Urban and rural differences in risk of admission to a care home: a census-based follow-up study

Research on admissions to care homes for older people has paid more attention to individual and social characteristics than to geographical factors. This paper considers rural-urban differences in household composition and admission rates. Cohort: 51,619 people aged 65 years or older at the time of the 2001 Census and not living in a care home, drawn from a data linkage study based on c.28% of the Northern Ireland population.Living alone was less common in rural areas; 25% of older people in rural areas lived with children compared to 18% in urban areas. Care home admission was more common in urban (4.7%) and intermediate (4.3%) areas than in rural areas (3.2%). Even after adjusting for age, sex, health and living arrangements, the rate of care home admission in rural areas was still only 75% of that in urban areas.People in rural areas experience better family support by living as part of two or three generation households. Even after accounting for this difference, older rural dwellers are less likely to enter care homes; suggesting that neighbours and relatives in rural areas provide more informal care; or that there may be differential deployment of formal home care services.

Does conurbation affect the risk of poor mental health? A population based record linkage study

To determine if urban residence is associated with an increased risk of anxiety/depression independent of psychosocial stressors, concentrated disadvantage or selective migration between urban and rural areas, this population wide record-linkage study utilised data on receipt of prescription medication linked to area level indicators of conurbation and disadvantage. An urban/rural gradient in anxiolytic and antidepressant use was evident that was independent of variation in population composition. This gradient was most pronounced amongst disadvantaged areas. Migration into increasingly urban areas increased the likelihood of medication. These results suggest increasing conurbation is deleterious to mental health, especially amongst residents of deprived areas

Residential segregation, dividing walls and mental health: A population-based record linkage study

Background
Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. Whilst most previous research has relied on conceptualized measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or “peacelines”) which can be used to accurately identify residential segregation.
Methods
We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health.
Results
Using multi-level logistic regression models we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a “peaceline” increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI: 1.14, 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI: 1.32, 1.48), even after adjustment for gender, age, conurbation, deprivation and crime.
Conclusions
Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation.

Acompanhamento de obra: optimização de soluções: técnicas de cofragem (Atlântico Estoril Residence)

Relatório de Estágio para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Edificações

Utilisation de la coronarographie en Suisse: une étude de population. [The use of coronary vessel radiography in Switzerland: a population study].

All patients having undergone a coronarography during 1984 have been surveyed in Switzerland. This retrospective study has used existing data in the 13 centers practicing this diagnostic procedure. 4921 coronarographies were carried out in 1984, amongst 4359 patients. In terms of population-based rates, the national figures are 77 procedures/100,000 residents, and 68 patients/100,000 residents. Female rates are one fourth of the male rates (27/100,000 versus 112/100,000). For both sexes, the highest utilization rates are for the age groups 60-64. Swiss figures are relatively low when compared with other developed countries. However, patterns of utilization are very different within the country: according to the Canton of residence of the patient, the utilization rates (standardized for age and sex) vary from 8/100,000 to 160/100,000. There is a distinct gradient from south-west to north-east, which closely corresponds to the distribution of centers practicing the procedure. More intriguing is the fact that cardiovascular mortality shows an inverse geographical gradient, with the highest mortality in Cantons having the lowest rate of coronarography. Various reasons for the observed variations are discussed, in relation with differences in supply of diagnostic and therapeutic equipments, but also in relation with various patterns of demand related to differential morbidity rates and/or differential patterns of clinical decision.

Delirium upon admission to Swiss nursing homes: a cross-sectional study.

