[Celestina, SUS and Sertão: a therapy clown experiment in popular education in health]. / Celestina, SUS e Sertão: uma experiência de palhaçaria na educação popular em saúde.

The scope of this paper is to elicit reflection on therapy clowns in the realm of Popular Education in Health. It describes and analyzes interventions conducted between October 2020 and December 2021 between civil service workers and patients in the Sertão Central hinterlands. Therapy clowning paved the way as a potent technology for humanized care treatment by the resident nurse. As an intermediary between scientific and popular knowledge, in its scenopoetic approach, it dealt creatively and humorously with taboo subjects for community health, promoting a light-hearted interaction experience with its audience. The experience revealed some points about the scarcity of investment to make projects like this viable, thereby empowering the institutionalization of Popular Education in Health. For this reason, we advocate the implementation of training sessions and workshops on concepts, challenges, and potentialities in Popular Education in Health. Therapy clowning, as a proposed action, is a transformative technology that inspires a proactive approach in the community through knowledge, loving care, and art.

Objetivo de promover reflexão sobre a palhaçaria, à luz da Educação Popular em Saúde. Descreve e analisa intervenções realizadas entre outubro de 2020 e dezembro de 2021, com usuários e servidores públicos no Sertão Central. A palhaça abriu alas para a territorialização e se mostrou potente tecnologia para uma atuação humanizada da enfermeira residente. Como interlocutora entre o saber científico e o popular, em sua corporalidade cenopoética, lidava de forma criativa e leve com assuntos tabus para a saúde comunitária, promovendo uma educação problematizadora e dialógica com seu público. A experiência fez-nos refletir nas lacunas de investimentos para viabilizar projetos como esse, fortalecendo a institucionalização da Educação Popular em Saúde. Assim, defendemos a implementação de formações e oficinas sobre conceitos, desafios e potencialidades da Educação Popular em Saúde. A palhaçaria, como proposta de atuação, é tecnologia transformadora que inspira o protagonismo à comunidade por meio de conhecimento, cuidado amoroso e arte.

Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

O mundo privado na UTI: análise da internação de pacientes oncológicos / The private world in the ICU: analysis of the hospitalization of oncology patientes / El mundo privado en la UCI: análisis de la hospitalización de pacientes oncológicos

O presente estudo buscou investigar a percepção que pacientes adultos de uma unidade de terapia intensiva (UTI) oncológica têm acerca da experiência de internação nesse setor. Trata-se de uma pesquisa de abordagem qualitativa e de compreensão. Sete pacientes de um hospital de câncer na região Sul do país foram pesquisados. Eles responderam a uma entrevista semiestruturada, a qual foi gravada e posteriormente transcrita, o que possibilitou o acesso às concepções prévias desses sujeitos acerca da UTI, aspectos psicológicos presentes durante a internação e concepções posteriores à experiência de internamento na unidade. Tais informações foram interpretadas por meio da análise de conteúdo. A partir dos resultados, foi possível verificar que a experiência de internação em contextos de terapia intensiva pode ser afetada, favorável ou desfavoravelmente, pelo conjunto de regras que o paciente traz consigo acerca do que é a UTI. Além disso, foi possível compreender também que os estímulos aversivos existentes nesse ambiente podem ser atenuados pela presença da família e por uma relação acolhedora e sensível com a equipe de saúde, favorecendo, assim, o repertório de enfrentamento do paciente frente a esse momento crítico de saúde.(AU)

This study aims to investigate the perception of adult patients in an oncology intensive care unit (ICU) regarding the experience of hospitalization in this sector. This is a research with a qualitative approach and understanding. Seven patients from a cancer hospital in the southern region of the country were surveyed. They answered a semi-structured interview, which was recorded and later transcribed, on the subjects' previous conceptions about the ICU, psychological aspects present during hospitalization, and conceptions subsequent to the hospitalization experience in the Unit. Such information was interpreted through content analysis. From the results, it was possible to verify that the experience of hospitalization in intensive care contexts can be affected, favorably or unfavorably, by the set of rules that the patient brings with them about what the ICU is. In addition, it was also possible to understand that the aversive stimulus existing in this environment can be attenuated by the presence of the family and by a welcoming and sensitive relationship with the health team, thus favoring the patient's coping repertoire when facing a critical moment of health.(AU)

