[Factors contributing to frailty in institutionalized older adults: a multi-institutional cross-sectional study].

AIM: To reveal the characteristics and the oral function of institutionalized frail older adults and the factors contributing to frailty. METHODS: This multicenter, cross-sectional study included 214 patients. A questionnaire was administered to registered dietitians from these institutions. Sex, age, height, weight, grip strength, calf circumference, level of care need, FRAIL-NH, MNA® -SF, dysphagia, food form and water thickening, number of medications, major diseases, comorbidities, independence in daily living of older people with dementia, use of medication with dry mouth, nutritional care issues (malnutrition-related problems) by multiple occupations in Nutrition and Eating Swallowing Screening, Assessment and Monitoring, and nine oral-related items were evaluated. RESULTS: One hundred six patients (49.5%) were classified as frail, 75% of the patients were women, and the mean BMI was 19.7 kg/m2. Older adults with frailty were characterized by high care needs, malnutrition, multiple comorbidities, multiple medications, eating and swallowing disorders, the requirement of feeding assistance, and the need to adjust the shape of meals and fluids. The multivariable OR (95%CI) for "choking and residue problems" was 1.81 (1.20-2.73), while that for "dietary concentration problems" was 4.28 (2.10-8.74). CONCLUSION: Caregivers must maintain posture and provide meal assistance. Professionals in various occupations must adjust the proper food form and medication content. Meal times must be examined in consideration of the times at which drugs will be most effective. Oral care must be provided, and an environment must be created to help the subject concentrate. Focusing on problems of choking, residue, and concentration on meals is expected to improve frailty, aspiration pneumonia, and the prognosis of institutionalized older adults.

Predicting informal dementia caregivers' desire to institutionalize through mining data from an eHealth platform.

BACKGROUND: Dementia is a leading factor in the institutionalization of older adults. Informal caregivers' desire to institutionalize (DI) their care recipient with dementia (PwD) is a primary predictor of institutionalization. This study aims to develop a prediction model for caregivers' DI by mining data from an eHealth platform in a high-prevalence dementia country. METHODS: Cross-sectional data were collected from caregivers registering on isupport-portugal.pt. One hundred and four caregivers completed the Desire to Institutionalize Scale (DIS) and were grouped into DI (DIS score ≥ 1) and no DI (DIS score = 0). Participants completed a comprehensive set of sociodemographic, clinical, and psychosocial measures, pertaining to the caregiver and the PwD, which were accounted as model predictors. The selected model was a classification tree, enabling the visualization of rules for predictions. RESULTS: Caregivers, mostly female (82.5%), offspring of the PwD (70.2), employed (65.4%), and highly educated (M 15 years of schooling), provided intensive care (Mdn 24 h. week) over a median course of 2.8 years. Two-thirds (66.3%) endorsed at least one item on the DIS (DI group). The model, with caregivers' perceived stress as the root of the classification tree (split at 28.5 points on the Zarit Burden Interview) and including the ages of caregivers and PwD (split at 46 and 88 years, respectively), as well as cohabitation, employed five rules to predict DI. Caregivers scoring 28.5 and above on burden and caring for PwD under 88 are more prone to DI than those caring for older PwD (rules 1-2), suggesting the influence of expectations on caregiving duration. The model demonstrated high accuracy (0.83, 95%CI 0.75, 0.89), sensitivity (0.88, 95%CI 0.81, 0.95), and good specificity (0.71, 95%CI 0.56, 0.86). CONCLUSIONS: This study distilled a comprehensive range of modifiable and non-modifiable variables into a simplified, interpretable, and accurate model, particularly useful at identifying caregivers with actual DI. Considering the nature of variables within the prediction rules, this model holds promise for application to other existing datasets and as a proxy for actual institutionalization. Predicting the institutional placement of PwD is crucial for intervening on modifiable factors as caregiver burden, and for care planning and financing.

Effects of early institutionalization involving psychosocial deprivation on cognitive functioning 60 years later: Findings of the LifeStories project.

