Psychosocial working conditions play a significant role for health during working age, as well as in post-retirement life. However, little is known about the impact of work stressors on cognitive and physical impairment assessed in combination. The aim was to study associations between midlife work stressors and physical and cognitive impairment in older age for women and men separately. The data were derived from two Swedish nationally representative surveys. The same participants were followed through three waves at the mean ages of 54, 61, and 81 (n=360). Multinomial logistic regression was used to assess the association between work stressors, and test of cognitive and physical function. Low control and passive jobs were associated with higher odds of cognitive impairment, and cognitive and physical impairment when assessed in combination. These findings were driven by associations found among men. Accumulated low control and passive jobs across midlife were associated with physical impairment in older age among men, but not among women. These results highlight the importance of work stressors for physical and cognitive impairment in older age. Improving psychosocial working conditions in midlife, in particular increasing the level of control among employees, may promote healthy aging.

Doctor of Philosophy / Department of Industrial & Manufacturing Systems Engineering / Malgorzata J. Rys / This dissertation is the result of studying different methods of increasing guide sign visibility and legibility to drivers during nighttime, to increase safety on roadways. It also studies intersection lighting to indicate the lighting benefits on nighttime crash frequency reduction. From a survey conducted, practices related to overhead guide sign illumination and retroreflectivity in United States were summarized. A laboratory experiment was conducted to compare light distribution of five light sources: Metal Halide, Mercury Vapor, High Pressure Sodium, induction lighting, and Light Emitting Diode (LED). Cost analysis of the five light sources was performed. Combining results of the laboratory experiment and the cost analysis, induction lighting was recommended for states that want to continue external sign illumination. A retroreflectivity experiment was conducted to compare three types of retroreflective sheeting: Engineering Grade (type I), Diamond Grade (type XI), and High Intensity (type IV), to determine the sheeting that best increases visibility and legibility. Diamond Grade (type XI) was found to be the optimal sheeting that increases visibility and legibility to drivers during nighttime. A glare experiment was conducted to expand the retroreflectivity experiment results. Four sheeting-font combinations of High Intensity (type IV) and Diamond Grade (type XI) materials and Series E (Modified) and Clearview fonts were compared. Results revealed an optimal sheeting-font combination of Diamond Grade (type XI) sheeting and Clearview font which increases the visibility and legibility of guide signs to drivers under presence of oncoming glare source. The Highway Safety Information System (HSIS) database was used to study the effect of intersection lighting on the expected crash frequency. Illuminated intersections showed 3.61% and 6.54% decrease in the expected nighttime crash frequency as compared to dark intersections in Minnesota and California, respectively. In addition, partial lighting at intersections decreases the expected nighttime crash frequency by 4.72% compared to continuous lighting in Minnesota. The recommended sheeting-font combination for Departments of Transportation was Diamond Grade (type XI) and Clearview. This combination will increase signs’ visibility and legibility to drivers, and consequently increase safety on roadways. Adding partial lighting at intersections will reduce the expected nighttime crash frequency, and increase safety on roadways.

Background: Adverse birth outcomes present a difficult and chronic challenge in Ontario, in Canada and in developed countries in general. Increasing proportions of preterm births, significant regional disparities and the high cost of treating all adverse birth outcomes have focused attention on explaining them and developing effective treatments. Methods: Birth outcomes and maternal characteristics for approximately 626,000 births, about 90% of births in 2005–2009, were linked to small geographic areas throughout Ontario. For each of four adverse outcomes: late preterm, moderate to very preterm, small for gestation age and still births, proportions of total births were calculated for the full province and for each small geographic area. Geographic hotspots of elevated rates were identified for each of the different adverse birth outcomes using the local Moran’s I statistic. Data for nine known ecologic and individual risk factors were then linked to the areas. Hierarchical regression analysis was used to model each of the outcomes for the full province and for dispersed local areas. The resulting models for the different outcomes were contrasted. Results: Significant geographic hotspots exist for each of the four outcomes. Hotspots for the different outcomes were found to be largely spatially exclusive. For like outcomes, predictive models differed markedly between local areas (i.e. local groups of hotspots) as well as between full-province and local areas. Ecologic level variables played a strong role in all models; the influence of individual level risk factors was consistently modified by ecologic risk factors except for small for gestational births. Conclusions: The finding of significant hotspots for different adverse birth outcomes indicates that certain geographic areas have aetiologies or patterns of predictors sufficient to create significantly elevated levels of particular outcomes. The finding that hotspots for the different adverse outcomes are largely exclusive implies that the aetiologies are specific; i.e., those that are sufficient to create significantly higher levels for one outcome do not also create significantly higher levels of others. The consistently strong role of ecologic level risk factors in modifying individual level risk factors implies that contextual characteristics are an important part of the aetiology of adverse birth outcomes. Differences in local area models suggest the existence of location-specific (rather than universal) aetiologies. The findings support the need for more careful attention to local context when explaining birth outcomes.

