Facing climate injustices: Community trust-building for climate services through arts and sciences narrative co-production.

The goal of this paper is to analyze how and with what results place-based climate service co-production may be enacted within a community for whom climate change is not a locally salient concern. Aiming to initiate a climate-centered dialogue, a hybrid team of scientists and artists collected local narratives within the Kerourien neighbourhood, in the city of Brest in Brittany, France. Kerourien is a place known for its stigmatizing crime, poverty, marginalization and state of disrepair. Social work is higher on the agenda than climate action. The team thus acknowledged that local narratives might not make much mention of climate change, and recognized part of the work might be to shift awareness to the actual or potential, current or future, connections between everyday non-climate concerns and climate issues. Such a shift called for a practical intervention, centered on local culture. The narrative collection process was dovetailed with preparing the neighbourhood's 50th anniversary celebration and establishing a series of art performances to celebrate the neighbourhood and its residents. Non-climate and quasi-climate stories were collected, documented, and turned into art forms. The elements of climate service co-production in this process are twofold. First, they point to the ways in which non-climate change related local concerns may be mapped out in relation to climate change adaptation, showing how non-climate change concerns call for climate information. Secondly, they show how the co-production of climate services may go beyond the provision of climate information by generating procedural benefits such as local empowerment - thus generating capacities that may be mobilized to face climate change. We conclude by stressing that "place-based climate service co-production for action" may require questioning the nature of the "services" rendered, questioning the nature of "place," and questioning what "action" entails. We offer leads for addressing these questions in ways that help realise empowerment and greater social justice.

Recovery of functional impairment after acute illness and mortality: one-year follow-up study.

BACKGROUND: Functional status in older people is a dynamic situation, which makes it necessary to evaluate functional capacity at different times to determinate their prognostic value. OBJECTIVE: To examine the association between functional status (baseline and change after acute illness) and mortality and functional changes at 1 year. METHODS: Hospital-based prospective longitudinal cohort study of all patients over 65 years old, admitted for multidisciplinary treatment of functional impairment after acute illness in a medium-stay unit (post-acute geriatric unit) of a teaching hospital ascribed to the Spanish National Health Service from Spain during 15 consecutive months. Functional status (Barthel Index, BI) was assessed prior to the acute illness, at admission in a post-acute unit, at discharge and 1 year later. At admission, other variables were collected: sociodemographic, main diagnostic for hospitalization (stroke, orthopedic process, or deconditioning), serum albumin, comorbidity (Charlson Index), cognitive status (Pfeiffer s Short Portable Mental Status Questionnaire). In order to analyze mortality 1 year after discharge, a Cox regression analysis was performed. RESULTS: Three hundred and sixty-nine patients constituted the study population, mean age was 80.74 years (SD 7.4), 66.6% were female and 1 year after discharge mortality was 20%. In the multivariate analysis, variables associated with a higher 1-year mortality were age (HR 1.06; 95% CI = 1.00-1.07) male gender (HR 2.11; 95% CI = 1.26-3.55), worse prior functional status (HR 0.98; 95% CI = 0.96-0.99), and higher functional loss in BI at admission (HR 1.02; 95% CI = 1.00-1.04). On the other hand, a greater functional gain in BI at discharge was associated with a lower 1-year mortality (HR 0.98; 95% CI = 0.96-0.99). CONCLUSIONS: The main functional gain obtained after treatment in a multidisciplinary post-acute geriatric unit is independently associated with a reduction in long-term mortality. In addition to baseline functional status and after acute illness, the subsequent potential recovery is very important to predict poor long-term outcomes.

Functional status and mortality at month and year in nonagenarians hospitalized due to acute medical illness.