QUESTIONS UNDER STUDY: We wished to investigate the prevalence of delirium in patients upon admission to nursing homes and whether or not the previous place of residence predicts delirium. METHODS: The Resident Assessment Instrument Minimum Data Set (RAI-MDS) and the Nursing Home Confusion Assessment Method (NHCAM) were used to determine whether the previous place of residence (community, nursing home, acute care, psychiatric, rehabilitation hospital) predicted the prevalence of sub-syndromal or full delirium in nursing home residents in three Swiss cantons (n = 11745). RESULTS: 39.7% had sub-syndromal and 6.5% had full delirium. Lower cognitive performance and increased depressive symptoms were significant predictors of higher NHCAM values independent of previous residence. Age, civil status, continence, newly introduced drugs, and basic activities of daily living were predictors in some resident groups. The variance of NHCAM scores explained varied between 25.1% and 32.3% depending on previous residence. CONCLUSIONS: Sub-syndromal and full delirium are common upon nursing home admission. Increased dependence and depression are consistently associated with higher NHCAM scores. Patients from psychiatric settings have an increased risk of delirium. Although factors associated with delirium depend on a patient's previous residence, all patients must be carefully screened for sub-syndromal and full delirium.

Lowenberger Residence 2004

The building accommodated 311 students in single and double rooms, and included a 300-seat dining hall, common lounges, and study rooms. The building is named after Arnie Lowenberger, a former faculty member who held many significant positions during Brock's early development. Lowenberger was the first Director of the School of Physical Athletics and Recreation, and became its first Dean when it was reconstituted into the Faculty of Physical Education. In these positions, he introduced varsity sports to Brock such as men's and women's basketball and men's hockey, implemented the first health and counseling services for students, planned the design of the original Physical Education building, and drafted the University's Physical Education degree program. He also was the first Director of Residences and the first Dean of Students.

The association between maternity insurance, residence status and selected perinatal outcomes among Chinese women

Objective: To investigate the impact of maternity insurance and maternal residence on birth outcomes in a Chinese population. Methods: Secondary data was analyzed from a perinatal cohort study conducted in the Beichen District of the city of Tianjin, China. A total of 2364 pregnant women participated in this study at approximately 12-week gestation upon registration for receiving prenatal care services. After accounting for missing information for relevant variables, a total of 2309 women with single birth were included in this analysis. Results: A total of 1190 (51.5%) women reported having maternity insurance, and 629 (27.2%) were rural residents. The abnormal birth outcomes were small for gestational age (SGA, n=217 (9.4%)), large for gestational age (LGA, n=248 (10.7%)), birth defect (n=48 (2.1%)) including congenital heart defect (n=32 (1.4%)). In urban areas, having maternal insurance increased the odds of SGA infants (1.32, 95%CI (0.85, 2.04), NS), but decreased the odds of LGA infants (0.92, 95%CI (0.62, 1.36), NS); also decreased the odds of birth defect (0.93, 95%CI (0.37, 2.33), NS), and congenital heart defect (0.65, 95%CI (0.21, 1.99), NS) after adjustment for covariates. In contrast to urban areas, having maternal insurance in rural areas reduced the odds of SGA infants (0.60, 95%CI (0.13, 2.73), NS); but increased the odds of LGA infants (2.16, 95%CI (0.92, 5.04), NS), birth defects (2.48, 95% CI (0.70, 8.80), NS), and congenital heart defect (2.18, 95%CI (0.48, 10.00), NS) after adjustment for the same covariates. Similar results were obtained from Bootstrap methods except that the odds ratio of LGA infants in rural areas for maternal insurance was significant (95%CI (1.13, 4.37)); urban residence was significantly related with lower odds of birth defect (95%CI (0.23, 0.89)) and congenital heart defect (95%CI (0.19, 0.91)). Conclusions: whether having maternal insurance did have an impact on perinatal outcomes, but the impact of maternal insurance on the perinatal outcomes showed differently between women with urban residence and women with rural residence status. However, it is not clear what are the reason causing the observed differences. Thus, more studies are needed.

Identification of rehabilitation needs after a stroke: an exploratory study

Affiliation: Jacqueline Rousseau : École de réadaptation, Faculté de médecine, Université de Montréal

The Hygiene Hypothesis and the risk of Crohn’s disease : a case-control study utilizing prospectively-collected exposure data from an administrative database

