O presente trabalho se propôs a fazer uma avaliação da higiene e saúde orais de pacientes geriátricos portadores de próteses totais. Devido ao crescimento da população idosa houve um aumento do número de pacientes que passaram a usar algum tipo de prótese (total, removível ou implantes). Espera-se que as próteses totais restituam as funções estéticas, mastigatórias e fonéticas, no entanto sua instalação não representa o final da reabilitação protética, existindo a necessidade da realização de controles periódicos. Um dos fatores essenciais para o sucesso do tratamento odontológico é a higienização eficiente, capaz de remover o biofilme das próteses. Em casos de estomatite protética associada à Cândida ssp, as medidas terapêuticas mais eficientes são os controles efetivos da higiene oral, assim como das próteses (HEARTWELL; RAHN, 1993). Partindo desse raciocínio, o índice de placa nas faces interna e externa das próteses totais maxilares foi avaliado, neste trabalho, através do uso de evidenciadores. Esse procedimento foi realizado em próteses novas tendo-se a preocupação de orientar, no momento da instalação, os portadores das mesmas sobre cuidados de higienização da cavidade oral e das próteses. Foi realizado ainda exame citológico do palato desses mesmos pacientes a fim de verificar a presença de Cândida albicans. Os resultados encontrados não mostraram diminuição dos índices de biofilme depositados nas próteses totais maxilares tanto dos pacientes do grupo experimental como dos pacientes do grupo controle, sendo que se procurou avaliar também distúrbios cognitivos. Estes resultados sugerem que o método de motivação não foi eficiente e que fatores psicológicos, sociais e culturais influenciam a motivação dos pacientes em relação a hábitos de saúde oral. / This research intended to evaluate hygiene and oral health in geriatric patients using complete dentures. Because the elderly population has increased fast much more people uses today some kind of prostheses (complete, removable or implants). It’s expected that complete dentures should replace facial expression, mastigatory function and speech as well. However this is not always possible because patients are supposed to accept the inconvenience and responsibility of taking care of their own prostheses. A very important step is to perform a good hygiene intending to control biofilm development on tooth surface as well as over the prostheses. In Candida-associated denture stomatites the most important therapeutic measure is institution of effective oral and denture hygiene (HEARTWELL; RAHN, 1993). Based on what was mentioned before it was analyzed by means of staining, the biofilm index in the internal and external faces of complete dentures. Such procedures were performed in the new prostheses after instructing the patient how to clean them. It was also performed a cytologic exam of the palatal mucosa to verify if Candida albicans were present, or not. The results did not show any diminution of the biofilm index accumulate in the maxillary prostheses of both groups: control and experimental with or without deficit of cognition. Such results suggest that the motivation method was not efficient and also that psychologic, social and cultural factors do influence the patient’s motivation when we deal with oral health.

