INTRODUÇÃO: O diagnóstico do estado nutricional por rastreamento e avaliação nutricional permite detectar desnutrição e se associa com desfechos clínicos negativos em pacientes adultos hospitalizados. OBJETIVO: Identificar o teste mais adequado para avaliação de risco e estado nutricional em relação a desfechos clínicos negativos em pacientes adultos hospitalizados; e investigar a complementaridade existente entre os testes de rastreamento (NRS 2002) e avaliação nutricional (SGA). MÉTODOS: Estudo prospectivo, sequencial, não intervencionista, realizado em 705 pacientes adultos de ambos os sexos, de distintas enfermarias, no Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Em até 48 horas da admissão aplicou-se em todos os pacientes quatro testes de rastreamento e avaliação nutricional (NRS 2002: Triagem de Risco Nutricional 2002, MUST: Triagem Universal de Risco Nutricional, MNA-SF: Mini Avaliação Nutricional Reduzida, e SGA: Avaliação Subjetiva Global). Os pacientes foram seguidos até o desfecho final, obtendo-se as intercorrências clínicas de complicações, tempo de internação prolongado e mortalidade. Analisou-se o desempenho de todos os testes por curvas ROC (Receiver Operating Characteristic Curve) e razão de verossimilhança (LR). Verificou-se a complementaridade entre NRS 2002 e SGA por regressão logística e o número necessário de pacientes a avaliar para encontrar um desfecho negativo (NNS). RESULTADOS: NRS 2002 detectou 27,9% (n=197) de risco nutricional, MUST 39,6% (n=279), MNA-SF 73,2% (n=516) e SGA indicou 38,9% de desnutrição moderada e grave (n=274). Os testes NRS 2002 e SGA mostraram melhor desempenho em predizer desfechos clínicos negativos que MUST e MNA-SF pela curva ROC. NRS 2002 apresentou LR positiva maior que os demais testes para todos os desfechos clínicos. Segundo a regressão logística, 13% (IC 10,0- 17,0%) dos doentes podem ter tempo de internação prolongado, 9% (IC 7,0- 12,0%) complicação moderada ou grave e 1% (IC 0,3 - 2,1%) mortalidade. Para tempo de internação prolongado, os pacientes desnutridos por SGA, classe B (SGA B) aumentam esta probabilidade em 1,9 vezes (IC 1,2-3,2 vezes, p=0,008) e SGA classe C (SGA C) em 3,8 vezes (IC 2,0-7,2 vezes, p<0,0001). Para pacientes em risco nutricional por NRS 2002 (NRS+), a probabilidade de complicação moderada e grave aumenta em 1,9 vezes (IC 1,1-3,5 vezes, p=0,03), em 1,9 vezes (IC 1,1-3,4 vezes, p=0,02) para doentes SGA B e em 17,8 vezes (IC 1,4-5,8 vezes, p=0,003) para doentes SGA C. A probabilidade para mortalidade aumenta em 3,9 vezes (IC 1,2- 13,1 vezes, p=0,03) para pacientes NRS+. O NNS calculado para todos os desfechos clínicos negativos em pacientes NRS+ & SGA C (em risco nutricional por NRS 2002 e desnutridos graves pela SGA) foi menor que para os testes isolados. CONCLUSÕES: NRS 2002 é o melhor teste de rastreamento nutricional. A aplicação de SGA em doentes sob risco nutricional por NRS 2002 aumenta a capacidade de predição de desnutrição em relação a desfechos clínicos negativos. / INTRODUCTION: The diagnosis of nutritional status by nutritional screening and assessment tools detects malnutrition and is associated with negative clinical outcomes in adult hospitalized patients. OBJECTIVE: To identify the most appropriate tool for analysis of nutritional risk and malnutrition in relation to adverse clinical outcomes in adult hospitalized patients, and to investigate the complementarity of the nutritional screening (NRS 2002) and nutritional assessment (SGA) tests. METHODS: A prospective, sequential, non-interventional study, conducted in 705 adult patients of both sexes, from different wards in the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Within 48 hours of admission, all the patients were submitted to four nutritional screening and assessment tests (NRS 2002: Nutritional Risk Screening 2002, MUST: Malnutrition Universal Screening Tool, MNA-SF: Mini Nutritional Assessment