The Churchill Falls are a second Niagara. They are situated in the interior of Labrador, about 200 miles from the nearest point of the open Atlantic coast, and about 225 miles north of the Gulf of St.Lawrence (figure 1-1). [...]

More than 50% of people with MS fall in any six-month period. The importance of developing a suitable falls management programme has been identified by people with MS and professionals. This thesis aimed to develop a model for an MS falls intervention. The studies employed a systematic approach to evaluate the risk factors for falls and to identify the optimal programme content, format and structure. Methods The thesis comprises two sections; the first involving a systematic review and an observational study of falls risk factors (n=148). Part two included a second systematic review to inform programme content, and a nominal group study (n=36) to explore approach, format and structure from the perspective of key stakeholders. Results Part one identified the potential target group (people at key mobility transition stages and those with progressive MS), and mechanisms by which the intervention could act (the identification of specific risk factors associated with falls in MS). These include non-modifiable disease and demographic characteristics (e.g. MS classification and gender), and potentially modifiable clinical characteristics (including balance, mobility, continence issues and medication usage). Part two identified that an MS specific falls programme should address falls and participation-related outcomes, incorporating educational activities and a programme of individually tailored gait, balance and functional training. The programme should use a collaborative approach; supporting participants to achieve sufficient intensity and duration of exercise and to integrate falls prevention strategies into their daily lives. The programme should enable participants to engage flexibly according to individual needs and preferences. Conclusions This thesis has identified specific risk factors associated with accidental falls in MS. The evaluation indicates that the success and sustainability of an MS falls programme requires that it is MS specific, employs a collaborative approach and moves away from the group-based, weekly format common to many generic falls programmes.

The tittle: The falls of senior people at home surroundings and thein preventions The goal: The goal of this theses was to finf out the degrese of seniors knowing at preventative moves which can avoid falls and through question forms to analyze how the information about danger from the falls at home surroundings influenced the seniors effort to modify their homes. The mothod: At my thesis I used the mothod of quantity analyses. I obtained the data through questionn aires. The interviewed respondents are senior people at age of 65 and more. I interviewed 130 respondents in total and Theky were dividend into 2 groups according to the age or purposes of this thesis. In the first group are seniors between 65 and 74 and the other group is represented by people at age 75 and more. The questionnaire contained 23 questions and was split u pinto 6 domains. The first free questions were related to personal datas and social background of seniors. Next free questions find out the fall at anamnesis and the others are directed to home safeness, foreknowledge about preventive moves and the reslting behavior of respondents in relation to Pasove increase of home safeness. The results: The single points of the questionnaire are graphically illustrated and compared with available literature or other essays. The...

