Numeracy skills for nurses: revision and review

Introduces a revision and working examples of the numeracy skills key to the role of nurses working with older people in nursing and residential homes.

An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

Peacebuilding at the Local Level: Refugee Return to Prijedor'

During the 1992-95 war, Prijedor was synonymous with mass killing, ethnic cleansing and detention camps. A decade after the end of the war, international agencies consider this town to be an example of successful foreign intervention. Thousands of Muslim displaced persons (DPs) returned to their pre-war homes, mosques have been rebuilt, and hard-line Serb nationalists have lost much influence. How could Prijedor turn from a hopeless case of ethnic violence to an example of successful intervention? This essay argues that Prijedor's (relative) success is due more to the determination of Muslim DPs than to the international peacebuilding strategy. The initial post-Dayton international intervention exacerbated the problem of internal displacement, raised ethnic tensions and left Prijedor in the hands of the same indicted war criminals responsible for the war. Against the advice of international agencies, which feared a backlash among the Bosnian Serbs, in 1998 Muslim DPs began returning home. Eventually, large-scale return improved ethnic relations and helped marginalize Bosnian Serb extremists. The essay concludes by highlighting the lessons from Prijedor, and identifies the domestic and international contribution to Prijedor's post-settlement success.

Integrating Land Use Planning and Transportation: Policy formulation in the Belfast Metropolitan Area

Much of the interest in sustainable cities relates to the inexorable rise in the demand for car travel and the contribution that certain urban forms and land-use relationships can make to reducing energy consumption. Indeed, this demand is fuelled more by increased spatial separation of homes and workplaces, shops and schools than by any rise in trip making. This paper evaluates recent efforts to integrate land-use planning and transportation policy in the Belfast Metropolitan Area by reviewing the policy formulation process at both a regional and city scale. The paper suggests that considerable progress has been made in integrating these two areas of public policy, both institutionally and conceptually. However, concerns are expressed that the rhetoric of sustainability may prove difficult to translate into implementation, leading to a further dislocation of land-use and transportation.

El contexto y el centro residencial para las personas adultos mayores en Colombia y España. La empresa social una alternativa para el bienestar

La protección a los adultos o personas mayores se ha convertido en una política de Estado, esto debido al creciente registro de vulneración de los derechos de los mismos. Por lo tanto, conocer estas políticas gubernamentales y sociales que se encuentran vigentes, también el actual sistema de seguridad social y su cobertura para ésta población tanto en España y Colombia, así como su contexto legal y social, además de identificar los espacios donde un adulto mayor encuentra la alternativa de vivir y compartir sus años longevos, ya sea en los llamados hogares geriátricos, residencias o centros de atención a mayores, como también el papel que las empresas solidarias juegan en la oferta y demanda de un mercado donde el segmento del adulto mayor de acuerdo a las necesidades en este contexto, genera mayores demandas de productos y profesionales especializados con sentido social. Este tejido de relaciones en pro del Bienestar hacía el adulto mayor, conlleva a presentar los resultados parciales de una investigación realizada en hogares o residencias para personas mayores ubicados en Ávila, Madrid y Santiago de Cali.

Inscribir el declive en el tiempo. Detroit: Auge y crisis de la ciudad industrial

A comienzos del siglo XX, Detroit era una ciudad dinámica en pleno desarrollo. Pronto se convirtió en la cuarta ciudad de Estados Unidos, la capital de la naciente industria automovilística. El crecimiento se prolongó hasta finales de los años 50, cuando, a pesar del auge económico de Estados Unidos y de su área metropolitana, Detroit comenzó a mostrar los primeros signos de estancamiento. La crisis se ha prolongado hasta hoy, cuando Detroit constituye el paradigma de la ciudad industrial en declive. Estas dos imágenes contrapuestas, el auge y la crisis, no parecen explicar por sí mismas las causas de la intensidad y persistencia del declive de Detroit. Analizar las interacciones entre crecimiento económico, políticas públicas locales y desarrollo urbano a lo largo del tiempo permitirá subrayar las continuidades y comprender en qué medida el declive de Detroit ancla sus raíces en el modelo planteado durante la etapa de auge.

La evolución de destinos turísticos litorales consolidados. Análisis comparado de Balneario Camnoriú (Brasil) y Benidorm (España)

El objetivo de este trabajo consiste en estudiar la evolución de los destinos turísticos litorales consolidados a partir del análisis comparado entre Balneario Camboriú y Benidorm. Se trata de dos destinos localizados en contextos territoriales y turísticos diferentes, en los que se contrastan de manera empírica los indicadores de evolución de los destinos y se vinculan las dinámicas evolutivas con el modelo territorial-turístico resultante en cada destino. El análisis realizado permite contrastar los postulados de los modelos evolutivos clásicos (Butler, 1980) e incorporar los nuevos planteamientos de la geografía económica evolutiva. La investigación delimita cronológicamente los periodos de desarrollo de ambos destinos para identificar los factores con mayor incidencia en la evolución de los mismos. Una evolución marcada, fundamentalmente, por la ubicación geográfica, la planificación y gestión urbanoturística a diferentes escalas, la dependencia de determinados mercados emisores y la influencia de factores macroeconómicos. Un conjunto de factores interrelacionados que dibujan trayectorias dispares para los destinos analizados.

