This study deals with the development of the number and the age and sex structure of Czech physicians according their medical specialty in the period 2000-2010. The aim of the study is to identify which medical specialties are already problematic or could face the lack of physicians and demographic ageing in the future and on the other hand which medical specialties are popular among young physicians. Firstly, the Czech health system and particular groups of health workforce are introduced. After that follows the analysis of the number and the sex and age structure according their medical specialty. The cluster analysis which produces groups of medical specialties with similar characteristics of development of the number and the structure was used for schematic overview. The second part of the study is focused on the most numerous fourteen medical specialties. The number of medical school graduates, the number of attestations and the development of workload of physicians regarding the number of ambulant treatment and hospitalization is taken into account.

The book distills the available information on osteoporosis into an easily comprehensible format that serves as a practical guide for busy clinicians. Contents:Definition & epidemiology -- Basic bone pathophysiology -- Bone densitometry -- Diagnosis -- Identifying patients at risk of fractures -- Non-pharmacologic management of osteopenia and osteoporosis -- Pharmacologic management of osteoporosis, part 1 -- Pharmacologic management of osteoporosis, part 2 -- Monitoring patients on treatment -- Vertebral augmentation procedures -- Corticosteroid-induced bone loss -- Primary hyperparathyroidism -- Premenopausal women -- Men -- Atypical femoral shaft fractures -- Osteonecrosis of the jaw -- Osteoporosis in children and adolescents. / https://dc.etsu.edu/etsu_books/1077/thumbnail.jpg

Three experiments examined normal-hearing and cochlear-implant listeners' abilities to perceive and use talker-specific information in the speech signal. In Experiment 1 voice similarity judgments were gathered from normal-hearing listeners to maximize variability across talkers used in Experiment 2. These judgments were submitted to a multidimensional scaling (MDS) analysis; this solution was used to select the talkers of Experiment 2. Experiment 2 was an approximate replication of Nygaard and Pisoni's (1998) work. In this study cochlear-implant and normal-hearing listeners were trained to recognize 6 different voices. The cochlear-implant users recognized the voices with 59.31% accuracy and the normal-hearing listeners achieved 92.64% accuracy. After training the listeners completed a sentence recognition task in noise. In the task 6 familiar talkers spoken half of the sentences and 6 novel talkers spoke the other half. It was predicted that sentences spoken by the familiar talkers would be more accurately perceived than those spoken by the novel talkers. However, there was no difference in accuracy, nor was there a difference in performance across the groups of listeners. The factors contributing to these null results were discussed at length. Experiment 3 gathered voice similarity judgments from the normal-hearing and cochlear-implant listeners of Experiment 2. These data were submitted to both classical and weighted MDS analyses. The voice maps showed notable differences in the perceptual spaces of the two groups of listeners. The participant space yielded from the weighted MDS showed great variation across all of the participants' judgments, but no clear trend supporting the listeners' group membership. In conclusion, despite listening via a constrained, electric signal, the cochlear-implant users were trained to recognize voices with notable accuracy (as were the normal-hearing listeners). Nevertheless, Experiment 2 failed to provide insight into talker familiarity's effect on the sentence recognition skills of cochlear-implant and normal-hearing listeners. These results are contrary to research with normal-hearing listeners that suggests talker familiarity facilitates speech processing in noise. The present studies did show, though, that cochlear-implant users appear to perceive and use talker-specific information differently than normal-hearing listeners.

Obstetric analgesia and anesthesia is an important concern today. The purpose of this study was to evaluate the effects of analgesia used in labor and delivery on the mother and newborn. The information obtained in this study evaluated the amount, time and types of analgesia and the effects on the mother and the newborn. Previous research has indicated adverse effects of analgesia and anesthesia on both mother and newborn, but conclusive results have not been obtained. Depressed respiratory function, increased use of oxygen, and low Apgar scores are among the effects reported for the newborn. Decreased uterine function, decreased satisfaction of the birth process, and risks attendant upon analgesia and anesthesia have been reported regarding the mother. Apgar scores, oxygen administered, and length of hospitilization for mother and newborn were the dependent variables measured by this study. The independent variables were amount, time, and administration of medication during labor and delivery. The control variables were the number of prenatal visits, number of previous pregnancies, and the stage of pregnancy at first visit to the physician. The subjects were grouped according to the amount of Demerol (the most commonly prescribed analgesia) administered, and comparisons were made between the highest and lowest groups. No significant differences were observed between the high and low Demerol groups in any of these variables. Significant differences were found in the area of Apgar scores and oxygen administration. These findings support the conclusion that analgesia and anesthesia administered during labor and delivery can have adverse effects in the newborn. Thus, the null hypothesis of no significant differences of effects of analgesia or anesthesia on mother and newborn was partially rejected. This research lends support to findings which suggest adverse effects of medication during labor. These supportive results could serve as a basis for future research investigating the amount of medication given in labor and delivery.

