Nutritional risk predicts readmission within 30 and 180 days after discharge among older adult patients across a broad spectrum of diagnoses.

BACKGROUND AND AIMS: Hospital readmissions can have negative consequences for older adult patients, their relatives, the hospital, and society. Previous studies indicate that older adult patients who are at nutritional risk during hospital admission are at higher risk of readmission. There is a lack of studies investigating this relationship across different older adult patient groups while using recommended instruments and adjusting for relevant confounders. Thus, the aim of the present study was to investigate whether nutritional status according to the Nutrition Risk Screening 2002 during hospitalization predicted readmission among older adult patients within 30 and 180 days across a broad spectrum of wards and diagnoses when adjusting for age, sex, length-of-stay, diagnosis, and discharge destination. MATERIALS AND METHODS: The present study is a retrospective cohort study based on registry data and included 21,807 older adult patients (≥65 years) hospitalized during a 5-year period. In order to investigate the relationship between nutritional risk and readmission, hierarchical logistic regression analyses with readmission within 30 days (n = 8371) and 180 days (n = 7981) as the dependent variable were performed. RESULTS: Older adult patients at nutritional risk during the index admission were 1.44 times more likely to be readmitted within 30 days after discharge (P < 0.001), and 1.47 times more likely to be readmitted within 180 days after discharge (P < 0.001), compared to older adult patients who were not at nutritional risk during index admission when adjusting for age, sex, discharge destination, diagnosis group, and length-of-stay. CONCLUSIONS: Our results highlight the importance of focusing on nutritional status in older adults as a factor in the prevention of readmissions, including ensuring that practices, resources, and guidelines support appropriate screening procedures. Because nutritional risk predicts readmission both in a 30-days and 180-days perspective, the results point to the importance of ensuring follow-up on the screening result, both in the hospital context and after discharge.

The intention to exercise and the execution of exercise among persons with multiple sclerosis--a qualitative metasynthesis.

PURPOSE: This review was designed as a qualitative metasynthesis aiming to identify factors influencing the intention to exercise and the execution of exercise among persons with multiple sclerosis (PwMS). METHOD: Based on principles laid out by Sandelowski and Barroso, this qualitative metasynthesis started with a systematic literature search for studies of PwMS's experiences relating to exercise in the following databases: CINAHL, Rehabilitation and Sports Medicine Source, PubMed, Web of Science and Psychology & Behavioral Science. The metasynthesis procedure also included critical appraisal using the Consolidated Criteria for Reporting Qualitative Research checklist, and integrating synthesis of the articles' findings. RESULTS: The metasynthesis included nine articles. Factors identified as influencing intention to exercise and the execution of exercise included social support, professional support and outcome expectations. Strong relationships between these three themes were detected for the intention to exercise, the execution of exercise or both among PwMS. CONCLUSIONS: The present metasynthesis offers a comprehensive understanding of factors influencing the intention to exercise and the execution of exercise among PwMS. Our findings reveal that health professionals influence the part of the process where PwMS enter the exercise setting, as well as the PwMS's intention to exercise. IMPLICATIONS FOR REHABILITATION: Social support, professional support and outcome expectations are potential facilitators and barriers for the intention to exercise and the execution of exercise among PwMS. Health professionals specializing in MS rehabilitation can influence the intention and the execution of physical exercise among PwMS when there exists a personal and supportive patient-professional relationship. Outcome expectations may impact the motivational and volitional phases of physical exercise.

A 3.5 year diary study: Remembering and life story importance are predicted by different event characteristics.

Forty-five participants described and rated two events each week during their first term at university. After 3.5 years, we examined whether event characteristics rated in the diary predicted remembering, reliving, and life story importance at the follow-up. In addition, we examined whether ratings of life story importance were consistent across a three year interval. Approximately 60% of events were remembered, but only 20% of these were considered above medium importance to life stories. Higher unusualness, rehearsal, and planning predicted whether an event was remembered 3.5 years later. Higher goal-relevance, importance, emotional intensity, and planning predicted life story importance 3.5 years later. There was a moderate correlation between life story importance rated three months after the diary and rated at the 3.5 year follow-up. The results suggest that autobiographical memory and life stories are governed by different mechanisms and that life story memories are characterized by some degree of stability.

The emotional content of life stories: positivity bias and relation to personality.

We examined whether past and future negative life story events, compared to past and future positive events, were less likely to be related to life story chapters and situated at a greater temporal distance from the present. We also examined relations between life stories and personality traits. Three hundred ten students and 160 middle-aged adults completed a measure of personality traits and identified chapters as well as past and future events in their life story. All life story components were rated on emotion and age. Negative future events were less likely to be a continuation of chapters and were more temporally distant than positive future events. Extraversion and Conscientiousness were related to more positive life stories, and Neuroticism was related to more negative life stories. This suggests that the life story is positively biased by minimising the negative future, and that the construction of life stories is related to personality traits.

What characterizes life story memories? A diary study of freshmen's first term.

We investigated whether memories are selected for the life story based on event characteristics. Sixty-one students completed weekly diaries over their first term at university. They described, dated and rated two events each week. Three months after the end of the term they completed an unexpected memory test. They recalled three memories from the diary period that were important to their life story. Three randomly selected events scoring low on importance to the life story functioned as control memories. Life story memories were rated higher on goal relevance, emotional intensity, importance and rehearsal in the diary and maintained their higher ratings at the test session, while ratings for control memories dropped off. Life story memories' content was less consistent over time but they were more accurately dated than control memories. The results suggest that event characteristics play an important role for the selection of life story memories.

Rumination is associated with the phenomenal characteristics of autobiographical memories and future scenarios.

In the present studies it was investigated whether rumination was associated with the phenomenal characteristics of autobiographical memories and future scenarios. In three studies student participants completed questionnaires on rumination and recalled and rated a positive and a negative memory. In Studies 2 and 3 participants also generated and rated a positive and a negative future scenario. Memories were rated on reliving and emotional valence; future scenarios were rated on reliving, emotional valence, and how probable the scenario was. Generally, the results showed that a higher degree of rumination was related to more reliving of negative memories and future scenarios as well as more negative expectations for the future scenarios. These processes may help explain why rumination predicts depression and other types of negative affect.