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PubMed1993

Physical condition, activity pattern, and environment as factors in falls by adult care facility residents.

This study surveyed 294 fall incident reports made over a three-year period concerning 95 residents in an adult care facility. We determined the frequencies of fall location, time of day or night, and assessed the precipitating factors from fall descriptions made by residents and/or their care givers. We found that 57% of the falls occurred in the residents' rooms, with private or shared bathrooms as the next most frequent locus. Precipitating factors were surveyed; 50.3% of the fall descriptions implicated environmental features (pieces of furniture were most frequently mentioned), the physical condition of the resident contributed to 24.3% of the falls, and specific physical activities were implicated in 7.9% of the falls. Multiple factors accounted for 6.5% of the total falls. In 17% of the cases, no clear indication of cause was found. Unsafe environments have been implicated as a fall risk factor. Despite adaptations to lessen environmental hazards, a large number of reportable falls occurred in this facility, which was for elderly individuals who were in relatively good health commensurate with their age.

Accidental Falls↗
PubMed2001

Personality characteristics of South African navy divers.

The first study aimed to determine the extent to which the 16 Personality Factor Questionnaire (16PF) can be used to describe successful divers in the South African Navy. The 16PF profiles of 100 divers were analyzed to describe the personality characteristics of naval divers. Results indicate that four personality factors were most descriptive of the sample. They were Group-orientation, Enthusiasm, Adventurousness, and Confidence. These factors seemed appropriate when discussed from an environmental demand perspective. The second study aimed to determine the extent to which the 16 PF can be used to differentiate between divers and submariners in the South African Navy. The two groups differed significantly on two factors--divers scored higher on Enthusiasm and submariners scored higher on Conservatism.

Adult↗
PubMed2004

Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors.

AIMS: To provide descriptive data on women who delivered at 23-25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. METHODS: Medical records of all women who had delivered in two tertiary care centres in 1992-1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. RESULTS: Of 197 women who delivered at 23-25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by pre-eclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59-3.74), administration of any antenatal steroids (OR: 2.21; 95% Cl: 1.14-4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5-5.73) were associated with survival. CONCLUSIONS: Women who deliver at 23-25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths.

Adult↗
PubMed1988

Detection of arthritogenic factor in adjuvant arthritis.

An evocation of arthritis by an Ag-specific lymphokine has recently been considered with the description of arthritogenic factor (AF) in rats with collagen arthritis. Because rats with CFA-induced arthritis also exhibit T cell reactivity to native type II collagen, T cell lines specific for this protein were established from CFA-injected rats. Supernatant material from these lines contained a type II collagen-binding lymphokine with functional and biochemical attributes identical with those described for AF, i.e., it was a 65-kDa species cross-reacting immunoprotein possessing the ability to incite an erosive, proliferative synovitis when injected into the knee joint of naive recipients. Similarities were also observed with HPLC and on two-dimensional gels. Lymph node cells from rats with arthritis created by injection of the synthetic adjuvant, CP-20,961 failed to produce AF, suggesting that this material is not a ubiquitous concomitant of inflammatory arthritis in the rat. Test injections into sites contiguous with the ear cartilage plate and into fibroblast-lined s.c. pouches suggested that cartilage was a requisite for the induction of inflammation by AF. These data identify a potentially shared effector pathway in the collagen and adjuvant models. The presence of AF in two frequently used models further supports the hypothesis that Ag-specific lymphokines can create autoimmune disease.

Animals↗
PubMed2005

Patient participation in nursing care: an interpretation by Swedish registered nurses.

AIMS AND OBJECTIVES: The aim of this study was to clarify Registered Nurses' understanding of patient participation in nursing care. Objectives were to investigate ward nurses' interpretation of the elements of patient participation and its implementation. BACKGROUND: One goal of health care is patient participation. Registered Nurses must encourage the participation of their patients in nursing care situations. A right for patients to make their own informed choices is laid down in Swedish laws and national and local directives. The concept of patient participation can be interpreted differently and is thus difficult to implement and evaluate. Current nursing literature provides little clarity of the elements and processes of patient participation and conceptual definitions differ. DESIGN AND METHODS: A qualitative approach was applied and the Grounded Theory method used. Thirty-one Registered Swedish Nurses described the meaning of patient participation and its implementation in nursing care. Seven focus group interviews with nurses providing inpatient somatic care were carried out in five hospitals in west Sweden. RESULTS: Four properties, describing nurses' approaches and procedures, constitute patient participation. The properties are: interpersonal procedure, therapeutic approach, focus on resources, opportunities for influence. These properties were considered crucial for patient participation in a nursing care context. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: The results clarify the concept of patient participation from a nursing perspective. A comprehensive description of important factors for patient participation could be made on the basis of nursing experience. This comprehensive description can be used in nursing care practice and its evaluation. The developed categories can be used in nursing care documentation of how patient participation is realized.