The National Quality Award Program, sponsored by the American Healthcare Association National Center for Assisted Living, was implemented to cultivate continuous quality improvement in nursing homes and assisted living facilities. Based upon the Baldridge Criteria for Performance Excellence, the program utilizes a systems-based or Big “Q” approach to quality and requires applicants to examine seven categories of their organizational environment including: 1) leadership, 2) strategy, 3) customers, 4) measurement, analysis, and knowledge management, 5) workforce, 6) operations, and 7) results. The subsequent dissertation examines whether award status is associated with better performance on publicly reported quality measures and financial performance within the nursing home setting. Findings suggest implementation of Baldridge principles may promote improved quality; however, further research is warranted to fully understand the relationship.

Rationale and study aims: Persons with mild cognitive impairment (MCI) experience declines in everyday functioning and cognitive performance greater than what is experienced in normal aging but less than that of dementia. Daily stress and daily memory complaints associated with cognitive deficits may contribute to greater psychological distress in the day-to-day experiences of persons with MCI. However, research examining the occurrence of daily stressors, daily memory complaints and psychological distress in MCI is limited, and it is not clear how the daily processes of stress and affect in persons with MCI compare to cognitively healthy older adults. This dissertation examined the occurrence of daily stressors, daily memory complaints, retrospective and daily well-being in persons with MCI compared to cognitively healthy controls. Main analyses examined whether daily stressors and daily memory complaints were associated with worse daily affect in MCI participants compared to controls, and whether increased daily stress was associated with a greater number of memory complaints. Methods: The study used a short-term repeated measures design, and included MCI and control participants recruited from a university-based memory clinic. The interviews consisted of a baseline interview and up to eight consecutive days of brief daily phone interviews. The interviews included both retrospective and daily measures of psychological well-being, daily stressors, daily memory complaints, and open-ended questions about daily experiences. Results: Persons with MCI reported a greater number of daily memory complaints and worse psychological distress, as measured by both retrospective and daily reports. There were no significant differences between MCI and control participants, however, in the frequency of daily stressors. In both unadjusted and adjusted analyses, on days when a participant reported more daily stressors, they had higher negative affect. The stress-negative affect relationship was stronger for MCI participants compared to controls. MCI and control participants who reported more memory complaints, on average, had higher negative affect. Discussion: Daily stressors were disproportionally associated with greater psychological distress in MCI participants as compared to cognitively healthy controls. Interventions targeting the potential distress associated with daily life may be beneficial for psychological well-being in persons with MCI. Future research should examine other potential mechanisms of distress in daily lives of persons with MCI in order to inform relatives and caregivers of persons with MCI, clinicians who give diagnoses to their patients, and individuals providing community support for individuals living with MCI.

The effectiveness of the A Matter of Balance (MOB) program, a multifactorial falls prevention intervention, is uncertain. Although targeting multiple risk factors of falling at the same time seems reasonable and desirable, in that falls are often caused by several risk factors, results from previous studies investigating the effects of multifactorial falls prevention interventions are inconsistent. In addition, research shows that single factor interventions (e.g., exercise) can produce the same effects. The cost-effectiveness of multifactorial falls prevention interventions has varied across studies (e.g., Jenkyn, Hoch, & Speechley, 2012; Tinetti, Baker, et al., 1994). Despite the fact that the American Geriatrics Society and British Geriatrics Society (2001) have incorporated multifactorial falls prevention interventions into geriatric practice guidelines, more studies are needed to better understand the effects of the MOB program on falls and risk factors for falling among older adults. The MOB program aims to reduce fear of falling by increasing self-efficacy and perceived control (Tennstedt et al., 1998). This program provides exercises to enhance older adults' physical capacities, lessons to teach seniors fall-related risk factors, and methods to enhance self-efficacy. Previous studies mainly focused on the effects of the MOB program on fear of falling and falls efficacy. However, falls, fear of falling, and physical frailty (e.g., poor balance) are all correlated. Little is known about the effects of the MOB program on falls and related physical risk factors. Meanwhile, fear of falling and falls efficacy are two constructs often used to delineate psychological consequences of falling, but there has been confusion about these two constructs. As a result, researchers have been using measures developed for falls efficacy to assess fear of falling in error. Previous study also shows that both fear of falling and falls efficacy need to be examined after intervention with separate appropriate measures(e.g., Valentine, Simpson, Worsfold, & Fisher, 2011). Nevertheless, in the research of the MOB program, studies often examined either fear of falling or falls efficacy, but not both (e.g., Tennstedt et al., 1998; Zijlstra et al., 2009). Therefore, whether the MOB program could improve both fear of falling and falls efficacy is uncertain. This dissertation includes three studies to examine the effects of the MOB program. The first study explores whether the program could effectively prevent falls and improve physical risk factors (i.e., mobility, walking speed, and postural control) among older adults. The second study examines the psychometric properties of a modified fear of falling measure and the effects of the program on fear of falling and falls-efficacy. The third study investigates whether the effects of the MOB program on falls, mobility, walking speed, and postural control can be maintained across five months. Three studies using a comparison group design were conducted to examine each objective. Data were collected at baseline (Time 1), the conclusion of the program (Time 2), and at a 3-month follow-up (Time 3). Overall, the studies in this dissertation show that older adults can improve their mobility, walking speed, postural control, fear of falling, and falls efficacy by participating in the MOB program but the program did not affect the total number of falls. The results also showed that older adults who received the MOB program reached their highest performance on mobility and walking speed immediately at the end of the program. However, their performance on postural control continued to improve and was the best at the 3-month follow-up.

