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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.
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Humanos , Anciano , Envejecimiento , Afecciones Crónicas Múltiples/prevención & control , Geriatría/tendencias , Anciano Frágil , Dinámica Poblacional , Prevención de EnfermedadesAsunto(s)
Formación de Concepto , Fragilidad , Geriatría , Liderazgo , Anciano , Evaluación Geriátrica , HumanosRESUMEN
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Humanos , Masculino , Femenino , Testimonio de Experto/métodos , Testimonio de Experto/tendencias , Guías de Práctica Clínica como Asunto/normas , Sociedades Médicas/normas , Sociedades Médicas/tendencias , Geriatría/métodos , Geriatría/organización & administración , Geriatría/normas , Servicios de Salud para Ancianos/normas , Encuestas y Cuestionarios , Internado y Residencia , Internado y Residencia/estadística & datos numéricos , Médicos/organización & administración , Médicos/estadística & datos numéricosRESUMEN
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Humanos , Anciano , Anciano de 80 o más Años , Geriatría/educación , Geriatría/métodos , Salud del Anciano , Anciano Frágil/psicología , Anciano Frágil/estadística & datos numéricos , Servicios de Salud para Ancianos/normas , Servicios de Salud para Ancianos , Sistemas Nacionales de SaludRESUMEN
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.
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Enfermedad Aguda/mortalidad , Anciano Frágil/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Actividades Cotidianas , Anciano de 80 o más Años , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Análisis Multivariante , Alta del Paciente , Estudios Prospectivos , Análisis de Regresión , Factores de RiesgoRESUMEN
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Factores de Riesgo , Hipertensión/epidemiología , Diabetes Mellitus/epidemiologíaRESUMEN
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?
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Conservación de los Recursos Naturales , Plásticos/análisis , Residuos/análisis , Contaminantes Químicos del Agua/análisis , Océano Atlántico , Playas/estadística & datos numéricos , Monitoreo del Ambiente , España , Residuos/estadística & datos numéricos , Contaminación Química del Agua/estadística & datos numéricosRESUMEN
Objetivo. Conocer la fiabilidad interobservador de los 4 índices de comorbilidad más utilizados en ancianos: índice de Charlson (ICh), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), índice de Kaplan-Feinstein (IKF), e índice de coexistencia de enfermedad (ICED). Material y métodos. Cuatro médicos, previamente entrenados, revisaron de forma independiente 40 historias clínicas de pacientes mayores de 75 años, ingresados por patología médica aguda, realizando los 4 índices y cronometrando el tiempo. Se analizó el coeficiente de correlación intraclase (CCI) para los índices cuantitativos (ICh y CIRS-G) y el coeficiente Kappa para índices cualitativos (IKF e ICED), las concordancias <0,4 se consideraron deficientes; 0,4-0,75 aceptable, y >0,75 excelente. Resultados. Los pacientes de las historias evaluadas tenían una edad media de 85,93 (±5,35) años, siendo el 72,5% mujeres. El CCI global de los 4 evaluadores para el ICh fue 0,78 (IC del 95%:0,67-0,86) y para el CIRS-G (score):0,66 (IC del 95%:0,53-0,78). Los valores del coeficiente Kappa para el IKF oscilaron entre 0,51-0,76 y para el ICED entre 0,44-0,66. El tiempo de aplicación fue menor para el ICh (mediana de 39 segundos [30-45]) e IKF (42 segundos [35-52]) y mayor para el CIRS-G (score) (128 segundos [110-160]) e ICED (102 segundos [80-124]). Conclusiones. De los 4 índices valorados, el ICh y el índice CIRS-G (score), son los que presentan una mejor fiabilidad interobservador. El ICh y el IKF, presentan menor tiempo de aplicación(AU)
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)(AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Comorbilidad/tendencias , Enfermedad Aguda/epidemiología , Servicios de Salud para Ancianos/estadística & datos numéricos , Salud del Anciano , Indicadores de Salud , 28599 , Estimación de Kaplan-Meier , Repertorio de BarthelRESUMEN
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).
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Comorbilidad , Evaluación Geriátrica/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
Objetivo. Tras objetivar la eficacia en la reducción de la incidencia de deterioro funcional y mayor probabilidad de volver al domicilio previo entre los pacientes ancianos hospitalizados por patología médica aguda atendidos en unidades geriátricas de agudos (UGA) frente a las unidades de cuidados convencionales nos proponemos evaluar la eficiencia de dicha atención. Material y métodos. Revisión sistemática y metaanálisis de estudios controlados (aleatorizados, no aleatorizados y casos-control) que compararon la atención en UGA con la atención en unidades convencionales de hospitalización en pacientes de 65 y más años con patología médica aguda. Se excluyeron estudios sobre bases de datos administrativas, los que evaluaban la atención sobre una sola patología y los que valoraban unidades con cuidados en fase aguda y subaguda. Se realizó una revisión bibliográfica de artículos publicados hasta el 31 de agosto de 2008 en Medline, Embase, Biblioteca Cochrane y listado de referencias de revisiones sistemáticas y artículos revisados. La selección de los estudios y extracción de datos sobre estancia y costes de atención hospitalaria se realizó por dos investigadores de forma independiente. Resultados. Se incluyeron 11 estudios, de los que 5 fueron aleatorizados, 4 no aleatorizados y 2 estudios caso-control disponiendo de datos de estancia para todos ellos y de costes hospitalarios en 7 (4 ensayos clínicos, 2 estudios no aleatorizados y 1 caso-control). El análisis global de todos los estudios mostró que, en comparación con los ancianos hospitalizados en unidades convencionales, los que lo hicieron en las UGA tuvieron una reducción estadísticamente significativa de la estancia hospitalaria (diferencia de medias de 1,01 días; IC del 95%, 1,66 a 0,36) y de los costes hospitalarios de atención (diferencia de medias de 330 dólares; IC del 95%, 540 a 120). Conclusiones. La atención en UGA es más eficiente que la proporcionada en unidades convencionales ya que, además de conseguir una reducción de la incidencia de deterioro funcional al alta y aumentar la probabilidad de volver al domicilio previo, lo hacen con una reducción de la estancia media hospitalaria y los costes hospitalarios de la atención(AU)
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 65years 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 1.01days; 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(AU)