Home About us Contact
|
Home About us Contact | ||
|
|
||
Home Visit (home + visit)
Selected AbstractsThe experiences of non-medical health professionals undertaking community-based health assessments for people aged 75 years and overHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2002Julie E. Byles BMed PhD Abstract Our objective was to explore the perceptions of allied health professionals who conducted over 3000 home-based health assessments within the general-practice-dominated Australian primary healthcare system. A series of semistructured qualitative interviews were carried out within the Department of Veterans' Affairs ,Preventive Care Trial', where health assessments are undertaken by health professionals in the homes of participating veterans and war widows. Health professionals were employed within the Preventive Care Trial to conduct assessments in 10 areas of New South Wales and Queensland. Subjects were mainly registered nurses, but also included a social worker, an occupational therapist, a physiotherapist and a psychologist. The health professionals described positive attitudes towards the health assessments, and showed that they have the broad range of necessary personal and professional skills to undertake them. Home visits were seen as an essential component and the most useful aspects included direct observation of home safety and medications. This study demonstrates that health assessments for older people can be acceptably and competently undertaken by suitably qualified allied health professionals, and that an effective collaborative approach to patient care can be achieved through such a system. [source] Safety and immunogenicity of live attenuated varicella vaccine in 9-month-old childrenPEDIATRICS INTERNATIONAL, Issue 6 2000Güler Kanra Background: The present study was conducted to evaluate the safety and immunogenicity of live attenuated varicella vaccine (Oka-strain) in 9-month-old infants. Methods: One hundred and fourteen infants were vaccinated once with live attenuated varicella vaccine (Valrix®; SmithKline Beecham Biologicals, Rixensart, Belgium) containing a mean virus titer of 104.0 plaque-forming units (p.f.u.) per dose. Signs and/or symptoms after vaccination were followed for 42 days. Home visits were made to detect solicited local reactions (0,3 days) and solicited general reactions (0,21 days), as well as unsolicited reactions. Specific varicella antibodies were determined by an indirect immunofluorescence method. The geometric mean titer and seroconversion rate were calculated. Results: Signs and/or symptoms were reported in 47.4% (54/114) of cases following vaccination. The only local symptom reported was pain on digital pressure at the injection site and this was reported in 28.1% (32/114) of infants. General symptoms were reported in 38.6% (44/114) of cases. The most frequently reported findings were fever (27.2%), which was mostly mild, restlessness (20.2%) and cough (11.4%). Only four unsolicited symptoms were reported and they were all unrelated to vaccination. No serious adverse event was reported. Of the 109 infants included in the immunogenicity analysis, 105 were seronegative and four were seropositive for antibodies against varicella before vaccination. The vaccine elicited seroconversion in 97.1% of initially seronegative cases. The post-vaccination geometric mean titer for these infants was 30.9 geometric mean titer (GMT). Conclusions: The vaccine was found to be safe and immunogenic when given to infants as young as 9 months of age. This may be of clinical significance during outbreaks of varicella and especially for developing countries. [source] The use of nationwide on-line prescription records improves the drug history in hospitalized patientsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008Bente Glintborg What is already known about this subject ,,Structured medication interviews improve the medication history upon hospitalization ,,Pharmacy records are valid lists of the prescribed medications available to individual patients ,,In Denmark, treating doctors now have access to their patients' pharmacy records through a real-time online electronic database What this study adds ,,Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits ,,Pharmacy records may be used to minimize patients' recall bias and improve the medication lists Background Structured medication interviews improve the medication history in hospitalized patients. In Denmark, a nationwide electronic version of individual pharmacy records (PR) has recently been introduced. Use of these records could improve the medication lists in hospitalized patients. Methods We prospectively included 500 patients admitted to an acute medical department. In individual patients, the PR was compared with (i) the medication list written in the patient chart and (ii) drug information provided by the patient during a structured drug interview upon admission and during a home visit after discharge. Results Median patient age was 72 years. Upon admission, patients reported using 1958 prescription-only medications (POM) (median four drugs per patient, range 0,14), of which 114 (6%) were not registered in PR. In PR, 1153 POM (median one per patient, range 0,11) were registered during the month preceding admission. The patients did not report 309 (27%) of these upon admission. Home visits were performed in a subgroup of 115 patients. During home visits, 18% of POM registered in PR during the preceding month were not reported. Drug type was predictive of reporting irrespective of patient sex or age. Cardiovascular drugs