OBJECTIVES: To analyze risk factors associated with short and long-term mortality in nonagenarians hospitalized due to acute medical conditions. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of all patients aged 90 years or older admitted in a geriatric unit during 2009 due to medical acute illness. Baseline variables were collected at admission (sex, cause of admission, Charlson index, serum albumin, functional, and mental status), functional loss at admission (as the difference between Barthel index(BI) 2 weeks before admission and BI at admission), and functional loss at discharge(as the difference between BI 2 weeks before admission and BI at discharge). The association of these variables with mortality at 1 month and 1 year after admission was analyzed by multivariate Cox regression analysis. RESULTS: Out of all patients admitted, 434 (33%) were 90 years old or older and 76.3% were female. Mortality at 1 month and 1 year after admission was 19% and 57%, respectively. In the month mortality multivariate analysis, being older (HR, 1.11; 95% CI=1.02 to 1.20), a previous Barthel index less than 40 points (HR, 5.87; 95% CI=1.16 to 29.67), and functional loss at admission (HR; 1.13; 95% CI=1.03 to 1.25) were independent risk factors. When patients that died 1 month after admission were excluded, the presence of hypoalbuminemia <3g/dl (HR, 2.70; 95% CI=1.69 to 4.32) and functional loss at discharge (HR-1.08, 95% CI=1.03 to 1.14) were the factors associated with 1 year mortality. CONCLUSIONS: In nonagenarians, functional impairment is the most important risk factor associated with short and long-term mortality after hospitalization due to acute medical illness.

[Functional gain and length of hospital stay at a medium-stay geriatric care unit at the Central Red Cross Hospital in Madrid, Spain]. / Ganancia funcional y estancia hospitalaria en la unidad geriatrica de media estancia del Hospital Central de Cruz Roja de Madrid.

BACKGROUND: The medium-stay or convalescent care geriatric units were defined by the Spanish National Health Institute in 1996 as being the level of geriatric hospital care aimed at recovering those functions, activities or sequelae having undergone changes as a result of different prior processes. This study is aimed at evaluating the characteristics of patients related to functional gain and stay in medium-stay geriatric units. METHODS: A study was made of all those patients admitted throughout the May 2000-December 2001 period. The weekly and overall functional gain was evaluated using the Barthel Index (BI), the hospital stay and the effectiveness (BI at discharge-BI at admission/during stay) having been evaluated. An improvement in the weekly gain of BI>5 points was set at the effectiveness threshold. RESULTS: A total of 459 patients averaging age 80.56 (+/-7.45) admitted for functional recovery from sequelae of ictus (48.4%), orthopedic disorders (26.3%) and immobility due to other ailments (23.5%) were evaluated. The total functional gain was 29.71 (+/-16.75) Barthel Index points, entailing an average stay of 24.93 (+/-12.94) days and a 1.44 (+/-1.02) effectiveness. The weekly functional gain was above the threshold set during the first three weeks, independently of the age and disorder for which admitted. In the multivariate regression analysis, the age, admission due to ictus, functional impairment prior to admission, cognitive impairment at admission, comorbility and delay in admission were related to a lesser functional gain. Admission due to ictus and a better functional condition prior to admission and better cognitive condition at admission were related to a longer stay. CONCLUSIONS: Hospital stays in medium-stay geriatric units is adequate, at least during the first three weeks. A comparison of the results among units should be adjusted by age, the disorder for which admitted, comorbility and functional and cognitive condition of the patients.

Protected areas in the Atlantic facing the hazards of micro-plastic pollution: first diagnosis of three islands in the Canary Current.

Coastal zones and the biosphere as a whole show signs of cumulative degradation due to the use and disposal of plastics. To better understand the manifestation of plastic pollution in the Atlantic Ocean, we partnered with local communities to determine the concentrations of micro-plastics in 125 beaches on three islands in the Canary Current: Lanzarote, La Graciosa, and Fuerteventura. We found that, in spite of being located in highly-protected natural areas, all beaches in our study area are exceedingly vulnerable to micro-plastic pollution, with pollution levels reaching concentrations greater than 100 g of plastic in 1l of sediment. This paper contributes to ongoing efforts to develop solutions to plastic pollution by addressing the questions: (i) Where does this pollution come from?; (ii) How much plastic pollution is in the world's oceans and coastal zones?; (iii) What are the consequences for the biosphere?; and (iv) What are possible solutions?