Este estudio pretendió investigar la percepción que tienen los pacientes adultos sobre la experiencia de hospitalización en una Unidad de Cuidados Intensivos (UCI) de oncología. Se trata de una investigación con enfoque cualitativo y de comprensión. Participaron siete pacientes de un hospital oncológico en la región Sur de Brasil. Se aplicó una entrevista semiestructurada, que fue grabada y, posteriormente, transcrita, lo que permitió acceder a las concepciones previas de los sujetos sobre la UCI, los aspectos psicológicos presentes durante la hospitalización y las concepciones posteriores a la experiencia de internación en la Unidad. Dicha información se interpretó mediante análisis de contenido. A partir de los resultados, fue posible constatar que la experiencia de hospitalización en cuidados intensivos puede ser afectada favorable o desfavorablemente por el conjunto de normas que el paciente trae consigo sobre qué es la UTI. Además, se constató que los estímulos adversos existentes en este ambiente pueden mitigarse mediante la presencia de la familia y la relación acogedora y sensible con el equipo de salud, lo que favorece así el repertorio de afrontamiento del paciente ante este momento crítico de salud.(AU)

Vitamins K and D deficiency in severe motor and intellectually disabled patients.

OBJECTIVES: We aimed to determine serum 25-hydroxyvitamin D (25(OH)D) and undercarboxylated osteocalcin (ucOC) levels in severe motor and intellectual disabilities (SMID) patients and their association with bone turnover biomarkers. METHODS: We assessed vitamin D and K levels as indicators of osteoporosis in institutionalized adults with SMID. From December 2019 to February 2020, 93 institutionalized patients (48 men, 45 women; median age, 49 years) underwent annual routine examinations. Serum ucOC, 25(OH)D, bone-specific alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase A 5b (TRACP-5b) levels as bone formation and resorption markers and calcium and phosphorous levels were measured. Vitamin K deficiency was indirectly assessed based on ucOC levels. RESULTS: Mean ucOC levels were higher than normal (i.e., vitamin K deficiency). Serum 25(OH)D levels were markedly diminished. Overall, 86% of patients had deficient 25(OH)D levels. These 25(OH)D-deficient patients had higher ucOC levels. Multiple linear regression analysis revealed an inverse correlation between 25(OH)D and ucOC levels. ucOC levels were significantly higher and 25(OH)D levels were significantly lower in tube feeding. TRACP-5b levels were significantly higher in elderly than in young women. BAP and TRACP-5b levels were normal in adults. No relationship existed between vitamin D and antiepileptic drug use. CONCLUSIONS: Vitamin K and D co-deficiency was common in SMID patients. Vitamin K and D deficiencies were worse in tube-fed patients than in oral intake patients. SMID patients should undergo regular monitoring of vitamin D and K levels and supplementation of these vitamins.

A guide to establishing national public health institutes through mergers

Many national public health institutes were established in the second half of the 20th century. Since they were established, the public health landscape has changed considerably, with new challenges, priorities, structures, technologies, skills, holistic approaches and funding and budget pressures. Multiple organizations related to public health have often been created in countries according to local needs, to implement different essential public health functions and operations and host specific disciplines.This guide aims to take advantage of the good practices, success factors and strategies of these institutes. The purpose is practical; it is intended to offer an initial source of information for merger initiatives and to raise awareness among decision-makers and key individuals of how complex this is. It also offers a step-by-step action plan for decision-makers and workshop facilitators to successfully prepare and implement the reorganization or merger of their national public health institute.This guide focuses its action points at the level of political decision-makers, health ministries and other key institutes and on their mission and vision: strategic and operational goals; professional development and leadership; project portfolios; validation processes; communication; and legal aspects.

