eubacteria (Bactérias totais). Equações de estimação generalizadas foram usadas para se estimar os efeitos dos tratamentos considerando-se a avaliação longitudinal. Resultados: Não foram observadas diferenças significativas entre os grupos para as contagens de Pg, Td, Tf, e Bactérias totais ao longo de 1 ano. Contudo, a partir dos 3 meses, as contagens de Pg e Tf aumentaram significativamente em ambos os grupos. As contagens de Bactérias totais e Td foram mantidas longitudinalmente. Por outro lado, as contagens médias das espécies bacterianas alvo permaneceram em baixos níveis (≤ 103) durante todo o estudo. Paralelamente, os parâmetros clínicos foram mantidos sem alterações significativas. Conclusões: As intervenções de manutenção investigadas produziram resultados microbiológicos semelhantes ao longo do tempo, o que demonstra o grande e importante impacto do controle do biofilme supragengival durante a fase de MPP. / Aim: Compare the effects of supragingival scaling alone (SPG) against the combined supra and subgingival scaling (SPG+SBG), on subgingival microbiota from patients during periodontal maintenance period (PMP), along 1 year. Material and Methods: Sixty-two patients with moderate or severe periodontitis (mean age 50.97 ± 9.26, 40 females, 24 smokers) were treated according to a non-surgical protocol. Ended the therapy phase, they entered a PMP and were randomly allocated to receive SPG or SPG+SBG interventions. Periodontal exams, oral hygiene instructions, and the respective intervention (SPG or SPG+SBG) were performed at quarterly appointments. Subgingival biofilm was sampled at baseline, 3, 6 and 12 months. Real-time PCR technique was used to quantify the bacteria species Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), and Eubacteria domain (Total bacteria). Generalized estimating equations were used to estimate treatment effects while accounting for longitudinal evaluation. Results: No significant inter-groups differences were observed to Pg, Td, Tf, and Total bacteria counts over 1 year. However, from 3 months onward, Pg and Tf counts increased significantly in both groups. Total bacteria and Td counts were maintained overtime. Still, the mean counts of target bacteria species remained at low levels (≤ 103) throughout the study. In parallel, the clinical parameters were maintained without significant changes. Conclusions: The PMP interventions yielded similar microbiological results along time, demonstrating the great impact and importance of supragingival biofilm control during PMP.

As the population ages, policymakers struggle to cope with the increasing demands for home care and institutional long-term care. This thesis project focuses on factors associated with the transition from home to institutional care for people with dementia. Using health administrative data at a population level, we construct a multivariable model that estimates the time between home care initiation after dementia diagnosis and placement in a long-term care home. From the model, we identify protective factors that allow people with dementia to remain at home for longer, with a particular emphasis on the health workforce and the contribution of formal and informal caregivers to delaying the transition from home to institutional care. Together, these results inform policymakers in capacity planning and in determining where investments should be targeted to maintain people with dementia at home, along with the associated health workforce implications.

Objetivos: Comparar o efeito do controle estrito do biofilme supragengival (SUPRA), em comparação ao controle combinado dos biofilmes supra e subgengival (SUPRA+SUB), na microbiota subgengival de pacientes durante a fase de manutenção periódica preventiva (MPP), ao longo de 1 ano. Materiais e métodos: Sessenta e dois pacientes com periodontite moderada ou avançada (idade média 50.97 ± 9.26 anos, 40 mulheres, 24 fumantes) foram tratados de acordo com um protocolo não-cirúrgico. Finalizada a fase terapêutica, os pacientes iniciaram a fase de MPP e foram randomicamente alocados para receber a intervenção SUPRA ou SUPRA+SUB. Exames periodontais, instruções de higiene bucal, e as respectivas intervenções (SUPRA ou SUPRA+SUB) foram realizados em consultas trimestrais. Biofilme subgengival foi coletado ao baseline, 3, 6 e 12 meses. Técnica de PCR em Tempo Real foi utilizada para quantificar as espécies bacterianas Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), e o domínio Eubacteria (Bactérias totais). Equações de estimação generalizadas foram usadas para se estimar os efeitos dos tratamentos considerando-se a avaliação longitudinal. Resultados: Não foram observadas diferenças significativas entre os grupos para as contagens de Pg, Td, Tf, e Bactérias totais ao longo de 1 ano. Contudo, a partir dos 3 meses, as contagens de Pg e Tf aumentaram significativamente em ambos os grupos. As contagens de Bactérias totais e Td foram mantidas longitudinalmente. Por outro lado, as contagens médias das espécies bacterianas alvo permaneceram em baixos níveis (≤ 103) durante todo o estudo. Paralelamente, os parâmetros clínicos foram mantidos sem alterações significativas. Conclusões: As intervenções de manutenção investigadas produziram resultados microbiológicos semelhantes ao longo do tempo, o que demonstra o grande e importante impacto do controle do biofilme supragengival durante a fase de MPP. / Aim: Compare the effects of supragingival scaling alone (SPG) against the combined supra and subgingival scaling (SPG+SBG), on subgingival microbiota from patients during periodontal maintenance period (PMP), along 1 year. Material and Methods: Sixty-two patients with moderate or severe periodontitis (mean age 50.97 ± 9.26, 40 females, 24 smokers) were treated according to a non-surgical protocol. Ended the therapy phase, they entered a PMP and were randomly allocated to receive SPG or SPG+SBG interventions. Periodontal exams, oral hygiene instructions, and the respective intervention (SPG or SPG+SBG) were performed at quarterly appointments. Subgingival biofilm was sampled at baseline, 3, 6 and 12 months. Real-time PCR technique was used to quantify the bacteria species Porphyromonas gingivalis (Pg), Treponema denticola (Td), Tannerella forsythia (Tf), and Eubacteria domain (Total bacteria). Generalized estimating equations were used to estimate treatment effects while accounting for longitudinal evaluation. Results: No significant inter-groups differences were observed to Pg, Td, Tf, and Total bacteria counts over 1 year. However, from 3 months onward, Pg and Tf counts increased significantly in both groups. Total bacteria and Td counts were maintained overtime. Still, the mean counts of target bacteria species remained at low levels (≤ 103) throughout the study. In parallel, the clinical parameters were maintained without significant changes. Conclusions: The PMP interventions yielded similar microbiological results along time, demonstrating the great impact and importance of supragingival biofilm control during PMP.

