Biennial report of the Commissioners of the Soldiers' Home at Marshalltown, Iowa,1889

This is the 1889 Biennial report of the Commissioners of the Soldiers' Home at Marshalltown, Iowa to the General Assembly of Iowa. It provides information on the services that the home provides to veterans and how the facility is maintained. It also contains a treasurer's report.

Quality of life, happiness and satisfaction with life of individuals 75 years old or older cared for by a home health care program

This case study identifies the elements that compose the Quality of Life (QofL) of individuals who were 75 years old or older and receive care at home. The study's sample was composed of individuals 75 years or older cared for by a home health care service in the primary health care unit in Vilafranca del Penedès, Spain (n=26). The variables included: a) socio-demographic data; b) concept of QofL; c) perception of QofL; d) reasons for their perception; d) satisfaction with life and related aspects; and f) feeling of happiness. Face to face interviews were conducted. A total of 76.9% of the individuals reported a good perception of QofL and the main reasons related to it were: health, family and social relationships, and the ability to adapt. Role Theory and Disengagement Theory explain the adaptation process of these individuals at this point in life.

Quality of life, happiness and satisfaction with life of individuals 75 years old or older cared for by a home health care program

This case study identifies the elements that compose the Quality of Life (QofL) of individuals who were 75 years old or older and receive care at home. The study's sample was composed of individuals 75 years or older cared for by a home health care service in the primary health care unit in Vilafranca del Penedès, Spain (n=26). The variables included: a) socio-demographic data; b) concept of QofL; c) perception of QofL; d) reasons for their perception; d) satisfaction with life and related aspects; and f) feeling of happiness. Face to face interviews were conducted. A total of 76.9% of the individuals reported a good perception of QofL and the main reasons related to it were: health, family and social relationships, and the ability to adapt. Role Theory and Disengagement Theory explain the adaptation process of these individuals at this point in life.

Report on the Iowa Veterans Home for the year ended June 30, 2013

Report on the Iowa Veterans Home for the year ended June 30, 2013

Antiretroviral therapy during pregnancy and premature birth: analysis of Swiss data.

BACKGROUND: There is an ongoing debate as to whether combined antiretroviral treatment (cART) during pregnancy is an independent risk factor for prematurity in HIV-1-infected women. OBJECTIVE: The aim of the study was to examine (1) crude effects of different ART regimens on prematurity, (2) the association between duration of cART and duration of pregnancy, and (3) the role of possibly confounding risk factors for prematurity. METHOD: We analysed data from 1180 pregnancies prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS). RESULTS: Odds ratios for prematurity in women receiving mono/dual therapy and cART were 1.8 [95% confidence interval (CI) 0.85-3.6] and 2.5 (95% CI 1.4-4.3) compared with women not receiving ART during pregnancy (P=0.004). In a subgroup of 365 pregnancies with comprehensive information on maternal clinical, demographic and lifestyle characteristics, there was no indication that maternal viral load, age, ethnicity or history of injecting drug use affected prematurity rates associated with the use of cART. Duration of cART before delivery was also not associated with duration of pregnancy. CONCLUSION: Our study indicates that confounding by maternal risk factors or duration of cART exposure is not a likely explanation for the effects of ART on prematurity in HIV-1-infected women.

Infections and functionnal impairment in nursing home residents : a reciprocal relationship

RESUME: Contexte : l'objectif de cette étude de cohorte prospective était de déterminer la relation entre la survenue d'infections et la dépendance fonctionnelle chez des résidents d'établissements de long séjour durant une période de 6 mois. Population et méthode : les patients inclus (1324 résidents) étaient âgés de 65 ans et plus (âge moyen 85.7 ans, 76.6% de femmes), étaient des résidents de 39 EMS du canton de Vaud. Au baseline, des données démographiques, médicales, concernant les facteurs de risque et protecteurs des infections ont été récoltées. Au cours du suivi de 6 mois, les infirmières des EMS ont documenté la survenue de symptômes et signes d'infection en utilisant les critères développés spécifiquement par l'APIC pour les établissements de long séjour. Les mesures du status fonctionnel ont été évaluées au baseline, à 3 mois et à 6 mois. Deux outcomes différents ont été utilisés : a) le déclin fonctionnel défini comme le décès ou une diminution des capacités fonctionnelles au suivi, b) le status fonctionnel mesuré par une échelle standardisée. Résultats : à la fin du suivi, la mortalité était de 14.6%, similaire pour les résidents avec et sans infection (16.2% versus 13.1%, P .11). Durant les 2 périodes de suivi de 3 mois, les sujets ayant présenté une ou plusieurs infections avaient des odds de déclin fonctionnel plus élevés, y compris après ajustement pour les caractéristiques démographiques, médicales et fonctionnelles du baseline, ainsi que la survenue de nouvelles maladies (odds ratio ajustés (OR) = 1.6, intervalle de confiance à 95% (IC) = 1.2-2.2, P = .002 et OR = 1.5, 95% IC= 1.1-2.0, P= .008, respectivement). Comparés aux résidents non infectés, les odds de déclin fonctionnel augmentaient significativement et graduellement chez ceux ayant eu une, respectivement 2 infections ou plus. L'analyse prédisant le score fonctionnel (restreinte aux sujets ayant survécu) a donné des résultats similaires. Finalement, une analyse de survie prédisant le temps jusqu'à la première infection a confirmé une augmentation progressive de la probabilité d'infection chez les sujets avec dépendance fonctionnelle modérée, respectivement sévère, comparés aux sujets indépendants à la ligne de base. Conclusion : chez les résidents de long séjour, les infections sont à la fois cause et conséquence de la dépendance fonctionnelle. Des études futures devraient être entreprises pour investiguer si des programmes de prévention des infections peuvent également contribuer à prévenir le déclin fonctionnel, un facteur important pour la qualité de vie de ces résidents. ABSTRACT: Objectives: To determine the relationship between infections and functional impairment in nursing home residents. Design: Prospective cohort study (follow-up period, 6 months). Setting: Thirty-nine nursing homes in western Switzerland. Participants: A total of 1,324 residents aged 65 and older (mean age 85.7; 76.6% female) who agreed to participate, or their proxies, by oral informed consent. Measurements: Functional status measured every 3 months. Two different outcomes were used: (a) functional decline defined as death or decreased function at follow-up and (b) functional status score using a standardized measure. Results: At the end of follow-up, mortality was 14.6%, not different for those with and without infection (16.2% vs 13.1%, P= .11) During both 3-month periods, subjects with infection had higher odds of functional decline, even after adjustment for baseline characteristics and occurrence of a new illness (adjusted odds ratio (AOR) = 1.6, 95% confidence interval (CI) = 1.2-2.2, P = .002, and AOR 1.5, 95% CI 1.1-2.0, P .008, respectively). The odds of decline increased in a stepwise fashion in patients with zero, one, and two or more infections. The analyses predicting functional status score (restricted to subjects who survived) gave similar results. A survival analysis predicting time to first infection confirmed a stepwise greater likelihood of infection in subjects -with moderate and severe impairment at baseline than in subjects with no or mild functional impairment at baseline. Conclusion: Infections appear to be both a cause and a consequence of functional impairment in nursing home residents. Further studies should be undertaken to investigate whether effective infection control programs can also contribute to preventing functional decline, an important component of these residents' quality of life.

Revisió sobre l’eficàcia de les intervencions dirigides a cuidadors informals de malalts amb demència per a reduir els nivells de morbiditat psicològica

Revisió sobre l’eficàcia de les intervencions dirigides a cuidadorsinformals de malalts amb demència per a reduir els nivells de morbiditatpsicològicaAntecedentsL’envelliment de la població està relacionat amb l’augment de la prevalença dedemències tals com la malaltia d’Alzheimer. El caràcter progressiu, incapacitanti irreversible de la malaltia d’Alzheimer comporta dependència i demanda,obligant l’aparició d’un cuidador informal per cobrir les necessitats del malalt.Amb l’evolució de la malaltia, augmenta l’exigència de les cures i el cuidador esveu en risc de patir alteracions a qualsevol nivell, principalment a nivellpsicològic.Objectius1. Avaluar l’efectivitat de les intervencions dirigides a cuidadors informals depersones amb demència per a reduir la morbiditat psicològica, segons latipologia de les intervencions i els seus components.2. Avaluar l’efectivitat de les intervencions dirigides a cuidadors informals depersones amb demència per a reduir la morbiditat psicològica, segons lescaracterístiques sociodemogràfiques del cuidador i la persona que rep lescures, el tipus de càrrega i els instruments de mesura.Material i mètodesEs va realitzar una revisió bibliogràfica en les bases de dades: MEDLINEPubMed, CSIC-IME, CUIDEN i Biblioteca Cochrane Plus sobre lesintervencions dirigides a cuidadors informals de demència o Alzheimerd’estudis publicats entre el gener de 2002 i febrer de 2013. Els criteris d’inclusióvan ser: cuidadors informals que convisquessin amb la persona a qui donen lescures i sense remuneració econòmica, persones amb demència o Alzheimer noinstitucionalitzades, intervencions comparades entre un grup experimental i ungrup control, prioritat per revisions sistemàtiques i metanàlisis. La mostra finalla van composar 7 estudis.ResultatsLes diferents intervencions analitzades van mostrar dades estadísticamentsignificatives tot i produir efectes discrets en les diferents variables demorbiditat psicològica. Les intervencions psicoeducatives i les intervencionsdirigides als pacients van resultar efectives en la millora de la sensació debenestar i la simptomatologia del malalt. Les intervencions psicològiques vanincidir en la sobrecàrrega i la depressió. Les intervencions de suport vanproduir un augment dels coneixements, habilitats i de la xarxa social delcuidador. El dia de descans va disminuir l’estrès, l’ansietat i la càrrega objectivaperò els efectes van ser a curt termini. Les intervencions múltiplesestructurades van mostrar una disminució del risc d’institucionalització. Lesintervencions centrades en la resolució de problemes, superiors a 6 sessions oaquelles que havien realitzat seguiment, van mostrar efectes a llarg termini finsals 12 mesos. Altres intervencions pràctiques com les realitzades al domicili oamb tecnologia, no van mostrar suficient evidència científica. El sexe i l’edat delcuidador així com la relació de parentesc amb el malalt van mostrar diferènciesen els efectes de les intervencions.ConclusionsLes intervencions s’han de planificar en funció de les necessitats del cuidadorja que no hi ha cap intervenció que incideixi en totes les variables de morbiditatpsicològica. La variabilitat de tipologia i composició de les intervencions, lesdiferències sociodemogràfiques del cuidador i la persona que rep les cures i lescaracterístiques dels estudis influeixen en l’heterogeneïtat de resultats de larevisió. Aquests fets limiten la contundència de resultats pel que cal seguirinvestigant

Iowa Veterans Home, Strategic Plan, FY2015-2019

This report outlines the strategic plan for Iowa Veterans Home, goals and mission.

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: The case of preterm birth

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother-infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother-infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n=26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months' corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother-infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers' posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother-infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother-infant interactions.

Iowa Veterans Home Performance Plan, FY2015

Agency Performance Plan

Assessing the possible direct effect of birth weight on childhood blood pressure : a sensitivity analysis.

To estimate the possible direct effect of birth weight on blood pressure, it is conventional to condition on the mediator, current weight. Such conditioning can induce bias. Our aim was to assess the potential biasing effect of U, an unmeasured common cause of current weight and blood pressure, on the estimate of the controlled direct effect of birth weight on blood pressure, with the help of sensitivity analyses. We used data from a school-based study conducted in Switzerland in 2005-2006 (n = 3,762; mean age = 12.3 years). A small negative association was observed between birth weight and systolic blood pressure (linear regression coefficient βbw = -0.3 mmHg/kg, 95% confidence interval: -0.9, 0.3). The association was strengthened upon adjustment for current weight (βbw|C = -1.5 mmHg/kg, 95% confidence interval: -2.1, -0.9). Sensitivity analyses revealed that the negative conditional association was explained by U only if U was relatively strongly associated with blood pressure and if there was a large difference in the prevalence of U between low-birth weight and normal-birth weight children. This weakens the hypothesis that the negative relationship between birth weight and blood pressure arises only from collider-stratification bias induced by conditioning on current weight.

The birth of the Rheic Ocean - Early Palaeozoic subsidence patterns and subsequent tectonic plate scenarios

New plate-tectonic reconstructions of the Gondwana margin suggest that the location of Gondwana-derived terranes should not only be guided by the models, but should also consider the possible detrital input from some Asian blocks (Hunia), supposed to have been located along the Cambrian Gondwana margin, and accreted in the Silurian to the North-Chinese block. Consequently, the Gondwana margin has to be subdivided into a more western domain, where the future Avalonian blocks will be separated from Gondwana by the opening Rheic Ocean, whereas in its eastern continuation, hosting the future basement areas of Central Europe, different periods of crustal extension should be distinguished. Instead of applying a rather cylindrical model, it is supposed that crustal extension follows a much more complex pattern, where local back-arcs or intra-continental rifts are involved. Guided by the age data of magmatic rocks and the pattern of subsidence curves, the following extensional events can be distinguished: During the early to middle Cambrian, a back-arc setting guided the evolution at the Gondwana margin. Contemporaneous intra-continental rift basins developed at other places related to a general post-PanAfrican extensional phase affecting Africa Upper Cambrian formation of oceanic crust is manifested in the Chamrousse area, and may have lateral cryptic relics preserved in other places. This is regarded as the oceanisation of some marginal basins in a context of back-arc rifting. These basins were closed in a mid-Ordovician tectonic phase, related to the subduction of buoyant material (mid-ocean ridge?) Since the Early Ordovician, a new phase of extension is observed, accompanied by a large-scale volcanic activity, erosion of the rift shoulders generated detritus (Armorican Quartzite) and the rift basins collected detrital zircons from a wide hinterland. This phase heralded the opening of Palaeotethys, but it failed due to the Silurian collision (Eo-Variscan phase) of an intra-oceanic arc with the Gondwana margin. During this time period, at the eastern wing of the Gondwana margin begins the drift of the future Hunia microcontinents, through the opening of an eastern prolongation of the already existing Rheic Ocean. The passive margin of the remaining Gondwana was composed of the Galatian superterranes, constituents of the future Variscan basement areas. Remaining under the influence of crustal extension, they will start their drift to Laurussia since the earliest Devonian during the opening of the Palaeotethys Ocean. (C) 2008 Elsevier B.V. All rights reserved.

Unplanned nursing home short stay : elderly patients characteristics and 3-month outcomes.

Background: Nursing home short stays (NHSS) in the canton of Vaud have been introduced for respite care purpose. However, a growing number of older patients are urgently admitted from home (within 24h) or directly after hospital discharge (58% of all admissions in 2010). NHSS appears therefore as an increasingly important component of the health care system, but the characteristics of admitted patients have not been previously described. A better knowledge would contribute to identify specific care needs and enhance their care. Objectives: 1) To describe the characteristics of patients admitted in unplanned NHSS ( after hospital stay or urgently from home); 2) To determine living disposition 3-month after NHSS discharge. Method: Over a 18-month period, elderly patients with unplanned NHSS admission to 2 facilities in Lausanne were identified. Demographic, social, health, and functional data, as well as main reason for admission were collected. Death and place of living at 3-months were collected using the administrative database. Results: Overall, 114 patients (mean age 83.1 ± 6.2 years, 77% women, 84% living alone) were assessed, 80% being admitted from hospital. Mean score in Lawton's instrumental ADL before NHSS admission was 4.6 ± 2.5 and 69% of the patients were home care recipients (median number of weekly visits: 5 ± 3). Patients reported going out 4.2 ± 1.3 times/week and 56% reported at least one fall over the past year. Among the 91 patients coming from the hospital, main reason for admission was injury/limb immobilization (58%), recuperation (13%) and functional impairment in basic ADL (10%). Mean score at Katz's Basic ADL at admission was 3.7 ± 1.9. Overall, 90% of patients were identified with gait and balance impairment, 78% with cognitive impairment and 70% with polypharmacy (>6 different drugs). At 3-month after NHSS discharge (N = 92), 72% patients were living at home, 16% had been admitted to long term care, and 6% died. Among patients living at home at follow-up, 11% had been readmitted to hospital during the follow-up period. Conclusion: Older patients with unplanned NHSS admission show a high prevalence of functional, mobility, and cognitive impairments, as well as other geriatric syndromes. Specific measures should be considered during these stays to prevent further functional decline and, possibly, hospital readmission. Patients admitted with basic ADLs impairment might be candidate for higher levels of care (rehabilitation).

Report on the Iowa Veterans Home for the year ended June 30, 2014

Report on the Iowa Veterans Home for the year ended June 30, 2014