Short Form and SGA: Subjective Global Assessment). Patients were followed until the final outcome, obtaining clinical outcomes of complications, length of hospital stay and death. The performance of the tests was analyzed by the ROC (Receiver Operating Characteristic) curve and likelihood ratio (LR). The complementarity of screening and assessment tools was analyzed by logistic regression, and the number of patients required to screen was obtained by calculating the number needed to screen (NNS). RESULTS: NRS 2002 detected 27.9% (n = 197) of nutritional risk, MUST 39.6% (n = 279), MNA-SF 73.2% (n = 516), and SGA detected moderate or severe malnutrition in 38.9% of the patients (n = 274). NRS 2002 and SGA had a better performance in predicting adverse clinical outcomes than MUST and MNA-SF confirmed by ROC curve. NRS 2002 had higher positive LR compared to the other tests for all the clinical outcomes. According to the logistic regression analysis, 13% (CI 10.0-17.0%) of the patients may have length of hospital stay, 9% (CI 7.0-12.0%) moderate or severe complications and 1% (CI 0.3 - 2.1%) mortality. For length of hospital stay, malnourished patients by SGA, class B (SGA B) increase this probability in 1.9 times (CI 1.2-3.2 times, p = 0.008) and SGA class C (SGA C) in 3.8 times (CI 2.0-7.2 times, p <0.0001). For patients nutritionally at risk by NRS 2002 (NRS +), the probability of moderate and severe complication increase in 1.9 times (CI 1.1-3.5 times, p = 0.03), in 1.9 times (CI 1.1-3.4 times, p = 0.02) for SGA B patients and 17.8 times (CI 1.4-5.8 times, p = 0.003) for SGA C patients. The probability of mortality increase in 3.9 times (CI 1.2-13.1 times, p = 0.03) for NRS+ patients. The NNS calculated for all adverse clinical outcomes in patients NRS+ & SGA C (at nutritional risk by NRS 2002 and severe malnourished by SGA), was lower than for the test separately. CONCLUSIONS: NRS 2002 is the best test for nutritional risk screening. The application of SGA in nutritionally at risk patients by NRS 2002 increases the predictive capacity of malnutrition in relation to adverse clinical outcomes.

A cultura do milho é uma das atividades agrícolas de maior importância no Brasil. O país é o terceiro maior produtor mundial e a produtividade média passou de 1800 kg ha-1 para 3000 kg ha-1 nos últimos 15 anos. A produção de grãos e a tolerância à seca são caracteres complexos e de difícil seleção e uma possibilidade para se aumentar a eficiência dos programas de melhoramento que visam o incremento da produção de grãos e a tolerância à seca seria através da seleção indireta para caracteres relacionados a elas como o stay-green e os componentes da produção. O presente trabalho teve por objetivo estudar os caracteres stay-green, produção de grãos e seus componentes em milho com a finalidade de reunir informações sobre a herança desses caracteres. Para tanto foi utilizada uma população obtida pelo cruzamento das linhagens L-14-04 B e L-08- 05 F, contrastantes para diversos caracteres. Progênies F2:3 derivadas desses cruzamento foram retrocruzadas com as linhagens parentais formando dois conjuntos com 250 progênies de retrocruzamento cada. Essas progênies foram avaliadas em até seis ambientes segundo o delineamento de látice simples 10x10 para os caracteres produção de grãos (PG), e seus componentes: comprimento de espiga (CE), diâmetro de espiga (DE), número de fileiras por espiga (NFi), número de grãos por fileira (NGF) e peso de 500 grãos (P500) e para o caráter relacionado a tolerância à seca stay-green (SG). Um mapa de ligação obtido com 177 marcadores SSR foi utilizado para mapear QTL para esses caracteres em cada uma das populações de retrocruzamento através da metodologia de mapeamento por intervalo composto expandido para múltiplos ambientes (mCIM). Os efeitos genéticos aditivos e de dominância para cada QTL mapeado foram obtidos por meio de contrastes entre os