O objetivo geral deste trabalho foi estudar a prevalência de quedas e fragilidade entre os idosos no ano de 2006, e a incidência de fragilidade no período de 2006 a 2010, tendo quedas como principal variável independente. Para tal objetivo foram utilizados os dados do Estudo SABE (Saúde, Bemestar e Envelhecimento), referentes aos idosos residentes no município de São Paulo em duas coletas (2006 e 2010). A amostra é representativa dos idosos residentes no município de São Paulo realizada por conglomerados com duplo estágio. Para a descrição das amostras em 2006 e 2010 foram realizadas análises bivariadas, cruzando-se as variáveis independentes e com as variáveis desfecho. Como se trata de amostra complexa, o teste para associação foi o de Rao-Scott que toma em conta os pesos amostrais. Os dados foram analisados através da técnica de Análise Multivariada, o que permitiu uma abordagem analítica, considerando o comportamento de cada variável per si e na presença das demais. Foi utilizado o modelo de regressão logística para prevalência de 2006 e os fatores associados à fragilidade. No período 2006-2010, para estudar os desfechos, foi empregado a regressão de Poisson para encontrar a Incidence Rate Ratio, ou seja, os fatores associados à incidência no período 2006- 2010. Neste último caso as categorias de fragilidade Pré-frágil e Frágil foram agrupadas em uma só. As incidências foram comparadas pelo teste de Cox baseado na regressão. Como resultado foi observado que a variável quedas foi significativa nas análises bivariada e na prevalência, mas não na análise de incidência. Na incidência da fragilidade no período de 2006 a 2010 temos associações significativas com as variáveis: idade, alteração da visão, dificuldade para cuidar próprio dinheiro, utilizar transporte e dificuldade para tomar seus remédios. Portanto, concluiu-se que muitas dessas variáveis são modificáveis, ou seja, é possível reabilitar ou adaptar para que o paciente possa ter uma melhor qualidade de vida e diminuir os riscos de fragilidade e/ou quedas. Assim, a importância de criação de grupos multidisciplinares de prevenção e promoção da saúde, além de novas pesquisas envolvendo quedas e fragilidade em idosos para que esses, mesmo frágeis, possam ter uma melhor qualidade de vida. / The objective of this work is to study the prevalence of falls and frailty among the elderly in 2006, and the incidence of frailty in the 2006-2010 period and falls as the main independent variable. For this objective will be used data from the SABE Study (Health, Wellbeing and Aging), relating to elderly people living in São Paulo in two collections (2006 and 2010). The sample is representative of the elderly in São Paulo carried out by conglomerates with dual stage. For a description of the samples in 2006 and 2010 bivariate analyzes will be carried out, crossing the independent variables and the outcome variables. As these are complex sample, the test for association will be the Rao-Scott that takes into account the sampling weight. Data were analyzed by multivariate analysis technique, which enabled an analytical approach, considering the behavior of each variable itself and in the presence of others. Was used the logistic regression model for 2006 prevalence and factors associated with fragility. In the period 2006-2010, to study the outcomes, was used Poisson regression to find the Incidence Rate Ratio, that is, factors associated with the incidence in 2006-2010. In the latter case the categories of Pre-frail and frail were grouped into one. The incidences were compared using Cox regression test based on. As a result it was observed that was significant in the variable falls bivariate analysis and the prevalence, incidence but not in the analysis. The incidence of frailty in the 2006-2010 period have significant association with age, abnormal vision, difficulty to look after their own money, using transport and difficult to take your medication. Therefore, it was concluded that many of these variables are modifiable, or it is possible to rehabilitate or adapt for the patient to get a better quality of life and reduce the risk of frailty and / or falls. Thus, the importance of creating multidisciplinary teams of prevention and health promotion, and new research involving falls and frailty in the elderly so that these, same fragile, can have a better quality of life.

