The need for Registered Nurses (RNs) in the long-term care of older people is being questioned, particularly in the context of nursing shortages, while suggestions for 'professionalising' Care Assistant (CA) roles are emerging. Despite ongoing debates about the importance of their work, research has so far been unable to provide an evidence-base for the outcomes of the work of either RNs or CAs in UK care homes. Using a multi-method interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer, this qualitative research sought to illuminate the distinct contributions made by RNs and CAs to outcomes for older people in care homes. RNs and CAs from around the UK contributed 'significant' examples of their work for Phase 1 of the study and Phase 2 comprised researcher fieldwork (observation, interviews and documentary analysis) in three care homes around England. Participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. The findings offer a rich and detailed analysis of the realities of the work, much of which takes place 'behind closed doors' and has been described to a limited extent in the literature. They suggest that the CAs' daily support helps residents to function and to feel valued, and that close, reciprocal, family-type relationships develop. The health knowledge and clinical expertise of good RNs is critical in determining residents' health outcomes, particularly in the long-term, and RNs' 24-hour 'perceptual presence' can make life or death differences in acute or emergency situations. RNs also influence the environment, atmosphere and quality of care in the home. In the context of the literature, the findings offer new insights into the role and contribution of RNs and CAs, the outcomes of their work and the priorities of residents. The study produced new models of RN and CA roles in care homes, encompassing dimensions not previously acknowledged in the literature or their job descriptions, and a new framework within which the outcomes of care for older people could be evaluated. The research offers a positive image of work with older people in independent sector care homes.

M Family Medicine research report - Faculty of Health Sciences / Residents of old age homes are at increased risk for the complications of influenza. Studies in developed countries have consistently shown that influenza vaccination of old age home residents and staff can significantly decrease morbidity and mortality rates and that influenza vaccination is one of the most cost effective interventions possible in this population. No studies have been done on the cost benefit of using influenza vaccine in old age home residents in South Africa. The aim of this study was to evaluate the costs of treating influenza and influenza-like illnesses in old age home residents, and to compare the costs in people who had received the influenza vaccine to those who had not. The study population comprised 151 people residing in two old age homes in Johannesburg, namely Sandringham Gardens and Nazareth House. The study population was divided into two groups- those who received influenza vaccine and those who had not been vaccinated. The residents of Nazareth House who gave consent had all been vaccinated. The subjects at Sandringham Gardens were sub- divided into two groups, namely: “Residents” and “Frail care / wards” section. The general health of the “Frail care” people was poorer than that of the “residents”. Medical records were reviewed, and details of the number of doctor consultations, medication and physiotherapy prescribed, special investigations performed and hospital referrals related to influenza and influenza-like infections were recorded. The costs were then calculated using “medical aid rates”. There were no significant differences in the treatment costs, comparing those who had been vaccinated to those who had not been vaccinated. There are a number of possible explanations for this. These include, most importantly, a low to moderate epidemic activity of influenza in the season that the study was conducted. Other explanations are low patient numbers, the use of symptoms for diagnosis and the use of over the counter therapy. Despite the findings in the present study, the international literature supports the view that influenza vaccination is a cost-effective intervention in the older adult population, particularly those at higher risk. These findings have been implemented in the official guidelines of many countries, including the South African Adult Influenza Vaccination Guideline.