La maladie de Crohn (MC) pédiatrique a des conséquences majeures sur la qualité de vie des patients atteints (troubles de croissance, absentéisme scolaire, etc). L’étiologie de la MC est inconnue. La théorie de l’hygiène (TH) stipule que les conditions de vie sanitaires des pays industrialisés préviennent l’exposition antigénique et empêchent le développement de la tolérance immunitaire chez les enfants. Ceci mènerait à une réaction excessive du système immunitaire lors d’expositions subséquentes et engendrerait le développement de maladies inflammatoires chroniques telles la MC. Objectif: Analyser l’association entre la fréquence, la temporalité et le type d’infections infantiles (indicateurs d’environnements pourvus d’antigènes) et le risque de MC pédiatrique. Une étude cas-témoin fût réalisée, les cas de MC provenant d’un centre hospitalier tertiaire montréalais. Les témoins, provenant des registres de la Régie d’assurance maladie du Québec (RAMQ), furent appariés aux cas selon leur âge, sexe et lieu de résidence. L’exposition aux infections fût déterminée grâce aux codes de diagnostic ICD-9 inscrits dans la base de données de la RAMQ. Un modèle de régression logistique conditionnelle fût construit afin d’analyser l’association entre infections et MC. Des ratios de cotes (RC) et intervalles de confiance à 95% (IC 95%) furent calculés. Résultats: 409 cas et 1621 témoins furent recrutés. Les résultats de l’analyse suggèrent un effet protecteur des infections infantiles sur le risque de MC (RC: 0,67 [IC: 0,48-0,93], p=0,018), plus particulièrement au cours des 5 premières années de vie (RC: 0.74 [IC: 0,57-0,96], p=0,025). Les infections rénales et urinaires, ainsi que les infections des voies orales et du système nerveux central (virale), semblent particulièrement associées à l’effet protecteur. Les résultats de l’étude appuient la théorie de l’hygiène: l’exposition aux infections infantiles pourrait réduire le risque de MC pédiatrique.

Consumption Expenditure Pattern of Scheduled Caste Households of Kerala: a Study of Idukki District

The present study made an attempt to analyze the socio-economic background and the consumption pattern of scheduled caste households in Idukki district. The objectives of the study are to examine consumption pattern among the scheduled cast population, differences in the average consumption expenditure of different decile groups, consumption expenditure elasticity of items, variations in expenditure of SC households on food, non-food and total expenditure and to examine the association between consumption expenditure and variables such as income, education, occupation and area of residence. The study reveals that the Monthly Per Capita Expenditure of scheduled castes population in rural Kerala is lower than that of the general population. Average household size is higher in rural sector for Scheduled Caste in Kerala as well as all-India. The per capita expenditure of Scheduled Castes of rural Kerala is found to be much lower than that of general population. The study has found that the levels of livings of the Scheduled Castes are far the below the expectations. Large percentage of the Scheduled Caste belongs to the lower income groups. This is due their very low economic status and the consequent employment prospects in low paying occupations. The consumption standards of the majority of Scheduled Castes are found much below that of General population. Effective implementation of the Schemes for their economic upliftment is needed for improving their consumption standards, Minimum Wage Act in the case of agricultural labourers etc. are some of recommendations on the basis of this study.

Effect of Community of Residence on Neurobehavioral Development in Infants and Young Children in a Flower-Growing Region of Ecuador

In this study we compared neurobehavioral development in Ecuadoran children living in two communities with high potential for exposure to organophosphate (OP) and carbamate pesticides to that of children living in a community with low potential for exposure. Residence in communities with high potential for exposure to OP and carbamate pesticides was associated with poorer neurobehavioral development of the child even after controlling for major determinants of delayed development. Malnourished populations may be particularly vulnerable to neurobehavioral effects of pesticide exposure.

Utilizing chromophoric dissolved organic matter measurements to derive export and reactivity of dissolved organic carbon exported to the Arctic Ocean: A case study of the Yukon River, Alaska

The quality and quantity of dissolved organic matter (DOM) exported by Arctic rivers is known to vary with hydrology and this exported material plays a fundamental role in the biogeochemical cycling of carbon at high latitudes. We highlight the potential of optical measurements to examine DOM quality across the hydrograph in Arctic rivers. Furthermore, we establish chromophoric DOM (CDOM) relationships to dissolved organic carbon (DOC) and lignin phenols in the Yukon River and model DOC and lignin loads from CDOM measurements, the former in excellent agreement with long-term DOC monitoring data. Intensive sampling across the historically under-sampled spring flush period highlights the importance of this time for total export of DOC and particularly lignin. Calculated riverine DOC loads to the Arctic Ocean show an increase from previous estimates, especially when new higher discharge data are incorporated. Increased DOC loads indicate decreased residence times for terrigenous DOM in the Arctic Ocean with important implications for the reactivity and export of this material to the Atlantic Ocean.

