Surgically-treated Hip Fracture in older People. With Special Emphasis on Mortality Analysis

Hip fractures are associated with significant morbidity and mortality. Cervical and trochanteric fractures have a different morphometry, surgical treatment, and outcome. Polypharmacy, common in older people, is associated with increased mortality. The risk factors for mortality can be identified based on cause-of-death analysis. In this population-based study, 461 older, surgically in 1999-2000 treated hip fracture patients were enrolled. Incidence, morphometry, medication, mortality, and cause-of-death were analysed. Hip fractures were most commonly sustained by women, occurred mostly indoors, and often in institutions. One in four patients had sustained a previous fracture. Routine clinical radiographs revealed no differences in the hip geometry between hip fracture types. Age-adjusted mortality was higher in men than in women during the follow-up. Chronic lung disease and male sex were predictors of mortality after cervical fracture. In men, potent anticholinergics were associated with excess age-adjusted mortality. Men were more likely to die from circulatory disease and dementia after hip fracture than women. Mortality after hip fracture was 3-fold higher than that of the general population, including every cause-of-death class. Fracture prevention in institutions and homes, indoor safety measures, and treatment of chronic lung diseases should be encouraged. Hip morphometry analyses require more accurate measures than that provided by routine radiographs. Careful use of potent anticholinergics may reduce mortality. Compared to the general population, excess mortality after hip fracture was evident up to 9 years after hip fracture. Cause-of-death analysis indicates that all major comorbidities require optimal treatment after hip fracture surgery.

Musikaliska möten man minns : om musikundervisningen i årskurserna sju till nio som en arena för starka musikpplevelser

Earlier research has shown that strong experiences related to music (SEM) can occur in very different contexts and take on many different forms. Experiences like these seem significant and have among other things reportedly had an affect on the individual's continuing relationship towards music, which makes them interesting from a pedagogical point of view. Formal teaching situations, though, are under-represented in studies where people have been asked to describe strong experiences that they have had in connection with music. The purpose of my thesis is to investigate what SEM may mean to pupils and teachers in lower secondary school (grades 7-9), and to inquire more deeply into the potential "space" for such experiences within school music education. On a comprehensive level my ambition is to deepen the understanding for SEM as a possible element in pedagogical situations. Three empirical perspectives are employed: pupil-, teacher- and curriculum perspectives. The pupil perspective involved an analysis of written accounts of 166 fifteen-year-olds, describing own strong experiences. The teacher perspective involved studying 28 music teachers' conceptions of the purpose of teaching music in school as well as their understanding about strong music experiences in school context. Further, the teachers' descriptions of SEM that they have had themselves were analysed. The curriculum perspective is reflected through a study of how music experience was represented in 24 local and 2 national curriculum texts for music. Grounded in a phenomenological-hermeneutical perspective the material have been analyzed both qualitatively and quantitatively. The result points towards the fact that the music education in school has the potential to become an arena for SEM and that this can happen in relation to a multitude of activities and genres and take on many different expressions. Only one pupil referred to a musical encounter in the classroom environment; all other experiences that occurred inside the frame of school activity had taken place in other arenas (the school hall, public concert halls, and so on). However, more than 98 % of the descriptions concerned musical encounters in leisure time contexts. The significance of SEM is further clarified by narrative constructions. SEM as a conception does not occur on the curriculum level; however the analyze revealed a number of interesting "openings" which are illustrated. Even though all teachers displayed a fundamentally positive attitude towards the idea of regarding SEM as a feature of formal musical learning, it became clear that many teachers never had approached this theme from a pedagogical point of view before. Still, they proved to have an evident "familiarity" towards the phenomenon based on their own experiences of receptive and performative musical encounter. The possible space for strong musical experiences within school music education is specified through a detailed illustration of six specific themes derived from the reasoning of the teachers. Furthermore, this is described through a mapping of the potential experiencing zone, constructed from the teachers descriptions of educational aims.

The history of Lapland : wherein are shewed the original manners, habits, marriages, conjurations, &c. of that people : written by John Scheffer, professor of law and rhetoric at Upsal in Sweden.