Práticas de cuidados paliativos em Instituição de Longa Permanência para Idosos / Palliative care practices in Long-Term Care facility for older adults

No cenário mundial, vive-se um processo de transição demográfica, devido ao aumento do número de idosos na sociedade. A mudança do espectro epidemiológico, associada às alterações sociais, econômicas e familiares, aumenta os índices de institucionalização que repercute em demanda crescente por vagas em Instituições de Longa Permanência para Idosos (ILPI). O motivo de admissão em uma ILPI, para a maioria dos residentes, é a presença de alguma doença crônica, sendo que estas instituições, muitas vezes, assumem o cuidado dos idosos até o momento de sua morte. Assim, as práticas de cuidados paliativos aproximam-se, cada vez mais, destas instituições. Com isso, levanta-se a preocupação em relação aos cuidados paliativos prestados aos idosos residentes em ILPI, tornandose importante conhecer as práticas de cuidados paliativos que nelas se desenvolvem. O presente estudo teve como objetivo geral identificar as práticas de cuidados paliativos vivenciadas no contexto de uma ILPI, na perspectiva da equipe multiprofissional. Trata-se de um estudo de abordagem qualitativa, realizado em uma ILPI de natureza filantrópica, localizada na cidade de Belo Horizonte. Os participantes foram 12 profissionais da equipe multiprofissional da instituição que fazem parte do cotidiano das práticas de cuidado prestadas ao idoso em cuidados paliativos. Realizou-se a coleta de dados por meio de observação participante e entrevistas com os profissionais da equipe. Submeteramse os dados à análise de conteúdo e organizaram-se os resultados em três categorias: dimensões do cuidado paliativo na ILPI, atores envolvidos nas práticas de cuidados paliativos no contexto da ILPI e organização da gestão das práticas de cuidados paliativos. Na primeira categoria, "dimensões do cuidado paliativo na ILPI", desvelaram-se e discutiram-se as seguintes dimensões: os cuidados paliativos na promoção de maior qualidade de vida, os cuidados paliativos como um cuidado e conforto, os cuidados paliativos como o cuidado realizado na fase final de vida e os cuidados paliativos e a espiritualidade. A segunda categoria se refere aos "atores envolvidos nas práticas de cuidados paliativos no contexto da ILPI" identificados como atores os profissionais que atuam no cuidado ao idoso em cuidados paliativos, o idoso em cuidados paliativos, a família desses idosos e os outros idosos que residem na ILPI. Na terceira categoria, "organização da gestão das práticas de cuidados paliativos", as dimensões analisadas incluem a rotina do cuidado voltado para os cuidados paliativos, organização do ambiente e as práticas de cuidados paliativos, o processo de construção dos cuidados paliativos e adaptações impostas pela pandemia do COVID-19. Assim, pode-se concluir que o estudo possibilitou a identificação de dimensões das práticas de cuidados paliativos na ILPI. A abordagem dos cuidados paliativos mostrou-se essencial para o cuidado do idoso institucionalizado, pois visa à qualidade de vida, à redução de sintomas e ao alívio do sofrimento. No desenvolvimento das práticas de cuidados paliativos, é importante que sejam incluídos todos os atores envolvidos. A inclusão de saberes de uma equipe multiprofissional mostrou-se relevante para estas práticas. Na rotina institucional, estão presentes práticas que seguem princípios dos cuidados paliativos. Ressaltase a importância da realização de ações que visem à formação dos profissionais que atuam em ILPI quanto aos cuidados paliativos. O fato de a coleta de dados ter sido realizada em apenas uma instituição é uma limitação do estudo. O desenvolvimento de novos estudos em relação a esta temática pode auxiliar em um aprofundamento quanto ao tema.

