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1.
Top Stroke Rehabil ; 24(6): 415-421, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28330419

RESUMO

OBJECTIVES: The study explores the association between sex and care dependency risk one year after stroke. METHODS: The study uses claims data from a German statutory health insurance fund. Patients were included if they received a diagnosis of ischemic or hemorrhagic stroke between 1 January and 31 December 2007 and if they survived for one year after stroke and were not dependent on care before the event (n = 1851). Data were collected over a one-year period. Care dependency was defined as needing substantial assistance in activities of daily living for a period of at least six months. Geriatric conditions covered ICD-10 symptom complexes that characterize geriatric patients (e.g. urinary incontinence, cognitive deficits, depression). Multivariate regression analyses were performed. RESULTS: One year after the stroke event, women required nursing care significantly more often than men (31.2% vs. 21.3%; odds ratio for need of assistance: 1.67; 95% CI: 1.36-2.07). Adjusted for age, the odds ratio decreased by 65.7% to 1.23 (n.s.). Adjusted for geriatric conditions, the odds ratio decreased further and did not remain significant (adjusted OR: 1.18 (CI: 0.90-1.53). DISCUSSION: It may be assumed that women have a higher risk of becoming care-dependent after stroke than men because they are older and suffer more often from geriatric conditions such as urinary incontinence at onset of stroke. Preventive strategies should therefore focus on geriatric conditions in order to reduce the post-stroke care dependency risk for women.


Assuntos
Dependência Psicológica , Reembolso de Seguro de Saúde/economia , Seguro Saúde/economia , Caracteres Sexuais , Acidente Vascular Cerebral , Atividades Cotidianas/psicologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Seguro Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral , Adulto Jovem
2.
BMC Geriatr ; 15: 135, 2015 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-26499064

RESUMO

BACKGROUND: The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease? METHODS: The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis. RESULTS: 21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0-65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82-16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88-6.71) in patients aged 76-85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %). CONCLUSIONS: Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.


Assuntos
Dependência Psicológica , Fraude/economia , Revisão da Utilização de Seguros/economia , Seguro Saúde/economia , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraude/tendências , Alemanha/epidemiologia , Humanos , Revisão da Utilização de Seguros/tendências , Seguro Saúde/tendências , Masculino , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico
3.
Water Res ; 42(20): 5054-60, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18929387

RESUMO

Solar water disinfection (SODIS) is a simple, effective and inexpensive water treatment procedure suitable for application in developing countries. Microbially contaminated water is filled into transparent polyethylene terephthalate (PET) plastic bottles and exposed to full sunlight for at least 6h. Solar radiation and elevated temperature destroy pathogenic germs efficiently. Recently, concerns have been raised insinuating a health risk by chemicals released from the bottle material polyethylene terephthalate (PET). Whereas the safety of PET for food packaging has been assessed in detail, similar investigations for PET bottles used under conditions of the SODIS treatment were lacking until now. In the present study, the transfer of organic substances from PET to water was investigated under SODIS conditions using used colourless transparent beverage bottles of different origin. The bottles were exposed to sunlight for 17h at a geographical latitude of 47 degrees N. In a general screening of SODIS treated water, only food flavour constituents of previous bottle contents could be identified above a detection limit of 1 microg/L. Quantitative determination of plasticisers di(2-ethylhexyl)adipate (DEHA) and di(2-ethylhexyl)phthalate (DEHP) revealed maximum concentrations of 0.046 and 0.71 microg/L, respectively, being in the same range as levels of these plasticisers reported in studies on commercial bottled water. Generally, only minor differences in plasticiser concentrations could be observed in different experimental setups. The most decisive factor was the country of origin of bottles, while the impact of storage conditions (sunlight exposure and temperature) was less distinct. Toxicological risk assessment of maximum concentrations revealed a minimum safety factor of 8.5 and a negligible carcinogenic risk of 2.8 x 10(-7) for the more critical DEHP. This data demonstrate that the SODIS procedure is safe with respect to human exposure to DEHA and DEHP.


Assuntos
Desinfecção/métodos , Reutilização de Equipamento/normas , Indicadores Básicos de Saúde , Plastificantes/análise , Luz Solar/efeitos adversos , Abastecimento de Água/normas , Bebidas , Honduras , Humanos , Nepal , Plastificantes/toxicidade , Polietilenotereftalatos/análise , Suíça
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