Added engraved title page: The history of Lapland.

Fractures in older people - incidence, predictors and consequences

In older populations, fractures are common and the consequences of fractures may be serious both for an individual and for society. However, information is scarce about the incidence, predictors and consequences of fractures in population-based unselected cohorts including both men and women and a long follow-up. The objective of this study was to analyse the incidence and predictors of fractures as well as functional decline and excess mortality due to fractures, among 482 men and 695 women aged 65 or older in the municipality of Lieto, Finland from 1991 until 2002. In analyses, Poisson’s, Cox proportional Hazards and Cumulative Logistic regression models were used for the control of several confounding variables. During the 12-year follow-up with a total of 10 040 person-years (PY), 307 (26%) persons sustained altogether 425 fractures of which 77% were sustained by women. The total incidence of fractures was 53.4 per 1000 PY (95% confidence intervals [95% CI]: 47.9 - 59.5) in women and 24.9 per 1000 PY (95% CI: 20.4 - 30.4) in men. The incidence rates of fractures at any sites and hip fractures were associated with increasing age. No significant changes in the ageadjusted incidence rates of fractures were found in either gender during the 12-year follow-up. The predictors of fractures varied by gender. In multivariate analyses, reduced handgrip strength and body mass index (BMI) lower than 30 in women and a large number of depressive symptoms in men were independent predictors of fractures. A compression fracture in one or more thoracic or upper lumbar vertebras on chest radiography at baseline was associated with subsequent fractures in both genders. Lower body fractures independently predicted both short- (0-2 years) and long-term (up to 8 years) functional decline in mobility and activities of daily living (ADL) performance during the 8-year follow-up. Upper body fractures predicted decline in ADL performance during longterm follow-up. In the 12-year follow-up, hip fractures in men (Hazard Ratio [HR] 8.1, 95% CI: 4.4-14.9) and in women (HR 3.0, 95% CI: 1.9-4.9), and fractures at the proximal humerus in men (HR 5.4, 95% CI: 1.6-17.7) were independently associated with excess mortality. In addition, leisure time inactivity in physical exercise predicted independently both functional decline and excess mortality. Fractures are common among older people posing serious individual consequences. Further studies about the effectiveness of preventing falls and fractures as well as improving care and rehabilitation after fractures are needed.

Social capital, coping and information behaviour of long-term unemployed people in Finland

Avhandlingen studerar hur långtidsarbetslösa klarar av sin situation, hurdant socialt kapital och informationsbeteende de har, samt granskar hur de ovannämnda faktorerna är relaterade till varandra. Därtill undersöks om det finns skillnader mellan finsk- och svenskspråkiga långtidsarbetslösa på de här tre livsområdena. I undersökningen består socialt kapital av sociala relationer, deltagande i organisatoriska aktiviteter samt känslan av tillhörighet med olika grupper och samfund. Gällande informationsbeteende är fokus på vardaglig informationssökning, vilka källor som används, och hurdana problem man stöter på när man söker information. Som mest påfrestande upplevdes arbetslösheten av män, som var i början eller mitten av sin arbetskarriär. De äldre (över 55 år) verkade på många sätt klara av arbetslöshetssituationen bättre än de yngre, som drabbades hårdare av ekonomiska problem och stress. Kvinnor kunde bättre än män bibehålla en positiv inställning, de hade t.ex. starkare sociala nätverk som stöd, medan mäns sociala relationer i högre grad verkade vila på en arbetsgemenskap, som blev allt svagare i och med utdragen arbetslöshet. Yngre män upplevde också ofta att deras hälsa hade försämrats, när den för kvinnor och äldre arbetslösa i genomsnitt blev bättre. När arbetslösas bemästring av arbetslöshetssituationen, sociala relationer och informationssökning granskades, framgick att människor som var aktiva på ett livsområde också var aktiva på andra livsområden. I de flesta fall framkom inte några större skillnader mellan finsk- och svenskspråkiga arbetslösa. Beträffande informationssökning var de upplevda problemen ändå av diametralt motsatt karaktär – för svenskspråkiga åsamkade för lite tillgänglig information ofta problem, medan problemet för de finskspråkiga var att hitta det väsentliga i informationsflödet. Finskspråkiga kände sig också mera fast anknutna till sin boendemiljö och det finska samhället i stort, svenskspråkiga hade däremot i genomsnitt bredare och tätare sociala nätverk.

