Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

Neste estudo, investigou-se a ocorrência de fármacos (naproxeno, paracetamol, diclofenaco, 17β-estradiol, sulfametazina, sulfadimetoxina e sulfatiazol) e produto de cuidados pessoais (metilparabeno) em amostras de água superficial do Rio Itapecuru (MA), do Rio Mogi Guaçu (SP) e do Rio Monjolinho e seus tributários (SP). As águas dos rios foram caracterizadas por parâmetros físicos e químicos e os analitos foram isolados e pré-concentrados por meio da extração em fase sólida (SPE) e, subsequentemente, analisados por cromatografia líquida acoplada à espectrometria de massas de alta resolução (LC-ESI-QqTOF/MS). O método desenvolvido foi validado e mostrou-se linear na faixa de 50 a 400 µg L-1, com coeficientes de determinação maiores que 0,99. Os limites de detecção e quantificação para todos os analitos foram 16 e 50 µg L-1, respectivamente, os valores de recuperação variaram entre 50 e 99%, a precisão intradia variou entre 0,26 e 6,99% e a exatidão variou entre 88,45 e 103,07%. Nas amostras provenientes do Rio Monjolinho e de seus tributários as concentrações máximas de paracetamol, naproxeno e metilparabeno foram 143,97, 75,90 e 56,18 µg L-1, respectivamente. Nas amostras coletadas no Rio Mogi Guaçu (SP) o metilparabeno e o naproxeno foram apenas detectados, bem como o metilparabeno no Rio Itapecuru (MA), uma vez que suas concentrações, apresentaram-se abaixo do limite de quantificação do método. A análise de componentes principais (PCA) mostrou que as variáveis oxigênio dissolvido (OD) e carbono orgânico total (TOC) estão altamente correlacionadas com as elevadas concentrações dos fármacos e metilparabeno encontradas nas amostras, assim como explicou o efeito da variabilidade espaço-temporal nas concentrações. As curvas de distribuição da sensibilidade das espécies (SSD) foram construídas e indicaram que sensibilidades distintas são obtidas dependendo das espécies e do analito ao qual esta foi exposta, evidenciando que a presença dos fármacos e do metilparabeno no ambiente aquático podem provocar desequilíbrio na cadeia alimentar. Portanto, este estudo traz informações analíticas e ecotoxicológicas importantes sobre os contaminantes emergentes em ambiente aquático, que podem ser utilizadas como base de dados para a criação de novas legislações que restrinjam a entrada desses compostos nos corpos aquáticos. / In this study, we investigated the occurrence of pharmaceuticals (naproxen, paracetamol, diclofenac, 17β-estradiol, sulfametazine, sulfadimethoxine and sulfathiazole) and personal care product (methylparaben) in surface water samples from the Itapecuru River (MA), Mogi Guaçu River (SP) and the Monjolinho River and its tributaries (SP). The river waters were characterized by physical and chemical parameters, the analytes were isolated and preconcentrated by solid phase extraction (SPE) and subsequently analyzed using liquid chromatography coupled to high resolution mass spectrometry (LC-ESI-QqTOF/MS). The chromatographic method presented coefficients of determination higher than 0.99 and linear ranges of 50 - 400 µg L-1. The limits of detection and quantification were 16 µg L-1 and 50 µg L-1, respectively, for all the analytes. Recovery values were 50 - 99 %, intraday precision were 0.26 - 6.99%, and accuracy were 88.45 - 103.07%. In the samples from Monjolinho River and its tributaries the maximum concentrations of paracetamol, methylparaben and naproxen were 143.97, 75.90, and 56.18 µg L-1, respectively. In the samples collected in Mogi Guaçu River (SP), methylparaben and naproxen were only detected, as well as methylparaben in the Rio Itapecuru (MA), since their concentrations were below the limit of quantification of the method. Principal components analysis (PCA) showed that the variables dissolved oxygen (OD) and total organic carbon (TOC) are highly correlated to the high concentrations of drugs and methylparaben found in the samples, as well as explaining the spatio-temporal variability in the concentrations. Species sensitivity distribution curves (SSD) were built and they indicated that different sensitivities are obtained depending on the specie and the analyte which it was exposed, evidencing that the presence of pharmaceuticals and methylparaben in the aquatic environment can cause imbalance in the food chain. Therefore, this study provides important analytical and ecotoxicological informations on emerging contaminants in the aquatic environment, which can be used as a database for the elaboration of a new legislation to restrict the entry of these compounds into aquatic bodies.

