Effect of Health Risk Assessment and Counselling on Health Behaviour and Survival in Older People: A Pragmatic Randomised Trial.

BACKGROUND Potentially avoidable risk factors continue to cause unnecessary disability and premature death in older people. Health risk assessment (HRA), a method successfully used in working-age populations, is a promising method for cost-effective health promotion and preventive care in older individuals, but the long-term effects of this approach are unknown. The objective of this study was to evaluate the effects of an innovative approach to HRA and counselling in older individuals for health behaviours, preventive care, and long-term survival. METHODS AND FINDINGS This study was a pragmatic, single-centre randomised controlled clinical trial in community-dwelling individuals aged 65 y or older registered with one of 19 primary care physician (PCP) practices in a mixed rural and urban area in Switzerland. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. The intervention consisted of HRA based on self-administered questionnaires and individualised computer-generated feedback reports, combined with nurse and PCP counselling over a 2-y period. Primary outcomes were health behaviours and preventive care use at 2 y and all-cause mortality at 8 y. At baseline, participants in the intervention group had a mean ± standard deviation of 6.9 ± 3.7 risk factors (including unfavourable health behaviours, health and functional impairments, and social risk factors) and 4.3 ± 1.8 deficits in recommended preventive care. At 2 y, favourable health behaviours and use of preventive care were more frequent in the intervention than in the control group (based on z-statistics from generalised estimating equation models). For example, 70% compared to 62% were physically active (odds ratio 1.43, 95% CI 1.16-1.77, p = 0.001), and 66% compared to 59% had influenza vaccinations in the past year (odds ratio 1.35, 95% CI 1.09-1.66, p = 0.005). At 8 y, based on an intention-to-treat analysis, the estimated proportion alive was 77.9% in the intervention and 72.8% in the control group, for an absolute mortality difference of 4.9% (95% CI 1.3%-8.5%, p = 0.009; based on z-test for risk difference). The hazard ratio of death comparing intervention with control was 0.79 (95% CI 0.66-0.94, p = 0.009; based on Wald test from Cox regression model), and the number needed to receive the intervention to prevent one death was 21 (95% CI 12-79). The main limitations of the study include the single-site study design, the use of a brief self-administered questionnaire for 2-y outcome data collection, the unavailability of other long-term outcome data (e.g., functional status, nursing home admissions), and the availability of long-term follow-up data on mortality for analysis only in 2014. CONCLUSIONS This is the first trial to our knowledge demonstrating that a collaborative care model of HRA in community-dwelling older people not only results in better health behaviours and increased use of recommended preventive care interventions, but also improves survival. The intervention tested in our study may serve as a model of how to implement a relatively low-cost but effective programme of disease prevention and health promotion in older individuals. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number: ISRCTN 28458424.

Knowledge and Expectations of Support People in Prenatal Genetic Counseling Sessions

Prenatal genetic counseling patients have the ability to choose from a myriad of screening and diagnostic testing options, each with intricacies and caveats regarding accuracy and timing. Decisions regarding such testing can be difficult and are often made on the same day that testing is performed. Therefore, it is reasonable to consider that the support people brought to an appointment may have a role in the decision-making process. We aimed to better define this potential role by examining the incoming knowledge and expectations of support people who attended prenatal genetic counseling appointments. Support people were asked to complete a survey at one of seven Houston area prenatal clinics. The survey included questions regarding demographics, relationship to patient, incoming knowledge of the appointment, expectations of decision-making and perceived levels of influence over the decisions that would be made during the counseling session. The majority (79.4%) of the 252 participants were spouses/partners. Overall, there was poor knowledge of the referral indications with only 33.5% of participants correctly identifying the patient’s indication. Participants had even poorer knowledge of testing options that would be offered during the session, as only 17.7% were able to correctly identify testing options that would be discussed during the genetic counseling session. Of participants, just 3.6% said that they did not want to be included in discussions about screening/testing options. Only a few participants thought that they had less influence over decisions related to the pregnancy than over non-pregnancy decisions. Participants who reported feeling like they had a higher level of influence were likely to attend more of the pregnancy-related appointments with the patient. Findings from this study have provided insight into the perspective of support persons and have identified gaps in knowledge that may exist between the patients and the people they choose to bring with them into the genetic counseling session. In addition, this study is a starting point to assess how much the support people think that they impact the decision-making process of prenatal genetic counseling patients versus how much the prenatal patients value the input of the support people.

"Power to the people" : De la Hegemonía al Policentrismo: Una mirada desde las Antípodas sobre el devenir del inglés en el contexto postcolonial de Asia del Sur

