City Government's Adoption of Housing Adaptation Policy Innovation for Older Adults: Evidence From China.

OBJECTIVES: Utilizing policy innovation and diffusion theory, this study aims to explain why city governments adopt housing adaptation policies that primarily benefit older people based on the case of China. METHODS: The data are drawn from an event history data set of a housing adaptation policy for older people collected from 283 Chinese cities from 2010 to 2018. Piecewise constant exponential models are utilized. RESULTS: The results indicate that cities facing greater internal pressure and a higher political status are more likely to adopt a housing adaptation policy for older people. Policy adoption by neighboring cities could further facilitate this process. DISCUSSION: Policy innovation and diffusion theory provide a useful framework for this study. That is, the Chinese city government's adoption of housing adaptation policy for older adults is initially driven by local needs and then accelerated by interactions among neighboring governments.

Retrospective Cohort Noninferiority Analysis of Barrier Cream in Preventing Pressure Injuries.

OBJECTIVE: To assess the effectiveness of a dimethicone- and zinc-based barrier cream compared with hyperoxygenated fatty acids in preventing pressure injuries (PIs) in patients at high or very high risk. METHODS: Researchers conducted a retrospective noninferiority study in an inpatient acute care hospital in Spain that included hospitalized patients in nonsurgical departments with impaired mobility. RESULTS: The study authors reviewed 522 patients in a control group (hyperoxygenated fatty acids) and an experimental group (barrier cream) over a period of 7 days. The incidence of PI was 31% in the control group and 31.1% in the experimental group. The hazard ratio for developing PI was 0.84 (confidence interval, 0.61-1.17; P = .32) in the experimental group compared with the control group, meeting the criteria for noninferiority. The Kaplan-Meier estimator indicated no statistically significant difference between groups (log-rank = 0.654). CONCLUSIONS: Dimethicone- and zinc-based barrier cream was not inferior to hyperoxygenated fatty acids in preventing PIs in hospitalized patients at high or very high risk of developing them during their hospital stay.

Evaluation of a Novel Ostomy Barrier Ring with Assisted Flow for Individuals with an Ileostomy.

OBJECTIVE: To determine the performance and user experience of a novel ostomy barrier ring over a 4-week period. METHODS: This single-arm investigation conducted across three clinical sites included 25 adult participants with an ileostomy for 3 months or longer. The participants used their standard ostomy pouching appliance along with a novel barrier ring for a period of 4 weeks. Skin condition was assessed using the Ostomy Skin Tool. Change in skin condition over the study period was recorded for each participant. The participants' experience in using the novel barrier ring was measured using a five-point Likert-type scale. RESULTS: Twenty of the 25 participants (80%) completed the trial. Of those participants, the median Ostomy Skin Tool score at both the beginning (range, 0-8) and end was 0 (range, 0-6). In terms of skin condition, 7 participants experienced an improvement in skin condition, 11 experienced no change, and 2 got worse. A median score of 5 out of 5 was recorded for all questions relating to user experience. CONCLUSIONS: Although not statistically significant, there was a clear trend toward improvements in peristomal skin condition using the novel barrier ring, even for participants who were already using a barrier ring. User feedback was positive with respect to comfort, device handling, and the perception of the device's ability to protect the skin. Further, most participants who already used a barrier ring indicated that the novel barrier ring would result in a longer wear time.

Effects of skin moisturizer on the skin barrier dysfunction model: An evaluation of the heel via tape-stripping in healthy, young adults.

BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.

Evaluating the Effectiveness of a Novel Skin Barrier Protectant in a Patient with Acute Radiodermatitis of the Vulva: A Case Report.

OBJECTIVE: To evaluate the use of a novel skin barrier protectant in a patient treated with radiotherapy for vulvar cancer. METHODS: This case report was conducted in a radiotherapy department with two women undergoing radiotherapy for vulvar carcinoma. A novel skin barrier protectant was evaluated in one patient; the other underwent the institutional standard skin care protocol. Skin reactions and pain were evaluated using the Radiotherapy Oncology Group Criteria. MAIN RESULTS: The patient who was treated with the skin protectant showed accelerated healing toward the end of radiotherapy, and this was accompanied with a decrease in pain (maximum pain score 6/10). In comparison, the patient treated with the standard skin care protocol had an extended healing process, experienced a higher pain level (maximum pain score 9/10), and required more nursing care. CONCLUSIONS: This case report is the first to suggest that this novel skin barrier protectant could effectively manage acute radiodermatitis in patients with cancer. This case report hopes to lay the foundation for future randomized controlled trials with a larger and broader patient population.