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-02-22T12:52:34Z No. of bitstreams: 1 Alexsandro Dantas Maia_.pdf: 5539206 bytes, checksum: 1bb51804b7e3a921d44bff69a326a041 (MD5) / Made available in DSpace on 2018-02-22T12:52:34Z (GMT). No. of bitstreams: 1 Alexsandro Dantas Maia_.pdf: 5539206 bytes, checksum: 1bb51804b7e3a921d44bff69a326a041 (MD5) Previous issue date: 2017-12-19 / Nenhuma / A presente dissertação tem como objetivo analisar as formas de atuação e as demandas/reinvindicações da Associação de Moradores em sua luta pelo direito à moradia na comunidade Sol Nascente, localizada no Distrito Federal. O objeto de estudo é a Comunidade Sol Nascente, tendo como foco a Associação de Moradores Mãos Solidárias, localizada na região administrativa de Ceilândia. É uma pesquisa na área das Ciências Sociais mas com uma perspectiva interdisciplinar por trabalhar com alguns teóricos do campo do Direito, História e Filosofia. O trabalho está inserido em uma vertente de consolidação de direitos constitucionais e no princípio da dignidade. Propõe-se a mostrar através de entrevistas com os principais líderes comunitários as principais demandas e reinvindicações relacionadas ao processo de regularização fundiária da localidade, e um dos pontos que mais teve destaque foi o reconhecimento como cidadão e pessoa com dignidade. / This dissertation aims to analyze the forms of action and demands / claims of the Residents' Association in their struggle for the right to housing in the Sol Nascente community, located in the Federal District. The object of study is the Sol Nascente Community, focusing on the Association of Solidary Residents Residents, located in the administrative region of Ceilândia. It is a research in the area of Social Sciences but with an interdisciplinary perspective for working with some theorists in the field of Law, History and Philosophy. The work is part of a consolidation of constitutional rights and the principle of dignity. It proposes to show through interviews with the main community leaders the main demands and claims related to the land regularization process of the locality, and one of the most important points was recognition as a citizen and a person with dignity.

A pesquisa analisou os fatores envolvidos na expansão recente do Turismo receptivo em três localidades situadas no entorno da cidade de Campos do Jordão, na Serra da Mantiqueira - SP: Santo Antonio do Pinhal, São Bento do Sapucaí e o distrito de São Francisco Xavier, pertencente ao município de São José dos Campos. Em virtude da expressividade do fenômeno turístico na área, justifica-se avaliar os efeitos da expansão das estruturas receptivas sobre a vida das populações. A abordagem privilegiou a questão do desenvolvimento sustentável como elemento definidor das ações dos organizadores do Turismo, e avaliou junto aos moradores as formas de participação no processo. O referencial teórico apoiou-se em autores da Geografia do Turismo e outras disciplinas da área de Ciências Sociais, as quais auxiliam no estudo do fenômeno turístico. Por meio de entrevistas com os organizadores e uma amostra dos residentes, utilizou-se a fenomenologia como método para captar as percepções e opiniões dos moradores quanto ao crescimento das atividades receptivas nas três localidades. Constatouse que aos fatores de atratividade originais, o clima e a paisagem serranos, outros estão sendo adicionados à área, em razão da saturação de Campos, como a tranqüilidade dos lugarejos, a paisagem rural e os recursos associados ao meio natural. Essas mudanças na oferta atendem novas demandas e geram formas inéditas de organização do espaço turístico na área, impondo desafios às populações envolvidas. / This study analyses the causes of the recent tourism growth among three sites located around the city of Campos do Jordão, on Serra da Mantiqueira, a hill area on the northeast of the state of São Paulo. The places named Santo Antonio do Pinhal, São Bento do Sapucaí e São Francisco Xavier (the latest is a district of the city of São Jose dos Campos), have their receptive structures been increased during last decade, as a consequence of the appeal of Campos do Jordão, which causes crescent demands over all that region. Due to the extention that Tourism activities are obtaining in the area, one can realize several effects over the residents living standards. As theoretical references the author used the concepts of sustainability, tourism planning, and categories such as tourist space and landscape, performing the first chapter. Study field avaliated the relations of residents which the phenomenon, using questionnaires as well as interviews with tourist authorities. The Phenomenology was the method used to analyze residents attitudes toward tourist policies and practices. Results showed that tourism activities are fastly increasing in those locations, causing new concerns and challenges to the residents.