were reported most and dermatologicals were reported less frequently. Underreporting might be due to recall bias, non-adherence or discontinuation of drugs. Conclusions Omission errors are frequent despite structured medication interviews. Pharmacy records or medication lists from all treating doctors must be included in medication reviews in order to reduce recall bias. [source] Integrated care of childhood disease in Brazil: Mothers' response to the recommendations of health workersACTA PAEDIATRICA, Issue 8 2005Antonio JL Alves da Cunha Abstract Aim: To describe the process of follow-up in primary care facilities where the Integrated Management of Childhood Illness (IMCI) strategy was implemented. IMCI was developed by WHO and UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality and morbidity. Methods: From August 2001 to February 2002, 229 sick children who had a health condition included in the IMCI case management guidelines were seen in six family healthcare facilities in Brazil. We analysed the care provided to 153 children who were recommended for a 2- or 5-d follow-up visit. Children who did not return were visited and assessed at home. Results: Only 87 children (56.9%) timely returned for follow-up: 70 had improved, eight presented the same health conditions, five were worse and four had a new problem. The main reasons given for not returning for follow-up were: the child had improved (35.1%) and other family priorities (47.4%). Home visits showed that, although most children had improved (n=49), some had a new health problem and one child was sick enough to be referred. Prescription of antibiotics was associated with increased probability of returning for a follow-up visit (RR =1.64 [1.22,2.20], p=0.001). Conclusion: Adherence to follow-up was just over 50%, mostly because the condition had already resolved, but some children were still sick and needed intervention. Training on counselling on the recognition of danger signs and when to return for a follow-up visit must be reinforced. [source] Prenatal maternal emotional complaints are associated with cortisol responses in toddler and preschool aged girlsDEVELOPMENTAL PSYCHOBIOLOGY, Issue 7 2009Anouk T.C.E. de Bruijn Abstract Associations between prenatal maternal emotional complaints and child behavioral and cognitive problems have been reported, with different relations for boys and girls. Fetal programming hypotheses underline these associations and state that the early development of the HPA-axis of the children may have been affected. In the present study, differences in cortisol responses of prenatally exposed and nonexposed children are examined for both sexes separately. Cortisol response patterns of a group preschool aged children that were prenatally exposed to high levels of maternal emotional complaints (N,=,51) were compared to a nonexposed group (N,=,52). Child saliva was collected at the start of a home visit (T1), 22,min after a mother,child interaction episode (T2), and 22,min after a potentially frustrating task (T3). Repeated measures analyses showed that prenatally exposed girls showed higher cortisol levels across the three episodes compared to nonexposed girls. No differences were found in boys. Maternal prenatal emotional complaints might be related to child HPA-axis functioning differently for boys and girls. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 553,563, 2009. [source] Accessibility, continuity and appropriateness: key elements in assessing integration of perinatal servicesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2003Danielle D'Amour RN PhD Abstract A trend toward the reduction in the length of hospital stays has been widely observed. This increasing shift is particularly evident in perinatal care. A stay of less than 48 hours after delivery has been shown to have no negative effects on the health of either the mother or the baby as long as they receive an adequate follow-up. This implies a close integration between hospital and community health services. The present article addresses the following questions: To what extent are postnatal services accessible to mothers and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the services provided by the appropriate source of care? The authors conducted a telephone survey among 1158 mothers in a large urban area in the province of Quebec, Canada. The results were compared to clinical guidelines widely recognised by professionals. The results show serious discrepancies with these guidelines. The authors found a low accessibility to services: less than half of the mothers received a home visit by a nurse. In terms of continuity of care, less than 10% of the mothers received a follow-up telephone call within the recommended time frame and only 18% benefited from a home visit within the recommended period. Finally, despite guidelines to the contrary, hospitals continue to intervene after discharge. This results in a duplication of services for 44.7% of the new-borns. On the other hand, 40.7% are not seen in the recommended period after hospital discharge at all. These results raise concerns about the integration of services between agencies. Following earlier work, the present authors have grouped explanatory factors under four dimensions: the strategic dimension, particularly leadership; the structural dimension, including the size of the network; the technological dimension, with respect to information transmission system; and the cultural dimension, which concerns the collaboration process and the development of relationships based on trust. [source] Victims of Domestic