Made available in DSpace on 2016-06-02T19:50:25Z (GMT). No. of bitstreams: 1 TeseVAGR.pdf: 3064239 bytes, checksum: 381f34490e3e91c32ab1ea5948e9c82a (MD5) Previous issue date: 2005-04-27 / Financiadora de Estudos e Projetos / Due to the rapid aging of the Brazilian population, the number of programs for the elderly is increasing. The objectives of this study were to: (a) analyze the organizations that offer services for the elderly, in a city in the state of Sao Paulo, Brazil, and (b) identify the support network used by dependent elderly. In the conduct of this study, all ethical guidelines that apply to studies with humans were followed. The organizations were identified using municipal registers, and others sources as Snow Ball Technique, and interviews were conducted with the head administrators. The organizations were grouped in four categories: long-term care (n=6); culture, leisure, sports, education and social activities (n=27); healthcare (n=21); and referral (n=1), totaling 55 organizations that offer services for the elderly. An advertising folder containing all pertinent information was produced and was it was presented to the Municipal Elderly Council in order to be advertised and upgraded. The greatest numbers of elderly were involved in cultural, leisure, sports, education and social programs, a category that emphasizes activities that promote social integration. However, in a two years period, of the 2183 registered participants, 225 withdrew (150 women and 75 men). To better understand this, interviews were conducted with program directors and service users in the highest use category, along with other documents. The most frequent reasons for withdrawal were illness (n=42) and death (n=42). Thus, in-depth interviews were conducted with elderly people, who withdrew due to illness, and their family members in their home. It was observed that the aggravating stages of some diseases caused an increased difficulty of instrumental activities on a daily basis contributed to some limitations, and among them the difficulty of continuing participating in the program. Issues like financial difficulties, adapted transportation and cultural values also were relevant to the organization of the family dynamics of interviewed people. It was verified that the most utilized support network by these people was the family. Caring places in the health area were also used in the treatment of the pathologies. New organization alternatives in terms of elderly caring need to be created to attend the population that grows and ages day after day. On the other hand, it is necessary to improve the conditions of existing caring institutions with the focus on team and qualified work in order to educate the population facing the aging process. / Em função do envelhecimento populacional, há no Brasil atualmente uma grande diversidade de serviços e programas para idosos. O objetivo deste trabalho foi analisar a oferta de serviços disponíveis para idosos com alguma dependência de uma cidade do interior paulista. Para identificar essas organizações foi realizado um levantamento junto à Prefeitura Municipal, usando-se a técnica Bola de Neve e uma pesquisa em listas telefônicas, através de palavras-chave. Foram realizadas entrevistas com os dirigentes das organizações encontradas, e as informações foram organizadas e sistematizadas em 4 categorias: moradia (n=6); cultura, lazer, esporte, educação e social (n=27); saúde (n=21) e suporte/encaminhamento (n=1), totalizando 55 organizações de atendimento ao idoso. Foi produzido um folder com essas informações, divulgado na comunidade e todo material desse folder foi entregue ao Conselho Municipal do Idoso para continuidade da atualização e divulgação. A categoria cultura, lazer, esporte, educação e social teve destaque quanto ao número de lugares e das pessoas que participavam. Ela desenvolve atividades que enfatizam a integração social. No entanto, quando as pessoas adoecem e passam a apresentar alguma dependência deixam de freqüentar estes espaços, conhecidos por grupos da terceira idade. Identificar quem eram os desistentes, desses lugares, que adoeceram e a rede de suporte formal e informal utilizada por eles e seus familiares, foram os objetivos seguintes desta pesquisa. Para tanto, foram realizadas entrevistas com os responsáveis dos programas da categoria: cultura, lazer, esporte, educação e social, além de consultas aos registros e entrevistas com usuários, depois de dois anos da primeira entrevista. Os resultados demonstraram que, dos 2183 inscritos, 306 pessoas (14%) deixaram de participar, sendo 211 mulheres (69%) e 95 homens (31%). Desses, 225, eram idosos; 150, mulheres (67%); e 75, homens (33%). A maioria dos coordenadores desconhecia os motivos pelos quais os idosos deixaram de participar, seguido dos motivos ter ficado doente (n=42) e ter morrido (n=42). Entrevistas em profundidade com os idosos, que deixaram de freqüentar por motivo de doença, e com seus familiares foram realizadas no domicílio dos mesmos. Constatou-se que o agravamento de algumas doenças dificultando principalmente as atividades instrumentais de vida diária foram as que contribuíram para algumas limitações cotidianas, dentre elas, continuarem a participar dos programas. Fatores como, dificuldades financeiras, transporte adaptado e valores culturais, também foram relevantes para a organização da dinâmica familiar dos entrevistados, frente à dependência cotidiana. Verificou-se que a rede de suporte mais utilizada por eles foi à família. Lugares de atendimento na área de saúde também foram utilizados pautados no tratamento de patologias. Novas alternativas de organizações de atendimento a idosos dependentes precisam ser criadas para atender a heterogeneidade de uma população que cresce cada vez mais e que está ficando cada vez mais idosa. Por outro lado, faz-se necessário melhorar o atendimento dos lugares já existentes, focalizando um trabalho integrado, sistematizado, qualificado no sentido de educar a população como um todo frente os desafios do processo do envelhecimento com ou sem dependência.