Attitude of Health Personnel↗
PubMed2001

Psychiatric disorder and personality factors associated with suicide in older people: a descriptive and case-control study.

OBJECTIVE: To determine the rates of psychiatric disorder and personality variables in a sample of older people who had committed suicide and to compare the rates in a subgroup of this sample with those in a control group of people who died from natural causes. DESIGN: Descriptive psychological autopsy study, including interviews with informants, of psychiatric and personality factors in 100 suicides in older people. Case-control study using subgroup of 54 cases and matched control group. SETTING: Four counties and one large urban area in central England, UK. SUBJECTS: Individuals 60 years old and over at the time of death who had died between 1 January 1995 and 1 May 1998, and whose deaths had received a coroner's verdict of suicide (or an open or accidental verdict, where the circumstances of death indicated probable suicide). The control group was an age-and sex-matched sample of people dying through natural causes in the same time period. MAIN OUTCOME MEASURES: ICD-10 psychiatric disorder, personality disorder and trait accentuation. MAIN RESULTS: Seventy-seven per cent of the suicide sample had a psychiatric disorder at the time of death, most often depression (63%). Personality disorder or personality trait accentuation was present in 44%, with anankastic or anxious traits the most frequent. Depression, personality disorder, and personality trait accentuation emerged as predictors of suicide in the case-control analysis. CONCLUSION: Personality factors, as well as depression, are important risk factors for suicide in older people.

Aged↗
PubMed2000

The well-being questionnaire: evidence for a three-factor structure with 12 items (W-BQ12).

BACKGROUND: The Well-being Questionnaire (W-BQ) has been designed to measure psychological well-being in people with a chronic somatic illness and is recommended by the World Health Organization for widespread use. However, studies into the factor structure of this instrument are still limited and their findings are inconsistent. This study aimed to investigate the factor structure of the Dutch version of the W-BQ. METHODS: A cross-validation design was used. A total of 1472 people with diabetes completed the W-BQ and were randomly assigned to group A or B. In group A (N = 736), exploratory factor analyses were conducted. Group B (N = 736) was split up into four subgroups of male or female patients with type 1 or type 2 diabetes. In these subgroups, confirmatory factor analyses were employed to test the model(s) developed in group A and the two models described in the literature (four-factor model with 22 items and a three-factor model with 12 items). RESULTS: Exploratory factor analyses yielded a three-factor model with 21 items (negative well-being, energy and positive well-being). In the subgroups of group B confirmatory factor analyses only accepted the three-factor model with 12 items. This factor solution was stable across gender, type of diabetes and level of education. CONCLUSIONS: The best description of the factor structure of the Dutch translation of the W-BQ was given by a three-factor solution with 12 items (W-BQ12), measuring positive well-being (four items), negative well-being (four items) and energy (four items).

Activities of Daily Living↗
PubMed1999

Body image, decision making, and breast cancer treatment.

This study was performed to describe women's satisfaction with body image before and 8 weeks after the surgical treatment of breast cancer compared with women without breast cancer. Additional aims were to describe women's perceived participation in decisions regarding choice of surgical procedure to treat their breast cancer, and postoperative satisfaction with their breast cancer treatment, as well as to explore factors influencing women's decisions regarding choice of surgical procedure. The design was prospective with a descriptive, comparative design. The convenience sample included 31 women with breast cancer from an urban breast health center, and 30 women without breast cancer from the community. The majority were college educated, white, ranging in age from 29-82 years. Women with breast cancer completed instruments before and 8 weeks after surgery. Women without breast cancer completed the instruments two times 8 weeks apart. Three instruments measuring body image satisfaction were used. Participation in treatment decision-making, having a treatment choice, and posttreatment satisfaction, along with a description of important factors in decision making, were measured with open and closed-ended questions. During the study period, women with breast cancer experienced a significant decrease in satisfaction with body image after surgery (p < .004). Satisfaction with body image remained constant in the women without breast cancer. Most (94%) of the women with breast cancer reported participating in treatment decisions about the type of surgical procedure used to treat their breast cancer, had a treatment choice (77%), and were moderately to very satisfied with the outcome of their surgeries (94%). Qualitative data results suggest that women's treatment decisions were based on their perceptions of "survival," that is, which type of surgery offered the best chance for long-term survival. These data suggest that satisfaction with body image is disturbed by surgery for breast cancer despite active participation in decisions regarding selection of treatment or postoperative satisfaction with type of surgical treatment received. These outcomes suggest that women need assistance in adjusting to alterations in body image from nurses and the need for research to describe effective interventions. Future studies of body image and breast cancer treatment should be conducted with larger samples, and at different points after surgery to determine the effects of mastectomy and breast-conserving surgery on the body image of breast cancer survivors over time.