The world has undergone a process of demographic transition, with an increase in the number of elderly people in society. The change in epidemiological settings, combined with social, economic, and family related changes, has led to an escalationin institutionalization rates, reverberating in vacancies in Long-Term Care Facility (LTCF) for older adults demand boost. The reason for admission in a LTCF, for most residents, is the presence of chronic diseases.These facilities often take care of the elderly until their death. Therefore, palliative care practices have been getting closer to these institutions. Due to this new adopted strategy, concerns have been raised regarding palliative services offered to LTCF residents, making it important to understand the institutional practices. This study aimed to identifythe palliative care practices used inside a LTCF institution, from the perspective of a multidisciplinary team. We performed a qualitative approach, which was conducted at a philanthropic LTCF in Belo Horizonte, Brazil. 12 members of the institution's multidisciplinary team were enrolled in this study. The studied individuals took part in the daily practice of palliative care delivered to the residents. Data was collected through observation and interviews with the participants. Further, it was submitted to content analysis organized into three categories: dimension of palliative care in the LTCF, subjectsinvolved in palliative care practices in the LTCF and organization of palliative care practices management. In the first previously mentioned category the dimensions discussed were: palliative care for the promotion of better quality of life, palliative care as care tool and comfort, palliative care as a care performed in the final phase of life and palliative care and spirituality. The second studied category we selected as subjects the healthcare providers who performed palliative care for the elderly, elderly individuals in palliative care, the elderly's family, and the interface of the other elderly who resided in the LTCF. Lastly, in the third category, the dimensions analyzed included the palliative care routine, environment organization and palliative care practices, construction process of palliative care and adaptations imposed by the COVID-19 pandemic. Thus, we concluded that the present study enabled the identification of the dimensions of palliative care practices in the LTCF. The palliative care approach has beenshowed to be essential for the caring of institutionalized elderly, as it is focused in quality of life, symptoms reduction and suffering mitigation. In the development of palliative care practices, it is important to include all involved subjects. The multidisciplinary team approach and knowledge proved to be relevant to these practices. Practices that followed the principles of palliative care can befound in the institutional routine. It is important to reinforce the importance of educational actions directed to healthcare providers professional growthwho work at LTCF in regard to palliative care. The limitation of this study is that data collection was carried out in only one institution. The development of further studies in this area could assist in creating more in-depth knowledge on this topic.

"¡Si pierdes, pero das espectáculo, lucharás de nuevo!" MMA y el concepto de deporte / "Se perder e der show, vai lutar de novo!" MMA e o conceito de esporte / "If you lose and fight hard, you'll fight again!" - MMA and the concept of sport

Resumo A caracterização do esporte moderno elenca elementos que o distinguem de outras práticas corporais. As artes marciais mistas (MMA) são frequentemente compreendidas como uma modalidade esportivizada a partir de mudanças que visaram ao regramento e à diminuição da violência. Este estudo objetivou analisar o MMA a partir daquilo que o distingue dos outros esportes com base no conceito de esportivização proposto por Elias e Dunning. A metodologia, etnográfica, utilizou a observação participante em uma academia de MMA e em eventos de luta, da produção de diários de campo e de entrevistas. Três categorias empírico-analíticas foram construídas para análise de elementos do MMA (o "dono do evento"; o espetáculo acima da vitória; e a violência como espetáculo), as quais sugerem debates com as noções de vitória, institucionalização, pertencimento e violência. Indicou-se a importância de um alargamento do conceito de esporte para compreender o MMA.

Abstract The characterization of modern sport lists elements that distinguish it from other bodily practices. Mixed Martial Arts (MMA) are often understood as a sportized modality based on changes aimed at regulating and reducing violence. This study analyzed MMA based on what distinguishes it from other sports based on the concept of sportization proposed by Elias and Dunning. The ethnographic methodology employed participant observation in an MMA academy and in fighting events, as well as field diaries and interviews. Three empirical-analytical categories were built to analyze elements of MMA - the "owner of the event," show rather than victory, and violence as a show - which suggest debates with the notions of victory, institutionalization, belonging and violence. The importance to broaden the concept of sport to understand MMA is underscored.