Reliability and agreement of skin barrier measurements in a geriatric care setting.

BACKGROUND: The non-invasive skin barrier measurements transepidermal water loss, stratum corneum hydration and the skin surface pH are widely used in clinical skin research. Relative and absolute measurement errors of these measurements are unknown in geriatric care settings. MATERIAL AND METHODS: Transepidermal water loss, stratum corneum hydration, skin surface pH and temperature were measured on the volar forearm and lower leg twice by trained raters within a cross-sectional study in ten nursing homes. Intrarater reliability was calculated using the ICC (1,1). Intrarater agreement was analyzed using Bland Altman Plots with limits of agreement. RESULTS: Two hundred twenty-three residents were included and mean age was 84.2 years. The highest ICC was found for transepidermal water loss and skin surface temperature of the leg with 0.95 (95% CI 0.93 to 0.96). The ICC of the stratum corneum was 0.91 (95% CI 0.88 to 0.93) for both investigated skin areas. The measurement of the pH at the lower leg had the lowest ICC with 0.73 (95% CI 0.66 to 0.78). Highest limits of agreement of approximately 8 a.u. were calculated for stratum corneum hydration and lowest limits of agreement of approximately 1 °C were calculated for skin surface pH. CONCLUSION: Relative measurement errors of transepidermal water loss and stratum corneum hydration were very low indicating that single measurements provide reliable estimates in this population and setting. However, the absolute measurement errors were high for both of these parameters. To increase reliability of skin surface pH we recommend at least two repeated measurements.

Examining the Impact of Knowledge Mobilization Strategies to Inform Urban Stakeholders on Accessibility: A Mixed-Methods study.

Urban areas offer many opportunities for people with disabilities, but limited accessibility may prevent their full engagement in society. It has been recommended that the experience-based perspective of people with disabilities should be an integral part of the discussion on urban accessibility, complementing other stakeholder expertise to facilitate the design of more inclusive environments. The goals of this mixed-method study were to develop knowledge mobilization (KM) strategies to share experience-based findings on accessibility and evaluate their impact for various urban stakeholders. Using a participatory approach, various KM strategies were developed including videos, a photo exhibit and an interactive game. These strategies were evaluated based on various impact indicators such as reach, usefulness, partnerships and practice changes, using quantitative and qualitative methods. The findings suggested that the KM strategies were effective in raising the awareness of various urban stakeholders and providing information and guidance to urban planning practices related to accessibility.

Structure of the Anesthesia Intensive Care Units: Recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology. / Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR).

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.

Bricks and Morals-Hospital Buildings, Do No Harm.

The volume and rigor of evidence-based design have increasingly grown over the last three decades since the field's inception, supporting research-based designs to improve patient outcomes. This movement of using evidence from engineering and the hard sciences is not necessarily new, but design-based health research launched with the demonstration that post-operative patients with window views towards nature versus a brick wall yielded shorter lengths of hospital stay and less analgesia use, promoting subsequent investigations and guideline development. Architects continue to base healthcare design decisions on credible research, with a recent shift in physician involvement in the design process by introducing clinicians to design-thinking methodologies. In parallel, architects are becoming familiar with research-based practice, allowing for further rigor and clinical partnership. This cross-pollination of fields could benefit from further discussion surrounding the ethics of hospital architecture as applied to current building codes and guidelines. Historical precedents where the building was used as a form of treatment can inform future concepts of ethical design practice when applied to current population health challenges, such as design for dementia care. While architecture itself does not necessarily provide a cure, good design can act as a preventative tool and enhance overall quality of care.

Wheelchair accessibility of mosques in Riyadh.