As quedas que são consideradas um problema de saúde pública, vêm expressivamente acometer a população idosa e pode ocasionar consequências físicas e sociais. Este estudo teve como objetivo identificar o perfil demográfico, de saúde e ambiental dos idosos e dos caidores, além de suas atitudes de risco. Tratou-se de um estudo observacional e transversal, realizado no município de Araraquara-SP, com envolvimento de 100 indivíduos, assistidos pela ESF. Os participantes foram escolhidos pelos prontuários, após, foram entrevistados em suas residências no período de agosto a dezembro de 2012. O formulário modificado baseado no estudo Saúde, Bem-estar e Envelhecimento foi utilizado contendo informações gerais, hábitos pessoais, atividade física, estado de saúde, histórico de quedas, estado funcional, característica da moradia, risco comportamental e antropometria. Os idosos (caidores ou não) e caidores eram maioria do sexo feminino, viúvos, baixa escolaridade e possuíam filhos. Predominaram aqueles que nunca fumaram, não ingeriam bebida alcoólica ou menos que um dia ao mês, administravam de 1 a 3 medicamentos e realizavam o nível moderado de atividade física. Quanto a auto-percepção de saúde, ambos os grupos diziam ser boa, referiam sua saúde comparada a 12 meses atrás como igual, e diziam ter saúde melhor comparada a pessoas da mesma idade; em relação a doença auto-relatada, prevaleceu a hipertensão arterial, e o quadro álgico esteve presente na maioria dos grupos, na região das costas. Em relação ao índice de massa corporal, em geral, eram eutróficos, e sobre o nível de dependência, predominaram os independentes nas atividades de vida diária. Quanto aos aspectos ambientais foram observados na entrada das casas rampas e no interior, tapetes soltos. O comportamento de risco no idoso mais evidente foi vestir calça em pé e para os caidores, não utilizar iluminação quando entrar em cômodo escuro. Esta pesquisa auxiliou a descrever os aspectos envolvidos na população e seu ambiente sobre a ação de cair. / Falls are considered a public health problem, come significantly affect the elderly population and can cause physical and social consequences. This study aimed to identify the demographic, health and environmental elderly and fallers, and their risk attitudes. This study was observational, cross-sectional conducted in the city of Araraquara-SP, involving 100 subjects, assisted by the Family Health Strategy. Participants were chosen by the records, and were interviewed in their homes during the period August to December 2012. The modified form based on the study Health, Wellbeing and Aging was used containing general information, personal habits, physical activity, health status, history of falls, functional status, housing characteristics, behavioral risk and anthropometry. The elderly (fallers and not it) and fallers were mostly female, widowed, low education and had son. Those who never smoked predominated, did not drink alcohol or less than one day per month, administered 1-3 drugs and performed the moderate level of physical activity. As the self-perception of health, both groups were said to be \"good\", reported their health compared to 12 months ago as \"equal\", and claimed to have health \"better\" compared to people of the same age, in relation to self-reported illness, prevalent hypertension and arthritis, rheumatism and arthrosis, his pain was present in most groups in the region of \"back.\" In relation to body mass index, in general, were eutrophic, and the level of dependence, those independent predominated the activities of daily living. Regarding environmental aspects were observed in the entrance of houses ramps and inside, loose rugs. The most obvious risk behavior in the elderly was \"wearing trousers standing\" and the fallers \"do not use lights when entering dark room.\" This research helped to describe the issues involved in the population and its environment on the action of falling.

As quedas que são consideradas um problema de saúde pública, vêm expressivamente acometer a população idosa e pode ocasionar consequências físicas e sociais. Este estudo teve como objetivo identificar o perfil demográfico, de saúde e ambiental dos idosos e dos caidores, além de suas atitudes de risco. Tratou-se de um estudo observacional e transversal, realizado no município de Araraquara-SP, com envolvimento de 100 indivíduos, assistidos pela ESF. Os participantes foram escolhidos pelos prontuários, após, foram entrevistados em suas residências no período de agosto a dezembro de 2012. O formulário modificado baseado no estudo Saúde, Bem-estar e Envelhecimento foi utilizado contendo informações gerais, hábitos pessoais, atividade física, estado de saúde, histórico de quedas, estado funcional, característica da moradia, risco comportamental e antropometria. Os idosos (caidores ou não) e caidores eram maioria do sexo feminino, viúvos, baixa escolaridade e possuíam filhos. Predominaram aqueles que nunca fumaram, não ingeriam bebida alcoólica ou menos que um dia ao mês, administravam de 1 a 3 medicamentos e realizavam o nível moderado de atividade física. Quanto a auto-percepção de saúde, ambos os grupos diziam ser boa, referiam sua saúde comparada a 12 meses atrás como igual, e diziam ter saúde melhor comparada a pessoas da mesma idade; em relação a doença auto-relatada, prevaleceu a hipertensão arterial, e o quadro álgico esteve presente na maioria dos grupos, na região das costas. Em relação ao índice de massa corporal, em geral, eram eutróficos, e sobre o nível de dependência, predominaram os independentes nas atividades de vida diária. Quanto aos aspectos ambientais foram observados na entrada das casas rampas e no interior, tapetes soltos. O comportamento de risco no idoso mais evidente foi vestir calça em pé e para os caidores, não utilizar iluminação quando entrar em cômodo escuro. Esta pesquisa auxiliou a descrever os aspectos envolvidos na população e seu ambiente sobre a ação de cair. / Falls are considered a public health problem, come significantly affect the elderly population and can cause physical and social consequences. This study aimed to identify the demographic, health and environmental elderly and fallers, and their risk attitudes. This study was observational, cross-sectional conducted in the city of Araraquara-SP, involving 100 subjects, assisted by the Family Health Strategy. Participants were chosen by the records, and were interviewed in their homes during the period August to December 2012. The modified form based on the study Health, Wellbeing and Aging was used containing general information, personal habits, physical activity, health status, history of falls, functional status, housing characteristics, behavioral risk and anthropometry. The elderly (fallers and not it) and fallers were mostly female, widowed, low education and had son. Those who never smoked predominated, did not drink alcohol or less than one day per month, administered 1-3 drugs and performed the moderate level of physical activity. As the self-perception of health, both groups were said to be \"good\", reported their health compared to 12 months ago as \"equal\", and claimed to have health \"better\" compared to people of the same age, in relation to self-reported illness, prevalent hypertension and arthritis, rheumatism and arthrosis, his pain was present in most groups in the region of \"back.\" In relation to body mass index, in general, were eutrophic, and the level of dependence, those independent predominated the activities of daily living. Regarding environmental aspects were observed in the entrance of houses ramps and inside, loose rugs. The most obvious risk behavior in the elderly was \"wearing trousers standing\" and the fallers \"do not use lights when entering dark room.\" This research helped to describe the issues involved in the population and its environment on the action of falling.

