Sources of nutrition information for persons living in Trinidad and Tobago

Health consumers worldwide obtain nutrition information from various sources; however, the sources Trinidadians and Tobagonians accessed were unclear. This cross-sectional, descriptive study ascertained from which sources Trinidadians and Tobagonians obtained nutrition information. Participants (n = 845) were surveyed with questions regarding demographics and nutrition information sources. Nearly 100% agreed nutrition information was important. Persons 18-64 years old mainly accessed print media (p<0.01) and ≥ 65years old predominantly accessed the non-print media. Significantly more tertiary educated people, ≥ 35 years old, retrieved information from print media (p=0.001), health care professionals (p=0.001), food labels (p=0.006), and non-print media (p=0.03) when compared to those < 35 years with similar education. Tertiary educated people (67%), selected the Internet when compared to those with without tertiary education (33%) (p<0.001). Knowing the nutrition information sources accessed, dietitians will be able to provide consistent, accurate, age specific nutrition information and promote healthy eating among Trinidadians and Tobagonians.

Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

Acknowledgements This study was funded by the Chief Scientist Office of the Scottish Government, grant CZH_4_495.

The development and validity of a functional assessment instrument for persons with major mental disorders

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

A psychophysical assessment of visual motion processing among high-functioning persons with autism

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

The development and validity of a functional assessment instrument for persons with major mental disorders

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

A psychophysical assessment of visual motion processing among high-functioning persons with autism

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy): Consensus Validation

Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriate medications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensus survey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinical pharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.
Methods: STOPPFrail criteria was initially created by the authors based on clinical
experience and appraisal of the available literature. Criteria were organised according to physiological system. Each criterion was accompanied by an explanation. Panellists ranked their agreement with each criterion on a 5-point Likert scale and invited to provide written feedback. Criteria with a median Likert response of 4/5 (agree/strongly agree) and a 25th centile of ≥4 were included in the final criteria.
Results: Three Delphi rounds were required. All panellists completed all rounds. Thirty criteria were proposed for inclusion; 26 were accepted. No new criteria were added. The first two criteria suggest deprescribing medications with no indication or where compliance is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers for hypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antagonists, anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, bone anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal antiinflammatories, corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers, muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics. Anticoagulants and anti-depressants were excluded. Despite incorporation of panellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remained inconclusive.
Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad consensus, to be potentially inappropriate in frailer older patients with limited life expectancy. STOPPFrail may assist in deprescribing medications in these patients.

Clinical Psychologists Training and Supervising IAPT Therapists to Work with Long-term Conditions and Medically Unexplained Symptoms: A Service Development Project

An IAPT service and a clinical health psychology team piloted a service development providing Step 2 and Step 3 services for individuals with long-term health conditions. Results indicate that such services may be offered with access to specialist training and supervision.

Persons : their identity and individuation

This study is about the nature of persons and personal identity. It belongs to a tradition that maintains that in order to understand what it is to be a person we must clarify what personal identity consists in. In this pursuit, I differentiate between the problems (i) How do persons persist? and (ii) What facts, if any, does personal identity consist in? Concerning the first question, I argue that persons persist three-dimensionally (the endurance view), and not four-dimensionally (the perdurarne view), on the ground that objects must always fall under some substance sortal concept S (the sortal dependency of individuation), and that the concept person entails that objects falling under it are three-dimensional. Concerning the second question, I differentiate between Criterianists, who maintain that it is possible to specify a non-circular and informative criterion for personal identity, and Non-Criterianists, who deny that such a specification is possible. I argue against Criterianist accounts of personal identity on the ground that they are either (i) circular, (ii) violate the intrinsicality of identity or (iii) do not adequately represent what we are essentially. I further criticise three Psychological Non-Criterianist accounts of personal identity on the ground that they wrongly assume that 'person' refers to mental entities. Instead I formulate the Revised Animal Attribute View where person is understood as a basic sortal concept which picks out a biological sort of enduring animals. In this, I claim that the real essence of a person is determined by the real essence of the kind of animal he is, without thereby denying that persons have a real essence as persons.

Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Evaluating the credibility of statements given by persons with intellectual disability

El objetivo del presente trabajo consistió en analizar las características diferenciales de los relatos emitidos por víctimas reales y simuladas con discapacidad intelectual ligera y moderada mediante el procedimiento de análisis de credibilidad de Control de la Realidad (RM). Dos evaluadores entrenados en los procedimientos de análisis de credibilidad mediante criterios de contenido evaluaron 13 relatos verdaderos y 16 relatos falsos. Los resultados encontrados muestran que existen pocas diferencias entre los dos tipos de relatos. Los únicos criterios que resultan significativos para discriminar entre los dos tipos de relatos son la cantidad de detalles y la longitud de las declaraciones espontáneas obtenidas mediante recuerdo libre. Ninguna de las características fenomenológicas examinadas resultó significativa para discriminar entre víctimas reales y simuladas. La representación gráfica mediante visualización hiperdimensional (HDV) considerando conjuntamente todos los criterios muestra una gran heterogeneidad entre relatos. Un análisis de conglomerados permitió clasificar los dos tipos de relatos con una probabilidad de acierto del 68.75 por ciento.

Adult missing persons: can an investigative framework be generated using behavioral themes?

There is a limited amount of research in the area of missing persons, especially adults. The aim of this research is to expand on the understanding of missing people, by examining adults' behaviours while missing and determining if distinct behavioural themes exist. Based on previous literature it was hypothesised that three behavioural themes will be present; dysfunctional, escape, and unintentional. Thirty-six behaviours were coded from 362 missing person police reports and analysed using smallest space analysis (SSA). This produced a spatial representation of the behaviours, showing three distinct behavioural themes. Seventy percent of the adult missing person reports were classified under one dominant theme, 41% were ‘unintentional’, 18% were ‘dysfunctional’, and 11% were ‘escape’. The relationship between a missing person's dominant behavioural theme and their assigned risk level and demographic characteristics were also analysed. A significant association was found between the age, occupational status, whether they had any mental health issues, and the risk level assigned to the missing person; and their dominant behavioural theme. The findings are the first step in the development of a standardised checklist for a missing person investigation. This has implications on how practitioners prioritise missing adults, and interventions to prevent individuals from going missing. Copyright © 2016 John Wiley & Sons, Ltd.

Disappeared Persons and Homicide in El Salvador

During 2012-2013, the homicide rate in El Salvador came down from 69.9 to 42.2 per 100,000 population following a truce between the leaders of the two major gangs, “Mara Salvatrucha” and “Barrio 18”, and government. But despite the apparent successes of the truce, it was speculated that the drop in murders could have been due to the killers simply hid the bodies of their victims. This paper aims at determining whether gangs effectively disappeared their victims to cut down the official counts of murders, or they committed these crimes for other reasons. The results from this study suggest that Salvadoran gangs had been using disappearance as a resource to gain sustained social control among residents of already gang-dominated areas, that together with homicide, disappearance is part of a process of territorial spread and strategic strengthening by which these groups are enhancing their capabilities to interfere in the alliances of Mexican drug trafficking organizations with Central American criminal organizations specializing in the transshipment of drugs and in providing access to local markets to distribute and sell drugs. Our findings show that the risk for disappearance has been large even before the truce was in place and that actually, it continues as such and going through a process of geographic expansion.

Mapping freshwater snails in Angola: distribution, identity and molecular diversity of medically important taxa

Introduction - This study was designed to determine the presence and identity of potential intermediate snail hosts of schistosomiasis in Bengo, Luanda, Kwanza Norte and Malanje Provinces in NW Angola. This is an area where infection with Schistosoma haematobium, causing urogenital schistosomiasis, is common but little is known about transmission of the disease. Angola has had a varied past with regards to disease control and is revitalising efforts to combat Neglected Tropical Diseases.