Violence: A Proposal for a Community Diagnosis Based on One of Two Domains of NANDA Taxonomy IIINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Patricia Serpa de Souza Batista PURPOSE To explore and identify diagnostic components to amplify NANDA nursing diagnoses by modifying the root violence. Whereas violence is nondebatable as a diagnostic concept in nursing, other alternatives have not been identified in the two existing diagnoses. METHODS Using the case study method, this qualitative study sought to identify commonalties in a population of women who were "donnas da casa" (homemakers) in a small rural community of approximately 100 families, typical of the Brazilian northeast. The sample of 7 women was identified through a larger study that had been based on health needs of the community. Data were obtained through observation during a home visit and a semistructured interview based on NANDA Taxonomy II. Observations were focused on hygiene, manner of dress, home environment, and physical and emotional state. Data were analyzed by content and clustered into major categories. From these a profile of the women and another of the partners emerged. FINDINGS Subjects ranged in age from 33 to 43 years, and number of children between 3 and 7. One of the 7 women was literate; 5 were underweight; all were slovenly attired. They appeared sad and older than their age. The majority seemed relieved to unburden themselves to the interviewers as they went through a gamut of emotions such as sadness, anguish, and irritability expressed through crying, restlessness, changes in body language, and tone of voice. The shortage of beds was supplemented by hammocks and mats or cardboard. The women spoke of being confined to their home and of male partners who drank on weekends, thus leaving them with little money for necessities of life. There were accounts of beatings when the partner returned home after drinking, overt nonacceptance of children from previous marriages, and general destruction of the family environment. New children were regarded as just another mouth to feed. DISCUSSION The profiles pointed to the necessity of identifying a new nursing diagnosis that would be linked, only tangentially, by the root violence to the two diagnoses in NANDA Taxonomies I and II. This insight led us to consider that a new method of listing NANDA diagnoses, by root only, is imperative in the evolution of Taxonomy II. Proposed descriptors, Victims of (Axis 3) and Domestic (Axis 6) would be identified by Axes, thereby facilitating the process of classifying in the Domains and Classes. The two existing NANDA diagnoses, risk for other-directed violence and risk for self-directed violence, are proposed for classification in Class 3, Violence, in Domain 11 of Taxonomy II. Safety/Protection could, by virtue of their modification power, find anchor in another domain such as Domain 6, Self-Perception. CONCLUSIONS Although Safety/Protection seems the most logical domain for classification by root, the axes, dimensions of human responses, could pull the diagnosis in another direction, thereby dictating other nursing interventions and nursing outcomes [source] Implementation of a community liaison pharmacy service: a randomised controlled trialINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2008Tam Vuong PhD Objective The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary-secondary care interface. Setting The study involved patients discharged from two acute-care tertiary teaching hospitals in Melbourne, Australia, returning to independent living. Methods Consecutive patients admitted to both hospitals who met the study criteria and provided consent were recruited. Recruited patients were randomised to receive either standard care (discharge counselling, provision of compliance aids and communication with primary healthcare providers when necessary) or the intervention (standard care and a home visit from a community liaison pharmacist (CLP) within 5 days of discharge). Participant medication was reviewed during the visit according to set protocols and compliance and medication understanding was measured. All participants were telephoned 8,12weeks after discharge to assess the impact of the intervention on adherence and medication knowledge. Key findings The CLP visited 142 patients with a mean time of 4.2 days following hospital discharge (range = 1,14 days). Consultations lasted 15,105 min (mean, 49 min; SD, ± 21 min). The CLPs retrospectively coded 766 activities and interventions that occurred during home visits, subsequently categorised into three groups: counselling and education, therapeutic interventions and other interventions. No statistical difference was detected in the number of medications patients reported taking at follow-up: the mean value was 7.72 (SD, ± 3.27) for intervention patients and 7.55 (SD, ± 3.27) for standard-care patients (P = 0.662). At follow-up self-perceived medication understanding was found to have improved in intervention patients (P < 0.001) and significant improvements from baseline in medication adherence were found in both standard-care (P < 0.022) and intervention (P < 0.005) groups; however, adherence had improved more in intervention patients. Conclusion The community liaison pharmacy service provided critical and useful interventions and support to patients, minimising the risk of medication misadventure when patients were discharged from hospital to home. [source] Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocolJOURNAL OF ADVANCED NURSING, Issue 6 2010Eva Abad-Corpa abad-corpa e., carrillo-alcaraz