Adult↗
PubMedDate not supplied

[Leukodystrophies: clinical aspects and findings with computerized tomography and magnetic resonance imaging].

Leukodystrophies are inherited white matter diseases due to abnormalities occurring in myelin synthesis and/or maintenance. The most common types of these rare childhood conditions are represented by adrenoleukodystrophy, metachromatic leukodystrophy, Canavan's, Alexander's, Krabbe's, and Pelizaeus-Merzbacher's diseases. Most of them are lethal during childhood, with the exception of the adrenoleukodystrophy-adrenomyeloneuropathy complex, which sometimes, during its early phases, may be cured with a dietary therapy. The aims of this paper are: 1) the description of inheritance factors, pathogenesis, pathological and clinical findings of each of the most frequent childhood leukodystrophies; 2) the description of the most common patterns of these conditions on CT and MR imaging; 3) the evaluation of the diagnostic capabilities of these two imaging techniques and the comparison of their results. Finally, some of the therapies suggested for the mild forms of these conditions are discussed. The evaluation of leukodystrophic patients with CT and MR imaging shows both imaging modalities to have high sensitivity, thanks to the detection of abnormally myelinated areas, which appear hypodense on CT and hyperintense on T2-weighted MR images. Frequently, both imaging modalities exhibit high specificity as well: they allow a differential diagnosis between the different types through the demonstration of their location in the early stages and of their mode of spread. The most typical example is represented by adrenoleukodystrophy, which is the most common type of leukodystrophy: the frequent occipito-parietal onset and the anterior and caudal progression allow a correct diagnosis to be made on CT and MR images in most cases. The comparison between CT and MR findings demonstrates a slight superiority of the latter: multiplanarity and high contrast resolution make MR imaging more sensitive than CT in the detection of both caudal spread and involvement of optic and acoustic nervous pathways. Furthermore, MR imaging allows a safe follow-up in children with leukodystrophy.

Adrenoleukodystrophy↗
PubMed2004

Sample trial to assess the level of understanding of the mechanisms of drug action.

The object of the present paper was to investigate whether or not the level of understanding of the mechanisms of drug action in nursing students is reflected in their descriptions of the factors in ineffective cases or adverse effects of prescribed medicines. The number of subcategories identified in the descriptions was closely connected with the test scores from the multiple-choice and short-answer written examination on 'Pharmacology and Pharmaceutics', and those from questions about the mechanisms of drug action. These results suggest that the number is useful for an estimated assessment of the level of understanding of the mechanisms of drug action.

Clinical Competence↗
PubMedDate not supplied

The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment.

The classification of the International Federation of Obstetrics and Gynecology (FIGO) for Trophoblastic Disease was changed at the meeting in Washington in September 2000 by combining the basic FIGO anatomic staging with the modified World Health Organization (WHO) risk factor scoring system. This presentation outlines the new system and provides a critical evaluation of the issues that have been resolved and those that are still outstanding.

Female↗
PubMed2000

Is it feasible or desirable to measure burdens of disease as a single number?

This paper questions the feasibility and desirability of creating a composite health index, such as the DALY (disability adjusted life years), that aggregates information about both mortality and morbidity into one number, to represent the burden of disease. Despite the expressed intention not to include contextual factors in the description of health states, in practice, doing so is unavoidable when trying to construct a health indicator. Including contextual factors leads to severe problems, however, regarding validity and reliability, and these are increased when evaluations of the described health states are made. This renders little confidence in DALYs as a measurement of the burden of disease. Using cost-effectiveness analyses and DALYs as tools in priority setting might have unwanted consequences, and this is not the only method of achieving economic efficiency. The use of this method might also serve to relieve politicians of the responsibility for resource allocation in the health sector. An alternative to a composite index is better and more comprehensive epidemiological data on sexual and reproductive health mortality, morbidity and diseases rather than the better use of health indicators of questionable validity and reliability. These kinds of data are now being collected in connection with the Global Burden of Disease Project. It should be up to the decisions-makers to allocate existing resources based on a balancing of the many good purposes and goals available.

Cost of Illness↗
PubMed1997

[Functional capacity in those over 60 and related social health factors (the ANCO Project for the Aged of Cordoba)].