Orientador: Eduardo Hebling / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-12T07:54:32Z (GMT). No. of bitstreams: 1 Coutinho_LorenaAlves_M.pdf: 1135268 bytes, checksum: e47d5b9869b01e8a35af855f67d41a1d (MD5) Previous issue date: 2008 / Resumo: O envelhecimento populacional e o desenvolvimento de uma filosofia preventiva no atendimento odontológico fazem com que um número maior de pessoas alcance idade avançada, mantendo a sua dentição. O processo de envelhecimento humano proporciona uma série de alterações anatômicas, fisiológicas e sociais nos pacientes que devem ser consideradas no atendimento odontológico. O objetivo deste estudo foi determinar a condição endodontica de pacientes idosos. Foram avaliados 942 dentes em 81 idosos, com idade acima de 60 anos, funcionalmente independentes ou parcialmente dependentes, com o mínimo de 3 dentes presentes na cavidade bucal, residentes em duas instituições da cidade de Piracicaba-SP, Brasil. Foram realizados exame clínico, radiográfico e testes complementares de vitalidade pulpar. Os resultados foram avaliados por estatística descritiva. A maioria dos dentes avaliados não apresentou lesões endodônticas, porém quando avaliados os dentes com canais tratados endodonticamente constatou-se uma alta prevalência de lesões apicais nestes dentes. Houve correlação entre canais endodonticamente tratados e lesões apicais decorrentes da qualidade dos tratamentos endodônticos. A prevalência de calcificações pulpares e dos canais radiculares observada na amostra foi elevada. Em conclusão, a alta prevalência de calcificações pulpares e dos canais radiculares, de lesões apicais e de necessidade de retratamentos endodônticos fazem com que a demanda por serviços de endodontia em idosos permaneça elevada. / Abstract: The ageing population and the development of a philosophy in preventive dental care are such that a larger number of people reaching old age while maintaining their teeth. The process of human aging provides a series of anatomical, physiological and social alterations in patients that should be considered in dental care. The aim of this study was to determine the endodontic status in elderly patients. 942 teeth were evaluated in 81 elderly patients, aged above 60 years, functionally independent or partly dependent, showed a minimum of 3 teeth in the mouth, residents in two institutions in the city of Piracicaba-SP, Brazil. The clinical trial and radiographic and pulp vitality examination were conducted. The data were evaluated through the descriptive statistic. The results showed that most of the teeth evaluated endodontic showed no injuries, but when evaluated the teeth with root canal treatment there was a high prevalence of apical injuries. There was correlation between root canal treatment and periodontitis apical and injuries due to the quality of endodontic treatments. The prevalence of canal and pulp calcifications observed was high. In conclusion, the high prevalence of canal and pulp calcifications, apical injuries, and need for endodontic treatment will be doing that demand for endodontic care stay elevated. / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Orientador: Eduardo Hebling / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-18T21:15:42Z (GMT). No. of bitstreams: 1 Souza_SilviaFerreirade_M.pdf: 622832 bytes, checksum: e711ade5c26d35edfa9b7f9cb5a5d983 (MD5) Previous issue date: 2011 / Resumo: O aumento da longevidade da população mundial faz com que a expectativa de manutenção da dentição possa ser observada em idosos. Esse fato pode acarretar em aumento da prevalência das doenças periodontais nessa população. O objetivo desse estudo foi avaliar a condição periodontal de idosos institucionalizados. Foram utilizados dados secundários provenientes de estudo anterior. Foram avaliados os exames radiográficos periapicais padronizados obtidos de uma amostra de 70 pessoas, de ambos os gêneros, com idade acima de 65 anos, funcionalmente independentes ou parcialmente independentes, com o mínimo de 6 dentes em ambas as arcadas, residentes em duas instituições da cidade de Piracicaba-SP, Brasil. As radiografias foram avaliadas por um examinador calibrado (Kappa > 85%), em ambiente escuro, com uso de lupa, negatoscópio e paquímetro digital. O Nível Ósseo Marginal (NOM) interproximal foi utilizado como parâmetro de avaliação. Os dados foram avaliados pelos testes de Wilcoxon e Kruskal-wallis. A prevalência de reduzido NOM foi alta, influenciando a expressiva perda dentária observada entre os idosos. Nenhuma diferença na distribuição do NOM entre os grupos de dentes foi observada. Futuras ações e políticas de saúde devem ser desenvolvidas para melhorar a condição periodontal para essa população / Abstract: The increase in longevity of the world population makes the expectation of maintenance of dentition can be observed in the elderly. This fact may result in increased prevalence of periodontal diseases in this population. The aim of this study was to evaluate the periodontal condition of institutionalized elderly. Secondary data from a previous study were used. Standardized periapical radiographic exams obtained from a sample of 70 subjects, both genders, aged above 65 years, functionally independent or partially independent, with a minimum of 6 teeth in both the arcades, residing in two institutions of the city of Piracicaba-SP, Brazil, were assessed. The radiographs were evaluated by a calibrated examiner (Kappa > 85%), in environment dark, using loupe, negatoscópio and digital caliper. Interdental Marginal Bone Level (MBL) was used as assessed parameter. The data were assessed by means of Wilcoxon and Kruskal-wallis tests. The prevalence of reduced MBL was high, influencing the expressive tooth loss among the elderly. No difference in a distribution of the MBL between the teeth groups was founded. Further preventive actions and health politics have been developed for improve the periodontal status for this population / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Biståndshandläggning är ett högst aktuellt ämne som diskuteras världen över och som forskas mycket om i Sverige. Syftet med studien var att undersöka hur biståndshandläggare upplever sin egen hälsa av att fatta beslut. Åtta biståndshandläggare intervjuades, varav två var män och sex kvinnor med ett åldersspann på 32–42 år. Sex av dessa hade en socionomexamen och två av de en beteendevetenskaplig kandidatexamen på högskolenivå. I analys av resultatet identifierades fyra grundkategorier: negativa upplevelser, stressupplevelser, positiva upplevelser och förhållningssätt. Resultatet visade att de biståndshandläggare som hade låg arbetserfarenhet upplevde stress genom handläggningsprocessen medan de som hade flera års erfarenhet inte påverkades i lika hög grad. Studien ligger till grund för framtida studier där framtida forskning kan breddas med hjälp av ett större urval för att kunna få en insyn i bredare perspektiv. Undersökningens slutsats var att individens hälsa påverkas genom beslutsprocessen både positivt som negativt.