Esta tesis buscará diferencias y similitudes sobre el fenómeno "Imperialismo Lingüístico" en contextos poscoloniales desde la mirada de lingüistas angloparlantes, por un lado occidentales, para quienes el inglés es su lengua materna, como así también orientales, para quienes es una segunda lengua. Creemos que los fuertes procesos de apropiación, naturalización, indigenización y re-significación de la lengua inglesa por parte de la población de Asia del Sur han hecho del inglés una lengua de carácter policéntrico, lengua de cultura (Guitarte, 1991) más que una lengua de carácter hegemónico, lengua de culto (Guitarte, 1991). Esta lengua poli/pluricéntrica, lejos de ser una lengua que perpetúe la inequidad social, como proponen los teóricos occidentales, es una lengua que empodera a sus hablantes, inclusive a aquellos más excluidos del sistema social como los dalits. Los textos para el análisis corresponden a las variedades postcoloniales del inglés indio (Indian English) y sri lankeano (Sri Lankean English) que se ubican dentro de los denominados inglés[es] Sud asiático[s] (South Asian English[es]). La evaluación en India y Sri Lanka (colonizados) respecto de la imposición de la Lengua Inglesa es altamente positiva, no sólo en los estratos sociales elevados sino también en los estratos sociales de menores recursos (los dalits). Esto se opone a la evaluación del mismo fenómeno visto desde occidente (colonizadores), quienes consideran haber cometido, a través de la imposición, una especie de genocidio lingüístico de las lenguas locales. Si bien, ambas posturas coinciden en ver al inglés como a un medio capaz de crear un nuevo estrato social: ?la casta de los hablantes bilingües del inglés?, creemos que la diferencia principal radica en que esta capacidad es vista como exclusiva por parte de los occidentales, y es vista como inclusiva por los orientales. Mientras que los primeros se preguntan quiénes quedan afuera del uso predominante del inglés para la comunicación y el acceso a la tecnología, la ciencia, la educación y la cultura; los orientales se preguntan quiénes quedan adentro del uso del inglés para las distintas funciones intra e internacionales. Los autores del este dan un paso más allá de la mera descripción del estado de cosas y proponen políticas lingüísticas que contemplan sus variedades estandarizadas. Queremos también mostrar que la capacidad de transformar algo negativo en positivo; algo que ha sido impuesto, en algo propio es característica de la cultura india. Esto se refleja también en otros ámbitos, como el audiovisual, el gastronómico o el religioso

"Power to the people" : De la Hegemonía al Policentrismo: Una mirada desde las Antípodas sobre el devenir del inglés en el contexto postcolonial de Asia del Sur

Esta tesis buscará diferencias y similitudes sobre el fenómeno "Imperialismo Lingüístico" en contextos poscoloniales desde la mirada de lingüistas angloparlantes, por un lado occidentales, para quienes el inglés es su lengua materna, como así también orientales, para quienes es una segunda lengua. Creemos que los fuertes procesos de apropiación, naturalización, indigenización y re-significación de la lengua inglesa por parte de la población de Asia del Sur han hecho del inglés una lengua de carácter policéntrico, lengua de cultura (Guitarte, 1991) más que una lengua de carácter hegemónico, lengua de culto (Guitarte, 1991). Esta lengua poli/pluricéntrica, lejos de ser una lengua que perpetúe la inequidad social, como proponen los teóricos occidentales, es una lengua que empodera a sus hablantes, inclusive a aquellos más excluidos del sistema social como los dalits. Los textos para el análisis corresponden a las variedades postcoloniales del inglés indio (Indian English) y sri lankeano (Sri Lankean English) que se ubican dentro de los denominados inglés[es] Sud asiático[s] (South Asian English[es]). La evaluación en India y Sri Lanka (colonizados) respecto de la imposición de la Lengua Inglesa es altamente positiva, no sólo en los estratos sociales elevados sino también en los estratos sociales de menores recursos (los dalits). Esto se opone a la evaluación del mismo fenómeno visto desde occidente (colonizadores), quienes consideran haber cometido, a través de la imposición, una especie de genocidio lingüístico de las lenguas locales. Si bien, ambas posturas coinciden en ver al inglés como a un medio capaz de crear un nuevo estrato social: ?la casta de los hablantes bilingües del inglés?, creemos que la diferencia principal radica en que esta capacidad es vista como exclusiva por parte de los occidentales, y es vista como inclusiva por los orientales. Mientras que los primeros se preguntan quiénes quedan afuera del uso predominante del inglés para la comunicación y el acceso a la tecnología, la ciencia, la educación y la cultura; los orientales se preguntan quiénes quedan adentro del uso del inglés para las distintas funciones intra e internacionales. Los autores del este dan un paso más allá de la mera descripción del estado de cosas y proponen políticas lingüísticas que contemplan sus variedades estandarizadas. Queremos también mostrar que la capacidad de transformar algo negativo en positivo; algo que ha sido impuesto, en algo propio es característica de la cultura india. Esto se refleja también en otros ámbitos, como el audiovisual, el gastronómico o el religioso

Blood pressure and mortality in elderly people aged 85 and older: community based study

Objective: To determine whether the inverse relation between blood pressure and all cause mortality in elderly people over 85 years of age can be explained by adjusting for health status, and to determine whether high blood pressure is a risk factor for mortality when the effects of poor health are accounted for.

A Coppe of the Plan of Cambridge New Meeting House which was excepted by the people, 1752

The floor plan details the proposed interior of the New Meeting House of the First Parish in Cambridge to be built near the College, in the present area of Lehman Hall. This land became Harvard property in 1833. The drawing includes space allotted for the pulpit, pews, and center aisle. The document is fragile.

List of benefactors who contributed to replacement of books and philosophical apparatus, May 4, 1764

This document lists the names of subscribers who promised funds towards the rebuilding of the library and philosophical apparatus. Entries are divided among three columns, "Apparatus," "Library," and "At large," and include the donor's name and amount promised. Gifts to the library included actual books as well as funds for book purchases.

List of benefactors who contributed to replacement of books and philosophical apparatus, 1765

This document lists the names of subscribers who promised funds towards the rebuilding of the library and philosophical apparatus. Entries are divided among three columns, "Apparatus," "Library," and "At large," and include the donor's name and amount promised. Gifts to the library included actual books as well as funds for book purchases.

Books and bookmen ...

Mode of access: Internet.

Fifty years among authors, books and publishers /

Mode of access: Internet.

A.L.A. portrait index; index to portraits contained in printed books and periodicals.

Reprint of the 1906 ed.

Anecdotes, observations, and characters, of books and men /

Mode of access: Internet.

A.L.A. portrait index; index to portraits contained in printed books and periodicals,

At head of title: Library of Congress.

Type for books and advertising

"Books for the type man": p. 150-153.