efeitos dos QTL mapeados nas duas populações de retrocruzamento. Foram mapeados 217 QTL para os sete caracteres avaliados sendo alguns desses de maior efeito, estáveis através dos diversos ambientes e co-localizados com QTL para outras características, o que os tornam bons candidatos para seleção assistida por marcadores moleculares. O grande número de QTL mapeados nesse estudo confirma não só a complexidade desses caracteres como também o poder de detecção do método de mapeamento (mCIM) e do delineamento utilizado nesse estudo (delinemento III). / Maize is one of the most important agricultural activities in Brazil. The country is the third largest world producer and the yield rose from 1800 kg ha-1 to 3000 kg ha-1 in the last 15 years. The grain yield and drought tolerance are complex traits, difficult to select. A possibility to increase the efficiency of breeding programs that aims to improve the grain yield and drought tolerance would be through indirect selection for traits related to them as the stay-green and yield components. The aim of this work was to study the characters stay-green, yield and its components in maize in order to gather information on the inheritance of these characters. For this purpose it was used a population obtained by crossing the lines L-14-04 B and L-08-05 F, contrasting to several traits. Progenies F2:3 from this cross were derived from backcrosses to the parental lines forming two sets of backcross progeny with 250 each. These progenies were evaluated in up to six environments according to the simple lattice design 10x10 for grain yield (PG), and their components: ear length (CE), ear diameter (DE), number of rows per ear (NFI), number of grains per row (NGF), weight of 500 grains (P500) and the drought tolerance related trait stay-green (SG). A linkage map obtained with 177 SSR markers were used to map QTL for these traits in each backcross population through the methodology of composite interval mapping expanded to multiple environments (mCIM). The additive and dominance genetic effects for each mapped QTL were obtained by means of contrasts between effects of QTL mapped in the two backcross populations. Two hundred seventeen QTL were mapped for seven traits evaluated, some of these are of mayor effect, stable through the various environments and co-located with QTL for other characteristics, what make them good candidates for molecular marker assisted selection. The large number of QTL mapped in this study confirms not only the complexity of these characters but also the detection power of the mapping method (mCIM) and of the design used in this study (design III).

Esta dissertação analisa a construção de estratégias, a partir dos modos de vida, para a permanência no campo dos jovens rurais no Litoral Norte do Rio Grande do Sul. O tema de pesquisa parte do questionamento: Que fatores estão relacionados à construção de modos de vida, a partir das estratégias dos jovens em permanecer no meio rural, enquanto agricultores, inseridos em sistemas de produção agroecológico ou em sistemas de produção convencional? Analisar este tema a partir da abordagem dos modos de vida possibilita um olhar mais vasto sobre a heterogeneidade de estratégias, com as quais os jovens rurais constroem visando sua permanência no campo, resistindo e se reproduzindo socialmente. A pesquisa de campo foi realizada nos municípios de Três Cachoeiras, Morrinhos do Sul e Mampituba, no Litoral Norte do Rio Grande do Sul, Brasil. Teve como procedimento metodológico, a pesquisa qualitativa, com análise de dados primários, gerados por 24 entrevistas com roteiros semiestruturados e observação. Como procedimento, utilizou-se da análise de discurso. As descobertas desta pesquisa apontam para características dos diversos modos de vida dos jovens rurais, as quais são fruto de sua trajetória e de seus elementos (ativos, capacitações e atividades), estabelecendo as