Acute hospitals have seen unprecedented demographic changes, where older age, frailty and cognitive impairment now characterise the majority of health service users. Delirium is very common in this setting, and adverse outcomes are well described. However, studies investigating cognitive outcomes after delirium in unselected samples have been lacking. This thesis had four objectives: (1) To estimate the prevalence of delirium in the general population (2) To assess the association of delirium with cognitive outcomes (3) To investigate how these associations relate to underlying dementia pathology (4) To develop novel methods for retrospectively ascertaining delirium. Methods: Data from three population-based neuropathology cohort studies were used: Vantaa 85+; Cambridge City over-75s Cohort (CC75C); MRC Cognitive Function and Ageing Study (CFAS). (1) To ascertain the prevalence of delirium in the general population, a measure of delirium was developed using data recorded in standardised interview schedules, with criterion validity evaluated through the association with mortality and dementia risk. (2) The association with cognitive outcomes was tested in a series of logistic regression models, where delirium was the exposure and dementia (or worsening dementia severity) was the outcome. In addition, the association with change in Mini-Mental Status Examination (MMSE) score was assessed using random-effects linear regression. (3) In brain donors from all three cohorts, the independent effects of delirium, dementia pathology, and their interaction, were investigated using the same approach. (4) A chart-based method for deriving a retrospective diagnosis for delirium was developed, validated against bedside psychiatrist diagnosis. Vignettes from the medical record were abstracted and delirium status decided by expert consensus panel. Results: (1) Age-specific prevalence in CFAS increased with age from 1.8% in the 65-69 year age group to 13.5% in the ≥90 age group (p<0.01 for trend). (2) Delirium was consistently associated with adverse cognitive outcomes: new dementia (OR 8.7, 95% CI 2.1 to 35); worsening dementia severity (OR 3.1, 95% CI 1.5 to 6.3); faster change in Mini-Mental Status Examination (MMSE) score (1.0 additional points/year, p<0.01) (3) In the neuropathology analyses, decline attributable to delirium was -0.37 MMSE points/year (p<0.01). Decline attributable to dementia pathology was -0.39 MMSE points/year (p<0.01). However, the combination of delirium and dementia pathology resulted in the greatest decline, where the interaction contributed a further -0.16 MMSE points/year (p=0.01), suggesting that delirium worsened cognitive trajectories in dementia, but through distinct pathophysiological pathways not accounted for by Alzheimer’s, vascular or Lewy body pathology. (4) The chart abstraction method yielded a sensitivity of 0.88 and specificity 0.75 for ‘possible delirium’, with lower sensitivity (0.58) and higher specificity (0.93) for ‘probable delirium’ (AUC 0.86, 95% CI 0.82 to 0.89). This thesis adds to the small body of work on delirium in prospective studies, with the first ever analyses conducted in whole populations. The findings suggest new possibilities regarding the pathology of cognitive impairment, positioning delirium and/or its precipitants as a critically inter-related mechanism.

Altered mental status (AMS), a common and serious entity in elderly Emergency Department patients, is not well recognized by physicians. Our prospective cohort study evaluated the implementation, by nurses and physicians, of the Ottawa 3DY Scale, a cognitive screening tool. We enrolled 260 patients (60.0% female, mean age 83.7). Screening rates were: overall - 78.3%; physician - 51.8%; and nurse - 64.2%. Interrater reliability was 0.65. Physician and nurse sensitivity was 78.9, 84.6% and specificity was 39.4, 54.2%, respectively, compared with the Mini-Mental State Exam. Patient living situation, educational level, triage location, hospitalization, admission location and 30 day mortality were associated with AMS. Implementation of the Ottawa 3DY Scale increased screening for AMS in elderly Emergency Department patients. It was feasible, sensitive, specific and had good interrater reliability. Use will lead to increased identification of cognitive impairment and ultimately result in improved care and outcomes in this vulnerable patient population.

The current status of gerontological nursing curricula in Canadian generic baccalaureate nursing programs has not been studied. As the Canadian society changes the health care system is struggling to provide adequate health care to the growing population over the age of 65. Nurses must be prepared to assist the elderly in the community and in institutions to cope with increasing disabilities. Therefore, the study of gerontological nursing should be a requirement in a nurses' basic education to prepare them to work with older clients in all settings. This study used a survey methodology to determine the present status of gerontological content in baccalaureate nursing education curricula. Questionnaires were sent to each of the 22 deans/directors of the Canadian generic baccalaureate nursing programs and to 31 provincial reputational "experts" in the field of gerontology. A return rate of 90% and 93% was obtained respectively. The study asked five questions: 1) What nursing model or concepts are used by the generic baccalaureate schools of nursing? 2) What gerontological content is included in these programs? 3) What gerontological content is integrated in courses or taught in required or elective specific gerontology courses? 4) What gerontological clinical experiences are required? and 5) Are faculty academically prepared to teach gerontological content? Answers to these questions were compared with similar questions asked of reputational "experts". A quarter of the schools did not use nursing concepts or models while many schools chose a nursing model which was not consistent with their philosophy of health. Ninety percent of the schools taught gerontology content in integrated courses; half of the schools also offered a specific gerontology course of which 40% were elective courses. Even though all 49 listed gerontology topics and 28 patient problems and care techniques were taught by the majority of the schools there is little evidence the schools are producing gerontology prepared nurses. The gerontology clinical hours accounted for only 7.4% of the total clinical experiences. The "experts" recommended gerontology receive 21% of the clinical hours and that it be dispersed in a variety of community and clinical settings. Few (5%) faculty members were prepared with a post graduate degree in gerontology to act as positive role models for the students. Few (2%) students chose a gerontology practicum in their last year. The findings and recommendations are meant to assist educators with the task of expanding the gerontological curricula in generic baccalaureate nursing programs. The nine recommendations address ways to assist schools to reevaluate their curriculum and improve nursing care to the elderly in Canadian society. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

This study surveyed the self perceptions of thirty individuals over sixty-five years of age, who lived in the Vancouver Quadra electoral district, in order to gather information about their needs. The study was designed to answer three questions. Do the elderly living at home in a specific geographical area of Vancouver perceive themselves as having needs in the need areas defined by the literature, namely housing, health, independent living, employment, economic security and interpersonal relations? Do the elderly in the selected sample perceive their needs as being met? Do the elderly in the selected sample perceive nurses as involved in helping them meet their needs? A semi-structured interview schedule was used to obtain information relevant to the research problem. The results of this study indicated that more than half the respondents, or 53 per cent, perceived needs in the need areas defined by the literature. The majority of perceived needs, or 76 per cent, were not met. None of the elderly whose needs were met perceived nurses as involved in helping them meet these needs. Moreover, the majority of the study sample, or 87 per cent, did not perceive nurses as potentially helpful in assisting them to meet their needs. The study recommends that nurses extend their current role and become actively involved in assessing and meeting the needs of the elderly living at home. / Applied Science, Faculty of / Nursing, School of / Graduate

In 1960, the Home for the Aged, an institution of the Province of British Columbia, underwent an official name change to Valleyview Hospital. The change in name indicated a change in the philosophy toward the treatment of the aged mentally ill person. This change can be equated with new knowledge about the physical, psychological and social aspects of aging. Formerly the program and the goal were related to custodial care; now, the program and the goal are related to treatment which will result in the aged mentally ill patient returning to a living arrangement in the community that is most appropriate to his needs. This study, cites the problems of aged people in this province, with particular reference to problems of mental illness. The process of admission to hospital, treatment programs and discharge procedures, particularly as they relate to the work of the Social Service Department, are described. Against this background of procedures, the particular criteria for discharge and rehabilitation planning, as related to the hospital and to the resources available in the community are examined. Particular patient groups are noted in relationship to the particular resource required to receive them back into community. The study reveals that, although, using hospital criteria for discharge, a large number of patients could be appropriately rehabilitated, but sufficient community resources, including family care, boarding and nursing homes, are lacking for such patients. Furthermore, community attitudes towards the aged mentally ill person have not changed to meet the new philosophy about their treatment in Valleyview Hospital. Since correspondence revealed that Valleyview Hospital is unique amongst mental hospitals for the aged on this continent, the study was of necessity a pilot one, and is primarily descriptive. However, the questionnaire method was used to gather data about existing living accommodation available to discharged patients. Finally, the study offers some suggestions for improvement and expansion of community resources, and of legislation concerning them which, if carried out, would ensure, to a greater extent, that the philosophy of treatment and rehabilitation, rather than custodial care, could be translated into practice. / Arts, Faculty of / Social Work, School of / Moorhouse, Clayton Herbert Todd; Starak, Igor / Graduate

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22389号 / 人健博第75号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 桂 敏樹, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM