Mental Health and Morbidity of Caregivers and Co-Residents of individuals with Dementia: A Quasi-Experimental Design

Objectives: To determine if providing informal care to a co-resident with dementia symptoms places an additional risk on the likelihood of poor mental health or mortality compared to co-resident non-caregivers.
Design: A quasi-experimental design of caregiving and non-caregiving co-residents of individuals with dementia symptoms, providing a natural comparator for the additive effects of caregiving on top of living with an individual with dementia symptoms. 
Methods: Census records, providing information on household structure, intensity of caregiving, presence of dementia symptoms and self-reported mental health, were linked to mortality records over the following 33 months. Multi-level regression models were constructed to determine the risk of poor mental health and death in co-resident caregivers of individuals with dementia symptoms compared to co-resident non-caregivers, adjusting for the clustering of individuals within households.
Results: The cohort consisted of 10,982 co-residents (55.1% caregivers), with 12.1% of non-caregivers reporting poor mental health compared to 8.4% of intense caregivers (>20 hours of care per week). During follow-up the cohort experienced 560 deaths (245 to caregivers). Overall, caregiving co-residents were at no greater risk of poor mental health but had lower mortality risk than non-caregiving co-residents (ORadj=0.93, 95% CI 0.79, 1.10 and ORadj=0.67, 95% CI 0.56, 0.81, respectively); this lower mortality risk was also seen amongst the most intensive caregivers (ORadj=0.65, 95% CI 0.53, 0.79).
Conclusion: Caregiving poses no additional risk to mental health over and above the risk associated with merely living with someone with dementia, and is associated with a lower mortality risk compared to non-caregiving co-residents.

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

Background
First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.
Methods
Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.
Results
One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8–12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1–2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.
Conclusion
First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

Vitamin D and Health

SACN reviewed the evidence on vitamin D and health to see if UK dietary recommendations, set in 1991, were still appropriate. In addition to the main report, you can read the SACN press release. In a change to previous advice, SACN is now recommending: a reference nutrient intake (RNI) of 10 micrograms of vitamin D per day, throughout the year, for everyone in the general population aged 4 years and older an RNI of 10 micrograms of vitamin D per day for pregnant and lactating women and population groups at increased risk of vitamin D deficiency a ‘safe intake’ of 8.5 to 10 micrograms per day for all infants from birth to 1 year of age a ‘safe intake’ of 10 micrograms per day for children aged 1 to 4 years The RNI and safe intakes were developed to ensure that the majority of the UK population has enough vitamin D to protect musculoskeletal health, all year round. SACN did not take account of sunlight exposure in making recommendations because of the number and complexity of factors that affect skin synthesis of vitamin D. The RNI and safe intakes refer to intake from all dietary sources: natural food sources fortified foods (including infant formula milk) supplements They also refer to average intakes over a period of time, such as a week, and take account of day-to-day variations in intake.

Patients' experiences of support for learning to live with diabetes to promote health and well-being : A lifeworld phenomenological study

Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient's perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.

Resident perceptions of natural resources between cities and across scales in the Pacific Northwest

As the global population becomes increasingly urban, research is needed to explore how local culture, land use, and policy will influence urban natural resource management. We used a broad-scale comparative approach and survey of residents within the Portland (Oregon)-Vancouver (Washington) metropolitan areas, USA, two states with similar geographical and ecological characteristics, but different approaches to land-use planning, to explore resident perceptions about natural resources at three scales of analysis: property level (“at or near my house”), neighborhood (“within a 20-minute walk from my house”), and metro level (“across the metro area”). At the metro-level scale, nonmetric multidimensional scaling revealed that the two cities were quite similar. However, affinity for particular landscape characteristics existed within each city with the greatest difference generally at the property-level scale. Portland respondents expressed affinity for large mature trees, tree-lined streets, public transportation, and proximity to stores and services. Vancouver respondents expressed affinity for plentiful accessible parking. We suggest three explanations that likely are not mutually exclusive. First, respondents are segmented based on preferences for particular amenities, such as convenience versus commuter needs. Second, historical land-use and tax policy legacies may influence individual decisions. Third, more environmentally attuned worldviews may influence an individual’s desire to produce environmentally friendly outcomes. Our findings highlight the importance of acknowledging variations in residents’ affinities for landscape characteristics across different scales and locations because these differences may influence future land-use policies about urban natural resources.

Discrete-event Simulation and Optimization to Improve the Performance of a Healthcare System

Thesis (Ph.D.)--University of Washington, 2016-08

Hemp fines - an agricultural by-product for biocomposites? A holistic approach

The technical, environmental and economic potential of hemp fines as a natural filler in bioplastics to produce biocomposites is the subject of this study – giving a holistic overview. Hemp fines are an agricultural by-product of the hemp fibres and shives production. Shives and fibres are for example used in the paper, animal bedding or composite area. About 15 to 20 wt.-% per kg hemp straw results in hemp fines after processing. In 2010 about 11,439 metric tons of hemp fines were produced in Europe. Hemp fines are an inhomogeneous material which includes hemp dust, shives and fibre. For these examinations the hemp fines are sieved in a further step with a tumbler sieving machine to obtain more specified fractions. The untreated hemp fines (ex work) as well as the sieved fractions are combined with a polylactide polymer (PLA) using a co-rotating twin screw extruder to produce biocomposites with different hemp fine content. By using an injection moulding machine standard test bars are produced to conduct several material tests. The Young’s modulus is increased and the impact strength reduced by hemp fines. With a content of above 15 wt.-% hemp fines are also improving the environmental (global warming potential) and economic performance in comparison to pure PLA.

Validation of Electronic Health Record Phenotyping of Bipolar Disorder Cases and Controls

Objective: The study was designed to validate use of elec-tronic health records (EHRs) for diagnosing bipolar disorder and classifying control subjects. Method: EHR data were obtained from a health care system of more than 4.6 million patients spanning more than 20 years. Experienced clinicians reviewed charts to identify text features and coded data consistent or inconsistent with a diagnosis of bipolar disorder. Natural language processing was used to train a diagnostic algorithm with 95% specificity for classifying bipolar disorder. Filtered coded data were used to derive three additional classification rules for case subjects and one for control subjects. The positive predictive value (PPV) of EHR-based bipolar disorder and subphenotype di- agnoses was calculated against diagnoses from direct semi- structured interviews of 190 patients by trained clinicians blind to EHR diagnosis. Results: The PPV of bipolar disorder defined by natural language processing was 0.85. Coded classification based on strict filtering achieved a value of 0.79, but classifications based on less stringent criteria performed less well. No EHR- classified control subject received a diagnosis of bipolar dis- order on the basis of direct interview (PPV=1.0). For most subphenotypes, values exceeded 0.80. The EHR-based clas- sifications were used to accrue 4,500 bipolar disorder cases and 5,000 controls for genetic analyses. Conclusions: Semiautomated mining of EHRs can be used to ascertain bipolar disorder patients and control subjects with high specificity and predictive value compared with diagnostic interviews. EHRs provide a powerful resource for high-throughput phenotyping for genetic and clinical research.

Fungal contamination in coffee samples: a public health concern

Introduction - Fungi are natural coffee contaminants and under certain environmental conditions have the potential to produce toxins. Many studies revealed that the important toxigenic fungal genera (Aspergillus and Penicillium) are natural coffee contaminants, and are present from the field to storage. Aspergilli from the Circumdati and Nigri sections are known to produce high levels of ochratoxin A, a mycotoxin known as nephrotoxic for animals and humans. This work aimed to evaluate fungal distribution and also the prevalence of Aspergillus sections Fumigati, Flavi, Nigri and Circumdati from Coffea arabica (Arabica coffee) and Coffea canephora (Robusta coffee) green samples.

Alergias a alimentos ou a derivados usados como excipientes em medicamentos

Aditivos químicos têm como principal objetivo melhorar os produtos industrializados, como fármacos, conferindo-lhes cor, aroma, textura, conservação, entre outros. Os aditivos utilizados na indústria farmacêutica são denominados excipientes, completando a massa ou o volume especificado no medicamento. São considerados substâncias inativas, uma vez que não apresentam propriedades curativas ou preventivas de doenças ou dos seus sintomas. No âmbito deste trabalho, foi realizado uma revisão bibliográfica sobre os excipientes naturais e sintéticos mais usados na indústria farmacêutica, agrupando-os mediante a sua função específica. Assim, foi feita uma breve descrição sobre alguns dos excipientes mais utilizados nas formulações farmacêuticas, nomeadamente os antioxidantes, os corantes, os edulcorantes e os conservantes, que visam garantir a conservação do produto em condições viáveis. Uma vez que os excipientes são considerados substâncias inativas, são vistos como inofensivos para a saúde. No entanto, é cada vez mais evidente que os excipientes não são sempre inertes e podem apresentar riscos para o desenvolvimento de reações alérgicas, podendo promover alterações mais prejudiciais. As reações alérgicas associadas aos excipientes são consideradas raras, visto que são incorporadas baixas concentrações destes em formulações farmacêuticas, tendo surgido, no entanto, diversos casos associados aos diferentes excipientes anteriormente referidos. Dependendo do excipiente e da sensibilidade do indivíduo, as alergias podem originar dermatites de contacto, prurido, urticária, edema, reações anafiláticas, entre outros. É importante salientar que o excesso de aditivos pode originar problemas de saúde, normalmente em indivíduos suscetíveis e na população pediátrica, sendo necessário aplicar cuidados adicionais que promovam uma maior vigilância e orientação no uso de medicamentos.

Desenvolvimento e caracterização de um sabonete contendo borras de café

Desde da antiguidade que o ser humano se preocupa com a sua aparência externa, em especial com a pele. Para além do desenvolvimento de cosméticos, surgiram também produtos mais complexos, os cosmecêuticos, que diferem dos cosméticos devido a poderem influenciar a função biológica da pele, causando modificações positivas e duráveis. O conceito de sustentabilidade é usado para definir ações e atividades humanas que visam suprir as necessidades atuais dos seres humanos, sem comprometer o futuro das próximas gerações. Ou seja, a sustentabilidade está diretamente relacionada ao desenvolvimento económico e material sem agredir o meio ambiente, utilizando os recursos naturais de forma inteligente para que eles se mantenham no futuro. Seguindo estes parâmetros, a humanidade pode garantir o desenvolvimento sustentável. As borras de café são consideradas como um subproduto alimentar, sem grande reutilização, o que promove danos no impacto ambiental. Por outro lado, as borras de café podem exercer grandes benefícios para a pele, pois são consideradas excelentes exfoliantes naturais com propriedades refirmantes. Os produtos à base de cafeína são aliados no combate à celulite, na estimulação da regeneração celular e da circulação sanguínea, bem como, no rejuvenescimento e revitalização da pele. Este trabalho consistiu no desenvolvimento de um sabonete, contendo borras de café, como forma de reaproveitamento de um subproduto alimentar rico em cafeína, com o intuito de obter produtos com boas propriedades cosméticas e elevada estabilidade física e química. As borras de café foram analisadas em termos da sua estabilidade física e química através de ensaios de estabilidade acelerada por centrifugação, textura, reologia e doseamento do teor de cafeína por HPLC. Os resultados obtidos através do controlo físico-químico dos sabonetes, da determinação do potencial irritante cutâneo e da análise sensorial efectuada em voluntários humanos, demonstraram que é possível preparar sabonetes de borra de café com boa estabilidade físico-química, boa tolerância cutânea e com características sensoriais adequadas, utilizando uma base de sabão constituída pelos ingredientes (INCI): Sodium Palmate, Sodium Palm Kernelate, Aqua (water), Glycerine, Fragância de café, Sodium Chloride, Butyrospermum Parkii Butter (Shea Butter), CI 778911 (Titanium Dioxide), Tetrasodium EDTA, CI 77499, Linalool e à qual foi adicionada 5% de borras de café.

Melhoria da qualidade de jerked beef pela substituição de nitrito de sódio por extratos naturais de própolis e erva mate como agente antioxidante

Jerked beef, an industrial meat product obtained from beef with the addition of sodium chloride and curing salts and subjected to a maturing and drying process is a typical Brazilian product which has been gradually discovered by the consumer. The replacement of synthetic antioxidants by natural substances with antioxidant potential due to possible side effects discovered by lab tests, consumer health, is being implemented by the meat industry. This study aimed to evaluate the lipid oxidation of jerked beef throughout the storage period by replacing the sodium nitrite by natural extracts of propolis and Yerba Mate. For jerked beef processing brisket was used as raw material processed in 6 different formulations: formulation 1 (control - in nature), formulation 2 (sodium nitrite - NO), formulation 3 (Yerba Mate - EM), formulation 4 (propolis extract - PRO), formulation 5 (sodium nitrite + Yerba Mate - MS + NO), formulation 6 (propolis extract + sodium nitrite - PRO + NO). The raw material was subjected to wet salting, dry salting (tombos), drying at 25°C, packaging and storage in BOD 25°C. Samples of each formulation were taken every 7 days for analysis of lipid oxidation by the TBARS method. In all formulations, were carried out analysis of chemical composition at time zero and sixty days of storage. The water activity analysis and color (L *, a *, b *) was monitored at time zero, thirty and sixty days of storage. The Salmonella spp count, Coliform bacteria, Termotolerant coliforms and coagulase positive staphylococci were taken at time zero and sixty days. The activity of natural antioxidants evaluated shows the decline of lipid oxidation up to 2.5 times compared with the product in natura and presented values with no significant differences between treatments NO and EM, confirming the potential in minimize lipid oxidation of Jerked beef throughout the 60 days of storage. The results also showed that yerba mate has a higher antioxidant capacity compared to the propolis except the PRO + NO formulation. When associated with yerba mate with sodium nitrate, TBARS values become close to values obtained only for the control samples with the addition of sodium nitrite. The proximal composition of the formulations remained within the standards required in the IN nº22/2000 for jerked beef. Samples that differ significantly at 5% are directly related to the established type of formulation. The count of microorganisms was within the standards of the DRC nº12/2001 required for matured meat products. The intensity of the red (a*) decreased with storage time and increase the intensity of yellow (b*) indicates a darkening of the product despite L* also have been increased. These results suggest that yerba mate is a good alternative to meat industry in reducing healing addition salts when associated with another antioxidant.

Nutrition and health claims in products directed at children via television in Spain in 2012

Objective: To describe the use of nutrition and health claims in products directed at children via television in Spain and to analyse their nutrient profile. Methods: A cross-sectional study of television food advertisements over 7 days in five Spanish television channels popular among children. The products were classified as core, non-core or miscellaneous, and as either healthy or less healthy, according to the United Kingdom Nutrient Profile Model. We registered all claims contained on the product (packaging and labelling) and its advertisement. We calculated the frequency distributions of health and nutrition claims. Results: During the 420 hours of broadcasting, 169 food products were identified, 28.5% in the dairy group and 60.9% in the non-core category. A total of 53.3% of products contained nutrition claims and 26.6% contained health claims; 62.2% of the products with claims were less healthy. Low-fat dairy products were the food category containing the highest percentage of health and nutrition claims. Conclusion: Over half of all food products marketed to children via television in Spain made some type of nutrition or health claim. Most of these products were less healthy, which could mislead Spanish consumers.

The importance of environmental sustainability in public procurement of medical devices in health care sector

The aim of this thesis was to examine the role of environmental sustainability in the procurement of medical devices in health care sector. Current literature is mainly focused on other product groups and medical devices have been left without sufficient attention. Nevertheless, EU has recently developed green public procurement criteria for medical devices (EU GPP criteria for health care EEE) in order to support and offer guidelines for purchasers in hospitals. In this study, the criteria were used as a framework in order to examine the most significant environmental aspects for medical devices. The empirical research was executed in Finnish public hospitals with mixed method approach; quantitative data was collected by a survey and qualitative data was collected by interviews held for procurement specialists. The focus was on understanding the importance of environmental sustainability in the procurement of medical devices and which environmentally sustainable features would be the most significant. Of interest was also the medical device supplier view and how they could take environmental sustainability into consideration.

Defining a management strategy for the azorean natural thermal resources : valuing criteria identification

Dissertação de Mestrado, Gestão de Empresas (MBA), 23 de Maio de 2016, Universidade dos Açores.