estratégias que são próprias e específicas de cada sistema de produção. Pode-se perceber, a partir da pesquisa de campo que os dois sistemas de produção que os jovens estão inseridos, apontam para diferentes estratégias, ou seja, sua forma de atuação e atividades desenvolvidas se difere. Alguns elementos como os diversos canais de comercialização adotados, a predisposição para o trabalho coletivo, a diversidade de alimentos produzidos e uma maior preocupação com o meio ambiente são algumas das características do sistema agroecológico. Neste sistema observa-se um portfólio de estratégias mais diversificado em relação ao sistema convencional. Por fim, o estudo mostrou que embora haja adversidades e o caminho que gera a saída do jovem do campo seja o mais comum, os jovens mostram a capacidade de construir modos de vida que garantam a sua permanência no campo, com acesso aos recursos necessários para o desenvolvimento da qualidade de vida no meio rural. / This dissertation analyzes the construction of strategies, from the livelihoods, to stay in the field of rural youth in the North Coast of Rio Grande do Sul. The research topic comes from the question: What factors are related to the construction of livelihoods, from the strategies of young people to remain in rural areas, while farmers, inserted in agroecological systems or conventional production systems? To analyze this issue from the approach livelihoods enables a wider look at the diversity of strategies, with which rural youth build aiming their stay in the field, resisting and reproducing socially. The field research was conducted in the municipalities of Três Cachoeiras, Morrinhos do Sul and Mampituba, in the North Coast of Rio Grande do Sul, Brazil. It had as a methodological procedure, qualitative research, with analysis of primary data generated by 24 semi-structured interviews and observation tours. As a procedure, we used the speech analysis. The findings of this research point to characteristics of the different livelihoods of rural youth, which are the result of its history and its elements (assets, capabilities and activities), establishing strategies that are unique and specific to each production system. It can be noticed from the field research that the two production systems that youth are inserted, point to different strategies, that is, their way of acting and developed activities differs. Some elements like the various marketing channels adopted, the predisposition for collective work, produced the diversity of food and a greater concern for the environment are some of the agroecological system features. In this system there has been a portfolio of diversified strategies in relation to the conventional system. Finally, the study showed that although there is adversity and the way that generates the young field output is the most common, young people show the ability to build livelihoods to ensure their stay in the country with access to the resources needed to the development of quality of life in rural areas.

Submitted by FERNANDA NASCIMENTO COSTA null (fer_costa92@hotmail.com) on 2017-02-20T15:07:32Z No. of bitstreams: 1 Dissertação.pdf: 1001755 bytes, checksum: b5d901864195444267f192a49e71be8f (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-02-22T19:46:52Z (GMT) No. of bitstreams: 1 costa_fn_me_bot.pdf: 1001755 bytes, checksum: b5d901864195444267f192a49e71be8f (MD5) / Made available in DSpace on 2017-02-22T19:46:52Z (GMT). No. of bitstreams: 1 costa_fn_me_bot.pdf: 1001755 bytes, checksum: b5d901864195444267f192a49e71be8f (MD5) Previous issue date: 2017-02-14 / Introdução: O estado nutricional, a capacidade funcional e a qualidade de vida são fatores importantes no envelhecimento e estimam a saúde dessa população. A literatura brasileira é escassa em relação às características destas variáveis em idosos institucionalizados e não-institucionalizados. Objetivo: Comparar o estado