INTRODUÇÃO: Os custos representam um problema crucial na formação e especialização do médico no mundo moderno. Conhecer os gastos relacionados ao ensino é importante para o planejamento financeiro das instituições de ensino. A cirurgia de catarata é um dos pontos centrais da formação do oftalmologista. O objetivo deste estudo foi comparar os custos e as complicações peroperatórias da cirurgia de catarata realizada por residentes com a cirurgia realizada por um cirurgião experiente. MÉTODOS: Neste estudo prospectivo, as cirurgias de facoemulsificação executadas por residentes durante os 3 primeiros meses de treinamento foram comparadas com cirurgias realizadas por um cirurgião experiente quanto aos custos e complicações. Foram incluídas 312 cirurgias, sendo 261 realizadas por residentes e 51 pelo cirurgião experiente. As cirurgias foram divididas, de acordo com a experiência cirúrgica do residente no momento da realização do procedimento (Grupo 1: 0 a 40 cirurgias; Grupo 2: 41 a 80 cirurgias; Grupo 3: mais de 80 cirurgias). RESULTADOS: O custo médio das cirurgias realizadas pelos residentes foi de R$ 802,74 ± 352,48 e pelo cirurgião experiente R$ 588,74 ± 44,68. No grupo 1, foram observados R$ 862,63 ± 382,17; no grupo 2 R$ 809,99 ± 377,92 e no grupo 3 R$ 702,16 ± 234,64. Quanto ao tempo de cirurgia, observou-se nas cirurgias dos residentes 54,2 ± 23,4 minutos e nas cirurgias do grupo controle (cirurgião experiente) 36,0 ± 15,3 minutos. O tempo observado no grupo 1 foi 57,6 ± 23,0 minutos; no grupo 2 foi 54,6 ± 24,7 minutos e no grupo 3 foi 49,0 ± 18,3 minutos. Todas as comparações foram estatisticamente significantes (P<0,05). A taxa de complicação encontrada nas cirurgias realizadas pelos residentes foi de 11,49% e nas cirurgias realizadas pelo cirurgião experiente foi de 1,92%. No grupo 1 observaram-se 9,65% de rotura de cápsula posterior e 8,77% de perda vítrea; no grupo 2, 7,37% de rotura de cápsula e 4,21% de perda vítrea e no grupo 3, 5,77% de rotura de cápsula e 3,85% de perda vítrea. Estas complicações não foram percebidas nas cirurgias do grupo controle. CONCLUSÃO: A cirurgia de catarata realizada pelo residente representa um aumento dos gastos estatisticamente significante para o serviço e um aumento nos riscos de complicação aos pacientes. A diferença cai progressivamente com a realização de mais procedimentos, demonstrando os efeitos do treinamento / BACKGROUND: The costs represent crucial problem in medical training and specialization in the modern world. Meet the expenses related to education is important for the financial planning of educational institutions. Cataract surgery is one of the central points of the training of ophthalmologists. The aim of this study is to compare the costs and complications of cataract surgery performed by residents with the surgery performed by an experienced surgeon. METHODS: In this prospective study, the phacoemulsification performed by residents during the first 3 months of training was compared with surgery performed by an experienced surgeon about the costs and complications. There were included 312 surgeries; residents performed 261 and an experienced surgeon performed 51. The surgeries were divided according to resident surgical experience at the time of performing the procedure (Group 1: 00-40 surgery, Group 2: 41-80 surgeries and group 3: more than 80 surgeries). RESULTS: The mean cost of surgeries performed by residents was R$ 802.74 ± 352.48 and by the surgeon was R$ 588.74 ± 44.68. In group 1, was observed a mean cost of R$ 862.63 ± 382.17; in group 2 R$ 809.99 ± 377.92 and in group 3 R$ 702.16 ± 234.64. Regarding the time of surgery, was observed in surgeries performed by residents 54.2 ± 23.4 minutes and in the surgery control group (surgeon) 36.0 ± 15.3 minutes. The time observed in group 1 was 57.6 ± 23.0 minutes; in group 2 was 54.6 ± 24.7 minutes and in group 3 was 49.0 ± 18.3 minutes. All comparisons were statistically significant (P <0.05). The complication rate found in surgeries performed by residents was 11.49% and the surgery performed by experienced surgeons was 1.92%. In group 1 we observed rates of 9.65% of posterior capsule rupture and 8.77% of vitreous loss; in group 2 was observed rate of 7.37% of capsule rupture and 4.21% of vitreous loss and in group 3 was observed rate of 5.77% of capsule rupture and 3.85% of vitreous loss. These complications were not observed in the surgery control group. CONCLUSION: Cataract surgery performed by the resident is a statistically significant increase in spending for the service and an increased risk of complications for patients. This difference progressively decreases with the completion of more procedures, demonstrating the effect of training