Exercise has many physical, cognitive, and social benefits, but the majority of older adults do not meet the recommended level of physical activity (Centers for Disease Control and Prevention, 2014). TAGteach, which combines elements of both behavioral coaching and acoustical feedback, has been demonstrated as an effective way to teach athletic skills (Fogel, Weil, & Burris, 2010; Quinn, Miltenberger, & Fogel, 2015; Stokes, Luiselli, Reed, & Fleming 2010). However, none of the current research on teaching athletic skills targeted an older population. This study evaluated TAGteach in a multiple baseline across behaviors design as a method of teaching 4 basic baton twirling skills to 3 women aged 62-73. Performance accuracy was low in baseline but improved substantially following the implementation of TAGteach. Participants also rated the intervention positively on a social validity survey. Implications and suggestions for future research are discussed.

Caregivers of persons with dementia, who are often older adults, report sleep disturbance, high rates of depressive symptoms and may be at risk for impaired cognition. This dissertation examined sleep, depressive symptoms, and cognition in older adults and caregivers of persons with dementia. The aims of the review of literature were to understand, in community dwelling adults 60 years and older, the relationships among sleep parameters (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and general sleep complaints), and the domains of cognition (Executive Function, Attention, Episodic Memory, Working Memory, Processing Speed), and global cognition. Based on the findings, the research on the association of subjective sleep parameters and cognition is inconclusive and there is insufficient evidence to confirm or deny the existence of a relationship between objective sleep parameters and cognition. The methods section examined whether in adults 60 years and older, Radloff’s postulated 4-factor structure replicates across Afro-Caribbean Americans, African-Americans, Hispanic-Americans, and European-Americans and determine whether there is evidence for measurement invariance across the four ethnic groups in their responses to the Center for Epidemiological Depression Scale (CES-D) statements. Radloff’s postulated 4-factor model fit the data adequately and the results suggest that there is evidence for configural and partial metric invariance. The final section examined the relationships among subjective sleep parameters (Sleep Onset Latency, Wake After Sleep Onset, Total Sleep Time, Time in Bed, Sleep Efficiency, Sleep Quality), depressive symptoms, and, crystallized, fluid and total cognition in caregivers of persons with dementia with poor sleep. Based on the findings, depressive symptoms also did not mediate the ability of the sleep parameters to predict cognitive performance. With the knowledge that there are potential associations among sleep parameters, depressive symptoms and cognition in caregivers, healthcare providers should collect baseline assessments on sleep, depressive symptoms and cognition from caregivers and monitor them on an ongoing basis to identify changes and intervene in a timely manner. More research studies incorporating measures to capture sleep variability and similar cognitive measures, are needed to clarify the relationships both in older adults and caregivers of persons with dementia.

The quality of care in nursing homes has been evaluated from many varying perspectives, but few studies have analyzed quality in light of complaints made to state survey agencies by residents, their family members, or other individuals interacting with the nursing home. This study analyzed complaints, investigation of complaint allegations, and complaint-related deficiency citations to determine their effect, if any, on the quality of care in nationwide nursing homes. Using the Online Survey Certification and Reporting (OSCAR) survey dataset for facility characteristics and the complaint investigation dataset for outcomes of complaint investigation, analyses conducted included descriptives, correlations, conceptual mapping for complaint-related deficiencies, chi-square tests of independence, t-tests, and generalized estimating equations. At baseline, approximately 66% of nursing homes were for-profit and roughly 53% belonged to a chain membership, while the average percent of residents receiving Medicaid for care reimbursement was 60%. Results indicated that nursing homes differed significantly by profit status and chain membership on whether a complaint was received and whether a deficiency citation was issued following a complaint investigation. Additionally, certain facility and resident-aggregated characteristics, as indicated by odds ratios, were associated with an increase in the likelihood of receiving a complaint or a complaint-related citation. With respect to facility characteristics, for-profit nursing homes and those nursing homes belonging to a chain membership were found to have more complaints and more complaint-related deficiency citations than nonprofit nursing homes and non-chain facilities. Resident-aggregated characteristics, such as a nursing home having more residents restrained, more residents with a catheter, or more residents with a diagnosis of depression, indicated a greater likelihood of receiving a complaint or complaint-related deficiency citation in longitudinal analyses. While additional research could aid in interpreting the effect of complaints on quality of care in nursing homes, study results indicate several facility and resident-aggregated factors that may aid in better understanding of quality of care and improve the training of surveyors and nursing home staff to improve quality of care for residents.