OBJECTIVE: To evaluate the functional status (FS) of the over-60 population in our city, relating it to various social, demographic and health factors. DESIGN: A descriptive, crossover study. SETTING: City of Córdoba. PARTICIPANTS: A sample of 1,103 subjects was obtained by systematic sampling of the non-institutionalised population over 60 years old (N = 49,674), using the latest update of the 1991 census. MEASUREMENTS AND MAIN RESULTS: Application of the OARS-MFAQ-VE multidimensional questionnaire using a face-to-face home interview. We analysed 14 items from the part of the questionnaire assessing FS. Subjects were classified into three groups. 7.6% (25.0-30.3) needed help to perform at least one AS and 15.9% (13.8-18.2) were unable to perform at least one. CONCLUSIONS: This study provides a description of the functional status of the elderly, which for the most part is excellent. Various social and health factors linked to functional incapacity were identified.

Aged↗
PubMed2003

[Psychosocial factors related to the use of psychotropic drugs in elderly persons].

This descriptive study examined psychosocial factors associated with the use of psychotropic medication among older adults living in the community (N = 160). Comparative and descriptive statistical analysis were performed. When compared with non users, psychotropic medication users were older and less formally educated; they were less satisfied with their life and their health; they had greater health problems, reported more depressive symptoms and had more limitations in their daily activities; and they scored lower on sleep satisfaction. Nurses should be aware of the psychotropic medication use among older adults and informed older adults about the risk of addiction and the pernicious effects of long term usage.

Activities of Daily Living↗
PubMed2004

How system designers think: a study of design thinking in human factors engineering.

The paper presents a descriptive study of design thinking in human factors engineering. The objective of the study is to analyse the role of interpretation in design thinking and the role of design practice in guiding interpretation. The study involved 10 system designers undertaking the allocation of cognitive functions in three production planning and control task scenarios. Allocation decisions were recorded and verbal protocols of the design process were collected to elicit the subjects' thought processes. Verbal protocol analysis showed that subjects carried out the design of cognitive task allocation as a problem of applying a selected automation technology from their initial design deliberations. This design strategy stands in contrast to the predominant view of system design that stipulates that user requirements should be thoroughly analysed prior to making any decisions about technology. Theoretical frameworks from design research and ontological design showed that the system design process may be better understood by recognizing the role of design hypotheses in system design, as well as the diverse interactions between interpretation and practice, means and ends, and design practice and the designer's pre-understanding which shape the design process. Ways to balance the bias exerted on the design process were discussed.

Automation↗
PubMed2005

Characterization of drug particle surface energetics and young's modulus by atomic force microscopy and inverse gas chromatography.

PURPOSE: Particulate interactions are dominated by aspects such as surface topography, exposed chemical moieties, environmental conditions, and thermodynamic properties such as surface free energy (gamma). The absolute value and relative magnitude of surface energies of a drug and excipients within a formulation can significantly influence manufacture, processing, and use. This study utilizes and compares the potentially complementary analytical techniques of atomic force microscopy (AFM) and inverse gas chromatography (IGC) in the quantitative determination of the surface energy of drug (budesonide) particles (micronized and unmilled) relevant to inhaled delivery. In addition, the study investigates with AFM another important parameter in determining material interactions, the local mechanical properties of the drug. METHODS: AFM was used to acquire force of adhesion (Fadh) and related work of adhesion (WA) and surface energy values between individual mironized drug particles and also model substrates (graphite and mica). In addition, AFM probes were used to interrogate the surface energy of unmilled drug particles. Measurement with AFM probes also yielded localized measurements of Young's modulus for the unmilled drug. IGC was also used to probe the surface characteristics of the bulk drug material. RESULTS: The average values for surface energies acquired from budesonide micronized particle interactions with graphite, mica, and drug particles of the same substance were found to range from 35 to 175, 5 to 40, and 10 to 32 mJ m(-2), respectively. The unmilled material displayed a range of values of 39-88 mJ m(-2) with an average of 60 mJ m(-2). The IGC result for the surface energy of the micronized material was 68.47 +/- 1.60 mJ m(-2). The variability in surface energy from AFM, a feature particularly apparent for the micronized material was attributed to two factors, intrinsic material variations within a single particle and assumptions present within the contact mechanics model used. Here we provide a detailed description of these factors to go some way to rationalize the results. The Young's modulus of the unmilled drug was determined to be approximately 10 GPa. CONCLUSION: The range of determined surface energies between the AFM measurement on graphite, mica, and the drug is proposed to reflect the different chemistries displayed by the drug at the single particle level. The maximum values of these ranges can be related to the sites most likely to be involved in adhesion. AFM and IGC yield surface energy estimates in approximate agreement, but clearly are interrogating surfaces in different fashions. This raises questions as to the nature of the measurement being made by these approaches and to the most appropriate time to use these methods in terms of a direct relation to formulation design, manufacture, and drug delivery. Finally, we demonstrate a novel method for assessing the Young's modulus of a drug from a single particle.

Administration, Inhalation↗