The purpose of this study was to explore Morro Bay residents’ attitudes toward tourism and knowledge about tourism in the three major tourism impact categories (economic, socio-cultural, and environmental). A mail-back questionnaire was hand-delivered during the winter of 2011 to 720 Morro Bay residents. In general, Morro Bay residents had slightly positive attitudes toward tourism in their community. The mean attitude score was 3.27 on a 5-point Likert type scale. The subjects had a relatively low level of tourism knowledge. The mean total indirect tourism knowledge score was 2.98 on a 5-point Likert-type scale. Residents’ total direct tourism knowledge score was 0.33 on a scale of zero to one. A multiple regression model was used to test for an association between residents’ knowledge about tourism, community attachment, socio-demographic variables, and residents’ attitudes toward tourism. The only variables that were associated with residents’ attitude toward tourism were: length of residency, interest in learning more about tourism, level of education, household income, subjective tourism knowledge, economic tourism knowledge, and environmental tourism knowledge. The two most significant variables were economic tourism knowledge and environmental tourism knowledge. Future research should test the effectiveness of different methods to increase residents’ tourism knowledge.

In low-income, suburban Black communities, the prevalence of diet-related chronic illnesses is alarming. Various influences often increase diet-related illnesses among this population. One influence is the use of SNAP benefits to purchase food. In this study, the influences of SNAP as well as other influences affecting food purchase decisions among the study population was examined. A qualitative multicase study approach was used and, face-to-face interviews were conducted, to understand the experiences of 20 low-income, current recipients of SNAP who were Black and lived in suburban, New York. The data indicated the most significant influence, communicated by the participants, was that children in the household had a great deal of influence over food purchases. This was followed by health issues and concerns of those in the household and, the SNAP benefit amount. The study results shed light on multiple issues faced not just with buying food, but with trying to buy healthy food on a SNAP budget. The findings are consistent with previous studies which suggest food choices are often influenced by personal and cultural ideals, and controlled by present income, family structure, and the health of family members. The study findings also support Bandura's conceptual framework which believes before changes in behavior can take place, factors that can possibly influence behavior must be considered. In conclusion, providing guidance for both public health and social service providers on the influences that effect behavior among specific populations may impact social change and lead to greater success in the prevention of diet-related chronic illnesses.

<p>Hip fractures are the most serious consequence of osteoporosis, and are one important cause of morbidity and mortality among the elderly. Prophylactic treatment for hip fractures are now available. Early detection of individuals with increased risk for hip fractures is therefor of great interest. A subset of non-institutionalised patients with a first hip fracture (cases;n=l18) and controls (n=263), aged 65-85 years, underwent dual X-ray absorptiometry (DXA) of the femoral neck, quantitative ultrasound (QUS) of the heel and phalanges and radiographic absorptiometry (RA) of the phalanges. The entire cohort was followed for approximately four years or to death. In women, DXA of the proximal femur and QUS of the heel showed a high predictive value for an incident first hip fracture, adjusted odds ratio (OR) 3.6 (95% confidence interval (CI) 2.4-5.5) and 3.4 (95%CI 2.2-5.0) respectively. The association was even stronger in men, but only for DXA of the proximal femu,r with an adjusted OR of4.8 (95%CI 2.3-9.9). Bone densitometry at non-weight-bearing sites, QUS and RA of the phalanges did not discriminate female cases from controls, but proved capable of separating male cases from controls. The risk of death was higher in cases than in controls, with a multivariate rate ratio (RR) of 3.4 (95%CI 1.7-7.0). There was no significant association between bone density and mortality. </p><p>Nursing home residents underwent QUS of the heel and phalanges. Almost all of the female residents and 51% of the male residents were, if the WHO-criterion for osteoporosis was applied, osteoporotic as assessed by heel and finger QUS. The QUS values were approximately 1.5 SD lower than expected for age and gender. </p><p>In this randomised controlled intervention study we evaluated the effect of external hip protectors in nursing home residents; 302 residents were allocated to wear such protectors and 442 were controls. External hip protectors were found to be effective in preventing hip fractures in nursing home residents, with an adjusted relative risk for hip fracture of 0.33 (CI 0.11 - 1.00). </p>