a., royo-morales t., pérez-garcía m.c., rodríguez-mondejar j.j., sáez-soto a. & iniesta-sánchez j. (2010) Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Journal of Advanced Nursing,66(6), 1365,1370. Abstract Title.,Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Aim., To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow-up planning for primary care patients with chronic obstructive pulmonary disease. Background., Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge. Methods., A quasi-experimental design will be adopted, with a control group and pseudo-randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary-level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. Discussion., The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses. [source] Psychometric Properties of the Activities-Specific Balance Confidence Scale and the Survey of Activities and Fear of Falling in Older WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2008Kristine M.C. Talley MS OBJECTIVES: To compare the psychometric properties of the Activities-specific Balance Confidence Scale (ABC) and the Survey of Activities and Fear of Falling in the Elderly (SAFE). DESIGN: Secondary analysis using baseline and 12-week data from a randomized, controlled trial on fall prevention. SETTING: Upper Midwest metropolitan area with assessments conducted in participants' homes. PARTICIPANTS: Population-based sample of 272 noninstitutionalized female Medicare beneficiaries aged 70 and older at risk of falling. MEASUREMENTS: Participants self-administered the ABC, SAFE, Geriatric Depression Scale, and Medical Outcomes Study 36-item Short Form Survey. During a home visit, a nurse practitioner administered the Berg Balance Test and Timed Up and Go, measured gait speed, and asked about falls and chronic illnesses. RESULTS: Baseline internal consistency measured using Cronbach alpha was 0.95 for the ABC and 0.82 for the SAFE. Baseline concurrent validity between the ABC and SAFE measured using a correlation coefficient was ,0.65 (P<.001). ABC and SAFE scores were significantly correlated at baseline with physical performance tests and self-reported health status. The ABC had stronger baseline correlations than the SAFE with most measures. Neither instrument demonstrated responsiveness to change at 12 weeks. CONCLUSION: The ABC and SAFE demonstrated strong internal-consistency reliability and validity when self-administered. The ABC had stronger associations with physical functioning and may be more appropriate for studies focused on improving physical function. Both instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively nonfrail older women. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population. [source] The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004Lindy Clemson BAppSc(OT), MAppSc(OT) Objectives: To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home. Design: A randomized trial with subjects followed for 14 months. Setting: The interventions were conducted in community venues, with a follow-up home visit. Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling. Intervention: The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit. Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant. Results: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50,0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17,0.59). Conclusion: The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option. [source] Clients' perceptions of support received from health visitors during home visitsJOURNAL OF CLINICAL NURSING, Issue 7 2005Caroline Plews BA Aims and objectives., The current study sought to identify how many mothers from 149 visits carried out by seven health visitors identified support as a feature of the visit, whether this type of support was unique to the health visitor and what support meant to them. These responses were then compared with the taxonomies of social support from the social support literature. Background., Some studies of client perceptions describe support as an element of home visits by health visitors. However, the importance, relevance and impact on the client of this support are not described in detail. Social support theory suggests that there are tangible benefits to people's well-being and their ability to cope with various challenges that may arise from individuals' perceptions of receiving support. Design., Qualitative study using semistructured interviews. Methods., Seven volunteer health visitors recruited 149 women into the study. These clients were interviewed by the researcher, usually within one week of the home visit by their health visitor. The discussions were audio-taped and the resulting transcripts analysed using content analysis. Findings., Thirty-seven women identified receiving support which they said was only available from the health visitor. The relevance of this support to the mother and the impact on her well-being varied within the group suggesting differing perceptions of support by clients according to their personal situation. There was a correspondence between the descriptions of support given by the women and the taxonomies of social support from the social support literature. Conclusion., For some interactions between clients and their health visitors the existing theory of social support may provide an explanation of how health visitors contribute to clients' perceived ability to cope and well-being. Relevance to clinical practice., Social support may be defined as a possible outcome of health visiting. This concept will have use within educational programmes to