nutricional, a qualidade de vida e a capacidade funcional entre idosos institucionalizados e não institucionalizados. Métodos: Estudo descritivo transversal. Foram avaliados 198 idosos, com 60 anos ou mais, de ambos os sexos, da comunidade e de Instituições de Longa Permanência para Idosos. Os idosos constituíram dois grupos: grupo de idosos institucionalizados (N=95) e grupo de idosos não institucionalizados (N=101). Em uma única visita, por meio de entrevista, aplicou-se o Mini Exame do Estado Mental, questionário sobre dados pessoais, autopercepção de saúde, estado nutricional (Índice de Massa Corpórea - IMC), capacidade funcional (Índice de Katz e Escala de Lawton) e qualidade de vida (World Health Organization Quality of Life Instrument, versão abreviada WHOQOL-BREF). A análise estatística das variáveis categorizadas foi realizada por meio do teste do qui-quadrado e as variáveis contínuas por meio do teste t-student, com significância de p≤0,05. Resultados: Houve diferença estatisticamente significante entre os grupos em relação ao estado nutricional (p<0,001), qualidade de vida (p<0,001) e capacidade funcional (Índice de Katz, p<0,001 e Escala de Lawton, p<0,001). Conclusão: No presente estudo, a institucionalização de idosos se relaciona com pior qualidade de vida e capacidade funcional, porém com relação ao estado nutricional, idosos não institucionalizados apresentaram um estado nutricional mais inadequado (baixo peso ou sobrepeso) quando comparados com idosos institucionalizados. / Introduction: Nutritional status, functional capacity and quality of life are important for the aging and health of the population. Brazilian literature is scarce in relation to the characteristics of variables in institutionalized and non-institutionalized elderly. Aims: To compare nutritional status, quality of life and functional capacity among institutionalized and non-institutionalized elderly. Methods: Cross-sectional descriptive study; 198 individuals aged 60 years or older, of both sexes, in community and long-stay institutions. The selected subjects were divided into two groups: group of institutionalized (N=95) and of non-institutionalized (N=101) subjects. The Mini Mental State Examination, a questionnaire on personal data, self-perceived health, nutritional status (body mass index - IMC), functional capacity (Katz Index and Lawton Scale) and quality of life (World Health Organization Quality of Life Instrument, abbreviated version WHOQOL-BREF). The statistical analysis of the categorized variables was performed using the qui-quadrado test and the continuous variables using the t-student test, with significance of p≤0,05. Results: There were statistically significant differences between non-institutionalized and institutionalized subjects considering, nutritional status (p<0,001), quality of life (p<0,001) and functional capacity (p<0,001). Conclusion: In this study, institutionalization of the elderly was related to poorer quality of life and functional capacity, but in relation to nutritional status, non-institutionalized elderly individuals presented a more inadequate nutritional status (low weight or overweight) when compared to institutionalized elderly.

Diversos serviços de saúde no Brasil vem apresentado episódios de superlotação, em um contexto onde os recursos são limitados. A redução do tempo de permanência em internações hospitalares tem como consequência direta a disponibilização de mais leitos-dia. O gerenciamento e melhoria do fluxo de pacientes ao longo das internações hospitalares é importante, sendo que o uso eficiente dos leitos pode acontecer devido a uma série de fatores. Estudos demonstram que equipes multidisciplinares podem realizar uma assistência de qualidade, reduzindo custos e o tempo em que os pacientes permanecem internados, sem impacto na reinternação ou mortalidade. Também há trabalhos que apontam a eficácia de unidades dedicadas ao