BACKGROUND: Institutionalization involving psychosocial deprivation affects child development negatively. However, there are few longitudinal studies, and no prospective study has yet examined the consequences of institutionalization in late adulthood. OBJECTIVE: Investigating effects of psychosocial deprivation on cognitive functioning 60 years later. PARTICIPANTS AND SETTING: A population-based survey of institutionalized infants and toddlers was conducted in Switzerland from 1958 to 1961 (n = 387; Mage = 0.93 years, SD = 0.53, 48 % female, 48 % Swiss nationality). In parallel, a comparison group of 399 family-raised children were assessed (Mage = 0.85 years, SD = 0.50, 46 % female, 100 % Swiss nationality). Six decades later, data on cognitive functioning were collected for 88 of the institutionalized group (Mage = 62.63 years, SD = 1.32), and 148 of the comparison group (Mage = 65.06, SD = 1.32). METHODS: Standardized tests were used: the Brunet-Lézine Developmental Test in early childhood and a short form of the Wechsler Adult Intelligence Scale in late adulthood. RESULTS: Formerly institutionalized individuals scored lower on cognitive functioning (d = - 0.67, p < .001), with the greatest difference in working memory (d = -0.78, p < .001). Longer duration of institutionalization increased the risk of lower cognitive functioning, indicating a dose-response effect. Institutionalization's impact on adult cognitive functioning was mediated by early childhood developmental status but not by later educational attainment. CONCLUSIONS: This study confirms the early experience hypothesis, indicating that early life conditions have lasting effects on human development, even into late adulthood.

The Role of Neighborhood Socioeconomic Status in Institutionalization of Home Health Care Patients With and Without Alzheimer's Disease and Related Dementias.

OBJECTIVES: To assess whether neighborhood socioeconomic status (SES) moderates the association between Alzheimer's disease and related dementias (ADRD) and successful discharge to the community. In addition, to explore whether the role of neighborhood SES on successful discharge for patients with ADRD varies by the severity of ADRD. DESIGN: This is a retrospective cohort study. SETTING AND PARTICIPANTS: Medicare Fee-for-service beneficiaries, aged 65 or older, who received home health care in 2019. METHODS: We used linear probability regression models with successful discharge to the community as the main outcome, and neighborhood SES and ADRD as independent variables. Also, we modified the Functional Assessment Staging Tool (FAST) to measure ADRD severity. RESULTS: Our study results show ADRD and residing in neighborhoods with lower socioeconomic conditions were independently associated with lower probabilities of successful discharge to the community. We also found that the differences in probabilities of remaining at home between patients with and without ADRD were larger among those in neighborhoods with lower SES (ADRD∗less disadvantaged neighborhood, coeff: -0.01, P < .001; ADRD∗more disadvantaged neighborhood, coeff: -0.02, P < .001; ADRD∗most disadvantaged neighborhood, coeff: 0.032, P < .001). Among patients with ADRD, patients with the most advanced ADRD were less likely to remain in their homes and community when living in neighborhoods with lower SES. CONCLUSIONS AND IMPLICATIONS: Our study results show that when patients with ADRD receiving home health care live in neighborhoods with lower SES, they face further challenges to remaining in their homes and community. Public health officials and community planners should consider using area-level interventions to improve care and health outcomes for patients with ADRD. Also, further research aimed at identifying the specific factors and resources influencing lower care quality and poorer health outcomes in socioeconomically disadvantaged neighborhoods, particularly for patients with ADRD, can provide valuable insights for the development and implementation of targeted interventions.

[Revue des effets de l'institutionnalisation sur le développement de la dépression chez les personnes âgées résidant en maison de retraite]. / Institutionalization effects on depression development in nursing home elderly residents: a review.

