Most appropriate placement for people with dementia: individual experts' vs. expert groups' decisions in eight European countries.

AIMS: To investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries. BACKGROUND: Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide. DESIGN: A modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project. METHODS: Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participants worked in small groups to reach joint decisions for the same vignettes. RESULTS: Considerable variation was seen in individuals' recommendations for more than half the case types. Cognitive impairment, functional dependency, living situation and caregiver burden did not differentiate between case types generating high and low degrees of consensus. Group-based decisions were more consistent, but country-specific patterns remained. CONCLUSIONS: A multidisciplinary approach would standardize the decisions made about the care needed by people with dementia on the cusp of care home admission. The results suggest that certain individuals could be appropriately diverted from care home entry if suitable community services were available.

Changes in schoolgirls' body measurements during a 30 year period.

Two data-sets containing the anthropometric measurements of Estonian schoolgirls aged 7-18 were analysed, one (set A) from the late sixties, size 1627 and the other (set K) from the late nineties, size 1546. In all data sets 8 measurements--three height, three breadth measures, chest circumference and mass--were measured using the same methodology, as well as BMI was calculated. The means of all the characteristics in age groups (size 100-150 individuals) were calculated and growth curves of means were approximated using polynomial least squares approximation. The maximal velocity points were found and the growth intensities in different body build groups were compared. It was proved that the usage of cross-sectional data for estimating growth curves is suitable for estimating the velocity of acceleration in different age groups. We found that the height of Estonian girls has increased during the last 30 years by about 4-5%, the breadth measurements--by about 1-2%, chest circumference up to 8% and BMI has decreased by 3-5%. The changes are quite modest in pre-puberty, most significant for girls aged 12-16 and smaller again for girls aged 17 and more. The maximal growth velocity has shifted for all characteristics to the earlier time. Comparison of different body build groups showed that the small girls of the sixties are quite similar to small girls in the nineties, but the differences are greater in the case of large and pycnomorphic girls.

Body build classes as a method for systematization of age-related anthropometric changes in girls aged 7-8 and 17-18 years.

A total of 462 schoolgirls aged 7-8 and 17-18 years were examined anthropometrically (45 body measurements and 10 skinfolds) in a cross-sectional study. The data were processed in two age groups: 7-8-year-olds (n = 205) and 17-18-year-olds (n = 257). Relying on average height and weight in the groups, both groups were divided into five body build classes: small, medium, large, pyknomorphous and leptomorphous. In these classes, the differences in all other body measurements were compared, and in both age groups, analogous systematic differences were found in length, width and depth measurements and circumferences. This enabled us to compare proportional changes in body measurements during ten years, using for this ratios of averages of basic measurements and measurement groups in the same body build classes. Statistical analysis by the sign test revealed statistically significant differences between various body build classes in the growth of averages. Girls belonging to the small class differed from the girls of the large class by an essentially greater increase in their measurements. Our results suggest that the growth rate of body measurements of girls with different body build can be studied by the help of body build classification.