BACKGROUND: Engagement in religious and spiritual activities and expression are important to many people. Praying in a mosque is a major component of basic worship for Muslims. Riyadh has a population of more than six million people and more than 17 thousand mosques. OBJECTIVE: The purpose of this study was to explore wheelchair accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers. METHODS: A survey was conducted to explore the opinions of wheelchair users and their caregivers regarding wheelchair accessibility of frequently used mosques. RESULTS: Forty-eight wheelchair users and 12 caregivers participated in the study. The main reason for being confined to a wheelchair was a motor vehicle accident (77%). The majority of the participants (84%) indicated that they needed assistance to propel their wheelchairs. Overall, 86% of wheelchair users and 84% of caregivers expressed dissatisfaction with the mosques' accessibility for wheelchair users. CONCLUSION: Mosques were found not to be accessible for wheelchair users. The current situation forces wheelchair users to pray in isolation in their houses, preventing them from participating in an important part of their faith. Though acts mandating the accessibility of public places for wheelchair users have been promulgated in the Kingdom of Saudi Arabia (KSA), the acts are not implemented in ways which can contribute to a meaningful, tolerable and independent life for wheelchair users.

The accessibility of fitness centers for people with disabilities: A systematic review.

BACKGROUND: Fitness centers could be ideal places for people with disabilities to engage in the recommended levels of physical activity for healthy well-being. However, one of the primary barriers to participation at fitness centers is an inaccessible built environment. OBJECTIVE: This review study aimed to evaluate the accessibility of public indoor fitness centers for people with disabilities. METHODS: We searched electronic databases and web based search engines using keywords and synonyms for fitness centers, people with disability and accessibility. Observational studies that used standardized measures to evaluate fitness centers were included and critically appraised using a modified version of the checklist for randomized and non-randomized studies developed by Downs and Black. We analyzed the data descriptively. This systematic review protocol is registered in PROSPERO (ID:CRD42016043945). RESULTS: A total of 533 fitness centers were evaluated for accessibility across 14 studies. Ten (85%) of the 14 studies were undertaken in the United States of America. Instruments (n = 2) used to evaluate fitness centers were based on the Americans with Disabilities Act compliance legislation and measured domains of physical access (e.g., bathrooms, equipment, parking) and system access (e.g., policies, programs, professional behavior). We calculated weighted percentage mean scores per accessibility domain. The least accessible domain was "hot tubs/whirlpools/saunas/steam rooms" at 33%, with "programs" being the most accessible domain at 68%. CONCLUSIONS: Fitness center accessibility for people with disabilities remains poor. Adopting the principles of universal design in legislation would achieve equitable access for all, thereby allowing people with disabilities to participate actively in their communities with dignity and autonomy.

Exploring accessibility issues of a public building for the mobility impaired. Case study: interstate bus terminal (ISBT), Vijayawada, India.

Right to access in the built environment creates equal and nondiscriminatory opportunities to a person with disabilities in order to move freely around and interact positively without hindrance and barriers. The objective of the study is to understand the existing accessibility related issues and implementation of guidelines and standards for public buildings. The technical verification using onsite and offsite access audit format for current provision of facilities in the internal and external environment has been carried out with the format prepared in reference to Central Public Works Department (CPWD) accessibility guidelines for mobility impaired and elderly and American Disability Act (ADA) guidelines. The access audit format included parameters like accessibility, safety, security, comfort and convenience and it addresses the barriers faced by wheel chair users, people with crutches, prosthetics and with non-assistive devices. The study addressed accessibility compliance in three zones of the building with initiation from parking area zone, inside the building, and area outside the building premises. The findings highlight the environmental barriers encountered by mobility impaired people and represented graphically in the layout plan and physical effort required to overcome the challenges in the built environment. The overall accessibility compliance is 42% in the interstate bus terminal. Implications for rehabilitation The study identifies the environmental limitations, human and technologically facilitators with the help of Central Public Works Department (CPWD) and American Disability Act (ADA) guidelines (1990). It highlights barriers for mobility-impaired users, by demonstrating in a spatial layout and the means to facilitate easy access with minimal frustration, stress and with less physical effort. It demonstrates the need for preparation of separate guidelines for making the existing types of buildings to be access and disabled-friendly. New accessibility guidelines shall be prepared by incorporating concepts like such as relative accessibility into new bus terminal buildings. Guidelines help the disabled in the process of rehabilitation and develop inclusiveness not rather than alienation.