Resumen La caracterización del deporte moderno tiene elementos que lo distinguen de otras prácticas corporales. Las artes marciales mixtas (MMA) suelen entenderse como una modalidad deportizada a partir de cambios destinados a regular y reducir la violencia. Este estudio tuvo como objetivo analizar el MMA a partir de aquello que lo distingue de otros deportes y tuvo como base​​ el concepto de "deportización" propuesto por Elias y Dunning. La metodología, etnográfica, utilizó la observación participante en un gimnasio de MMA y en eventos de lucha, la producción de diarios de campo y entrevistas. Se construyeron tres categorías empírico-analíticas para analizar elementos del MMA (el "dueño del evento", el espectáculo por encima de la victoria y la violencia como espectáculo), las que sugieren debates sobre las nociones de victoria, institucionalización, pertenencia y violencia. Se señala la importancia de ampliar el concepto de deporte para comprender el MMA.

Meaning of well-being of older institutionalized persons in abandonment situation.

OBJECTIVE: To understand the meaning of well-being of older persons in situation of abandonment. METHODS: a qualitative phenomenological study, carried out in a nursing home in Tepic, Nayarit, from 2017 to 2019. Intentional sampling with 12 older persons aged 60 and above. Data collection occurred by phenomenological interview. The ethical criteria of the General Health Law were respected. Participants signed the Informed Consent Form. Data analysis took place through phenomenological analysis. RESULTS: four themes have emerged: 1. Living Activities of Daily Living; 2. Attention to physical needs; 3. Coexistence; 4. Spirituality experience. CONCLUSION: for older persons, living institutionalized implies a process of adaptation and transformation to their context and state of life, restructuring their needs that provide well-being. It is important to approach these scenarios to establish ways of experiencing aging that favor a full quality of life.

Contextualizing geneticization and medical pluralism: How variable institutionalization of traditional, complementary, and alternative medicine (TCAM) conditions effects of genetic beliefs on utilization.

As genetic models are increasingly incorporated in medicine, health service users seem to accept these models to varying degrees. To appreciate these differences, this paper examines how health service users' genetic beliefs of health are associated with their use of traditional, complementary, and alternative medicine (TCAM) via responses from 31 countries in the 2011 ISSP survey. It finds an interesting contrast between East Asian countries and other countries in the world. The negative association between genetic beliefs and TCAM use is strong in the latter, whereas it is weak in the former. More intriguingly, the analysis demonstrates significant cross-national differences within East Asian countries. Chinese and Koreans reveal a negative relationship between genetic beliefs and TCAM use, while Japanese show a positive relationship. The paper provides an explanation to these cross-national differences by drawing on comparative studies of medical systems. When TCAM is institutionalized as valid and distinct medical resources, and when TCAM is practically available to everyday use, health service users who subscribe to genetic beliefs are likely to use TCAM as well. These findings contribute to revealing the pragmatic nature of health-seeking action and the institutional context in which geneticization and medical pluralism are conditioned to form.

Animal-Assisted Therapy Improves Communication and Mobility among Institutionalized People with Cognitive Impairment.