Triple isotope (δD, δ17O, δ18O) study on precipitation, drip water and speleothem fluid inclusions for a central European cave (NW Switzerland)

Deuterium (dD) and oxygen (d18O) isotopes are powerful tracers of the hydrological cycle and have been extensively used for paleoclimate reconstructions as they can provide information on past precipitation, temperature and atmospheric circulation. More recently, the use of 17Oexcess derived from precise measurement of d17O and d18O gives new and additional insights in tracing the hydrological cycle whereas uncertainties surround this proxy. However, 17Oexcess could provide additional information on the atmospheric conditions at the moisture source as well as about fractionations associated with transport and site processes. In this paper we trace water stable isotopes (dD, d17O and d18O) along their path from precipitation to cave drip water and finally to speleothem fluid inclusions for Milandre cave in northwestern Switzerland. A two year-long daily resolved precipitation isotope record close to the cave site is compared to collected cave drip water (3 months average resolution) and fluid inclusions of modern and Holocene stalagmites. Amount weighted mean dD, d18O and d17O are �71.0‰, �9.9‰, �5.2‰ for precipitation, �60.3‰, �8.7‰, �4.6‰ for cave drip water and �61.3‰, �8.3‰, �4.7‰ for recent fluid inclusions respectively. Second order parameters have also been derived in precipitation and drip water and present similar values with 18 per meg for 17Oexcess whereas d-excess is 1.5‰ more negative in drip water. Furthermore, the atmospheric signal is shifted towards enriched values in the drip water and fluid inclusions (D of ~ þ 10‰ for dD). The isotopic composition of cave drip water exhibits a weak seasonal signal which is shifted by around 8e10 months (groundwater residence time) when compared to the precipitation. Moreover, we carried out the first d17O measurement in speleothem fluid inclusions, as well as the first comparison of the d17O behaviour from the meteoric water to the fluid inclusions entrapment in speleothems. This study on precipitation, drip water and fluid inclusions will be used as a speleothem proxy calibration for Milandre cave in order to reconstruct paleotemperatures and moisture source variations for Western Central Europe.

Microgranitic Enclaves as Products of Self-mixing Events: a Study of Open-system Processes in the Maua Granite, Sao Paulo, Brazil, Based on in situ Isotopic and Trace Elements in Plagioclase

Felsic microgranular enclaves with structures indicating that they interacted in a plastic state with their chemically similar host granite are abundant in the Maua Pluton, SE Brazil. Larger plagioclase xenocrysts are in textural disequilibrium with the enclave groundmass and show complex zoning patterns with partially resorbed An-rich cores (locally with patchy textures) surrounded by more sodic rims. In situ laser ablation-(multi-collector) inductively coupled plasma mass spectrometry trace element and Sr isotopic analyses performed on the plagioclase xenocrysts indicate open-system crystallization; however, no evidence of derivation from more primitive basic melts is observed. The An-rich cores have more radiogenic initial Sr isotopic ratios that decrease towards the outermost part of the rims, which are in isotopic equilibrium with the matrix plagioclase. These profiles may have been produced by either (1) diffusional re-equilibration after rim crystallization from the enclave-forming magma, as indicated by relatively short calculated residence times, or (2) episodic contamination with a decrease of the contaminant ratio proportional to the extent to which the country rocks were isolated by the crystallization front. Profiles of trace elements with high diffusion coefficients would require unrealistically long residence times, and can be modeled in terms of fractional crystallization. A combination of trace element and Sr isotope data suggests that the felsic microgranular enclaves from the Maua Pluton are the products of interaction between end-member magmas that had similar compositions, thus recording `self-mixing` events.