RESUMEN
PURPOSE: To assess how vitamin D status is associated with health-related quality of life (HRQOL) among older residents of Canada. DESIGN: We analysed baseline data of 1,493 Canadians aged 50 years and over in Alberta on HRQOL (EQ-5D-5L) and serum 25-hydroxyvitamin D (25(OH)D) as a measure of vitamin D status. We applied multivariable regression methods to examine the association between vitamin D status and each of the five dimensions and the summary index of the EQ-5D-5L. RESULTS: Participants with higher serum 25(OH)D levels were significantly less likely to report problems with mobility, usual activities, and depression and anxiety. Specifically, age- and gender-adjusted odds ratios for reporting problems with mobility, usual activities, and depression and anxiety were 0.58 (95 % confidence interval 0.44-0.78), 0.67 (0.50-0.89), and 0.67 (0.51-0.88) per 100 nmol/L increase in 25(OH)D, respectively. No significant associations were observed for problems with self-care and with pain and discomfort. HRQOL scores combining the responses of each of the five dimensions increased significantly with increasing serum 25(OH)D levels. CONCLUSIONS: This is the first study to reveal the importance of vitamin D for the five dimensions of HRQOL in a community-based sample. The observed associations of vitamin D and HRQOL call for intervention studies to strengthen the evidence of the potential benefits of vitamin D supplementation for HRQOL among older adults.
Asunto(s)
Estado de Salud , Calidad de Vida , Vitamina D/análogos & derivados , Anciano , Anciano de 80 o más Años , Alberta , Ansiedad , Estudios Transversales , Depresión , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Autocuidado , Encuestas y Cuestionarios , Vitamina D/sangre , Deficiencia de Vitamina D/complicacionesRESUMEN
The second phase of a Canada-wide study of ethics committees in English-language hospitals in Canada involved site visits to five selected hospitals to assess the effectiveness of the ethics committee. In this article the findings of this pilot study are reported, including the perspectives of physicians, nurses and hospital administrators on the ethics committee of the various hospitals. The results of the study, albeit limited by being a pilot study, raise a series of questions for hospital administrators, medical administrators and nursing administrators.
Asunto(s)
Actitud del Personal de Salud , Comités de Ética Clínica , Comités de Ética/organización & administración , Administración Hospitalaria/normas , Canadá , Recolección de Datos , Estudios de Evaluación como Asunto , Administradores de Hospital , Personal de Enfermería en Hospital , Rol del Médico , Proyectos Piloto , Formulación de Políticas , Derivación y Consulta , Desarrollo de PersonalRESUMEN
A survey of English-language hospitals with more than 300 beds in Canada was conducted in 1989 to assess institutional ethics committees. A dramatic increase was found in the growth of such committees, compared with a similar survey taken in 1984. The growth and the activities of institutional ethics committees are discussed, noting the need for more attention for research on their effectiveness.
Asunto(s)
Comités de Ética Clínica , Ética Institucional , Administración Hospitalaria/tendencias , Comité de Profesionales/estadística & datos numéricos , Canadá , Miembro de Comité , Estudios de Evaluación como Asunto , Encuestas y CuestionariosRESUMEN
The debate over futility is driven, in part, by physicians' desire to recover some measure of decision-making authority from their patients. The standard approach begins by noting that certain interventions are futile for certain patients and then asserts that doctors have no obligation to provide futile treatment. The concept of futility is a complex one, and many commentators find it useful to distinguish 'physiological futility' from 'qualitative futility'. The assertion that physicians can decide to withhold physiologically futile treatment generates little controversy. The claim that they can withhold qualitatively futile treatment runs afoul of standard objections to medical paternalism. There is reason to believe that the conceptual distinction will not be maintained in clinical practice. This paper contends that the scientific data which would support a physician's unilateral decision to withhold physiologically futile treatment also provide support for an institutional policy restricting access to the treatment. The data the doctor uses to take decision-making power out of the hands of the patient can be used by the administrator to take power out of the hands of the doctor. While this loss of power is unproblematic, there is reason to believe that the ambiguity in the term 'futility' will allow a much greater loss of physicians' power.
Asunto(s)
Actitud Frente a la Salud , Toma de Decisiones , Inutilidad Médica , Médicos , Medición de Riesgo , Valores Sociales , Privación de Tratamiento , Consenso , Ética Médica , Costos de la Atención en Salud , Humanos , Obligaciones Morales , Defensa del Paciente/legislación & jurisprudencia , Autonomía Personal , Asignación de Recursos , IncertidumbreRESUMEN
Hospital ethics committees continue to proliferate, despite the fact that their impact upon practice has not been rigorously evaluated. This paper investigates the reasons why the often recommended evaluation has not yet occurred. One reason cited is that three different roles - education, policy formulation, and case review - need to be assessed. The principal reason why the most novel of the roles, case review, has not been evaluated is because of unresolved dispute over the goals of review.