People and the intertidal : human induced changes, biodiversity loss, livelihood implications and management in the Western Indian Ocean

Vad händer i tidvattenzonen? Var går gränsen mellan land och hav, vad händer i tidvattenzonen och vem ansvarar för detta? I västra Indiska oceanen (VIO) kan avståndet mellan den lägsta nivån för lågvattnet och den högsta nivån för högvattnet vara flera kilometer och nivåskillnaderna upp till 6 meter och detta skapar ett stort och föränderligt område. Syftet med min avhandling är att öka förståelsen för tidvattenzonen i tropiska och subtropiska västra Indiska oceanen. Sammanfattningsvis visar mina studier att det finns ett mycket stort värde i den komplexa tidvattenzonen, men också att det här området hotas från både land och hav, genom t.ex. överexploatering, erosion och föroreningar. Uttnyttjandet av tidvattenzonen är stort och min avhandling har visat att aktiviteter såsom fiske i form av plocking av musslor och andra ryggradslösa djur och hamnaktiviteter påverkar den biologiska mångfalden negativt, vilket leder till försämrad levnadsstandard för resursutnyttjande människor i regionen. För att förbättra situationen krävs det mer forskning, miljöövervakning och bättre förvaltning av tidvattenzonen. Experter i regionen har rangordnat förslag på förvaltningsstrategier som skulle kunna testas för att förbättra miljön och skapa ett mer hållbart nyttjande. Avhandlingen visar även att det är möjligt att använda fjärranalysteknik såsom satellitbildsanalys för att kvantifiera mängden sjögräsvegetation (i form av biomassa), vilket kan ha stor betydelse för att förbättra storskalig miljöövervakning av kustnära naturtyper (habitat). I avhandlingsarbetet har jag använt mig av ett multidisciplinärt tillvägagångssätt och använt metoder såsom ekologisk och biologisk provtagning, intervjuer, observationer, diskussionsgrupper, frågeformulär och fjärranalys. Resultaten presenterade i denna avhandling ger en ökad kunskap om tidvattenzonen i utvecklingsländerna inom VIO-regionen som kan användas för att initiera och fortsätta att utveckla hållbara förvaltningsstrategier av biologiska resurser.

Eleven som aktør i dialog med kunst : ungdoms erfaring med kunstundervisningens innhold og metode i faget kunst og håndverk i norsk grunnskole

Avhandlingen har sitt utspring i mitt engasjement for elevers møte med kunst i grunnskolen i faget kunst og håndverk og mitt syn på ungdom som kompetente bidragsytere til forskningen om fenomener som angår deres liv. Elevene er informanter til, eller aktører i, forskning på fenomenet dialog med kunst. Dialog med kunst er her definert som en helhetlig prosess som innlemmer alt fra elevenes møte med visuelle kunstverk til deres eget skapende arbeid. At avhandlingens fagdidaktiske problemområde er elevers praktisk skapende virksomhet, knytter undersøkelsen til slöjdpedagogisk forskning. Avhandlingens overgripende hensikt er å bidra til utvikling av fagdidaktikken i kunst og håndverk med utgangspunkt i elevenes erfaringer med kunstundervisningens innhold og metode på ungdomsskoletrinnet. Studien består av kasusstudier på to ungdomsskoler. Data ble innsamlet igjennom intervjuer, deltakende observasjon, dokumenter, prosessbøker og foto av formingsprodukter. Ungdoms dialog med kunst i skolen blir analysert og fremstilt ut fra et erfart og et operasjonalisert perspektiv. Funnene speiles i ulike fagdidaktiske tendenser, det vil si ulike hovedoppfatninger i debatten om det moderne samfunn, og i et virksomhetsteoretisk perspektiv. Resultatene fra undersøkelsen utfordrer oss til en fagdidaktisk nyorientering når det gjelder ungdoms møte med kunstverk i skolen, i retning av et mer ungdomskulturelt innhold og relasjonelle kunstmøter som er narrative, tolkningsorientert, opplevelsesorientert, dialogiske og flerstemmige. Undersøkelsen viser at elevene liker det praktisk skapende arbeidet, men at undervisningen i sterkere grad bør ta i bruk digital kunnskap og handle om hvordan kunst kan brukes som utgangspunkt for skapende arbeid, og den bør legge til rette for det læringspotensialet som ligger i dialogen elevene imellom. Elevene liker en undervisning som ikke bare handler om estetiske virkemidler, materialer og teknikker, men også om kommunikasjon og ytringsfrihet. Resultatene viser at det frie skapende arbeid består av tre likeverdige aspekter: det individuelle, det kulturelle og det sosiale. Både funnene og avhandlingens virksomhetsteoretiske perspektiv kan bidra til diskursen om kreativitetsbegrepet og identitetskonstruksjon i vårt moderne samfunn. Virksomhetssystemet blir i denne avhandlingen utviklet til en teori for skapende arbeid i faget kunst og håndverk, et overgripende fagdidaktisk rammeverk for bild/bildkonst og slöjdfaget satt inn i et nordisk utdanningsperspektiv.

Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.

Rikottujen ikkunoiden nollatoleranssi. Tutkimus New Yorkin rikoksentorjunnan uuskonservatiivi-mallista Suomessa

Väitöskirja on kriminologista kontrollin ja rikoksentorjunnan tutkimusta sekä poliisitutkimusta. Kohteena on ympäri maailmaa levinnyt nollatoleranssiksi kutsuttu järjestyspoliisistrategia. Strategiaa kokeiltiin vuosituhannen vaihteessa vuoden kestäneessä järjestyksenvalvonnan hankkeessa Tampereella. Vaikka kyseessä oli kokeilu, niin tutkimuksessa osoitetaan toimintatavan olleen ja olevan pitkälti kiinteä osa perinteistä suomalaisen järjestyspoliisin toimintaperiaatetta. Artikkeliväitöskirja sisältää viisi vuosina 1998–2005 julkaistua kirjoitusta. Kokoavan yhteenvetoartikkelin tutkimusongelmat ovat seuraavat: Millaisia ovat Yhdysvaltojen ja Suomen järjestyspoliisitoiminnan nollatoleranssien mekanismien, kontekstien ja vaikutusten keskeiset erot ja yhtäläisyydet? Millainen on Tampereen nollatoleranssikokeilu ja New Yorkin rikottujen ikkunoiden nollatoleranssi rikoksentorjunnan arvioinnin ja moraalisäätelyn esimerkkeinä? Tampereen kokeilun prosessi- ja vaikuttavuusarviointitutkimus koostaa tutkimuksen empiirisen aineiston. Hankkeen alku- ja loppumittauksena toimi lomakekysely tamperelaisille (2 x n2000). Lisäksi analyysissä käytettiin kansalaiskyselyn uhrikyselyä, poliisin rikos- ja päivystyskeskustilastoja, Tilastokeskuksen tilastoja, hankkeen suoritelomakkeita sekä rangaistusvaatimus- ja rikesakkolomakkeita sekä kouluterveystutkimuksia. Tampereen poliiseille tehtiin lomakekysely ja teemahaastatteluja. Sosiaali-, nuoriso- ja vapaaehtoistyöntekijöitä sekä yli viisikymmentä tamperelaista nuorta sekä kymmenkunta tamperelaista aikuista haastateltiin. Yhdysvaltojen osalta nojaudutaan verrattain suureen määrään julkaistua korkeatasoista ja ajankohtaista kriminologista tutkimusta. New Yorkiin ja Yhdysvaltoihin sovelletussa hallintavalta- ja moraalisäätelyanalyysissa rikotut ikkunat -teoria osoittautuu uuskonservatiiviseksi moraaliprojektiksi, joka opastaa kaupunkeja hankkimaan itselleen oikeuden tiukkaan järjestyksenvalvontaan. Aiemmin sen oli estänyt kansalaisoikeusmyönteinen lakien tulkinta. New Yorkissa ja Tampereella syntyi useita kielteisiä sivu- ja vastavaikutuksia, kuten ongelmien siirtymistä (displacement). Tämä on yksi keskeinen tulos tilannetorjunnan ja kontrollin tehostamisen ja kohdistamisen hankkeissa. Tulokset haastavat arvioimaan kriittisesti, ovatko kaikki lapsiin ja nuoriin kohdistuvat varhaisen puuttumisen hankkeet seuraustensa perusteella oikeutettuja.