Disorders of communication, social relationships, and psychomotricity are often characterized by cognitive impairment, which hinders daily activities and increases the risk of falls. This study aimed to evaluate the efficacy of an animal-assisted therapy (AAT) program in an institutionalized geriatric population with cognitive impairment. The variables evaluated included level of communication and changes in gait and/or balance. We performed a two-arm, parallel controlled, open-label, nonrandomized cluster clinical trial in two nursing home centers from an urban area. Patients in the two centers received 12 weekly sessions of physiotherapy, but the experimental group included AAT with a therapy dog. The study included a total of 46 patients (23 Control Group [CG], 23 Experimental Group [EG]) with a median age of 85.0 years. Of these, 32.6% had mild-moderate cognitive decline (Global Deterioration Scale of Reisberg [GDS] 2-4) and 67.4% severe cognitive decline (GDS 5-6). After the intervention, patients in the CG and EG showed a statistically significant improvement in all the response variables. When comparing both groups, no statistically significant differences were found in any of the Tinetti scale results (measuring gait and balance). However, the communication of patients in the EG, measured on the Holden scale, showed a statistically significant greater improvement postintervention than that of patients in the CG. AAT can be useful as a complementary, effective treatment for patients with different degrees of cognitive decline.

Institutionalized elderly people with dementia: an integrative review on nursing care.

OBJECTIVE: To ascertain the characteristics of the nursing care provided to institutionalized elderly people with dementia. METHODS: Integrative review of studies published between 2013 and 2017, in English, Spanish, and Portuguese, from the databases BDENF, LILACS, CINAHL, PubMed, SciELO, TRIP, and National Guideline Clearing House. Thematic data analysis was used. RESULTS: From the data collected in the 41 included studies, three themes emerged: Care with a focus on the needs of elderly people in LTCIEs; Care based on the work process of the nursing team; and Shared care. Final considerations: Elderly care can take place from different perspectives: that of the elderly; the nursing team; and it can be shared among the different parties involved. The importance of communication must be stressed, as do the development of skills and attitudes of the team, as well as proper training and support, good environment in the care process, and an approach centered on the institutionalized elderly.

Combination of 3-Dimensional Virtual Reality and Hands-On Aromatherapy in Improving Institutionalized Older Adults' Psychological Health: Quasi-Experimental Study.

BACKGROUND: In Taiwan, which has one of the most rapidly aging populations in the world, it is becoming increasingly critical to promote successful aging strategies that are effective, easily usable, and acceptable to institutionalized older adults. Although many practitioners and professionals have explored aromatherapy and identified its psychological benefits, the effectiveness of combining 3-dimensional (3D) virtual reality and hands-on aromatherapy remains unknown. OBJECTIVE: A quasi-experimental trial was designed to evaluate the effectiveness of this combination in lowering perceived stress and promoting happiness, sleep quality, meditation experience, and life satisfaction among institutionalized older adults in Taiwan. METHODS: A total of 60 institutionalized elderly participants either received the combined intervention or were in a control group. Weekly 2-hour sessions were implemented over 9 weeks. The outcome variables were happiness, perceived stress, sleep quality, meditation experience, and life satisfaction, which were assessed at baseline and after the intervention. RESULTS: Generalized estimating equation (GEE) analyses indicated that the experimental group showed significant post-intervention improvements in terms of scores for happiness, perceived stress, sleep quality, meditation experience, and life satisfaction (n=48; all P<.001). Another GEE analysis showed that the significant improvements in the 5 outcome variables persisted in participants aged 80 years and older (n=35; all P<.001). CONCLUSIONS: This is the first trial to explore the effectiveness of a combination of 3D virtual reality and hands-on aromatherapy in improving older adults' psychological health. The results are promising for the promotion of psychological health in institutionalized older adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT04324216; https://clinicaltrials.gov/ct2/show/NCT04324216.

[Osteoporosis treatment in patients over 75 years old with fractures living in nursing home]. / Prise en charge de l'ostéoporose fracturaire chez les patients de plus de 75 ans vivant en institution.