In this contribution, we investigate the relationships between paid and unpaid work in the lifeworlds of employed informal carers against the background of the Austrian long-term care regime. We pursue a twofold argument: On the one hand, we emphasize that combining paid and unpaid work currently poses serious difficulties for employed family carers in their everyday lives and impacts their current and future financial and social security. On the other hand, we argue that the relationships between employment and informal care are in fact not well understood by the common concepts of "reconciliation" or "work-life balance". These concepts are not able to explain the complexities of employed carers' lived realities and fail to adequately address the fundamental contradiction in the idea of a "reconciliation" of paid and unpaid work.

Master of Science / Department of Hotel, Restaurant, Institution Management and Dietetics / Carol W. Shanklin / The purposes of this study were to explore factors associated with residents’ dining experience in assisted living facilities and to investigate the influence that these factors had on perceived quality and residents’ satisfaction with their dining experience. Food quality, service quality, mealtime customization, and dining room environment were the four constructs explored. Focus groups were conducted with residents of three assisted living facilities to determine attributes of the constructs that were important to them. A total of 22 residents participated in the three focus groups. A questionnaire developed by Huang was revised to include measurement items identified in the focus groups. The questionnaire was distributed to residents of 16 randomly selected assisted living facilities within a 110 mile radius of the research institution. Of the 492 residents in 16 facilities, 246 completed the questionnaire for a response rate of 50%. Residents evaluated the attributes on a 5-point likert scale (1-strongly disagree; 5-strongly agree). Service quality (4.03) and dining room environment (3.97) attributes were rated significantly higher than food quality (3.64) and customization attributes (3.42). Resident satisfaction also was evaluated on a 5-point scale (1-very dissatisfied; 5-very satisfied). Residents were satisfied with the overall dining experience (3.94) and the overall facility (3.97). Residents were less satisfied with food served (3.67) or the amount of choices they had at meals (3.58). Residents were satisfied with services (3.95) and the dining room atmosphere (3.98). Satisfaction with services and the dining room atmosphere were significantly higher than food served and amount of choices at mealtimes. Residents’ perceptions of food quality, service quality, level of customization, and dining room environment had a positive influence on their satisfaction with the overall dining experience. Residents’ perceptions of food quality had a positive influence on satisfaction with the food served, service quality impacted satisfaction with services, level of customization effected satisfaction with the amount of choices, and dining room environment influenced satisfaction with the dining room atmosphere. Administrators, foodservice directors, and dietitians employed in assisted living facilities can use the results to improve the dining experience for residents and ultimately improve residents’ quality of life.