Patterns of community participation across the seasons: A year-long case study of three Canadian wheelchair users.

PURPOSE: The aim of this study was to explore the patterns of wheelchair users' community participation across a one-year period, including periods with substantial differences in weather conditions. We sought to develop a detailed understanding of the patterns of, and influences on, wheelchair use and participation within wheelchair users' own communities. METHOD: We conducted an instrumental case study of three purposefully selected individuals who use a wheelchair. Participants' wheelchairs were instrumented with a GPS data logger and data were collected for one week per month across a year. A prompted recall interview was conducted with participants each month, in order to gain an understanding of the influences on their community participation patterns. RESULTS: For each participant, the percent of trips taken at various trip distance ranges and the mean trips/days and overall distance traveled at or above 0 °C and below 0 °C are reported. Three distinct patterns were identified in response to variations in weather conditions: (1) season and transportation options are linked: winter limits community participation; (2) winter conditions are surmountable: with the right supports year-round participation is maintained; and (3) pre-planning is the key: winter conditions affects ease, choices and options but not overall participation. CONCLUSIONS: While winter weather conditions created community participation challenges, individuals responded differently based on their unique circumstances. The findings highlight the importance of policy that addresses the dynamic nature of weather and the needs of people with disabilities as specific individuals. Implications for rehabilitation Wheelchair users experience both similar and unique challenges regarding seasonal weather conditions that influence their community participation patterns. While some individual wheelchair users effectively maintain their community participation patterns across the year, they employ their own specific strategies in response to winter weather challenges. Ready access to vehicular transportation that is accessible regardless of weather condition is a key factor in promoting community participation across the year for wheelchair users. Accessible community environments can become inaccessible with the addition of winter weather conditions and thus the changing nature of community participation across the seasons should be considered.

Prospective Associations of Local Destinations and Routes With Middle-to-Older Aged Adults' Walking.

Background and Objectives: To examine prospective associations of perceived attributes of local destinations and routes with middle-to-older aged adults' 4-year changes in walking for transport (WT) and walking for recreation (WR). Research Design and Methods: Data were collected from adults aged 50-64 years old, living in Adelaide, Australia. Participants (N = 454) reported weekly frequency of WT and WR at baseline (2003-2004) and follow-up (2007-2008). Attributes of local destinations and routes were based on self-reported measures at baseline and included: proximity to utilitarian and recreational destinations, the number of such destinations within 10 and 11-20 min walk from home, street connectivity, and walking paths. Generalized additive mixed models were used to examine the associations of perceived destination and route attributes with changes in frequency of WT and WR. Results: Higher levels of perceived proximity to utilitarian destinations, reporting a larger number of utilitarian destinations within 10 min walk from home and higher street connectivity were associated with more positive changes in frequency of WT. Higher levels of perceived proximity to recreational destinations and better walking paths were associated with more positive changes in frequency of WR. No curvilinear relationships were observed and baseline frequency of walking did not moderate the associations. Discussion and Implications: Proximity of utilitarian and recreational destinations, well-connected streets, and better walking paths can be supportive of long-term participation in walking among middle-to-older aged adults. Environmental and policy initiatives focusing on such destination and route attributes have the potential to support residents' aging in place.

Proposta de reestruturação física da unidade produtora de refeição de organização militar / Proposal of physical restructuring of the unit producing meal of military organization

A alimentação no âmbito militar apresenta a importante tarefa de manutenção da saúde. O objetivo deste estudo foi propor uma reestruturação física da unidade produtora de refeição de uma organização militar (OM) na cidade de Natal-RN. Foi realizado um estudo descritivo utilizando a planta baixa atual, e a lista de verificações presente na Portaria nº 854 da Secretaria de Logística, Mobilização, Ciência e Tecnologia (SELOM) de 04 de Julho de 2005, que regulamenta as boas práticas em segurança alimentar nas Organizações Militares (OM). Foi analisado um total de 68 itens, divididos, em: localização, edificações e instalações, iluminação, ventilação, piso, teto, paredes portas, janelas, lixo, instalações sanitárias, esgoto, lavatórios para higienização das mãos abastecimento de água e layout. Após avaliar a planta baixa observaram-se várias irregularidades no layout como setorização e distribuição das áreas e fluxograma deficiente. Foi proposto um novo layout para redimensionar o fluxo, e os setores. A proposta da nova unidade consolidou a importância da nutricionista no processo de elaboração e execução do projeto de uma unidade de produtora de refeição (UPR) com a finalidade de minimizar os riscos de contaminação dos alimentos.

