A Census-based longitudinal study of variations in survival amongst residents of nursing and residential homes in Northern Ireland

Background: despite the intensive services provided to residents of care homes, information on death rates is not routinely available for this population in the UK. Objective: to quantify mortality rates across the care home population of Northern Ireland, and assess variation by type of care home and resident characteristics. Design: a prospective, Census-based cohort study, with 5-year follow-up. Participants: all 9,072 residents of care homes for people aged 65 and over at the time of the 2001 census with a special emphasis on the 2,112 residents admitted during the year preceding census day. Measurements: age, sex, self-reported health, marital status, residence (not in care home, residential home, dual registered home, nursing home), elderly mentally infirm care provision. Results: the median survival among nursing home residents was 2.33 years (95% CI 2.25–2.59), for dual registered homes 2.75 (95% CI 2.42–3.17) and for residential homes 4.51 (95% CI 3.92–4.92) years. Age, sex and self-reported health showed weaker associations in the sicker populations in nursing homes compared to those in residential care or among the non-institutionalised. Conclusions: the high mortality in care homes indicates that places in care homes are reserved for the most severely ill and dependent. Death rates may not be an appropriate care quality measure for this population, but may serve as a useful adjunct for clinical staff and the planning of care home provision.

Predicting intentions to purchase organic food: The role of affective and moral attitudes in the Theory of Planned Behaviour

This study examined the usefulness of integrating measures of affective and moral attitudes into the Theory of Planned Behaviour (TPB)-model in predicting purchase intentions or organic foods. Moral attitude was operationalised Lis positive self-rewarding feelings of doing the right thing. Questionnaire data were gathered in three countries: Italy (N = 202), Finland (N = 270) and UK (N = 200) in March 2004. Questions focussed on intentions to purchase organic apples and organic ready-to-cook pizza instead of their conventional alternatives. Data were analysed using Structural Equation Modelling by simultaneous multi-group analysis of the three Countries. Along with attitudes, moral attitude and subjective norms explained considerable shares of variances in intentions. The relative influences of these variables varied between the Countries, such that in the UK and Italy moral attitude rather than subjective norms had stronger explanatory power. In Finland it was other way around. Inclusion of moral attitude improved the model fit and predictive ability of the model, although only marginally in Finland. Thus the results partially Support the usefulness of incorporating moral measures as well as affective items for attitude into the framework of TPB. (c) 2007 Elsevier Ltd. All rights reserved.

Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N¼16) or control (usual practice continued; N¼16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% con?dence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were signi?cantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

Coordinated Control of DFIG and FSIG-based Wind Farms under Unbalanced Grid Conditions

This paper investigates the control and operation of doubly-fed induction generator (DFIG) and fixed-speed induction generator (FSIG) based wind farms under unbalanced grid conditions. A DFIG system model suitable for analyzing unbalanced operation is developed, and used to assess the impact of an unbalanced supply on DFIG and FSIG operation. Unbalanced voltage at DFIG and FSIG terminals can cause unequal heating on the stator windings, extra mechanical stresses and output power fluctuations. These problems are particularly serious for the FSIG-based wind farm without a power electronic interface to the grid. To improve the stability of a wind energy system containing both DFIG and FSIG based wind farms during network unbalance, a control strategy of unbalanced voltage compensation by the DFIG systems is proposed. The DFIG system compensation ability and the impact of transmission network impedance are illustrated. The simulation results implemented in Matlab/Simulink show that the proposed DFIG control system improves not only its own performance, but also the stability of the FSIG system with the same grid connection point during network unbalance.