Cómo transformar el concepto de fragilidad en intervenciones eficientes: transversalidad y liderazgo de la geriatría / How to transform the concept of frailty into efficient interventions: transversality and leadership of geriatrics

No disponible

¿Qué opinan los socios de la Sociedad Española de Geriatría y Gerontología sobre las guías de práctica clínica en geriatría? / What do the members of the Spanish Society of Geriatrics and Gerontology think about clinical practice guidelines in geriatrics?

No disponible

[The interrater reliability of four common comorbidity indexes used in elderly patients]. / Fiabilidad interobservador de los 4 índices de comorbilidad más utilizados en pacientes ancianos.

OBJECTIVE: To report on the interrater reliability of four common comorbidity indexes used in the hospitalised elderly: Charlson Index (CI), Geriatric Cumulative Illness Rating Scale (CIRS-G), Index of Co-existent Disease (CoD) and Kaplan-Feinstein Index (KFI). METHOD: Four trained observers, independently reviewed the same 40 medical charts of hospitalised geriatric patients. Scores for the four indexes were calculated, along with the intraclass correlations coefficient (ICC) (quantitative index: CI and CIRS-G) and Kappa coefficient (qualitative index: CoD and KFI). The agreement <0.4 was considered deficient, 0-4-0.75 acceptable and >0.75 excellent. RESULTS: A total of 40 patients (29 women) of 85.93 (±5.35) years were analysed. Intraclass correlations coefficient: CI: 0.78 (95% CI: 0.67-0.86); CIRS-G (score): 0.66 (95% CI: 0.53-0.78). Kappa coefficient: KFI: 0.51 to 0.76; CoD: 0.44-0.66. The application time was lower for the Charlson index (median of 39seconds [30-45]) and the KFI (42seconds [35-52]) and higher for CIRS-G (score) (128seconds [110-160]) and CoD (102seconds [80-124]). CONCLUSIONS: Of the four comorbidity indexes used in a hospitalised elderly population, the CI, and CIRS-G (score), are those that have better interrater reliability. The Charlson index and KFI show a lower application time than the CIRS-G (score).

Las guías de práctica clínica en geriatría: ¿son realmente útiles? / Clinical practice guidelines in geriatrics: are they really useful?

No disponible

[Efficiency of acute geriatric units: a meta-analysis of controlled studies]. / Eficiencia de las unidades geriátricas de agudos: metaanálisis de estudios controlados.

OBJECTIVE: After analysing the effectiveness in the reduction in the incidence of functional impairment and a higher probability of returning home between elderly patients hospitalised due to an acute medical illness cared for in acute geriatric units (AGU) compared to conventional care units, we propose to assess the efficiency of this care. MATERIAL AND METHODS: A systematic review and meta-analysis was made of controlled studies (randomised, no randomised and case-control) that compared care in UGA with care in conventional hospital units of patients of 65 years and over with an acute medical illness. Studies on administrative data bases, those that evaluated care of a single disease, and those that assessed units with care in the acute and sub-acute phase were excluded. A literature review was performed on articles published up to 31st of August 2008 in Medline, Embase, Cochrane Library, and references of systematic reviews and reviewed articles. The selection of the studies and the extraction of data on the hospital stay and care costs was made independently by two different researchers. RESULTS: A total of 11 studies were included, of which 5 were randomised, 4 were non-randomised, and 2 case control, all of them providing data on hospital stay, with 7 of them providing data on hospital costs (4 clinical trials, 2 non-randomised and 1 case-control). The overall analysis of all the studies showed that those admitted to UGA had a statistically significant reduction in hospital length of stay compared to the elderly hospitalised in conventional units (mean difference -1.01 days; 95% CI, -1.66 to -0.36) and hospital care costs (mean difference of -330 US dollars; 95% CI, -540 to -120). CONCLUSIONS: Care in AGU is more efficient than that provided in conventional units, since, as well as achieving a reduction in the incidence of functional impairment at discharge and increasing the probability of returning home, they reduce mean hospital stay and the hospital care costs.

Evidencia científica y práctica clínica en octogenarios: a propósito del manejo de la hipercolesterolemia / Evidence-based medicine and clinical practice in octogenarians: The management of hypercholesterolemia

No disponible