Depression is a prevalent mental health issue among elderly people residing in nursing homes, with significant implications for quality of life. From an initial pool of 175 articles, seven met the inclusion criteria, including four longitudinal studies, two controlled trials, and one systematic review. The findings indicate mixed outcomes regarding the impact of institutionalization on the trajectory of depression, underlining the complexity of its support. A number of risk factors appear to be associated with depression, such as gerontopsychiatric disorders, functional impairment, chronic illness and gender. Interventions such as increased exposure to natural light and psycho-educational programmes could be relevant therapeutic tools. This review emphasizes the need for more robust longitudinal research, and uniform depression assessment methods to better manage depression at the entrance of the nursing home.

Educational interventions to prevent urinary infections in institutionalized elderly people. Quasi-experimental Study.

Objective: To analyze the effectiveness of an educational intervention among nursing professionals and caregivers to prevent urinary tract infections in institutionalized elderly people. Methods: this is a quasi-experimental study carried out with 20 people (7 nurses and 13 formal caregivers). A questionnaire was applied during the pre-intervention stage, then professional training was carried out and finally, the questionnaire was reapplied 6 months after the intervention. The prevalence profile and factors associated with urinary infections in 116 elderly people was evaluated before and after the educational interventions. Statistical analysis was performed using association and correlation tests, logistic regression model comparison and prevalence rates. Results: The average number of correct answers by the nursing professionals and caregivers after the educational intervention increased from the pre to the post-test by 52% regarding signs of urinary infection, 32% regarding its symptoms, 72.5% regarding its treatment, 40% regarding personal/behavioral and morbidity-related risk factors, 59% regarding conditional factors and 43.8% regarding its preventive measures. The team of caregivers showed a greater gain in knowledge compared to the nursing team in almost every question (p<0.05). The length of time working in elderly care showed no positive correlation with any variable (R< p>0.05). The prevalence of urinary tract infection in the pre-intervention period was 33.62%, and 20% in the post-intervention period. Conclusion: The educational intervention was effective in preventing urinary tract infections in the elderly. The increased knowledge acquired by nurses and caregivers was associated with a reduction in the infection rate and an improvement in the most prevalent modifiable factors for the development of this type of pathology.

Association between exposure to plasma mixture of essential and toxic elements and the lipid profile in institutionalized older adults.

BACKGROUND: Older adults have a progressive deficiency in the ability to detoxify chemical elements and are susceptible to dyslipidemia and changes in glycemic control. The objective was to evaluate the association of the mixture of essential and toxic elements in the plasma of institutionalized older adults and test the associations with lipid profile variables and glycemic control. METHODS: Data were obtained from 149 Brazilian older adults aged ≥60 living in nursing homes (NH) in Natal, Brazil. The concentrations of sixteen chemical elements in plasma and lipid profile parameters and glycemic control of 149 institutionalized older adults were measured. Bayesian kernel machine regression was used to estimate the associations of the mixture of chemical elements with total cholesterol (TC), high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides (TG), fasting glucose, and glycated hemoglobin. RESULTS: Non-linear responses to exposure were observed for iron (Fe) about TC, LDL-c, and TG, and for barium (Ba) and copper (Cu) about TG. The concentration of the mixture of chemical elements below the 35th percentile was associated with a decrease in TC. Fe was the main element in the effect of the mixture associated with TC. CONCLUSIONS: The lower concentrations of the mixture of chemical elements in plasma had a protective effect on the increase in TC, with Fe being the main element. Considering the results, the levels of essential and toxic elements in the plasma of older adults require extensive screening, mainly to prevent dyslipidemia and monitor clinical interventions.

The protective measure for institutional care of children and adolescents from the perspective of national studies. / A medida protetiva de acolhimento institucional de crianças e adolescentes na perspectiva dos estudos nacionais.