OBJECTIVE: Recommendations for the management of major fractures in institutionalized patients over 75 years old were updated by the GRIO (French group for research and information on osteoporosis) in 2012 and in 2018. This study is an evaluation of practices in osteoporosis management in institutionalized old patients. METHODS: Evaluation of diagnostic and therapeutic management in medical observations of all residents over 75 years old with a history of major fracture in 4 nursing homes. RESULTS: 105 residents were included with the prevalence of osteoporosis fracture of 32.1%. The most common fractures were hip fractures (60.9%) and vertebral fracture (45.8%). Treatments were: calcium supplementation (14.3% of residents), vitamin D (52.4%), rehabilitation (70.5%) and specific treatment (biphosphonates 11.4%). Complete management (calcium supplementation, vitamin D, physical activity and osteoporosis treatment) was found in 5 residents (4.7%). Few factors were related to complete treatment initiation. Residents initially managed in medicine departments were more treated than those in surgical wards (25.0 vs 6.5%; p = 0.0144) rather than those managed by specialists (rheumatologist or geriatrician: 8 vs 4; p < 0.001). Creatinine clearance was significantly higher in residents with calcium supplementation (52.7 ± 27.9 vs 39.1 ± 9.6; p = 0.0505). Regimen number tend to be higher in residents receiving vitamin D (8.9 ± 2.7 vs 6.7 ± 3.4; p = 0.0753). CONCLUSION: This evaluation of professional practices showed that only a minority of residents received complete anti-osteoporotic treatment despite their risk factor for fracture recurrence. Such an evaluation should be systematic at the entry in nursing home, given the number of falling residents.

High Prevalence of Hypovitaminosis D in Institutionalized Elderly Individuals is Associated with Summer in a Region with High Ultraviolet Radiation Levels.

Vitamin D may play a significant role in regulating the rate of aging. The objective of the study was to assess vitamin D status and its associated factors in institutionalized elderly individuals. A total of 153 elderly individuals living in Nursing Homes (NH) were recruited into the study. Serum 25-hydroxyvitamin D [25(OH)D] concentration was used as the biomarker of vitamin D status, and it was considered as the dependent variable in the model. The independent variables were the type of NH, age-adjusted time of institutionalization, age, sex, skin color, body mass index, waist and calf circumference, physical activity practice, mobility, dietary intake of vitamin D and calcium, vitamin D supplementation, use of antiepileptics, and season of the year. Serum 25(OH)D concentrations less than or equal to 29 ng/mL were classified as insufficient vitamin D status. The prevalences of inadequate dietary intake of vitamin D and calcium were 95.4% and 79.7%, respectively. The prevalence of hypovitaminosis D was 71.2%, and the mean serum concentration of 25(OH)D was 23.9 ng/mL (95% confidence interval [CI]: 22.8-26.1). Serum 25(OH)D concentration was associated with the season of summer (p = 0.046). There were no associations with other independent variables (all p > 0.05). The present results showed that a high prevalence of hypovitaminosis D was significantly associated with summer in institutionalized elderly individuals.

"Moving on" through the locked ward system for women with intellectual disabilities.

BACKGROUND: The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how "moving on" is defined and perceived. METHODS: The study reports on an ethnographic study using the field-notes and the 26 semi-structured interviews with detained women and staff on three wards. RESULTS: We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. CONCLUSION: The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements.

Useful lessons for the provision of services in long-term care facilities in South Korea: operators' experiences illuminate the phenomenon of working with the elderly in the field.

PURPOSE: The aim of this study was to gain a deeper understanding of elderly long-term care facilities by focusing on insights provided by the operators of these facilities. METHODS: In this phenomenological study, 10 participants who operated nursing home businesses were interviewed. Of the 10 participants, seven had graduated from a nursing programme and three had studied social welfare. RESULTS: The experiences of facility operators could be organized into four themes: "Starting as a facility operator", "Dream of an ideal long-term care facility", "Struggling desperately in practice", and "Obtaining hope by providing care". These four themes were divided into 18 subthemes, constituting 96 meaningful statements. CONCLUSION: Despite the obvious gap between reality and ideals with regard to caring for residents, operators used a person-centred care strategy for the elderly at their facilities. Our findings indicate that, despite diverse barriers and hardships, participants were encouraged when they offered person-centred healthcare services for the elderly under their care, based on a philosophy of a holistic understanding of humans and respect for human life and dignity. Facility operators who are leaders in the practical field should be involved in the decision/policy-making process, to support health and well-being in the elderly in institutionalized settings.