demonstrate to students how health visiting can have an impact on clients' well-being. Similarly, the concept could be used to investigate and record health visiting practice. [source] An evaluation of a GP out-of-hours service: meeting patient expectations of careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2004Kate Thompson MSc Abstract Background, The reorganized out-of-hours general practitioner (GP) service, resulting in the creation of out-of-hours cooperatives has been widely welcomed by the medical profession. However, GP satisfaction remains only one aspect of this reorganized service and patients' views and levels of satisfaction must have a contribution to make to the organization and delivery of the service. Aim, To assess patient satisfaction at two out-of-hours cooperatives in Northern Ireland. Method, A sample of 4466 patients contacting the out-of-hours service was surveyed by postal questionnaires using a previously validated patient satisfaction instrument. Results, Patients who initially requested to be seen at the out-of-hours centre were more likely to receive the contact they requested than those who requested telephone advice or a home visit. Only 41.8% of patients requesting a home visit actually received one. Patients were generally satisfied with the service provided and most satisfied with the ,doctor's manner' and the ,explanation and advice' received. Patients who received the contact they initially requested were more satisfied with all aspects of the service than other patients. The type of contact actually received had little effect on the satisfaction levels reported by patients who received the contact they initially requested. Conclusion, The population should be made fully aware of the services provided by out-of-hours cooperatives to enable them to have realistic expectations. With realistic expectations, patients are more likely to receive the medical contact they request and consequently will be more satisfied with the service provided. High satisfaction level is an important outcome measure of any out-of-hours service as it increases patient confidence and compliance and ultimately clinical outcome. [source] Risk factors for early lactation problems among Peruvian primiparous mothersMATERNAL & CHILD NUTRITION, Issue 2 2010Susana L. Matias Abstract The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother,infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study. Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as ,10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as ,10% of birthweight by day 3. One hundred seventy-one mother,infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), <8 breastfeeds during the first 24 h (days 0 and 3), and gestational age <39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score <8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency. Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support. [source] Buddhist nuns on the move: an innovative approach to improving breastfeeding practices in CambodiaMATERNAL & CHILD NUTRITION, Issue 1 2007Benjamin T. Crookston Abstract The benefits of initiating breastfeeding in the first hour of life and exclusively breastfeeding thereafter are well documented. However, little is known about how best to promote these practices. In this study, we assess the impact of Buddhist nuns and wat (pagoda) grannies on optimal breastfeeding behaviours in rural Cambodia. We did so by interviewing randomly selected mothers of infants less than 6 months of age. A total of 440 mothers in programme and control communities completed the baseline survey (before programme start-up), and 467 mothers responded 1 year later. Mothers' exposure to breastfeeding promotion activities was high. At follow-up, 76% of mothers in programme communities indicated that nuns had advised them about breastfeeding, 73% received a home visit and 72% reported attending an educational session. At baseline, mothers in programme communities were 11% more likely (RR = 1.11, CI: 0.74,1.68) than mothers in control communities to initiate breastfeeding in the first hour of life. At follow-up, they were 62% more likely (RR = 1.62, CI: 1.30,2.01) to do so. Similarly, at baseline, mothers in programme communities were 54% more likely (RR = 1.54, CI: 1.21,1.96) than mothers in control communities to breastfeed exclusively in the previous 24 h. At follow-up, they were 81% more likely (RR = 1.81, CI: 1.49,2.21) to do so. Programme planners may consider using community-based volunteers as one strategy to improve breastfeeding practices and child survival. [source] A systematic approach for teaching the home visitMEDICAL EDUCATION, Issue 11 2005Ruth Kannai No abstract is available for this article. [source] Incidence of acute respiratory infections and the relationship with some factors in infancy in Antalya, TurkeyPEDIATRICS INTERNATIONAL, Issue 1 2002Nilay Etiler Abstract Background: Acute respiratory infections (ARI) are one of the major problems of childhood in developing countries. The objective of the study was to obtain the incidence of ARI and its risk factors in Antalya, Turkey. Methods:,We carried out a prospective cohort study on 204 infants who were born between 1 November and 31 December 1997, in the area of two primary health-care units in the Antalya city center. The research group was followed periodically every 2 months by home visits and the infants were investigated to determine their symptoms of ARI. The weight and length of children were measured in every home visit. Additional questions about socioeconomic status, some