Identifying research needs for wheelchair transfers in the built environment.

PURPOSE: The purpose of this study is to describe the results of focus groups held during the Independent Wheelchair Transfer (IWT) Workgroup. The aims were to facilitate exchange of ideas on (1) the impact of the built environment on the wheelchair transfer process within the community (i.e. moving from wheelchair to and from other surfaces (e.g. furniture, toilet seat, bath bench, car seat) to participate in daily activities), (2) wheelchair users' needs during transfers in the built environment, and (3) future research directions. METHOD: Live web-based conferencing using Adobe Connect technology (Clarix Technologies, Inc., Pittsford, NY) was utilized to conduct three focus groups composed of experts in the field of assistive technology. Investigators independently reviewed focus group meeting transcripts and used qualitative methods to identify main themes. RESULT: Thirty-one experts in assistive technology and related fields participated in focus groups. Nine main themes were found including the effect of transfer skills training, space considerations in the built environment, wheelchair configuration, and the interaction between the built environment, user preferences, and transfer techniques. All groups raised issues about the transfer process in areas of the built environment with limited access, the effect of wheelchair users' transfer techniques, and user preferences during transfers. CONCLUSIONS: The area of independent transfers is multi-faceted and several factors require consideration when contemplating environmental changes to improve accessibility for wheelchair users. Obvious opportunity exists for research which could lead to advances in transfer technology, environments, and techniques for wheelchair users. Implications for Rehabilitation Tremendous opportunities for research collaborations in the field of assistive technology: To develop new terminology to describe wheelchair transfers. To improve the design of the built environment for wheelchair users. To investigate wheelchair transfer training techniques.

Housing accessibility and its associations with participation among older adults living with long-standing spinal cord injury.

OBJECTIVES: To describe the housing situation and aspects of participation among older adults living with long-standing spinal cord injury (SCI) with attention to SCI severity, and to examine whether and how objective housing accessibility (based on objectively measurable criteria) is associated with aspects of participation. DESIGN: Cross-sectional study utilizing the assessment tools Impact on Participation and Autonomy (IPA) and Housing Enabler (HE). Adjusting for demographic, social and injury related data, associations between objective housing accessibility and aspects of participation were analyzed by means of ordinal regression models. SETTING: Home and community settings. PARTICIPANTS: Older adults (≥ 50 years) (N = 123), with a traumatic or non-traumatic SCI for at least 10 years. To make comparisons within the sample, three groups of SCI severity were formed using the American Spinal Injury Association (ASIA) Impairment Scale. RESULTS: Housing adaptations and environmental barriers were common and differed between SCI severity groups; those with AIS D injuries had fewer adaptations and more environmental barriers indoors. A majority of the participants in the total sample perceived their participation as good or very good in most of the IPA activities studied. Accessibility indoors was significantly associated with autonomy indoors (P = 0.009), family role (P = 0.002) and participation problems (P = 0.004); more accessibility problems were associated with less participation and more participation problems. CONCLUSION: This study indicates that optimizing the housing environment for older adults with SCI can potentially increase their participation and make them more autonomous. Further studies based on longitudinal data are needed to determine the causality of the associations identified.

Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis.

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

Americans With Disabilities Act (ADA) Accessibility Guidelines for Transportation Vehicles. Final rule.

The Architectural and Transportation Barriers Compliance Board (Access Board or Board) is issuing a final rule that revises its existing accessibility guidelines for non-rail vehicles--namely, buses, over-the-road buses, and vans--acquired or remanufactured by entities covered by the Americans with Disabilities Act. The revised guidelines ensure that such vehicles are readily accessible to, and usable by, individuals with disabilities. The U.S. Department of Transportation (DOT) is required to revise its accessibility standards for transportation vehicles acquired or remanufactured by entities covered by the Americans with Disabilities Act (ADA) to be consistent with the final rule.