Background: Adverse birth outcomes present a difficult and chronic challenge in Ontario, in Canada and in developed countries in general. Increasing proportions of preterm births, significant regional disparities and the high cost of treating all adverse birth outcomes have focused attention on explaining them and developing effective treatments. Methods: Birth outcomes and maternal characteristics for approximately 626,000 births, about 90% of births in 2005–2009, were linked to small geographic areas throughout Ontario. For each of four adverse outcomes: late preterm, moderate to very preterm, small for gestation age and still births, proportions of total births were calculated for the full province and for each small geographic area. Geographic hotspots of elevated rates were identified for each of the different adverse birth outcomes using the local Moran’s I statistic. Data for nine known ecologic and individual risk factors were then linked to the areas. Hierarchical regression analysis was used to model each of the outcomes for the full province and for dispersed local areas. The resulting models for the different outcomes were contrasted. Results: Significant geographic hotspots exist for each of the four outcomes. Hotspots for the different outcomes were found to be largely spatially exclusive. For like outcomes, predictive models differed markedly between local areas (i.e. local groups of hotspots) as well as between full-province and local areas. Ecologic level variables played a strong role in all models; the influence of individual level risk factors was consistently modified by ecologic risk factors except for small for gestational births. Conclusions: The finding of significant hotspots for different adverse birth outcomes indicates that certain geographic areas have aetiologies or patterns of predictors sufficient to create significantly elevated levels of particular outcomes. The finding that hotspots for the different adverse outcomes are largely exclusive implies that the aetiologies are specific; i.e., those that are sufficient to create significantly higher levels for one outcome do not also create significantly higher levels of others. The consistently strong role of ecologic level risk factors in modifying individual level risk factors implies that contextual characteristics are an important part of the aetiology of adverse birth outcomes. Differences in local area models suggest the existence of location-specific (rather than universal) aetiologies. The findings support the need for more careful attention to local context when explaining birth outcomes.

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.