O objetivo geral deste trabalho foi estudar a prevalência de quedas e fragilidade entre os idosos no ano de 2006, e a incidência de fragilidade no período de 2006 a 2010, tendo quedas como principal variável independente. Para tal objetivo foram utilizados os dados do Estudo SABE (Saúde, Bemestar e Envelhecimento), referentes aos idosos residentes no município de São Paulo em duas coletas (2006 e 2010). A amostra é representativa dos idosos residentes no município de São Paulo realizada por conglomerados com duplo estágio. Para a descrição das amostras em 2006 e 2010 foram realizadas análises bivariadas, cruzando-se as variáveis independentes e com as variáveis desfecho. Como se trata de amostra complexa, o teste para associação foi o de Rao-Scott que toma em conta os pesos amostrais. Os dados foram analisados através da técnica de Análise Multivariada, o que permitiu uma abordagem analítica, considerando o comportamento de cada variável per si e na presença das demais. Foi utilizado o modelo de regressão logística para prevalência de 2006 e os fatores associados à fragilidade. No período 2006-2010, para estudar os desfechos, foi empregado a regressão de Poisson para encontrar a Incidence Rate Ratio, ou seja, os fatores associados à incidência no período 2006- 2010. Neste último caso as categorias de fragilidade Pré-frágil e Frágil foram agrupadas em uma só. As incidências foram comparadas pelo teste de Cox baseado na regressão. Como resultado foi observado que a variável quedas foi significativa nas análises bivariada e na prevalência, mas não na análise de incidência. Na incidência da fragilidade no período de 2006 a 2010 temos associações significativas com as variáveis: idade, alteração da visão, dificuldade para cuidar próprio dinheiro, utilizar transporte e dificuldade para tomar seus remédios. Portanto, concluiu-se que muitas dessas variáveis são modificáveis, ou seja, é possível reabilitar ou adaptar para que o paciente possa ter uma melhor qualidade de vida e diminuir os riscos de fragilidade e/ou quedas. Assim, a importância de criação de grupos multidisciplinares de prevenção e promoção da saúde, além de novas pesquisas envolvendo quedas e fragilidade em idosos para que esses, mesmo frágeis, possam ter uma melhor qualidade de vida. / The objective of this work is to study the prevalence of falls and frailty among the elderly in 2006, and the incidence of frailty in the 2006-2010 period and falls as the main independent variable. For this objective will be used data from the SABE Study (Health, Wellbeing and Aging), relating to elderly people living in São Paulo in two collections (2006 and 2010). The sample is representative of the elderly in São Paulo carried out by conglomerates with dual stage. For a description of the samples in 2006 and 2010 bivariate analyzes will be carried out, crossing the independent variables and the outcome variables. As these are complex sample, the test for association will be the Rao-Scott that takes into account the sampling weight. Data were analyzed by multivariate analysis technique, which enabled an analytical approach, considering the behavior of each variable itself and in the presence of others. Was used the logistic regression model for 2006 prevalence and factors associated with fragility. In the period 2006-2010, to study the outcomes, was used Poisson regression to find the Incidence Rate Ratio, that is, factors associated with the incidence in 2006-2010. In the latter case the categories of Pre-frail and frail were grouped into one. The incidences were compared using Cox regression test based on. As a result it was observed that was significant in the variable falls bivariate analysis and the prevalence, incidence but not in the analysis. The incidence of frailty in the 2006-2010 period have significant association with age, abnormal vision, difficulty to look after their own money, using transport and difficult to take your medication. Therefore, it was concluded that many of these variables are modifiable, or it is possible to rehabilitate or adapt for the patient to get a better quality of life and reduce the risk of frailty and / or falls. Thus, the importance of creating multidisciplinary teams of prevention and health promotion, and new research involving falls and frailty in the elderly so that these, same fragile, can have a better quality of life.