Hip fractures are the most serious consequence of osteoporosis, and are one important cause of morbidity and mortality among the elderly. Prophylactic treatment for hip fractures are now available. Early detection of individuals with increased risk for hip fractures is therefor of great interest. A subset of non-institutionalised patients with a first hip fracture (cases;n=l18) and controls (n=263), aged 65-85 years, underwent dual X-ray absorptiometry (DXA) of the femoral neck, quantitative ultrasound (QUS) of the heel and phalanges and radiographic absorptiometry (RA) of the phalanges. The entire cohort was followed for approximately four years or to death. In women, DXA of the proximal femur and QUS of the heel showed a high predictive value for an incident first hip fracture, adjusted odds ratio (OR) 3.6 (95% confidence interval (CI) 2.4-5.5) and 3.4 (95%CI 2.2-5.0) respectively. The association was even stronger in men, but only for DXA of the proximal femu,r with an adjusted OR of4.8 (95%CI 2.3-9.9). Bone densitometry at non-weight-bearing sites, QUS and RA of the phalanges did not discriminate female cases from controls, but proved capable of separating male cases from controls. The risk of death was higher in cases than in controls, with a multivariate rate ratio (RR) of 3.4 (95%CI 1.7-7.0). There was no significant association between bone density and mortality. Nursing home residents underwent QUS of the heel and phalanges. Almost all of the female residents and 51% of the male residents were, if the WHO-criterion for osteoporosis was applied, osteoporotic as assessed by heel and finger QUS. The QUS values were approximately 1.5 SD lower than expected for age and gender. In this randomised controlled intervention study we evaluated the effect of external hip protectors in nursing home residents; 302 residents were allocated to wear such protectors and 442 were controls. External hip protectors were found to be effective in preventing hip fractures in nursing home residents, with an adjusted relative risk for hip fracture of 0.33 (CI 0.11 - 1.00).

Globally, there are 2.5 billion people who do not have access to improved sanitation. One third of these people are living in India. Bad sanitation is both undignified and causes the spread of diseases like diarrhoea. It is a large challenge to handle the problematic situation with sanitation, especially in urban areas. Sustainable sanitary systems that are energy self-sufficient and do not require sewage system are needed. There are new techniques with this in mind that are under development. The aim of this thesis is to investigate the possibilities to implement a sustainable sanitary system in slum areas of Mumbai. The chosen area and existing sanitary techniques is investigated in the literature study. To understand the user requirements and their living situation, a field study is performed in slum areas of Mumbai. Interviews are held with experts from organisations working with the sanitary situation in the area to get a deeper understanding about their experiences. The sanitary situation today is not well functioning, a new way of solving the problem is needed and it has to happen soon. Through an analysis of the empirical findings, three different sanitary situations are presented. It is important that each area is investigated to identify what situation there is, before building new sanitary facilities. To achieve a more sustainable sanitation, one system for each of the three situations should be developed. Requirements for each of the situations are presented and they all have two things in common, the toilet is shared between a determined amount of people and the user has the responsibility for the maintenance. From a cross mapping between the investigated sanitary techniques and the requirements for the three situations, it is clarified what techniques that are suitable in which context. No one of the investigated techniques is a perfect match and further development is needed. One of the sanitary situations is taken further through concept development. The concepts are compared against the requirements to identify the best concept. The best concept with modifications is visualised to exemplify how it may be designed. In the comparison between the requirements and concepts, gaps in the design and issues for further development are identified. The core of this master thesis is to emphasise the importance of having a holistic approach concerning the sanitary situation. It is important that new techniques are being developed with a close connection to the users and the specific environment. By investing money in more sustainable systems, the situation for the slum residents in Mumbai can be improved and at the same time contribute to a more sustainable society.