atendimento de doenças específicas. A admissão de pacientes dentro de critérios bem definidos aumenta o giro de leitos. Com o objetivo de analisar se a equipe multidisciplinar Medicina Interna – Emergência (MIE) poderia contribuir para a redução do tempo de permanência hospitalar dos pacientes portadores de doenças prevalentes, sem alterar os indicadores de reinternação e mortalidade, o presente estudo experimental, controlado, não-randomizado, comparou o período pré e pós-intervenção, ou seja, a criação de uma Unidade de Curta Permanência no Serviço de Medicina Interna, do Hospital de Clínicas de Porto Alegre (HCPA). Foram analisadas internações ocorridas através da Emergência do HCPA, de pacientes com 14 anos ou mais, com as doenças prevalentes classificadas conforme grupos do CID-10 (J09-J018; J40-J47; N30-N39; I30-I52; I60-I69; B20-B24; C15-C26; A30-A49; e E10-E14), no período compreendido entre 01 de dezembro de 2008 a 30 de novembro de 2010 (n = 11040). Os resultados do estudo demonstram que após a criação da equipe E-MEI e a sua unidade de curta permanência, houve uma redução do tempo de permanência dos pacientes internados pelas causas selecionadas (antes: 10,89 ± 13,17 dias, após: 9,47 ± 11,24 dias, p = 0,006), e uma diminuição mais acentuada nas internações do Serviço de Medicina Interna [antes (n = 680): 14,33 ± 14,57 dias, após (n = 1243): 9,77 ± 10,62 dias, p = 0,000]. Não ocorreu alteração na taxa de mortalidade de todos os pacientes admitidos para as causas selecionadas [antes (n = 3800): 11,3%, após (n = 3958): 11,8% p = 0,123]. Também não houve alteração na taxa de reinternação de 7 dias na amostra estudada [antes (n = 3369): 7,2%, depois de (n = 3491): 6,7%, p = 0,407]. / Several health services in Brazil has shown episodes of overcrowding, in a context where resources are limited. Reducing the length of stay in hospital has as a direct consequence the provision of more beds-day. Managing and improving the flow of patients throughout the hospital is important, and the efficient use of beds can happen due to a number of factors. Studies have shown that multidisciplinary teams can perform quality care, reducing costs and the time patients remain hospitalized, with no impact on mortality or rehospitalization. There are also studies that show the effectiveness of units dedicated to the treatment of specific diseases. The admission of patients into well-defined criteria increases the turnover of beds. With the objective of analyzing the multidisciplinary team Internal Medicine – Emergency, could help to reduce the length of hospital stay of patients with diseases prevalent, without changing the indicators of rehospitalization and mortality, the present study experimental, controlled, not -randomized study compared the pre-and post-intervention, ie the creation of a Short Stay Unit in the Department of Internal Medicine, Hospital de Clinicas de Porto Alegre (HCPA). We analyzed hospital admissions through the Emergency HCPA, for patients aged 14 years or older with prevalent disease groups classified according to the ICD-10 (J09-J018, J40-J47, N30-N39, I30-I52, I60-I69; B20-B24, C15-C26, A30-A49, and E10-E14), during the period from December 1, 2008 to November 30, 2010 (n = 11,040). The study results show that after the creation of the multidisciplinary team, and its Short Stay Unit, there was a reduction in the length of stay of inpatients by selected causes (before: 10.89 ± 13.17 days after: 9 47 ± 11.24 days, p = 0.006) and a greater reduction in hospitalizations Service of Internal Medicine [before (n = 680): 14.33 ± 14.57 days after (n = 1243): 9, 77 ± 10.62 days, p = 0.000]. No change in the mortality rate of all patients admitted to selected causes [before (n = 3800): 11.3% after (n = 3958): 11.8% p = 0.123]. There was also no change in the rate of readmission than 7 days in our sample [before (n = 3369): 7.2% after (n = 3491): 6.7%, p = 0.407].