Neste estudo, investigou-se a ocorrência de fármacos (naproxeno, paracetamol, diclofenaco, 17β-estradiol, sulfametazina, sulfadimetoxina e sulfatiazol) e produto de cuidados pessoais (metilparabeno) em amostras de água superficial do Rio Itapecuru (MA), do Rio Mogi Guaçu (SP) e do Rio Monjolinho e seus tributários (SP). As águas dos rios foram caracterizadas por parâmetros físicos e químicos e os analitos foram isolados e pré-concentrados por meio da extração em fase sólida (SPE) e, subsequentemente, analisados por cromatografia líquida acoplada à espectrometria de massas de alta resolução (LC-ESI-QqTOF/MS). O método desenvolvido foi validado e mostrou-se linear na faixa de 50 a 400 µg L-1, com coeficientes de determinação maiores que 0,99. Os limites de detecção e quantificação para todos os analitos foram 16 e 50 µg L-1, respectivamente, os valores de recuperação variaram entre 50 e 99%, a precisão intradia variou entre 0,26 e 6,99% e a exatidão variou entre 88,45 e 103,07%. Nas amostras provenientes do Rio Monjolinho e de seus tributários as concentrações máximas de paracetamol, naproxeno e metilparabeno foram 143,97, 75,90 e 56,18 µg L-1, respectivamente. Nas amostras coletadas no Rio Mogi Guaçu (SP) o metilparabeno e o naproxeno foram apenas detectados, bem como o metilparabeno no Rio Itapecuru (MA), uma vez que suas concentrações, apresentaram-se abaixo do limite de quantificação do método. A análise de componentes principais (PCA) mostrou que as variáveis oxigênio dissolvido (OD) e carbono orgânico total (TOC) estão altamente correlacionadas com as elevadas concentrações dos fármacos e metilparabeno encontradas nas amostras, assim como explicou o efeito da variabilidade espaço-temporal nas concentrações. As curvas de distribuição da sensibilidade das espécies (SSD) foram construídas e indicaram que sensibilidades distintas são obtidas dependendo das espécies e do analito ao qual esta foi exposta, evidenciando que a presença dos fármacos e do metilparabeno no ambiente aquático podem provocar desequilíbrio na cadeia alimentar. Portanto, este estudo traz informações analíticas e ecotoxicológicas importantes sobre os contaminantes emergentes em ambiente aquático, que podem ser utilizadas como base de dados para a criação de novas legislações que restrinjam a entrada desses compostos nos corpos aquáticos. / In this study, we investigated the occurrence of pharmaceuticals (naproxen, paracetamol, diclofenac, 17β-estradiol, sulfametazine, sulfadimethoxine and sulfathiazole) and personal care product (methylparaben) in surface water samples from the Itapecuru River (MA), Mogi Guaçu River (SP) and the Monjolinho River and its tributaries (SP). The river waters were characterized by physical and chemical parameters, the analytes were isolated and preconcentrated by solid phase extraction (SPE) and subsequently analyzed using liquid chromatography coupled to high resolution mass spectrometry (LC-ESI-QqTOF/MS). The chromatographic method presented coefficients of determination higher than 0.99 and linear ranges of 50 - 400 µg L-1. The limits of detection and quantification were 16 µg L-1 and 50 µg L-1, respectively, for all the analytes. Recovery values were 50 - 99 %, intraday precision were 0.26 - 6.99%, and accuracy were 88.45 - 103.07%. In the samples from Monjolinho River and its tributaries the maximum concentrations of paracetamol, methylparaben and naproxen were 143.97, 75.90, and 56.18 µg L-1, respectively. In the samples collected in Mogi Guaçu River (SP), methylparaben and naproxen were only detected, as well as methylparaben in the Rio Itapecuru (MA), since their concentrations were below the limit of quantification of the method. Principal components analysis (PCA) showed that the variables dissolved oxygen (OD) and total organic carbon (TOC) are highly correlated to the high concentrations of drugs and methylparaben found in the samples, as well as explaining the spatio-temporal variability in the concentrations. Species sensitivity distribution curves (SSD) were built and they indicated that different sensitivities are obtained depending on the specie and the analyte which it was exposed, evidencing that the presence of pharmaceuticals and methylparaben in the aquatic environment can cause imbalance in the food chain. Therefore, this study provides important analytical and ecotoxicological informations on emerging contaminants in the aquatic environment, which can be used as a database for the elaboration of a new legislation to restrict the entry of these compounds into aquatic bodies.