Agricultura urbana, condición para el desarrollo sostenible y la mejora del paisaje

Este artículo resulta de investigaciones en torno al “enverdecimiento” de las ciudades y las oportunidades de la agricultura urbana para la alimentación de una población en constante aumento que no trabaja la tierra. También es fruto de actividades de mejora de ambientes urbanos realizadas con la Escuela de Ingenieros Agrónomos de la Universidad Politécnica de Madrid. A través de casos de agricultura urbana, entendiendo por ella el conjunto de prácticas para la producción de alimentos y plantas ornamentales dentro de las ciudades y en sus entornos, se analizan alternativas para la recuperación de espacios construidos e incremento de la calidad de vida de la población. Todo ello se traduce, además, en creación de riqueza y mejora del paisaje urbano, siempre desde criterios de sostenibilidad que favorecen el desarrollo local desde la Cumbre de la Tierra de Río de 1992 y la Conferencia sobre Desarrollo Sostenible Río+20 de 2013.

Factors influencing eating a varied diet in old age

OBJECTIVE:
To investigate the influences of resources and food-related goals on the variety of food choice among older people.
DESIGN:
A questionnaire-based survey in eight European countries: Poland, Portugal, United Kingdom, Germany, Sweden, Denmark, Italy and Spain.
SUBJECTS:
Participants (n 3200) were above 65 years of age and living in their own homes. The samples were quota samples, eight groups of fifty in each country, based on gender, age and living circumstances, reflecting the diversity of each of the national populations based on education, income and urbanization of living environment.
RESULTS:
Hierarchical multiple regression analysis showed that income, health status, access to a car and living arrangement affected the level of dietary variety. The perceived level of different food-related resources impacted the consumption of a varied diet over and above actual resource levels. Food-related goals contributed to variety of food intake that was not accounted for by the amount of material resources possessed or the social and other resources perceived to be possessed.
CONCLUSIONS:
Older people's variety of food intake depended on material resources (e.g. monthly income, access to a car, living arrangement, physical and mental health). However, in addition to these variables, the way older people perceived other resources, such as their level of appetite, their food knowledge, their perception of the distance to the shops, access to high-quality products, having better kitchen facilities, access to good service providers and support from friends and neighbours, all contributed to how varied a diet they ate.

The impact of personal resources and their goal relevance on satisfaction with food-related life among the elderly.

The study explored how actual resources, perceived levels of different types of resources and goal relevance of these resources affect older people's satisfaction with food-related life using a survey in eight European countries, where 3291 participants above 65 years of age and living in their own homes took part. Satisfaction with food-related life was measured using Satisfaction With Food-related Life (SWFL) scale developed by Grunert, Raats, Dean, Nielsen, Lumbers and The Food in Later Life Team. [(2007). A measure of satisfaction with food-related life. Appetite, 49, 486–493]. Results showed that older people rated the resources that they believed to have plentiful of as being highly relevant to achieve their goals. The individuals who rated the relevance and their level of different resources as high were also more satisfied with their food-related quality of life. Further, satisfaction with food-related life, as was expected, was predicted by income, health measures and living circumstances. However, the study also showed that perceived levels of other resources such as support of family and friends, food knowledge, storage facilities also added to the individuals’ satisfaction with food-related life. In addition, the congruence between perceived level and relevance of a resource was also shown to add to people's satisfaction with food-related life, implying that older people's satisfaction with food-related life depends not only on the level of resources they think they have but also on their goals and how important they think these resources are to achieving their goals.

Risks to home care workers: Professional perspectives

Care at home is fundamental to community care policy, but the simultaneous growth of health and safety regulation has implications for home care services because of the duty of employers towards home care workers. This grounded theory study set in Northern Ireland used data from 19 focus groups and nine semi-structured interviews with a range of health and social services professionals and managers to explore perspectives on planning long term care for older people. Home care workers faced a wide range of hazards in the homes of clients, who themselves were faced with adapting their living habits due to their changing health and care needs and 'risks.' Creative approaches were used to ensure the health and safety of home care workers and simultaneously to meet the choices of clients. Staff experienced feelings of conflict when they judged it necessary to impose their way of providing home care and thus impose their values on clients to create a safe working environment. There was variation between and within organizations in terms of the staff focus on client needs or on their employer responsibility towards home care workers. The planning of home care services must take account of both the choices of clients and the hazards facing home care staff.