Bakgrund: Antalet personer med demenssjukdom ökar i Sverige och i övriga världen. Sjukdomen har stor påverkan på den drabbade personens liv, livskvalitet och autonomi. Det finns ännu ingen behandling som botar sjukdomen, men det finns mycket att göra för att öka livskvaliteten och stödja personer med demenssjukdom. Generellt sett har utevistelse visat sig ha stor betydelse för personers välmående. Men beroende på den ofta begränsade utemiljöns tillgänglighet och tidsbrist hos omvårdnadspersonalen så kommer många personer med demenssjukdom mer sällan ut än de som självständigt kan sörja för sin utevistelse. Därför är det av vikt att beskriva kunskap om utevistelse för personer med demenssjukdom boende på vårdhem. Syfte: Syfte är att sammanställa kunskap om utevistelsens betydelse för personer med demenssjukdom boende på vårdhem. Metod: En litteraturöversikt grundad på 13 vårdvetenskapliga artiklar, av kvantitativ och kvalitativ ansats. Resultat: Utevistelse i olika typer av trädgårdar, aktiviteter utomhus och att vistas ute i dagsljus har positiva effekter på personer med demenssjukdom, som ökat välbefinnande, minskat behov av läkemedel, ökad funktionell och kognitiv förmåga. Omvårdnadspersonal och anhöriga har kunskap i att utevistelse kan påverka personer med demenssjukdom positivt, och det är viktigt att möjliggöra utevistelse och erbjuda aktiviteter utomhus som är individuellt anpassade efter behov och förmåga. Slutsats: För personer med demenssjukdom ansågs utevistelsen som positivt, samt en bidragande faktor till att personer med demenssjukdom kände ökad livskvalitet. Aktiviteterna bör vara individanpassade för störst effekt på deras välbefinnande. / Background : The number of people with dementia is increasing in Sweden and the rest of the world. The disease has major impact on life itself, quality of life and autonomy for the affected person. There is still no treatment that cures the disease, but much can be done to increase the quality of life and support for people with dementia. In general, outdoor stay has proven to be of great importance to well-being. However, due to the often restricted outdoor environment's availability and lack of time from the healthcare professionals, many people with dementia rarely outweigh those who can independently provide for their own ability for outdoor stay. Therefore, it is important to describe the knowledge of outdoor stay for people with dementia living at nursing homes. Aim: The purpose is to put together knowledge about the meaning of outdoor stay for people with dementia living at nursing homes. Method: A literature review based on 13 scientific articles, quantitative and qualitative. Result: Outdoor stay in the form of different types of gardens, outdoor activities and exposure of daylight have positive effects on persons with dementia disease, as increased well-being and physical and cognitive function, and need of medication. Health care professionals and family members have knowledge about positive effects of outdoor stay for people with dementia disease, and it is important to make outdoor stay possible and offer activities outdoors that are individually adapted by need and ability. Conclusions: For people with dementia outdoor stay had positive results and as a contributing factor to people with dementia disease feeling increased quality of life. The outdoor activities should be individually adapted to the greatest effect on their well-being.

Poisoning is frequently associated with psychological and physiological co-morbidities that can be assessed in order to improve patients' management and reduce cost. The primary objective of this study is to conduct a review of emergency department (ED) poisonings to characterize its demographics and assess associated co-morbidities. The second objective is to explore correlation between personal history of diseases and poisonings. Predictors for poisonings and its outcomes were investigated and risk factors for suicidal poisoning and how it relates to mental illnesses were explored. Six hundred and forty nine cases admitted to ED between 2004 and 2007 were studied. Results indicate that difference in ethnic background was substantial as poisoning cases were predominantly African Americans (79.9%) between 36-45 years old with a male to female ratio of 1.3. Intentional illicit drug overdose was the greatest risk factor for ED poisonings, and among the 649 cases, heroin overdose was the most common cause of poisoning at 35.4% (n=230), cocaine overdose at 31.7% (n=206), heroin and cocaine overdose at 4.3% (n=28), multiple drug poisoning at 5.5% (n=36), and antidepressant/antipsychotic poisoning at 6% (n=39). A significant correlation between heroin poisonings and asthma (F=20.29, DF=1, p= .0001) was found, as well as between cocaine poisoning and hypertension (F=33.34, DF=1, p=.0001), and cocaine poisoning and cardiovascular diseases (F=35.34, DF=1, p=.0001). Another significant finding is the change in the pattern of the route of illicit drug use from injection to inhalation; it is thought this may reduce the rate of HIV and Hepatitis transmission via hypodermic needles among illicit drug users. As well, inhalation and insufflation may be risk factors that aggravate preexisting asthma. Mental illnesses, chiefly depression, remain one of the greatest risk factors for suicidal poisoning beside age, Hispanic race, gender, ingestion route and unemployment. This study provides supporting evidence that poisoning, particularly deliberate poisoning with illicit drugs remains a serious issue that significantly aggravates co-morbidities and raises treatment cost by increasing both the rate of hospitalization and hospital length of stay (LOS). Pragmatic guidelines and innovations in reducing heroin and cocaine abuse in these patients may lessen the severity of diseases and reduce its burden on the healthcare system and on society.

Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective design to examine whether routine ONS use was associated with hospital length of stay (LOS) among 570 adult inpatients at a regional medical center diagnosed with heart failure, adjusting for significant personal, locational, and time variables. It was unique in the inclusion of epidemiological triad variables. Using multiple logistic regression to control for covariates, ONS use was associated with higher LOS in this sample (odds ratio=2.43). High LOS was also associated with higher Charlson Comorbidity Index (CCI) values, discharge destination, White ethnicity, female gender, and hospital room location. This study is expected to contribute to positive social change by helping inform hospital staff on factors affecting patient outcomes and LOS, and highlighting the need for continued research on interventions to improve care in hospitals.

There has been an increase in the number of individuals with mental illness being housed in correctional facilities over the last 50 years. In this study, the length of pretrial detention was compared for inmates who have a mental illness and are compliant with psychiatric medications, inmates who have a mental illness and are noncompliant or not prescribed psychiatric medication, and inmates with no mental illness. I also examined if inmates who have a mental illness have less severe charges and if there was a difference in the classification of mental health diagnoses for inmates who are and are not compliant with psychiatric medications. The study used the closed charts of 427 male inmates from 1 county jail in New Jersey from the year 2016. The theoretical foundation of this study is Abraham Maslow's hierarchy of needs, as it is believed that the basic physiological and safety needs should be met in order to provide mental health treatment. A combination 1-way analyses of variance (ANOVA) and chi-squared analysis was used to examine the data. It was concluded that inmates with mental illness who are medication compliant are incarcerated significantly longer pretrial than inmates with no mental illness. It was also found that there was a difference in the types of charges received between those with and without a mental illness. Lastly, the study found that there was no significant difference between each of the classifications of mental illness when comparing inmates with mental illness who are and are not compliant with psychiatric medications. The implication for positive social change is the benefits to the inmates with mental illness and the correctional facilities, as it confirms that inmates with a mental illness require more tailored and treatment specific services for a longer period of time.

In Oregon, "Incompetent to Stand Trial (1ST) Patients" were observed to be increasing in number, remaining in the hospital longer, and costing more to treat. A study was designed to investigate variables that could be used to predict their length of stay at Oregon State Hospital. Data for thirteen independent variables (gender, age, having an Axis I psychosis level diagnosis, having an Axis I substance-related diagnosis, having an Axis II personality disorder diagnosis, evidence of involuntary medications, being on atypical medications at discharge, number of seclusion and restraint events, number of felony charges, number of misdemeanor charges, and number of inter-ward transfers) and one dependent variable (length of stay) were analyzed for 198 1ST patients discharged from Oregon State Hospital between January, 1999 and December, 2001. Bivariate correlations for all variables, and length of stay (LOS) means for all levels of each variable were examined and discussed. A standard multiple regression analysis was performed. The regression model accounted for 36.5% (32.7% adjusted) of the variability in (log) LOS. R for regression was found to be significantly different from zero. Five variables were found to be significant contributors to explaining the variability in (log) LOS: (square root) number of inter-ward transfers (16%), gender (5.8%), evidence of involuntary medications (5.2%), (square root) number of felony charges (2.8%), and (square root) number of seclusion and restraint events (1.6%). Despite accounting for more variability in LOS than several previous studies with psychiatric patients, 67.3% of the variability was unaccounted for by the regression model. Unstandardized regression coefficients for untransformed variables were interpreted, revealing that gender, number of inter-ward transfers, and evidence of involuntary medications significantly predicted the largest increases in LOS. Recommendations were made for further research related to LOS of 1ST patients. / Graduation date: 2003