The U.S. Congress has made health information technology a central component of the national quest to improve health care delivery. The problem addressed in this study was the uncertainty among healthcare providers regarding the benefits of health care information technology adoption relative to healthcare delivery processes and outcomes. The purpose of the study was to understand the effectiveness of information technology as perceived by healthcare providers. The research questions were designed to investigate the relationship between health information technology and organizational effectiveness, exchange of information, organizational process, organizational productivity, and direct personal care. Sociotechnical systems theory and Donabedian's framework for health care quality evaluation were the theoretical bases for this quantitative study. Data were provided through anonymous online survey of 116 healthcare workers, and analyzed using multiple regression and Spearman's correlation coefficient. The results of the study showed a statistically significant positive correlation between organizational effectiveness, organizational exchange of information, organizational process, organizational productivity, and healthcare information technology. No statistically significant correlation existed between personal care and health information technology. These findings suggest that providers' frequent use of healthcare information technology, like telemedicine, makes patients less involved. The implications for social change include enabling healthcare providers to develop an efficient and effective way to engage with patients, in order to achieve effective patient-centered organization.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents. / May 2009

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents.

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents.

Made available in DSpace on 2016-06-02T20:34:59Z (GMT). No. of bitstreams: 1 6522.pdf: 11813930 bytes, checksum: 7b3b28c9003cd9b02191060694246535 (MD5) Previous issue date: 2015-01-29 / Universidade Federal de Sao Carlos / Three different classes of emerging contaminants were analyzed in surface water samples, suspended particulate matter (SPM) and sediments from the Jundiaí River Basin - SP. The hormones 17-β-estradiol and 17-α-ethinylestradiol were the only compounds that were not detected in the matrices studied. Caffeine was the compound detected with the highest concentrations for water samples, with values up to 25000 μg/L, while in sediment samples and MPS, triclosan was the compound that had the highest concentrations, with 0.90 μg/g 79.1 g/g, respectively. Other compounds more often detected included atenolol, carbamazepine, diclofenac, propranolol and triclosan, with mean concentrations up to 17 ng/L in samples from Piraí Creek and greater than 120 ng/L for samples from Jundiaí River. A seasonal effect was observed in the concentrations of the compounds and the higher values for all of these were obtained for samples from a sampling point located downstream of a sewage treatment plant. It was found a high correlation between the concentrations of detected compounds and the electrical conductivity, which allowed suggesting the use of new contamination markers by sewage. The occurrence of studied compounds was widespread among samples from Rio Jundiaí, showing the high level of environmental impact to which this water body is exposed. / Três diferentes classes de contaminantes emergentes foram analisadas em amostras de água superficial, material particulado suspenso (MPS) e sedimentos provenientes da Bacia Hidrográfica do Rio Jundiaí - SP. Os hormônios 17-β- estradiol e 17-α-etinilestradiol foram os únicos compostos não detectados nas matrizes estudadas. A cafeína foi o composto detectado com as maiores concentrações para as amostras de água, com valores de até 25000 μg/L, enquanto nas amostras de sedimento e MPS, o triclosan foi o composto que apresentou as maiores concentrações, atingindo 0,90 μg/g e 79,1 μg/g, respectivamente. Outros compostos mais frequentemente detectados incluíram o atenolol, a carbamazepina, o diclofenaco, o propranolol e o triclosan, com concentrações médias de até 17 ng/L nas amostras do Ribeirão Piraí e superiores a 120 ng/L para o Rio Jundiaí. Observou-se um efeito sazonal nas concentrações dos compostos e os valores mais elevados para todos estes foram obtidos no ponto amostral localizado a jusante de uma estação de tratamento de esgotos. Verificou-se uma alta correlação entre as concentrações dos compostos detectados e a condutividade elétrica, o que possibilitou sugerir a utilização de novos marcadores de contaminação por esgotos. A ocorrência dos compostos em estudo foi generalizada para as amostras do Rio Jundiaí, demonstrando o alto nível de impacto ambiental a que esse corpo aquático está exposto.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.