Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents.

OBJECTIVES: Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation (EF) and educational outreach visits (EOVs), in order to introduce nutritional guidelines (e.g. screening, food quality and mealtime ambience), into a nursing home (NH) setting and to evaluate the clinical outcomes. DESIGN: A controlled study with baseline and follow-up measurements. SETTING: Four NHs. PARTICIPANTS: A total of 101 NH residents. INTERVENTION: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. MEASUREMENTS: The outcomes were nutritional status (Mini Nutritional Assessment-Short Form, MNA-SF), body mass index (BMI), functional ability (Barthel Index, BI), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life (EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. RESULTS: After a median of 18 months, nutritional parameters (MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group (p=0.008). Multiple linear regression analyses indicated that the intervention group assignment (EF) was independently from other potentially related factors associated with less cognitive decline. CONCLUSION: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.

Sanitation without pollution.

The most effective way of protecting drinking water resources from domestic sewage is to use technologies that do not produce sewage. This paper gives an overview of emerging alternatives in the form of ecological sanitation systems for urban and peri-urban areas. A key feature of ecological sanitation is that it regards human excreta as a resource to be recycled rather than as waste to be disposed of. Examples given include ecological sanitation systems based on dehydration and decomposition from Mexico, El Salvador, Sweden, India and Vietnam. These systems need neither water for flushing, nor pipelines for transport, nor treatment plants and arrangements for the disposal of toxic sludge. Large scale application of ecological sanitation would lead to less environmental pollution, reduced water consumption, considerable savings on sewers and treatment plants and increased employment. In addition it would provide valuable resources for food production and wasteland development.