Randomized controlled study on the effectiveness of animal-assisted therapy on depression, anxiety, and illness perception in institutionalized elderly.

AIM: The aim of this study was to verify dog-assisted therapy's effectiveness on depression and anxiety in institutionalized elderly. Patients' illness perception was examined to identify core beliefs regarding mood, personal control, and illness coherence because they can affect treatment compliance. Subjective perception of pain, social interaction, and setting-bound observable variables were also studied. METHODS: This study involved a randomized sample of institutionalized patients 65 years of age and older; the treatment group had 17 subjects and the control group had 14 subjects. All patients were administered the Mini-Mental State Examination, 15-item Geriatric Depression Scale, Positive and Negative Affect Schedule, Generalized Anxiety Disorder 7, Illness Perception Questionnaire, and Numeric Pain Rating Scale. Intra- and inter-group data analysis was performed before and after treatment. Over the course of 10 weeks, patients participated in individual 30-min sessions. An observational methodology was developed to record verbal and non-verbal interactions between the elderly, the dog, and the dog handler. RESULTS: A large effect size and a statistically significant decrease in 15-item Geriatric Depression Scale scores were identified in the treatment group. No significant differences were detected in the Generalized Anxiety Disorder 7, Positive and Negative Affect Schedule, and Numeric Pain Rating Scale. However, the Positive and Negative Affect Schedule and the Numeric Pain Rating Scale showed a moderate decrease. The Illness Perception Questionnaire's timeline (acute/chronic) and treatment control subscales showed a clinically relevant, large effect size. CONCLUSIONS: Dog-assisted therapy has proved to be effective in reducing symptoms of depression in institutionalized elderly. The increase in verbal interactions with the handlers throughout the study suggests the dog acts as a facilitator of social interaction, eliciting positive emotional responses. Dog-assisted therapy shows promising results in the perception of illness timeline and treatment control, indicating potential enhancement of the sense of treatment-related empowerment. However, further study is required.

La continuidad de cuidados en salud mental y la construcción de la red de protección en los menores en riesgo / The continuity of mental health care and the construction of the protection entwork for children at risk

Este trabajo pretende abordar la atención a los menores en salud mental, desde la prevención y la atención del riesgo psicosocial de forma holística hasta la construcción de la atención en red en su ámbito comunitario. El objetivo es lograr una intervención más eficaz que garantice la continuidad de cuidados abordando todas las contingencias que aparezcan en las distintas etapas de la vida, evitando la institucionalización y la medicalización, y respetando los derechos que amparan a los niños

This work tries to tackle the attention of minors in mental health, from the prevention and attention of the psychosocial risk in a holistic way, to the construction of the network attention, in its community level. The aim is to reach a more efficient intervention able to guarantee the continuity of the attentions, facing all the risks that appear in the different life stages, avoiding the institutionalization and medication, plus, respecting the rights that protect children

Experiences of adolescent crack users and their relatives with psychosocial care and institucionalization. / Experiências de adolescentes em uso de crack e seus familiares com a atenção psicossocial e institucionalização.

The Drug User Comprehensive Care Policy establishes that care practices should cover biopsychosocial realms. However, evidence reveals an institutionalized practice, in which families prioritize the subject's seclusion from its context of use. This study aimed to understand the implications of psychosocial care and institutionalization in meeting the needs of adolescent crack users and their families. Eleven teenagers and six relatives narrated their experiences through in-depth interviews, which were analyzed in the light of Paul Ricoeur's Phenomenological Hermeneutics. A flow was observed in which teenagers seeking care are initially institutionalized and then referred to replacement services. Thus, there is an urgent need to strengthen the psychosocial care network so that adolescent crack users' care is offered comprehensively, ensuring respect for their fundamental rights, such as the right to freedom and to experience family or community life.