This article aims to analyze the national scientific production on protective measures aimed at institutional care for at-risk children and adolescents in Brazil. By carrying out an integrative review, we seek to reflect on the main trends, themes, institutional actors, methodologies, and objectives of studies on the aforementioned measure and to analyze how the conditions and the right to health are presented and articulated in these references. Six thematic units were identified in the collection: Perceptions and roles of different actors in institutional reception processes; Processes of autonomy, dismissal, and causes of institutional care; Legislative aspects, evaluation of services, and identification of profiles; Family and community coexistence; Education and professional training; and Physical and mental health of sheltered children and adolescents. In Brazil, specifically, few studies investigate the concepts of the children and adolescents placed in shelters concerning protective measure processes or access to education. The link between poverty and institutionalization appears prominently and the scarcity of activities aimed primarily at family reintegration is evident. A large number of surveys point to the difficulties in implementing legislation.

O artigo tem como objetivo analisar a produção científica nacional sobre as medidas protetivas de acolhimento institucional para crianças e adolescentes em situação de risco no Brasil. Através da realização de uma revisão integrativa, busca-se refletir sobre as principais tendências, temas, atores institucionais, metodologias e objetivos dos estudos acerca da referida medida e analisar como se apresentam e se articulam as condições e o direito à saúde nessas referências. Seis unidades temáticas foram identificadas no acervo: percepções e papéis de diferentes atores nos processos de acolhimento institucional; processos de autonomia, desligamento e causas de acolhimento institucional; aspectos legislativos, avaliação de serviços e identificação de perfis; convivência familiar e comunitária; educação e formação profissional; e saúde física e mental de crianças e adolescentes acolhidos. No Brasil, especificamente, poucos estudos investigam as concepções dos acolhidos sobre os processos de medida protetiva, assim como o acesso à educação. O vínculo entre pobreza e institucionalização aparece com destaque e fica evidenciada a escassez de atividades visando a reintegração familiar de maneira prioritária. Um número alto de pesquisas aponta para as dificuldades de implementar legislações.

Cross-cultural validation of the Berg balance scale to assess balance among Hungarian institutionalised older adults.

PURPOSE: To translate the Berg Balance Scale (BBS) to Hungarian and to evaluate the psychometric characteristics of the Hungarian version (HU-BBS). METHODS: In total, 150 institutionalised older adults were recruited for the study. Eighty-one participants completed the retesting. Internal consistency, intra- and inter-rater reliability, and 95% limits of agreement of the HU-BBS were examined. Construct validity was assessed through convergent, discriminant, and known-group validity. RESULTS: The overall Cronbach's alpha was 0.943. The intra- and inter-rater reliability was excellent (intraclass correlation coefficient > 0.92). The Bland-Altman analysis revealed a mean inter-rater difference of 0.284 [-2.193-2.744] and a mean intra-rater difference of 0.259 [-2.657-3.162]. Regarding convergent validity, the HU-BBS was correlated with the functional status (r = 0.833), Timed Up and Go test (r= -0.824), and age (r= -0.606). The HU-BBS scores of women were similar to those of men (p = 0.104), showing discriminant validity. Additionally, the HU-BBS scores were lower among faller than among non-faller participants (p ˂ 0.0001), establishing known-group validity. CONCLUSIONS: Translation and cultural adaptation of the original scale was successful. The HU-BBS proved to be a reliable, valid tool confirming that it can be used in future clinical and scientific work on Hungarian older adults.Implications for rehabilitationInstitutionalised older adults are vulnerable and at a high risk of developing further decline in postural control, contributing to an increase in limited functional mobility and risk for falls.The Berg Balance Scale is a widely used tool originally developed to measure postural control in older adults.The Hungarian version of the Berg Balance Scale tested on institutionalised older adults shows excellent test-retest reliability, good internal consistency, and acceptable convergent construct validity.The Hungarian version of the Berg Balance Scale is a valid and reliable tool for measuring postural control among Hungarian-speaking institutionalised older adults both in clinical practice and scientific studies.

Factors associated with institutionalization among the oldest old: Results based on the nationally representative study 'old age in Germany (D80+)'.

