954 resultados para Long-term care facilities


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- Objective We sought to assess the effect of long-term exposure to ambient air pollution on the prevalence of self-reported health outcomes in Australian women. - Design Cross-sectional study - Setting and participants The geocoded residential addresses of 26 991 women across 3 age cohorts in the Australian Longitudinal Study on Women's Health between 2006 and 2011 were linked to nitrogen dioxide (NO2) exposure estimates from a land-use regression model. Annual average NO2 concentrations and residential proximity to roads were used as proxies of exposure to ambient air pollution. - Outcome measures Self-reported disease presence for diabetes mellitus, heart disease, hypertension, stroke, asthma, chronic obstructive pulmonary disease and self-reported symptoms of allergies, breathing difficulties, chest pain and palpitations. - Methods Disease prevalence was modelled by population-averaged Poisson regression models estimated by generalised estimating equations. Associations between symptoms and ambient air pollution were modelled by multilevel mixed logistic regression. Spatial clustering was accounted for at the postcode level. - Results No associations were observed between any of the outcome and exposure variables considered at the 1% significance level after adjusting for known risk factors and confounders. - Conclusions Long-term exposure to ambient air pollution was not associated with self-reported disease prevalence in Australian women. The observed results may have been due to exposure and outcome misclassification, lack of power to detect weak associations or an actual absence of associations with self-reported outcomes at the relatively low annual average air pollution exposure levels across Australia.

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A laboratory study was undertaken to determine the persistence and efficacy of spinosad against Rhyzopertha dominica (F.) in wheat stored for 9 months at 30 degrees C and 55 and 70% relative humidity. The aim was to investigate the potential of spinosad for protecting wheat from R. dominica during long-term storage in warm climates. Wheat was treated with spinosad at 0.1, 0.5 and 1 mg kg(-1) grain and sampled after 0, 1.5, 3, 4.5, 6, 7.5 and 9 months of storage for bioassays and residue analyses. Residues were estimated to have declined by 30% during 9 months of storage at 30 degrees C and there was no effect of relative humidity. Spinosad applied at 0.5 or 1 mg kg(-1) was completely effective for 9 months, with 100% adult mortality after 14 days of exposure and no five F, adults produced. Adult mortality was < 100% in some samples of wheat treated with 0.1 mg kg(-1) of spinosad, and live progeny were produced in all samples treated at this level. The results show that spinosad is likely to be an effective grain protectant against R. dominica in wheat stored in warm climates.

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The current study explored the perceptions of direct care staff working in Australian residential aged care facilities (RACFs) regarding the organizational barriers that they believe prevent them from facilitating decision making for individuals with dementia. Normalization process theory (NPT) was used to interpret the findings to understand these barriers in a broader context. The qualitative study involved semi-structured interviews (N = 41) and focus groups (N = 8) with 80 direct care staff members of all levels working in Australian RACFs. Data collection and analysis were conducted in parallel and followed a systematic, inductive approach in line with grounded theory. The perceptions of participants regarding the organizational barriers to facilitating decision making for individuals with dementia can be described by the core category, Working Within the System, and three sub-themes: (a) finding time, (b) competing rights, and (c)not knowing. Examining the views of direct care staff through the lens of NPT allows possible areas for improvement to be identified at an organizational level and the perceived barriers to be understood in the context of promoting normalization of decision making for individuals with dementia.

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Residue retention is an important issue in evaluating the sustainability of production forestry. However, its long-term impacts have not been studied extensively, especially in sub-tropical environments. This study investigated the long-term impact of harvest residue retention on tree nutrition, growth and productivity of a F1 hybrid (Pinus elliottii var. elliottii × Pinus caribaea var. hondurensis) exotic pine plantation in sub-tropical Australia, under three harvest residue management regimes: (1) residue removal, RR0; (2) single residue retention, RR1; and (3) double residue retention, RR2. The experiment, established in 1996, is a randomised complete block design with 4 replicates. Tree growth measurements in this study were carried out at ages 2, 4, 6, 8 and 10 years, while foliar nutrient analyses were carried out at ages 2, 4, 6 and 10 years. Litter production and litter nitrogen (N) and phosphorus (P) measurements were carried out quarterly over a 15-month period between ages 9 and 10 years. Results showed that total tree growth was still greater in residue-retained treatments compared to the RR0 treatment. However, mean annual increments of diameter at breast height (MAID) and basal area (MAIB) declined significantly after age 4 years to about 68-78% at age 10 years. Declining foliar N and P concentrations accounted for 62% (p < 0.05) of the variation of growth rates after age 4 years, and foliar N and P concentrations were either marginal or below critical concentrations. In addition, litter production, and litter N and P contents were not significantly different among the treatments. This study suggests that the impact of residue retention on tree nutrition and growth rates might be limited over a longer period, and that the integration of alternative forest management practices is necessary to sustain the benefits of harvest residues until the end of the rotation.

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Dwindling water supplies for irrigation are prompting alternative management choices by irrigators. Limited irrigation, where less water is applied than full crop demand, may be a viable approach. Application of limited irrigation to corn was examined in this research. Corn was grown in crop rotations with dryland, limited irrigation, or full irrigation management from 1985 to 1999. Crop rotations included corn following corn (continuous corn), corn following wheat, followed by soybean (wheat-corn-soybean), and corn following soybean (corn-soybean). Full irrigation was managed to meet crop evapotranspiration requirements (ETc). Limited irrigation was managed with a seasonal target of no more than 150 mm applied. Precipitation patterns influenced the outcomes of measured parameters. Dryland yields had the most variation, while fully irrigated yields varied the least. Limited irrigation yields were 80% to 90%> of fully irrigated yields, but the limited irrigation plots received about half the applied water. Grain yields were significantly different among irrigation treatments. Yields were not significantly different among rotation treatments for all years and water treatments. For soil water parameters, more statistical differences were detected among the water management treatments than among the crop rotation treatments. Economic projections of these management practices showed that full irrigation produced the most income if water was available. Limited irrigation increased income significantly from dryland management.

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Three anaerobic ponds used to store and treat piggery wastes were fully covered with permeable materials manufactured from polypropylene geofabric, polyethylene shade cloth and supported straw. The covers were assessed in terms of efficacy in reducing odour emission rates over a 40-month period. Odour samples were collected from the surface of the covers, the surface of the exposed liquor and from the surface of an uncovered (control) pond at one of the piggeries. Relative to the emission rate of the exposed liquor at each pond, the polypropylene, shade cloth and straw covers reduced average emission rates by 76%, 69% and 66%, respectively. At the piggery with an uncovered control pond, the polypropylene covers reduced average odour emission rates by 50% and 41%, respectively. A plausible hypothesis, consistent with likely mechanisms for the odour reduction and the olfactometric method used to quantifying the efficacy of the covers, is offered.

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Cultivation and cropping of soils results in a decline in soil organic carbon and soil nitrogen, and can lead to reduced crop yields. The CENTURY model was used to simulate the effects of continuous cultivation and cereal cropping on total soil organic matter (C and N), carbon pools, nitrogen mineralisation, and crop yield from 6 locations in southern Queensland. The model was calibrated for each replicate from the original datasets, allowing comparisons for each replicate rather than site averages. The CENTURY model was able to satisfactorily predict the impact of long-term cultivation and cereal cropping on total organic carbon, but was less successful in simulating the different fractions and nitrogen mineralisation. The model firstly over-predicted the initial (pre-cropping) soil carbon and nitrogen concentration of the sites. To account for the unique shrinking and swelling characteristics of the Vertosol soils, the default annual decomposition rates of the slow and passive carbon pools were doubled, and then the model accurately predicted initial conditions. The ability of the model to predict carbon pool fractions varied, demonstrating the difficulty inherent in predicting the size of these conceptual pools. The strength of the model lies in the ability to closely predict the starting soil organic matter conditions, and the ability to predict the impact of clearing, cultivation, fertiliser application, and continuous cropping on total soil carbon and nitrogen.

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Rainfall variability is a major challenge to sustainable management in semi-arid rangelands. We present empirical evidence from a large, long-term grazing trial in northern Australia on the relative performance of constant heavy stocking, moderate stocking at long-term carrying capacity and variable stocking in coping with climate variability over a range of rainfall years. Moderate stocking gave good economic returns, maintained pasture condition and minimised soil loss and runoff. Heavy stocking was neither sustainable nor profitable in the long term. Variable stocking generally performed well but suffered economic loss and some decline in pasture condition in the transition from good to poor years. Importantly, our results show that sustainable and profitable management are compatible in semi-arid rangelands.

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This project addresses the R&D priority for an Environmentally Sustainable Queensland through the strategy of developing and implementing ecologically sustainable fishing practices. The principal findings of this research project will be discussed at a national workshop with the twin goals of promoting an understanding of the major elements of sustainable fish stocking practices and discussing and planning the way forward for the implementation of change. The workshop participants will include fisheries managers, representatives from interested community groups and other stakeholders.

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In our recent paper [1], we discussed some potential undesirable consequences of public data archiving (PDA) with specific reference to long-term studies and proposed solutions to manage these issues. We reaffirm our commitment to data sharing and collaboration, both of which have been common and fruitful practices supported for many decades by researchers involved in long-term studies. We acknowledge the potential benefits of PDA (e.g., [2]), but believe that several potential negative consequences for science have been underestimated [1] (see also 3 and 4). The objective of our recent paper [1] was to define practices to simultaneously maximize the benefits and minimize the potential unwanted consequences of PDA.

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The purpose of this report is to present the final results of all activities conducted under HAL Project VG05053 ‘Virus identification and development of long-term management strategies for the rhubarb industry’. The report provides a summary of project findings, a description of technology transfer activities, and recommendations arising from the outcomes of the project. The overall objective of this project was to devise a strategy for the control of rhubarb decline disease through 1) knowledge of the viruses present and their epidemiology, 2) production of virus-free planting material via tissue culture, and 3) formation of a national grower group to represent industry.

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Objective: In Australian residential aged care facilities (RACFs), the use of certain classes of high-risk medication such as antipsychotics, potent analgesics, and sedatives is high. Here, we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference. Design: This is a prospective observational study. Setting: Four RACFs in Queensland, Australia, are included. Participants: A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation. Results: Residents’ mean (standard deviation, SD) age was 83.0 (8.1) years and 64.1% were female. They had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean (SD) of 9.6 (4.2) regular medications. Ninety-one percent of patients were taking five or more medications daily. Of total medications prescribed (n=1,469), geriatricians recommended withdrawal of 9.8% (n=145) and dose alteration of 3.5% (n=51). New medications were initiated in 47.7% (n=73) patients. Of the 10.3% (n=151) medications considered as high risk, 17.2% were stopped and dose altered in 2.6%. Conclusion: There was a moderate prevalence of potentially inappropriate high-risk medications. However, geriatricians made relatively few changes, suggesting either that, on balance, prescription of these medications was appropriate or, because of other factors, there was a reluctance to adjust medications. A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients. Further research, including a broader survey, is required to understand these dynamics.

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Regardless of the existence of antibiotics, infectious diseases are the leading causes of death in the world. Staphylococci cause many infections of varying severity, although they can also exist peacefully in many parts of the human body. Most often Staphylococcus aureus colonises the nose, and that colonisation is considered to be a risk factor for spread of this bacterium. S. aureus is considered to be the most important Staphylococcus species. It poses a challenge to the field of medicine, and one of the most problematic aspects is the drastic increase of the methicillin-resistant S. aureus (MRSA) strains in hospitals and community world-wide, including Finland. In addition, most of the clinical coagulase-negative staphylococcus (CNS) isolates express resistance to methicillin. Methicillin-resistance in S. aureus is caused by the mecA gene that encodes an extra penicillin-binding protein (PBP) 2a. The mecA gene is found in a mobile genomic island called staphylococcal chromosome cassette mec (SCCmec). The SCCmec consists of the mec gene and cassette chromosome recombinase (ccr)gene complexes. The areas of the SCCmec element outside the ccr and mec complex are known as the junkyard J regions. So far, eight types of SCCmec(SCCmec I- SCCmec VIII) and a number of variants have been described. The SCCmec island is an acquired element in S. aureus. Lately, it appears that CNS might be the storage place of the SCCmec that aid the S. aureus by providing it with the resistant elements. The SCCmec is known to exist only in the staphylococci. The aim of the present study was to investigate the horizontal transfer of SCCmec between the S. aureus and CNS. One specific aim was to study whether or not some methicillin-sensitive S. aureus (MSSA) strains are more inclined to receive the SCCmec than others. This was done by comparing the genetic background of clinical MSSA isolates in the health care facilities of the Helsinki and Uusimaa Hospital District in 2001 to the representatives of the epidemic MRSA (EMRSA) genotypes, which have been encountered in Finland during 1992-2004. Majority of the clinical MSSA strains were related to the EMRSA strains. This finding suggests that horizontal transfer of SCCmec from unknown donor(s) to several MSSA background genotypes has occurred in Finland. The molecular characteristics of representative clinical methicillin-resistant S. epidermidis (MRSE) isolates recovered in Finnish hospitals between 1990 and 1998 were also studied, examining their genetic relation to each other and to the internationally recognised MRSE clones as well, so as to ascertain the common traits between the SCCmec elements in MRSE and MRSA. The clinical MRSE strains were genetically related to each other; eleven PFGE types were associated with sequence type ST2 that has been identified world-wide. A single MRSE strain may possess two SCCmec types III and IV, which were recognised among the MRSA strains. Moreover, six months after the onset of an outbreak of MRSA possessing a SCCmec type V in a long-term care facility in Northern Finland (LTCF) in 2003, the SCCmec element of nasally carried methicillin-resistant staphylococci was studied. Among the residents of a LTCF, nasal carriage of MR-CNS was common with extreme diversity of SCCmec types. MRSE was the most prevalent CNS species. Horizontal transfer of SCCmec elements is speculated to be based on the sharing of SCCmec type V between MRSA and MRSE in the same person. Additionally, the SCCmec element of the clinical human S. sciuri isolates was studied. Some of the SCCmec regions were present in S. sciuri and the pls gene was common in it. This finding supports the hypothesis of genetic exchange happening between staphylococcal species. Evaluation of the epidemiology of methicillin-resistant staphylococcal colonisation is necessary in order to understand the apparent emergence of these strains and to develop appropriate control strategies. SCCmec typing is essential for understanding the emergence of MRSA strains from CNS, considering that the MR-CNS may represent the gene pool for the continuous creation of new SCCmec types from which MRSA might originate.

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For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute care hospitals in Australia. Patients had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean of 7.2 regular medications at admission to hospital and 8.1 medications on discharge, with hyper-polypharmacy (≥10 drugs) increasing from 24.3% to 32.5%. Many drugs were preventive medications whose time until benefit was likely to exceed the expected lifespan. In summary, frail patients continue to be exposed to extensive polypharmacy and medications with uncertain risk–benefit ratio.