environmental characteristics, and nutrition practice were asked. Data were entered into the computer and the Z -scores were calculated by the Epi Info 5 package program. The incidence rates, relative risks and confidence intervals were calculated by Microsoft Excel version 5.0 program. Results:,The incidence of ARI was 6.53 episodes per child per year among the children in the research group. The factors that influenced the incidence of ARI were lack of mother's and father's education, heating by wood stove, being a low-birthweight infant, not being completely breast-fed in the first 4 months of life and being stunted. There were no associations between the number of persons per room or smoking status of family members with ARI incidence. Conclusion:,Our results demonstrated that ARI were also associated with some socioeconomic, environmental and nutritional status characteristics such as paternal education, house ownership, breast-feeding, stunting, prematurity and burning of biomass fuels in Turkey. [source] Psychosocial determinants of behaviour problems in Brazilian preschool childrenTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 4 2004Luciana Anselmi Background:, This investigation aimed at examining, through an epidemiological study, the social demographic, family and individual determinants of behaviour problems in preschool children. Method:, Six hundred and thirty-four children, age four years, and their mothers, belonging to a cohort of 5,304 children being followed from birth, took part in the study. During a home visit, the child's behaviour problems and IQ were examined, as well as the prevalence of maternal psychiatric disorder, the quality of the home environment, and other social demographic, family and individual factors. Results:, The results revealed a prevalence of children's behaviour problems of 24% (clinical and borderline groups). Regression analysis showed that maternal psychiatric disorder, education and age, number of younger siblings and quality of the home environment explained 28% of the variance of the child's behaviour problems. Conclusions:, The results point to the multi-determination of child behaviour problems. [source] Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2006Anne BARTU Abstract Background:, Postnatal home-visiting programs for illicit drug-using mothers have reported some success in reducing harms in some areas but there is a lack of data on their impact on breastfeeding and immunisation rates. Aims:, To investigate the effect on breastfeeding, immunisation and parental drug use. The hypothesis was that the outcomes of the home-visiting group (HVG) would be superior to the control group (CG). Method:, One hundred and fifty-two illicit drug-using women were recruited at 35,40 weeks gestation from King Edward Memorial Hospital, Perth, Western Australia and randomised after delivery to the HVG or the CG. The HVG had eight home visits; the CG had telephone contact at two months and a home visit at six months. The HVG received education and support for parenting, breastfeeding and child development. This was not provided by the research midwives for the CG. Results:, The main drugs were heroin, amphetamines, cannabis and benzodiazepines. Immunisation rates were similar for each group. Median duration of breastfeeding for the HVG was eight weeks (95% CI, 3.8,12.2); for the CG ten weeks (95% CI, 7.3,12.7). Drug use was reduced during pregnancy but increased by six months post-partum in both groups. The retention rates were: HVG 93%; CG 86%. Conclusion:, The hypothesis for this study was not supported. Long-term studies are urgently required to assess the effects of parental drug use on infant and child development. [source] The use of nationwide on-line prescription records improves the drug history in hospitalized patientsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008Bente Glintborg What is already known about this subject ,,Structured medication interviews improve the medication history upon hospitalization ,,Pharmacy records are valid lists of the prescribed medications available to individual patients ,,In Denmark, treating doctors now have access to their patients' pharmacy records through a real-time online electronic database What this study adds ,,Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits ,,Pharmacy records may be used to minimize patients' recall bias and improve the medication lists Background Structured medication interviews improve the medication history in hospitalized patients. In Denmark, a nationwide electronic version of individual pharmacy records (PR) has recently been introduced. Use of these records could improve the medication lists in hospitalized patients. Methods We prospectively included 500 patients admitted to an acute medical department. In individual patients, the PR was compared with (i) the medication list written in the patient chart and (ii) drug information provided by the patient during a structured drug interview upon admission and during a home visit after discharge. Results Median patient age was 72 years. Upon admission, patients reported using 1958 prescription-only medications (POM) (median four drugs per patient, range 0,14), of which 114 (6%) were not registered in PR. In PR, 1153 POM (median one per patient, range 0,11) were registered during the month preceding admission. The patients did not report 309 (27%) of these upon admission. Home visits were performed in a subgroup of 115 patients. During home visits, 18% of POM registered in PR during the preceding month were not reported. Drug type was predictive of