OBJECTIVES: To examine the factors associated with institutionalization among individuals aged 80 years and over in Germany (total sample and stratified by sex). METHODS/DESIGN: We used data from the nationally representative 'Old Age in Germany (D80+)' (analytic sample: n = 9572 individuals), including individuals aged 80 years and over in Germany. Institutionalization (private living vs. institutionalization) served as an outcome measure. For the written interview, data collection took place from November 2020 to April 2021. Multiple logistic regressions of the overall sample (also stratified by sex) were applied. RESULTS: In the analytic sample, 10.2% (95% CI: 9.2%-11.3%) of the participants were institutionalized. The odds of being institutionalized were positively associated with being female (OR: 2.02, 95% CI: 1.08 to 3.80), being 90 years and over (compared to 80-84 years, OR: 1.67, 95% CI: 1.17 to 2.40), not being married (e.g., being single compared to being married: OR: 14.06, 95% CI: 6.73 to 29.37), higher education (e.g., high education compared to low education: OR: 1.88, 95% CI: 1.25 to 2.84), more favorable self-rated health (OR: 1.32, 95% CI: 1.07 to 1.62) and greater functional impairment (OR: 15.34, 95% CI: 11.91 to 19.74). Sex-stratified regressions were also conducted, mostly yielding similar results. CONCLUSION: Our study highlighted the role of several sociodemographic factors (particularly marital status, e.g., being single) and functional impairment for the risk of institutionalization among the oldest old in Germany. This study confirms findings in studies in younger samples that functional decline is the main factor associated with institutionalization. As functional decline may be modifiable, efforts to maintain functional abilities may be important. This knowledge is important for relevant groups (such as clinicians and policy-makers) because it may guide early intervention and prevention efforts, can help allocate healthcare resources effectively and shape policies to support independent living. Further insights using longitudinal data is recommended.

Prevalence of Malnutrition in a Group of Institutionalized Psychogeriatric Patients Using Different Diagnostic Criteria.

Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.

School- and intervention-related factors associated with institutionalization of health promotion interventions in elementary schools. / Facteurs liés aux écoles et facteurs liés aux interventions dans le contexte de l'institutionnalisation des interventions de promotion de la santé dans les écoles primaires.

INTRODUCTION: Long-term availability of health-promoting interventions (HPIs) in school settings can translate into health benefits for children. However, little is known about factors associated with HPI institutionalization in schools. In this study, we identified correlates of the institutionalization of HPIs offered in elementary schools in Quebec, Canada. METHODS: In two-part, structured telephone interviews over three academic years (2016-2019), elementary school principals (or their designees) throughout Quebec identified an index HPI offered at least once in their school during the previous three years, and were asked whether it was institutionalized (i.e. explicitly written in the school's educational project, e.g. in the form of educational objectives and means of achieving them). We examined associations between institutionalization and 10 school-related and 16 HPI-related characteristics in univariable and multivariable logistic regression analyses. RESULTS: School key informants (n = 163) reported on 147 different HPIs that had been available in their schools in the past three years, 56% of which were institutionalized. Three aspects of school culture-parent/community engagement with the school, school/teacher commitment to student health and school physical environment-were positively associated with HPI institutionalization. HPI-related characteristics positively associated with HPI institutionalization included number of competencies addressed by the HPI, number of teaching strategies employed, modifications made to the HPI prior to or during implementation and perceived success of the HPI. Inviting families or community groups to participate in the HPI was inversely associated with institutionalization. CONCLUSION: Better understanding of factors associated with HPI institutionalization may inform the development of school-based HPIs that have the potential for sustainability.

Costs of care trajectories of people with dementia compared with matched controls. Longitudinal analysis of linked health and administrative data.