Objectives: To develop and validate a survey that can be used to measure key infection prevention and control (IP&C) structures and processes in LTC facilities. Methods: This study was designed using a three-phase methodology. In Phase I, six structural and process composite indices were developed based on the 2004 PHAC recommendations for IP&C in LTC and other literature. During the second phase of the study, a group of 7 experts in LTC IP&C used the Delphi methodology to validate and further develop the survey based on group consensus. Five Safety Principles published by the Institute of Medicine were also provided to the experts so they could be used to complement and further develop the concepts covered by the survey. The Delphi phase began in April and ended in October 2007; 114 worksheets were sent to experts to support the consensus-reaching process. Once the validity of a survey draft had been established based on expert-group consensus, it was pilot-tested in Phase III using 20 randomly selected LTC facilities in Fraser Health. Findings: The three-phase methodology used in this study was very useful and innovative way to further develop and validate the literature-based survey developed in Phase I for IP&C in long term care. In addition, by merging two bodies of knowledge and thought into the process, concepts and components that are not explicitly described in IP&C literature yet were felt to be key in program success, were incorporated into the measurement tool. Using Delphi, the experts expressed a need for IP&C professionals working in LTC to increase their knowledge, understanding and use of safety theory and strategies. They also felt that interdisciplinary work, the development of a culture of safety, and the development clear and simple IP&C systems are key ways in which infections can be prevented and outbreaks quickly controlled. In Phase III, the pilot-study analysis demonstrated the utility, validity and reliability of the survey. In addition, the analysis showed that there is a tendency for facilities to have lower levels of components within the Leadership Index and the ICP Index. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The purpose of this study is to learn about the professional development practices of physiotherapists working in long-term care homes in Ontario. A survey was created based on relevant literature and piloted for this study. The survey included both quantitative and open-ended questions. 44 Physiotherapist responded, which represents approximately 10% of physiotherapists working in long-term care in Ontario. The results indicate that physiotherapists are isolated from their physiotherapist peers and lack access to communities of practice, professional socialisation, professional culture and social regulation. Although physiotherapists’ interactions with interprofessional teams added breadth to their knowledge, these interactions did not enhance their profession-specific skills. Many physiotherapists are seeking professional community and social supports in healthcare settings outside of the long-term care context. The implications of this study are that physiotherapists, their professional associations, and their college must understand the importance of professional socialization in learning, and ensure that physiotherapists working in long-term care have access to and seek such social support. Physiotherapy service providers in long-term care should provide mentoring, support and opportunities for social learning for their clinicians. Finally, long-term care homes and the Ministry of Health and Long-term care need to ensure that policies provide a better definition of the role of physiotherapists in long-term care.

Health-care delivery involves clinical handover processes that occur at many levels of inpatient care. These processes are essential to an effective health-care system due to their role in achieving efficient communication, reducing transmission time, and lowering costs. Ensuring safe and effective handover requires the coordination of multiple care providers that work together to deliver patient care efficiently. Poor coordination during handover can have major effects on patient care, leading to loss of information and contributing to adverse events. As health-care delivery evolves to become more patient-centered, handovers from short- to long-term care need to maintain a strong communication, which in turn will depend on the evolution of support systems for that communication. Due to the wide range of care providers and patient needs, there has so far been a lack of research work on handover processes. This study aims to explore the clinical handover process for patients moving from a cardiology unit to home and community care settings, and how they are affected by varying degrees of communication. It relies on literature review and a case study conducted at Montfort Hospital, Ontario, to identify and analyze the major factors involved in this type of handover, and to form suggestions about how this process could be improved. This thesis analyzes process scenarios arising in the case study, modeling them using business process management (BPM) tools and techniques to identify problems and formulate solutions. A model of the existing process is created and analyzed using business process management notation (BPMN), and is then subjected to analysis, the results of which identify several communication issues with a potential to cause delays and information loss. The findings highlight the importance of collaboration among care providers, and indicate the potential uses of BPM methodology to choreograph that collaboration. The study ultimately shows how improvements to collaboration and information exchange can increase the communication effectiveness in handover processes and reduce the probability of adverse patient events.

Using a pre- and post-test design with both experimental and control groups, the research was conducted to see if life review improved the independence, depression, and integrated functioning of the institutionalized elderly. The elderly on the long term care unit of an acute care hospital waiting to be placed in a long term care facility were studied using a pre- and post-test design. Patients who were not depressed and could communicate in English were included in the study. They were randomly assigned to the experimental and control groups when possible. Patients in the experimental groups attended eight life review sessions over a four week period while the control groups carried on with the usual activities on the unit. Three scales, the Geriatric Depression Scale, Activities of Daily Living Evaluation Form, and the Geriatric Rating Scale were administered before the four week period and after. Data was also collected during the sessions on group process using the Group Process Observational Checklist on the experimental groups. Demographic data was collected on all the patients in the study. It was found that the experimental group did become more independent, integrated and less depressed. This study indicated that life review is beneficial for the institutionalized elderly but, it could not show exactly what variables in the life review process contributed to these positive results. Replication studies are needed to validate these findings. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate