Abstract Introduction Most countries including Australia are experiencing an ageing of their population, with an increasing proportion of frail older persons requiring hospitalisation from acute illness. The aging process places the older person at risk of geriatric syndromes, such as falling, dependency in performance of Activities of Daily Living and instrumental Activities of Daily Living, confusion, bladder and bowel incontinence. New or deteriorating geriatric syndromes are a frequent occurrence among hospitalized older patients. Hospital associated factors associated with these outcomes include complications of medical therapies; polypharmacy and excessive bed rest. Few studies have been conducted into factors predicting risk of negative outcomes in older patients admitted to medical units of acute care teaching hospitals. If available, a screening tool with few predictive factors, able to be administered close to the time of admission could be used to identify patients at lower and higher risk. It is imperative that such a tool is developed empirically and tested for its accuracy in identifying patients at high risk. Aims of the research The first aim was to identify the proportion of patients aged ≥ 70 years, admitted to acute care medical units that experienced a negative outcome. These outcomes included falls during hospitalisation, presence of new or a significant decline in existing pressure ulcers, significant decline in independently performing Activities of Daily Living (ADLs), requiring increased care needs at discharge, readmission to hospital with 28 days of the index hospitalisation, bladder and bowel incontinence, and delirium. The second aim was to identify factors predicting the risk of two of these negative outcomes: requiring a higher level of care at discharge, and experiencing a decline in independently performing ADLs. Based on the predictive factors, two screening tools to identify patients at risk were developed and validated. Method A prospective cohort study of 413 acute general medical patients, aged ≥ 70 years and consecutively admitted to an acute care metropolitan 700-bed teaching hospital was conducted. Consenting patients expected to remain in hospital for more than 48 hours were included. Patients were excluded if they were admitted to intensive or coronary care units, admitted for terminal care only or were transferred from a general medical to another unit within 24 hours of admission to the ward. Trained research nurses assessed patients and used the interRAI Acute Care instrument to collect information on candidate predictive variables and negative outcomes. Patients were assessed within 36 hours of admission and at discharge to obtain information on predictive variables and negative outcomes. Patients were also followed daily to identify any instances of transient negative outcomes during hospitalisation and at 28 days following discharge to identify any instances of readmission to hospital. The 413 cases were randomly split into 309 cases in the development cohort and 104 cases in validation cohort. Logistic regression models were used to identify the predictive factors independently associated with two negative outcomes, requiring a higher level of care at discharge and experiencing a decline in independently performing ADLs. Findings At least one negative outcome was experienced by 53% of the development and 63% of the validation cohort. The most common negative outcomes experienced were: delirium (27%; 23%), a significant decline in ADLs (19%, 22%), requiring a higher level of care at discharge (16%, 16%), and readmission to hospital within 28 days of discharge (17%, 28%) in the development and validation cohorts respectively. The logistic regression analysis identified four independent factors associated with requiring higher levels of care at discharge: ‘short term memory problems’ (OR 4.21, 95% CI 1.79, 9.89; p=0.001); ‘dependence in toilet use’ (OR 3.51, 95% CI 1.14, 10.84; p=0.029); ‘dependence in hygiene’ (OR 2.76, 95% CI 1.16, 6.56; p=0.021), and ‘use of community services prior to admission’ (OR 2.41, 95% CI 1.12, 5.16; p= 0.024). A screening tool developed to assess patients at lower and higher risk had a sensitivity, specificity, positive predicted value (PPV) and negative predictive value (NPV) of 77.27%, 73.66%, 36.56% and 94.29% respectively. Reasonable accuracy was evident when tested in the validation sample. Sensitivity, specificity, PPV and NPV were 60%, 76.32%, 33.33% and 90.63% respectively. Predictive factors associated with a significant decline in ADLs were: ‘history of falling’(OR 2.21, 95% CI 1.12, 4.36; p= 0.023), ‘no interest in things enjoyed normally’ (OR 4.30, 95% CI 1.92, 9.64; p=0.000), ‘dependence in management of finances’ (OR 3.93, 95% CI 1.63, 9.48; p =0.002) and ‘hearing problems’ (OR 2.38, 95% CI 1.05, 5.39; p =0.038). The screening tool had sensitivity, specificity, PPV and NPV in the development cohort of 74.55%, 69.13%, 36.6% and 92% respectively and 45%, 65.79%, 25.7% and 82% respectively in the validation sample. Conclusion The tools require further validation in larger samples in diverse settings. Future research should focus on developing a screening tool that could predict risk of a number of negative outcomes to enhance the provision of quality patient care.

Introdução: A Bioimpedância Elétrica (BIA) é um método fácil de usar, rápido, barato, não invasivo e de fácil reprodutibilidade utilizado para verificar as mudanças na composição corporal. O Ângulo de Fase (AF), obtido através da BIA, reflete a relativa contribuição dos fluidos e membranas para o corpo humano, sendo associado como um marcador prognóstico em diversas situações clínicas. Objetivos: Avaliar o AF como indicador de desfechos negativos em pacientes cirúrgicos (ocorrência de infecção e/ou morte e tempo de permanência hospitalar). Metodologia: Foram avaliados pacientes com idade de 18 a 80 anos internados no Hospital de Clínicas de Porto Alegre com indicação de cirurgia eletiva. As avaliações foram realizadas no momento da internação, 48 e 72 horas após a cirurgia. Foram avaliados peso, altura e Índice de Massa Corporal (IMC), estado nutricional através da Avaliação Nutricional Subjetiva Global (ANSG) e Ângulo de Fase através da BIA. Resultados: Foram avaliados 142 pacientes, segundo o IMC, 59,2% dos pacientes foram classificados como eutróficos, 3,5% moderadamente desnutridos e 37,3% apresentaram algum grau obesidade. A avaliação por ANSG verificou que 76,1% dos pacientes estavam eutróficos, 23,2% moderadamente desnutridos e 0,7% desnutridos graves. Os baixos valores para o AF obtidos nas 3 avaliações não se apresentaram como indicadores de desfechos negativos em pacientes cirúrgicos. Conclusões: O AF não se demonstrou um indicador para desfechos negativos em pacientes cirúrgicos. / Introduction: Electrical Bioimpedance (BIA) is an easy to use, fast, inexpensive, noninvasive and highly reproducible used to verify the changes in body composition. The Phase Angle (PA), obtained by BIA reflects the relative contribution of fluid and membranes for the human body, being associated as a prognostic marker in various clinical situations. Objectives: To evaluate the AF as an indicator of negative outcomes in surgical patients. Methodology: We studied patients aged 18 to 80 years at the Hospital de Clínicas de Porto Alegre with indication of elective surgery. Evaluations were performed at admission, 48 and 72 hours after surgery. Body weight, height and Body Mass Index (BMI), nutritional status by Subjective Global Assessment (SGA) and Phase Angle through the BIA. Results: According to BMI, 59.2% of patients were classified as eutrophic, 3.5% moderately malnourished and 37.3% had some degree obesity. The assessment by SGA found that 76.1% of patients were eutrophic, 23.2% moderately malnourished and 0.7% severely malnourished. The low values obtained for the AF in three evaluations were not presented as indicators of negative outcomes in surgical patients. Conclusions: AF is not an indicator to show negative outcomes in surgical patients.

Introdução: A Bioimpedância Elétrica (BIA) é um método fácil de usar, rápido, barato, não invasivo e de fácil reprodutibilidade utilizado para verificar as mudanças na composição corporal. O Ângulo de Fase (AF), obtido através da BIA, reflete a relativa contribuição dos fluidos e membranas para o corpo humano, sendo associado como um marcador prognóstico em diversas situações clínicas. Objetivos: Avaliar o AF como indicador de desfechos negativos em pacientes cirúrgicos (ocorrência de infecção e/ou morte e tempo de permanência hospitalar). Metodologia: Foram avaliados pacientes com idade de 18 a 80 anos internados no Hospital de Clínicas de Porto Alegre com indicação de cirurgia eletiva. As avaliações foram realizadas no momento da internação, 48 e 72 horas após a cirurgia. Foram avaliados peso, altura e Índice de Massa Corporal (IMC), estado nutricional através da Avaliação Nutricional Subjetiva Global (ANSG) e Ângulo de Fase através da BIA. Resultados: Foram avaliados 142 pacientes, segundo o IMC, 59,2% dos pacientes foram classificados como eutróficos, 3,5% moderadamente desnutridos e 37,3% apresentaram algum grau obesidade. A avaliação por ANSG verificou que 76,1% dos pacientes estavam eutróficos, 23,2% moderadamente desnutridos e 0,7% desnutridos graves. Os baixos valores para o AF obtidos nas 3 avaliações não se apresentaram como indicadores de desfechos negativos em pacientes cirúrgicos. Conclusões: O AF não se demonstrou um indicador para desfechos negativos em pacientes cirúrgicos. / Introduction: Electrical Bioimpedance (BIA) is an easy to use, fast, inexpensive, noninvasive and highly reproducible used to verify the changes in body composition. The Phase Angle (PA), obtained by BIA reflects the relative contribution of fluid and membranes for the human body, being associated as a prognostic marker in various clinical situations. Objectives: To evaluate the AF as an indicator of negative outcomes in surgical patients. Methodology: We studied patients aged 18 to 80 years at the Hospital de Clínicas de Porto Alegre with indication of elective surgery. Evaluations were performed at admission, 48 and 72 hours after surgery. Body weight, height and Body Mass Index (BMI), nutritional status by Subjective Global Assessment (SGA) and Phase Angle through the BIA. Results: According to BMI, 59.2% of patients were classified as eutrophic, 3.5% moderately malnourished and 37.3% had some degree obesity. The assessment by SGA found that 76.1% of patients were eutrophic, 23.2% moderately malnourished and 0.7% severely malnourished. The low values obtained for the AF in three evaluations were not presented as indicators of negative outcomes in surgical patients. Conclusions: AF is not an indicator to show negative outcomes in surgical patients.

Introdução: A Bioimpedância Elétrica (BIA) é um método fácil de usar, rápido, barato, não invasivo e de fácil reprodutibilidade utilizado para verificar as mudanças na composição corporal. O Ângulo de Fase (AF), obtido através da BIA, reflete a relativa contribuição dos fluidos e membranas para o corpo humano, sendo associado como um marcador prognóstico em diversas situações clínicas. Objetivos: Avaliar o AF como indicador de desfechos negativos em pacientes cirúrgicos (ocorrência de infecção e/ou morte e tempo de permanência hospitalar). Metodologia: Foram avaliados pacientes com idade de 18 a 80 anos internados no Hospital de Clínicas de Porto Alegre com indicação de cirurgia eletiva. As avaliações foram realizadas no momento da internação, 48 e 72 horas após a cirurgia. Foram avaliados peso, altura e Índice de Massa Corporal (IMC), estado nutricional através da Avaliação Nutricional Subjetiva Global (ANSG) e Ângulo de Fase através da BIA. Resultados: Foram avaliados 142 pacientes, segundo o IMC, 59,2% dos pacientes foram classificados como eutróficos, 3,5% moderadamente desnutridos e 37,3% apresentaram algum grau obesidade. A avaliação por ANSG verificou que 76,1% dos pacientes estavam eutróficos, 23,2% moderadamente desnutridos e 0,7% desnutridos graves. Os baixos valores para o AF obtidos nas 3 avaliações não se apresentaram como indicadores de desfechos negativos em pacientes cirúrgicos. Conclusões: O AF não se demonstrou um indicador para desfechos negativos em pacientes cirúrgicos. / Introduction: Electrical Bioimpedance (BIA) is an easy to use, fast, inexpensive, noninvasive and highly reproducible used to verify the changes in body composition. The Phase Angle (PA), obtained by BIA reflects the relative contribution of fluid and membranes for the human body, being associated as a prognostic marker in various clinical situations. Objectives: To evaluate the AF as an indicator of negative outcomes in surgical patients. Methodology: We studied patients aged 18 to 80 years at the Hospital de Clínicas de Porto Alegre with indication of elective surgery. Evaluations were performed at admission, 48 and 72 hours after surgery. Body weight, height and Body Mass Index (BMI), nutritional status by Subjective Global Assessment (SGA) and Phase Angle through the BIA. Results: According to BMI, 59.2% of patients were classified as eutrophic, 3.5% moderately malnourished and 37.3% had some degree obesity. The assessment by SGA found that 76.1% of patients were eutrophic, 23.2% moderately malnourished and 0.7% severely malnourished. The low values obtained for the AF in three evaluations were not presented as indicators of negative outcomes in surgical patients. Conclusions: AF is not an indicator to show negative outcomes in surgical patients.

Introduction: Older persons usually suffer from multiple chronic disorders and consequently use more medications than younger adults and often polypharmacy. Polypharmacy is, unfortunately, one of the risk factors for negative outcomes in the old age. The aim of this diploma thesis was to summarize by narrative literature review the negative outcomes of polypharmacy in older adults documented in pharmacoepidemological studies published between 2005 and 2015 years. The outputs of this diploma thesis create part of results of the research subgroup "Aging and Changes in the Therapeutic Value of Medications in the Aged" (Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles Univerzity) and the EU COST Action initiative IS1402 (2015-2018). Methods: Using datasets of Web of Science, PubMed and Embase, the narrative literature review was conducted in the period 2014 - 2015, in which we summarized outcome studies dealing with negative outcomes of polypharmacy in older patients published between 2005- 2015 years. Key words for the literature review were: "seniors, older patients, elderly, older age, polypharmacy, polymedication, multiple drug use, negative outcomes, impact, hospitalization, mortality, averse reactions, averse drug events, costs, expenditures. We identified 563 studies...

Introduction: Older persons represent a quickly growing segment of the population worldwide and more vulnerable population to various adverse drug reactions and adverse outcomes. Many explicit criteria of potentially inappropriate medications (PIMs) have been developed in different countries in order to improve the quality and safety of geriatric prescribing and to reduce the risk of drugs in older adults. The aim of this diploma thesis was to summarize (using narrative literature review) the negative outcomes of potentially inappropriate medications documented in pharmacoepidemological studies published by 2016 year. The outputs of diploma thesis create a part of the effort of the research subgroup "Aging and Changes in the Therapeutic Value of Medications in the Aged" and EU COST Action initiative IS1402 (2015-2018). Methods: The literature review using PubMed and Web of Science datasets during the period 10/2015 - 1/2017 was conducted. 421 studies were identified during the primary literature search and after thorough consideration of abstracts 67 (16%) of studies were selected for works on summary tables (354 of studies were excluded because in these studies only prevalence of PIMs, no negative outcomes were documented, or PIMs were defined based on implicit criteria or full text of articles...

Background: Children who enter foster care usually do so because of maltreatment by their birth families. Early adversity such as this is associated with many negative outcomes, including disturbances of attachment and mental health in childhood and throughout the lifespan. Young children (under 5) are particularly at risk due to maltreatment rates being highest in this age range, and because of the vital brain development that occurs during this time. Improving the quality of existing relationships for young children is the most cost effective way to improve mental health outcomes. It is important that research investigates which relational and psychological variables that exist within the foster carer-child relationship may be protective against developing negative mental health outcomes, so as to inform carer training and future interventions for this vulnerable group. Aims: The aims of this research project were twofold. The first aim was to systematically review the existing literature on links between foster carer psychological variables (such as commitment to their foster child), and/or child psychological variables (such as their attachment style), and the mental health outcomes of children in foster care. The second aim was to investigate whether foster carer acceptance, commitment, awareness of influence and reflective functioning (RF) predict the mental health outcomes of Scottish preschool aged children who are looked after in foster care. Method: A systematic review of the existing literature was undertaken to address the first aim. The search strategy resulted in 12 quantitative studies that investigated links between child or carer psychological variables and child mental health outcomes. An empirical study of 179 pre-school aged children in foster care in Scotland was carried out to address the second aim. Participants were taking part in a wider RCT of a novel intervention to improve outcomes and permanency decisions for children in foster care. Foster carer acceptance, commitment, and awareness of influence was assessed using the This Is My Baby Interview, and scores of RF were coded from the transcripts of this interview using a computer-based algorithm. Child mental health information was gathered using the Infant Toddler Social Emotional Assessment. Data was gathered at 2 time points; baseline assessments occurred around 4 weeks after entry to care, and follow-up assessments were carried out a year later. Results: The systematic review found good evidence that foster child attachment security is linked to more positive mental health outcomes. It also found some evidence suggesting that foster carer psychological variables such as commitment and quality of caregiving also relate to child mental health outcomes, but this research is in its infancy and it is therefore difficult to draw firm conclusions around this. The results of the empirical study showed that carer commitment and awareness of influence predict child competence at baseline, and RF predicts internalising and externalising problems at follow up. No predictive relationships were found between carer variables and child mental health over time. Conclusion: The results from both studies suggest that carer psychological variables such as commitment to their foster child may relate to child mental health development. These results have implications in terms of foster carer training, and for intervention development for this vulnerable population. This research is however in its infancy, and the results suggest a complex picture with regard to carer psychological variables and child mental health. Large-scale high quality longitudinal research is needed to provide a clear understanding of these relationships.

Previous literature has indicated a relationship between poverty, participation in extracurricular activities, and developmental outcomes. The current study aimed to investigate and develop a deeper understanding of extracurricular activities (ECAs) and their impacts on adolescent development using two self-report tools, the YES 2.0 and the Delinquent Attitude Scale (DAS). The researcher surveyed 174 high school seniors from students attending schools in poverty areas and students attending schools not located in poverty areas in Mississippi, examining disparities in ECA opportunities, barriers to participation, and the positive and negative impacts of ECAs on development. Additional data were collected from school administrators, allowing the researcher to compare ECA participation among students attending schools in poverty areas and students attending schools not located in poverty areas and the barriers that impact this participation. Results showed that students attending schools in poverty areas were less likely to participate in ECAs than those students attending schools not located in poverty areas. Lack of awareness about programs was the most common barrier reported by students. To address this, it is recommended that schools emphasize recruiting for ECAs and involve students at younger ages. Regarding the impact of ECAs on development, participation in ECAs was found to have a positive impact on certain developmental areas, regardless of poverty area. Negative outcomes were minimal in all poverty areas. However, excessive participation in ECAs adversely affected grades among students attending schools in poverty areas. Overall, this study highlights the importance of addressing disparities in ECA opportunities and barriers to participation and the potential positive impact of ECAs on adolescent development.