OBJECTIVES: To provide insight into the health and social care costs during the disease trajectory in persons with dementia and the impact of institutionalization and death on healthcare costs compared with matched persons without dementia. METHODS: Electronic health record data from family physicians were linked with national administrative databases to estimate costs of primary care, medication, secondary care, mental care, home care and institutional care for people with dementia and matched persons from the year before the recorded dementia diagnosis until death or a maximum of 4 years after the diagnosis. RESULTS: Total mean health and social care costs among persons with dementia increased substantially during the disease trajectory, mainly due to institutional care costs. For people who remained living in the community, mean health and social care costs are higher for people with dementia than for those without dementia, while for those who are admitted to a long-term care facility, mean health and social care costs are higher for people without dementia than for those with dementia. CONCLUSIONS: The steep rise in health and social care costs across the dementia care trajectory is mainly due to increasing costs for institutional care. For those remaining in the community, home care costs and hospital care costs were the main cost drivers. Future research should adopt a societal perspective to investigate the influence of including social costs.

Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study.

OBJECTIVES: To clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex). METHODS: Data from the nationally representative "Old Age in Germany (D80+)" were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire). RESULTS: Higher loneliness was significantly associated with not being married (e.g., widowed compared to being married, ß=0.37, p<.001), being institutionalized (ß=0.33, p<.001), low education (high education compared to low education, ß=-0.07, p<.01), a higher number of chronic conditions (ß=0.02, p<.001), poor self-rated health (ß=-0.19, p<.001) and greater functional impairment (ß=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex). CONCLUSION: Several sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Institutions and institutionalisation: They're part of everyday life.

BACKGROUND: Institutions are established patterns of recurrent social relationships playing a fundamental part in all our lives. The family is the best-known institution, but other 'total' institutions serve as organisations directly affecting the lives of many individuals in the healthcare sector. OBJECTIVE: This paper examines the sociological theory of institutionalisation as applied to individuals admitted to aged-care facilities, where the complete life-rounds of inmates occur within clearly defined limits. The study provides a framework to enable general practitioners, nurses and healthcare professionals to better appreciate the processes involved as individuals adapt to their new environment. DISCUSSION: Sociology provides valuable insights for healthcare providers in understanding how individuals adapt to their loss of independent living and find themselves subjected to intimate regulation in the total institution. The biopsychosocial model of healthcare delivery is better understood when we as health professionals have greater insights to appreciate the competing processes at work.

Impactos psicossociais nas sexualidades de pessoas em contextos de institucionalização / Psychosocial impacts on the sexualities of people in contexts of institutionalization / Impactos psicosociales en las sexualidades de las personas en contextos de institucionalización

INTRODUÇÃO: As sexualidades das pessoas institucionalizadas atravessam diversos modos de opressão, pois prevalece ainda uma construção social arcaica da sexualidade como algo constrangedor ou até mesmo pervertido, baseado em uma redução do seu real significado, e ainda acompanhada de moralismos, preconceitos e estigmas. OBJETIVO: Analisar os diversos modos de sexualidades dentro de um contexto de institucionalização, a Casa de Acolhimento O Resgate, localizada na cidade de Icó-CE. MÉTODO: O estudo é fruto de um delineamento qualitativo de uma pesquisa-intervenção. O campo de pesquisa foi um equipamento de política pública voltado para o acolhimento e residência de pessoas em situação de rua na cidade de Icó-CE, cujas pessoas são na grande maioria atendidas pelo Centro de Atenção Psicossocial do município. A construção de dados foi fruto do desenvolvimento do Projeto de Extensão Aquarela que criou dispositivos grupais com aproximadamente 12 moradores e a participação dos profissionais atuantes no equipamento durante o primeiro semestre de 2022. RESULTADOS E DISCUSSÕES: Percebeu-se a reprodução de preconceitos e tabus relacionados às sexualidades, juízos de valores e percepções que dificultam uma noção fluída e crítica no cotidiano. Além disso, há também a restrição do próprio equipamento, já que se sabe o quanto esse assunto é ainda tratado por um cunho proibicionista e moralista. CONCLUSÃO: Falar sobre sexualidades é um movimento de resistência sobre regimes de opressão sobre a subjetividade humana. Ao mesmo modo que possibilita criar condições de acesso e reflexão a outros direitos (família, relações afetivas, sociabilidade, etc), dos quais são renegados para pessoas que passam por equipamentos de institucionalização.