reporting irrespective of patient sex or age. Cardiovascular drugs were reported most and dermatologicals were reported less frequently. Underreporting might be due to recall bias, non-adherence or discontinuation of drugs. Conclusions Omission errors are frequent despite structured medication interviews. Pharmacy records or medication lists from all treating doctors must be included in medication reviews in order to reduce recall bias. [source] A single ultrasonographic scan at age 65 years excludes 95 per cent of men from future aneurysm riskBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001P. Crow Background: In 1988, 236 men, then aged 65 or 66 years, underwent an abdominal ultrasonographic scan as part of a pilot study for an aneurysm screening programme; 223 (95 per cent) had an aortic diameter of 25 mm or less, and form the main study group. Methods: This group was followed with repeat ultrasonography in 1993 and 2000. Eight men (4 per cent) were lost to follow-up or refused further scanning, but all are known to be still alive. Eighty-six men (39 per cent) died during the 12-year follow-up. Causes of death were investigated. None was related to abdominal aortic aneurysm (AAA). Some 129 men (58 per cent) had all three ultrasonographic scans, including some arranged in other hospitals or performed with a portable scanner at a home visit. Mean(s.e.m.) aortic diameter for this group was 18·9(2·3) mm in 1988, 19·0(2·6) mm in 1993 and 20·2(3·8) mm in 2000. Results: At the scan in 2000, four men had an aortic diameter greater than 30 mm (32, 34, 34 and 36 mm respectively). In contrast, of the 13 men with an aortic diameter greater than 25 mm in 1988, three have undergone elective aneurysm repair, eight have died from causes unrelated to AAA and two remain under ultrasonographic surveillance. Conclusion: Using an aortic diameter threshold of 25 mm, a single ultrasonographic scan at the age of 65 years is able to exclude 95 per cent of men who appear extremely unlikely ever to develop a clinically significant aortic aneurysm and to identify the 5 per cent who require further follow-up. © 2001 British Journal of Surgery Society Ltd [source] Tracking Inner City Substance Users from the Emergency Department: How Many Contacts Does It Take?ACADEMIC EMERGENCY MEDICINE, Issue 2 2008Rebecca Cunningham MD Abstract Background:, Longitudinal studies of substance users report difficulty in locating and completing 12-month interviews, which may compromise study validity. Objectives:, This study examined rates and predictors of contact difficulty and in-person follow-up completion among patients presenting with cocaine-related chest pain to an inner-city emergency department (ED). The authors hypothesize that less staff effort in contacting patients and lower follow-up rates would bias subsequent substance use analysis by missing those with heavier substance misuse. Methods:, A total of 219 patients aged 19 to 60 years (65% males; 78% African American) with cocaine-related chest pain were interviewed in the ED and then in person at 3, 6, and 12 months. Demographics, substance use measures, and amount/type of research staff contacts (telephone, letters, home visits, and locating patient during return ED visits) were recorded. Poisson and negative binomial regression analyses were conducted to predict quantity of patient contacts for the 12-month follow-up. Results:, Interview completion rates at 3, 6, and 12 months were 78, 82, and 80%, respectively. Average contact attempts to obtain each interview were 10 at 3 months (range 3,44), 8 at 6 months (1,31), and 8 at 12 months (1,49); 13% of patients required a home visit to complete the 12-month interview. Participants requiring more contact attempts by staff were younger and reported more frequent binge drinking at baseline (p < 0.05), but were less likely to meet criteria for substance abuse or dependence (p < 0.5), or to report prior mental health treatment (p < 0.05). Comparisons of parallel regressions predicting contact difficulty based on the entire sample, the low-effort group, and the difficult-to-reach group showed variation in findings. Conclusions:, This study demonstrates that substantial staff effort is required to achieve adequate retention over 12 months of patients with substance misuse. Without these extensive efforts at follow-up, longitudinal analyses may be biased. [source] A meta-analysis of home visiting programs: Moderators of improvements in maternal behavior,INFANT MENTAL HEALTH JOURNAL, Issue 5 2010M. Angela Nievar A meta-analysis of home visiting programs for at-risk families (K = 35, N = 6,453) examined differences in the effects of programs on maternal behavior. On average, programs with more frequent visitation had higher success rates. The frequency of home visits explained significant variance of effect sizes among studies in the United States, with two visits per month predicting a small, substantive effect. Intensive programs or programs with at least three visits per month were more than twice as effective as were less intensive programs. Home visiting programs using nurses or mental health professionals as providers were not significantly more effective than were programs using paraprofessionals. In general, programs showed a positive effect on maternal behavior, but programs with frequent home visits were more successful. Un meta-análisis de programas de visita a casa para familias bajo riesgo (K = 35, N = 6,453) examinó las diferencias en cuanto a los efectos de programas sobre la conducta maternal. En promedio, los programas con visitas más frecuentes