There remain vast knowledge gaps in the global south as to how tourism will affect climate change and vice versa. Recent extreme weather events in southern Africa attributed to climate variability and change have led to speculation that, the Victoria Falls, is under threat from climate change. This research was aimed at examining the two-way linkage between tourism and climate change. The research adopted a pragmatism paradigm in a mixed-method case study. A number of research techniques were used to investigate the problem, namely: an online survey (n=427), secondary data analysis, field observation and interviews. Data analysis was done making use of Mann-Kendall Trend Analysis, QuestionPro analytics, Microsoft Excel Analysis Toolpak, Tools from ArcMap 10.3.1 and SPSS 24. Content analysis and thematic analysis was used to analyse secondary and interview data respectively. It emerged that the Victoria Falls is experiencing climate change, which resulted in statistically significant increase in temperature over the past 40 years of between 0.3°C and 0.75°C per decade. However, no significant changes in rainfall were noted, although there has been a seasonal shift in average rainfall onset. Weather extremes and annual rainfall point to increased occurrence and severity of extreme years of droughts and wetting which has in turn also affected waterflow regime at the waterfalls. The changes have a negative impact on wildlife, tourists, and tourism business in the area. The study also revealed that tourism is an equally significant driver of climate change through carbon emissions throughout its value chain. Carbon emissions from tourism value chain are set to increase in the foreseeable future despite efforts of going green by the industry owing to exponential growth of the industry. There is, therefore, a need for the industry to adapt, mitigate and intensify green tourism efforts to achieve sustainability. The study further suggests that there is a need for better communication and education to build resilience and capacity for the tourism industry to deal with climate change. Further research is suggested to ascertain the tourism threshold for the area, impact of climate change on wildlife and basin changes that led to water flow increase in the Zambezi River. / Environmental Sciences / Ph. D. (Environmental Management)

No description available.

Incidents of falls among the elderly increase with age. About $31 million is spent annually in the United States on medical costs related to fall injuries in the elderly. This project evaluated the outcomes of a fall reduction program implemented in an assisted living facility (ALF). The Stop Elderly Accidents, Death & Injury program developed by the Centers for Disease Control and Prevention was implemented by the ALF for 60 days prior to the outcome evaluation project. The program included a convenience sample of 62 residents and involved medication evaluation, exercises, assistive devices, environmental risk reduction, and evaluation of blood pressure. Bandura's theory on self-efficacy was applied in guiding the implementation process. The practice-focused question compared the fall rate among the ALF's elderly residents during the 30-day period following implementation of the program, and the previous 12months. The fall rates were analyzed with descriptive statistics. Results showed the preintervention fall rate was 6.6 falls per month, while at the end of the 30-day postimplementation period, that rate was reduced by 39.4% to 4 falls per month. The conclusion of this outcome-evaluation project is that falls among the elderly in the ALF can be reduced with evidence-based programs. The recommendation is that ALFs should have fall reduction programs, thereby avoiding unnecessary complications of falls among elderly residents. Implications for nursing practice include improved understanding of falls as a safety issue for ALF residents and the need for nurse practitioners to take a more active role as advocates for fall prevention programs in ALFs. The positive societal change produced is improved safety and reduction in fall injuries among the elderly in assisted living facilities.