Comparing adult-youth and adult-adult online sexual solicitation: Manipulative behaviors, situational factors, and outcomes

Online sexual solicitation (solicitation) of youth has received widespread media and research attention during the last decade. The prevalence rates of youth who have experienced solicitation or solicitation attempts vary between studies depending on the methodology used (e.g., whether youth or adults are the target study group). In studies focusing on youth victims, the prevalence of solicitation attempts made by adults during the past year is typically reported to be between 5 and 9%. Adults who solicit youth online have been found to use deception and other manipulative behaviors to gain access to sexual activities with youth. However, previous studies have lacked a control group of adults who solicit other adults online. Without this comparison, one could argue that deceiving others online about one’s identity, and engaging in manipulative behaviors, is an inherent part of most online sexual interactions with strangers. Additionally, little is known about the associations between manipulative behaviors and the solicitation outcomes. In research concerning offline sexual behaviors, it has been noted that situational factors, such as sexual arousal, may alter both sexual interest and behavior. The effects of situational factors on online sexual behaviors have been less extensively studied (especially so with a quantitative approach); no studies have to date focused on adults’ solicitation of youth. Investigating the role of a lowered sexual age preference and the role of situational factors in the soliciting adults could be an important step in order to receive deeper knowledge of the role of traits and states in the context of solicitation. Additionally, there is a lack of knowledge of the effect of the age of the youth. Although previous studies on solicitation has found that older youth, compared with younger youth and children, are more often solicited, the possible reasons for this have not been investigated. Are adults who solicit youth affected by legal deterrence (through the legal age of consent), is it because older youth are more available online, or are the adults’ age preferences merely a product of a normally distributed age preference in the population? The purpose of the present thesis was fivefold: 1) to obtain an estimate of the frequency of adults’ solicitation of youth as self-reported and observed in actual behavior; 2) to explore whether the legal age of consent (LAC) affects solicitation frequency, or whether a normally distributed sexual age preference more accurately describe the proportion of solicited youth of different ages; 3) to investigate the associations of both traits (e.g., lower sexual age preference) and states (immediate situational factors, such as alcohol intoxication), and the solicitation target; 4) to explore whether adults who solicit youth and adults who solicit adults are equally deceitful and manipulative online, and whether the different solicitation outcomes are as common in both groups; and 5) to investigate whether the deceitful and manipulative behaviors engaged in had different associations with the solicitation outcomes depending on the age of the solicited. In the survey study, a convenience sample of 1393 adult participants (aged 18 years or older) self-reported any online communication with strangers during the past year. Of these, 56% (776 respondents) reported that they had solicited or attempted to solicit at least one stranger. Of the respondents, 453 (58.4%) were men, and 323 (41.6%) were women. Participants with only adult contacts (18 years or older) constituted the majority (640 respondents). In contrast, 136 individuals reported a youth contact (a 13 year old or younger, or a 14 to 17-year old). Approximately half of the participants were men in the adult contact group, while 75% of the participants were men in the youth contact group. Approximately 60% of the participants with youth contacts were recruited from two websites associated with a pedophilic sexual interest. In an online quasi-experimental study, with researchers impersonating youth of different ages (10–18 year olds) in chat rooms, 251 online conversations with chat room visitors made up the entire sample. All chat room visitors alleged to be men. The self-reported frequency of having solicited youth (0–17-year olds) during the past year was approximately 10% in our sample of adults who reported communicating with any strangers online. When we observed this behavior in chat rooms, we found that approximately 30% of the chat room visitors who believed they interacted with a 10 to 14 year old attempted to solicit the youth. We found that solicitation attempts increased equally much when increasing the age of the impersonated youth from 14 to 16, as from 16 to 18. Thus, we concluded that a normally distributed age preference in the population was a more plausible explanation to the effect of the age of the solicited, rather than the LAC (here; 15 and 16). If the chat room visitors would have been deterred only by the LAC, we would have expected that the change in amount of solicitation attempts from an illegal age group to a legal age group would have been significantly stronger than changes between age groups within illegal-illegal and legal-legal groups. Our subsample of survey participants from the pedophilia-related websites expectedly reported that they had solicited youth more often in comparison to the sample gathered through general (i.e., not associated with any particular sexual preference) websites. We also found that participants with a youth contact reported higher levels of sexual arousal and shame before the sexual interaction with their online contact, compared with participants with an adult contact. Additionally, the participants with youth contacts who reported consumption of child- and adolescent pornography also reported being more sexually aroused before the interaction, compared to the participants with youth contacts who did not report consumption of these kinds of pornography. We also found clear indications that the online sexual interaction had an alleviatory effect on reported levels of sadness, boredom and stress, independent of the age of the contact. Generally, the participants with youth and adult contacts reported deceiving their contacts as often and suggesting keeping the communication a secret from someone as often. Participants with a youth contact, however, reported using more persuasion techniques for online sexual purposes or for the purpose of an offline meeting, compared to those with an adult contact. In the chat rooms, we found that more indirect ways of future sexual communication (e.g., continuing chatting) was suggested by the chat room visitors that were under the assumption of interacting with youth aged 10 to 14, compared with more direct means (e.g., meeting offline). Survey participants with youth contacts who had used deception, suggested keeping the interactions a secret, and/or persuaded their contact by appealing to the contacts feelings of love and attachment for the participant had also more often engaged in cybersex with the contact. No other manipulative behaviors were associated with the other investigated solicitation outcomes (receiving a sexual picture, meeting offline, and engaging in sexual contact offline) within this group of participants. However, using deception, suggesting secrecy and using persuasion was also positively associated with certain solicitation outcomes within participants with an adult contact. In summary, adults’ solicitation of youth is much more frequent when observed in chat rooms than self-reported. Additionally, an underlying lowered sexual age preference seems to be a motivating factor on a group level in adults who solicit youth. We concluded that directed prevention efforts should be made on pedophiliarelated websites. Additionally, the role of situational factors, especially sexual arousal in persons with a pedo- or hebephilic sexual interest should be investigated further in the context of online sexual solicitation.