INTRODUCTION: The sexualities of institutionalized people go through various modes of oppression, since an archaic social construction of sexuality as something embarrassing or even perverted still prevails, based on a reduction of its real meaning, and is still accompanied by moralisms, prejudices and stigmas. OBJECTIVE: To analyze the various modes of sexualities within institutionalization, the Casa de Acolhimento O Resgate in the city of Icó-CE. METHOD: The study is the result of a qualitative design of a research-intervention. The research field was a public policy equipment focused on the reception and residence of homeless people in the city of Icó-CE, whose people are mostly assisted by the Psychosocial Care Center of the municipality. The construction of data resulted from the development of the Aquarela Extension Project that created group devices with approximately 12 residents and the participation of professionals working on the equipment during the first semester of 2022. RESULTS AND DISCUSSIONS: We noticed the reproduction of prejudices and taboos related to sexualities, value judgments and perceptions that make it difficult to have a fluid and critical notion in everyday life. In addition, there is also the restriction of the equipment itself, since it is known how much this subject is still treated in a prohibitionist and moralistic way. CONCLUSION: Talking about sexualities is a movement of resistance against regimes of oppression of human subjectivity. At the same time, it makes it possible to create conditions for access and reflection on other rights (family, affective relationships, sociability, etc.), which are denied to people who are institutionalized.

INTRODUCCIÓN: Las sexualidades de las personas institucionalizadas pasan por diversos modos de opresión, ya que aún prevalece una construcción social arcaica de la sexualidad como algo vergonzoso o incluso pervertido, basada en una reducción de su significado real, y aún acompañada de moralismos, prejuicios y estigmas. OBJETIVO: Analizar los diversos modos de sexualidad en un contexto de institucionalización, la Casa de Acolhimento O Resgate localizada en la ciudad de Icó-CE. MÉTODO: El estudio es el resultado de un diseño cualitativo de una investigación-intervención. El campo de investigación fue un equipamiento de política pública centrado en la acogida y residencia de personas sin hogar en la ciudad de Icó-CE, cuyas personas son atendidas por el Centro de Atención Psicosocial del municipio. La construcción de datos fue el resultado del desarrollo del Proyecto de Extensión Aquarela que creó dispositivos grupales con aproximadamente 12 residentes y la participación de profesionales que trabajan en el equipamiento durante el primer semestre de 2022. RESULTADOS Y DISCUSIONES: Notamos la reproducción de prejuicios y tabúes relacionados a las sexualidades, juicios de valor y percepciones que dificultan una noción fluida y crítica en la vida cotidiana. Además, existe también la restricción del propio equipo, ya que es sabido cuánto este tema aún es tratado de forma prohibicionista y moralista. CONCLUSIÓN: Hablar de sexualidades es un movimiento de resistencia contra los regímenes de opresión de la subjetividad humana. Al mismo tiempo, permite crear condiciones de acceso y reflexión sobre otros derechos (familia, relaciones afectivas, sociabilidad, etc.), que son negados a las personas institucionalizadas.

Open government data use: The Brazilian states and federal district cases.

PURPOSE: This paper presents the results of an online survey and subsequent interviews investigating whether, how, and why public administrations of Brazilian states and the federal district (Federation Units) use open government data. According to the literature reviewed, the questions were categorized into four big groups: benefits, barriers, enablers, and drivers. DESIGN/METHODOLOGY/APPROACH: The Survey method, based on a questionnaire followed by interviews, was used to collect and analyze data from the open data officers of 26 Brazilian Federation Units. FINDINGS: The use of open government data is controversial as responses from the questionnaires and interviews do not match and raise questions about how well-represented each Federation Unit was. Evidence of open government data use was found. Among others, findings showed that political leadership committed to using open data facilitates and motivates public agents to use these data. Additionally, interviews indicated that the lack of human resources with the knowledge, skills, and capabilities to use open data is a relevant barrier to data use. Findings also revealed that open government data mainly support policy and decision-making processes. PRACTICAL IMPLICATIONS: This research contributed to the open data and public administration fields. It portrays diverse realities of open government data use and institutionalization in Brazilian state and district public administrations. In addition, it provides lists of open government data use benefits, barriers, drivers, and enablers from the perspective of these administrations so that they can benchmark against each other and improve their OGD use. ORIGINALITY AND RESEARCH IMPLICATIONS: For academia, this research provides empirical evidence of the factors influencing public administrations' use of open government data at the subnational level in Brazil. Even though Brazil ranks high on OGD global assessments, few studies on its use and reuse in the public sector were identified. This is one of the first academic studies focusing on open government data use in the country. It also contributes by offering to the academic community two instruments, a questionnaire and an interview protocol, which can be applied to other public settings to expand this study's results or open new research paths by applying them to other contexts.