tuvieron puntajes más altos en cuanto al éxito del programa. La frecuencia de las visitas a casa explicó la significativa variación del alcance de los efectos tal como se presenta en los estudios en los Estados Unidos, con el resultado de que dos visitas por mes predijeron un efecto pequeño y substancial. Los programas intensivos, o programas con tres visitas por mes por lo menos fueron más del doble efectivos que los programas menos intensivos. Los programas de visitas a casa en los que participan enfermeras o profesionales de la salud mental como proveedores del servicio no fueron significativamente más efectivos que los programas en los que participan ayudantes de profesionales. En general, los programas mostraron un efecto positivo en la conducta maternal, pero los programas con frecuentes visitas a casa fueron más exitosos. Une méta-analyse de programmes de visite à domicile pour des familles à risques (K = 35, N = 6,453) a examiné les différences dans les effets des programmes sur le comportement maternel. En moyenne, les programmes avec des visites plus fréquentes ont reçu de meilleurs taux de succès. La fréquence des visites à domicile a expliqué une variance importante de tailles d'effet au sein des études aux Etats-Unis, avec deux visites par mois prédisant un petit effet d'importance. Les programmes intensifs ou les programmes avec au moins trois visites par mois se sont avérés être deux fois plus efficaces que les programmes moins intensifs. Les programmes de visite à domicile utilisant des infirmières ou des professionnels de la santé mentale comme visiteurs ne se sont pas avérés être plus efficaces que les programmes utilisant des paraprofessionnels. En général, les programmes ont fait état d'un effet positif sur le comportement maternel, mais les programmes avec des visites à domicile fréquentes se sont avérés plus couronnés de succès. Eine Meta-Analyse von Unterstützungsprogrammen für gefährdete Familien (K = 35, N = 6453) die im häuslichen Umfeld stattfinden, untersuchte Unterschiede der Wirkung auf das Verhalten der Mütter. Im Durchschnitt zeigten Programme mit häufigeren Besuchen höhere Erfolgsraten. Die Häufigkeit der Hausbesuche zeigte einen signifikanten Effekt innerhalb der nordamerikanischen Studien. Zwei monatliche Besuche zeigten bereits einen kleinen aber stichhaltigen Effekt. Intensive Programme und solche mit mindestens drei monatlichen Besuchen waren bereits mehr als doppelt so wirksam wie die weniger intensive Programme. Die Programme mit Hausbesuchen, in denen Krankenschwestern oder Experten der seelischen Gesundheit eingesetzt wurden, waren nicht signifikant wirksamer als Programme, in denen ungeschulte Mitarbeiter einsetzt wurden. Generell zeigten die Programme eine positive Wirkung auf das mütterliche Verhalten, wobei die Programme mit häufigeren Hausbesuchen erfolgreicher waren. [source] A theory of maternal engagement with public health nurses and family visitorsJOURNAL OF ADVANCED NURSING, Issue 2 2005Susan M. Jack PhD RN Background., Home visiting by public health nurses and family visitors is promoted as an important intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage, and commonly drop out of home visiting programmes prematurely. Purpose., This paper reports a study developing a theory that describes the process by which mothers of children at-risk engage with public health nurses and family visitors in a blended home visiting programme. Methods., Grounded theory was used to guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving public health nurse and family visitor home visits were recruited from a public health unit in Canada. Data were collected through client record reviews and 29 in-depth interviews that explored participants' experiences, beliefs and expectations about engagement. Data collection and analysis continued until all categories were saturated. Findings., Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with public health nurses and family visitors through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear; (2) building trust; and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the public health nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship. Conclusion., Public health nurses working with families at risk need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients. [source] Relations among mother and home visitor personality, relationship quality, and amount of time spent in home visitsJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 6 2003Elizabeth A. Sharp Evaluations of a variety of home-based early childhood intervention programs show that home visit rates fall short of the number prescribed. In an attempt to add to knowledge about reasons for this phenomenon, the current study explored associations among mother and home visitor personality, relationship quality, and time spent in home visits. Maternal negative emotionality was positively related to both time spent in home visits and relationship quality. Maternal positive emotionality was inversely related to time spent in home visits. Home visitor negative emotionality was also positively related to mothers' assessments of relationship quality; however, it was inversely related to the amount of time spent in home visits. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 591,606, 2003. [source] Focussed, comprehensive home visits prevent falling when targeted to specific groups of older people at high risk of fallsAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2009Esther Steultjens No abstract is available for this article. [source] | |||||||||||||||||||||||||||||||