Effect of a single tetanus-diphtheria vaccine dose on the immunity of elderly people in São Paulo, Brazil

Epidemiological data regarding tetanus and diphtheria immunity in elderly people in Brazil are scarce. During the First National Immunization Campaign for the Elderly in Brazil in April 1999, 98 individuals (median age: 84 years) received one tetanus-dyphtheria (Td) vaccine dose (Butantan Institute, lot number 9808079/G). Inclusion criteria were elderly individuals without a history of severe immunosuppressive disease, acute infectious disease or use of immunomodulators. Blood samples were collected immediately before the vaccine and 30 days later. Serum was separated and stored at -20ºC until analysis. Tetanus and diphtheria antibodies were measured by the double-antigen ELISA test. Tetanus and diphtheria antibody concentrations lower than 0.01 IU/mL were considered to indicate the absence of protection, between 0.01 and 0.09 IU/mL were considered to indicate basic immunity, and values of 0.1 IU/mL or higher were considered to indicate full protection. Before vaccination, 18% of the individuals were susceptible to diphtheria and 94% were susceptible to tetanus. After one Td dose, 78% became fully immune to diphtheria, 13% attained basic immunity, and 9% were still susceptible to the disease. In contrast, 79% remained susceptible to tetanus, 4% had basic immunity and 17% were fully immune. Although one Td dose increases immunity to diphtheria in many elderly people who live in Brazil, a complete vaccination series appears to be necessary for the prevention of tetanus.