The value of preoperative diagnostic testing and geriatric assessment in frail institutionalized elderly with a hip fracture; a secondary analysis of the FRAIL-HIP study.

PURPOSE: The aim of this study was to provide a comprehensive overview of (preoperative and geriatric) diagnostic testing, abnormal diagnostic tests and their subsequent interventions, and clinical relevance in frail older adults with a hip fracture. METHODS: Data on clinical consultations, radiological, laboratory, and microbiological diagnostics were extracted from the medical files of all patients included in the FRAIL-HIP study (inclusion criteria: hip fracture, > 70 years, living in a nursing home with malnourishment/cachexia and/or impaired mobility and/or severe co-morbidity). Data were evaluated until hospital discharge in nonoperatively treated patients and until surgery in operatively treated patients. RESULTS: A total of 172 patients (88 nonoperative and 84 operative) were included, of whom 156 (91%) underwent laboratory diagnostics, 126 (73%) chest X-rays, and 23 (13%) CT-scans. In 153/156 (98%) patients at least one abnormal result was found in laboratory diagnostics. In 82/153 (50%) patients this did not result in any additional diagnostics or (pharmacological) intervention. Abnormal test results were mentioned as one of the deciding arguments for operative delay (> 24 h) for 10/84 (12%) patients and as a factor in the decision between nonoperative and operative treatment in 7/172 (4%) patients. CONCLUSION: A large number and variety of diagnostics were performed in this patient population. Abnormal test results in laboratory diagnostics were found for almost all patients and, in majority, appear to have no direct clinical consequences. To prevent unnecessary diagnostics, prospective research is required to evaluate the clinical consequences and added value of the separate elements of preoperative diagnostic testing and geriatric assessment in frail hip fracture patients.

[Cognitive, Emotional and Dependency Level on Institutionalized Older Adults]. / Estado cognitivo, emocional y nivel de dependencia en personas adultas y mayores institucionalizadas.

INTRODUCTION: It is necessary to analyze the aging process in institutionalized older people. For this purpose, a descriptive and analytical epidemiological study was carried out in nursing homes for older adults before the COVID-19 pandemic. OBJECTIVE: Provide an in-depth insight into cognitive (MEC), emotional (Geriatric Depression Scale), and functional (Barthel Scale) status within the older adult participants. METHOD: A sample of 973 participants analyzed the relationship between cognitive status, vulnerability to depression, and autonomous performance in Daily Day Activities (DDA) to predict the impact of the comorbidity of these variables. Therefore, in addition to the general distribution of the sample in the previously mentioned dimensions, differences were analyzed according to gender, age, educational level, and geographic area. RESULTS: The results confirm the hypothesis that a more impaired cognitive state is associated with higher levels of depression and lower functional capacity. The MEC scores have positive and highly significant correlations with Barthel and Yesavage. The relationship between dementia and autonomy is observed for both sexes, while the relationship between dementia and depression is only observed in women. The educational level influences the MEC scores (the more education, the better performance) and the Barthel scores (the less education, the greater dependency). Statistically significant differences were also found depending on the area of residence location. CONCLUSIONS: The more deteriorated cognitive state will be associated with a higher level of depression and lower functional capacity in daily life activities.