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Institutional Care (institutional + care)
Selected AbstractsPrecursors and correlates of criminal behaviour in womenCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2004Dr Julie Messer Background The precursors and correlates of criminal behaviour in women were examined in this longitudinal study of women in their late thirties. Methods The sample consisted of a high-risk group of women (n = 86) and a comparison group ( n = 97): the former had been raised in institutional care. Questionnaire measures of childhood behaviour problems and detailed interview data from two time points in adulthood were obtained, along with official records of offending. Results In terms of childhood precursors, antisocial behaviour, institutional rearing, hyperactivity and adolescent conduct disorder were found to be significantly related to offending. Later adolescent factors were also found to be important: mixing with deviant peers and leaving school without any qualifications or plans for work. Correlates of offending in adulthood included difficulties in mental health, drug use, marriage and parenting. Further analysis was undertaken to clarify the associations by using ex-care status and conduct disorder as covariates. Discussion Well-established predictors of offending in male samples seem quite as important for women and girls. The findings also suggested strong links between offending and problems in parenting. Copyright © 2004 Whurr Publishers Ltd. [source] The last 3 months of life: care, transitions and the place of death of older peopleHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2005Marianne Klinkenberg PhD Abstract Many older people die in hospitals, whereas research indicates that they would prefer to die at home. Little is known about the factors associated with place of death. The aim of the present study was to investigate the care received by older people in the last 3 months of their life, the transitions in care and the predictors of place of death. In this population-based study, interviews were held with 270 proxy respondents to obtain data on 342 deceased participants (79% response rate) in the Longitudinal Aging Study Amsterdam. In the last 3 months of life, the utilisation of formal care increased. Half of the community-dwelling older people and their families were confronted with transitions to institutional care, in most cases to hospitals. Women relied less often on informal care only, and were more dependent than men on institutional care. For people who only received informal care, the odds of dying in a hospital were 3.68 times the odds for those who received a combination of formal and informal home care. The chance of dying in a hospital was also related to the geographical region. The authors argue that future research is needed into the association that they found in the present study, i.e. that decedents who received both formal and informal care were more likely to die at home. In view of the differences found in geographical region in relation to place of death, further investigation of regional differences in the availability and accessibility of care is indicated. [source] Formal support, mental disorders and personal characteristics: a 25-year follow-up study of a total cohort of older peopleHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2003G. Samuelsson PhD Abstract The present study was designed to describe the pattern of long-term formal support received by people with mental disorders, and to investigate the relationship between the medical, psychological and social characteristics of the participants and types of formal support. This study is based on a cohort (n = 192) of people born in 1902 and 1903 in a community in Southern Sweden. The research participants were assessed using interviews, psychological tests and medical examinations. Information was collected about the use of primary healthcare and social services. The first assessment took place when the cohort was aged 67 years, and then on eight further occasions until they were 92. The participation rate ranged from 72% to 100%. During the observation period of 25 years, 53% of people with dementia eventually received both home help and institutional care compared to 34% of people with other psychiatric diagnoses and 12% of people with good mental health. The last group had all physical health problems and/or problems with activities of daily living. However, 35% of the dementia group, 46% with other psychiatric diagnoses and 52% of people with good mental health did not receive any formal support. Males and self-employed people were significantly less likely to use formal support. The institutionalised group reported loneliness significantly more often than the other two groups. In a logistic regression analysis, loneliness, low social class, high blood pressure and low problem-solving ability were predictors of formal support use. People with a mental disorder, including dementia, were significantly more likely to use formal support compared to people with good mental health. Social factors were the main factors predicting formal support. [source] How Much Is Postacute Care Use Affected by Its Availability?HEALTH SERVICES RESEARCH, Issue 2 2005Melinda Beeuwkes Buntin Objective. To assess the relative impact of clinical factors versus nonclinical factors,such as postacute care (PAC) supply,in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Data Sources and Study Setting. Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. Study Design. We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. Data Collection/Extraction Methods. A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999. Principal Findings. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. Conclusions. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes,or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes. [source] Diagnostic and therapeutic value of apomorphine in Parkinsonian patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2004J.C. Sharma Summary Apomorphine is a dopamine agonist administered subcutaneously for the management of motor symptoms of Parkinson's disease (PD). Patients with Parkinsonian syndrome underwent an apomorphine challenge for therapeutic efficacy, a positive response being a reduction of >15% score on motor unified PD rating scale. Of the 42 patients, aged 37,81, disease duration 12 months to 20 years, 36 had a positive response. Six non-responders were later diagnosed as non-PD as compared with only two of the 36 responders. Tremor-predominant patients obtained higher motor response. Few patients demonstrated a delayed positive response. Seven (three idiopathic PD (iPD), four non-PD) suffered adverse reactions of nausea, vomiting or ill-sustained symptomatic fall in BP. Majority of the patients who continued with apomorphine therapy were able to reduce levodopa and achieved an improvement in dyskinesia and motor symptoms. Thirteen responding patients were managed by increasing dopamine agonists. Five patients, intolerant of oral dopamine agonists, were able to beneficially tolerate apomorphine. Age and disease duration did not influence tolerability or efficacy. The patients treated with apomorphine were able to significantly reduce the dose of levodopa, and there was a reduction in dyskinesia, hallucinations and fluctuations (all p < 0.05). In some patients, apomorphine prevented admission to institutions. We also describe the use of apomorphine in acutely ill patients unable to ingest oral medication. Apomorphine seems to have a diagnostic element for iPD. Its use leads to a reduction in dyskinesia, improvement in motor symptoms and prevention of institutional care. Apomorphine test also identifies patients likely to benefit with an increase in oral medication. Age and disease duration should not prevent the use of this valuable drug. Apomorphine also has a role in acutely ill PD patients. [source] Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-upINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2006Hanna-Mari Alanen Abstract Objective To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. Design Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. Setting Of the data providers 16 were hospital-based institutions and 25 residential homes. Participants Each of the data sets included 3662-3867 resident assessments. Results The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63,0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03,1.48). Conclusions The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population. Copyright © 2006 John Wiley & Sons, Ltd. [source] Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older peopleINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 3 2003Paul Clarkson Abstract Background This paper investigates the potential effects of a policy change in the funding of UK residential care. The White Paper Modernising Social Services (Cm 4169, 1998) outlined plans to change the distribution of the Residential Allowance (RA), payable in support of residents in independent residential or nursing home care, from a component of income support paid direct to establishments to a grant to local authorities. This change was intended to remove the perverse incentive in accessing independent residential care more favourably than local authority care. A further objective was to encourage local authorities to use the grant to support home-based alternatives to residential care. The policy rests on a model in which price signals dictate the choice of care for an older person. By, in effect, raising the price of independent residential and nursing home care, the policy provides an incentive for authorities to seek alternatives to institutional care. Methods Managers from 16 UK social services departments attended a focus group discussion, completed questionnaires and provided information to assist in calculating the potential diversionary effect of the policy. Results Managerial estimates indicated a small diversionary effect of the policy; A potential effect of 0.26 and 0.19 per 1000 older people diverted from residential and nursing care respectively. Conclusions The study indicated that wider organisational factors other than price are likely to play a greater role in deciding whether an older person is admitted to care. Changes in public funding alone do not reflect the complexities involved in decision-making concerning the residential placement of older people. Copyright © 2003 John Wiley & Sons, Ltd. [source] Quality of institutional care of older people as evaluated by nursing staffJOURNAL OF CLINICAL NURSING, Issue 18 2008Arja Isola Aims., The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. Background., The healthcare division of one Finnish city authorised an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re-survey was conducted in 2001, using the same criteria of quality assessment. Methods., A survey research method was used. All the seven institutions providing long-term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78·6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76·8%. Results., The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. Relevance to clinical practice., The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long-term institutional care. [source] Prevalence and associated factors of pneumonia in patients with vegetative state in TaiwanJOURNAL OF CLINICAL NURSING, Issue 7 2008Li-Chan Lin PhD Aims., The aim of this study was to investigate the prevalence rate and influencing factors of pneumonia associated with long-term tube feeding in special care units for patients with persistent vegetative states (PVS) in Taiwan. Background., Pneumonia is a significant cause of morbidity, hospitalization and mortality in the nursing home population. Tube feeding has been found as a risk factor for the occurrence of pneumonia. Methods., Two hundred sixty subjects were chosen from three hospital-based special care units for patients with PVS and 10 nursing facilities for persons in PVS in Taiwan. All subjects, who were diagnosed with PVS, received either financial aid for institutional care or were means-tested from The Bureau of Social Welfare of cities and counties in Taiwan. Data were collected through chart review and observations. Results., The prevalence rate of pneumonia in nursing facilities for patients with PVS was 14·2%. The prevalence rate of tube-feeding in nursing facilities for PVS was 91·2%. The mean duration of tube-feeding was 73·21 SD 55·33 months. A total of 90·4% was fed with a nasogastric (NG) tube. Having a lower intake of food and fluids daily and having been institutionalized for a shorter period were three dominant factors associated with the occurrence of pneumonia. Conclusion., Research findings reveal that the incidence of pneumonia is higher in patients who do not receive adequate food and water. Continuing in-service training to improve caregivers' knowledge and skill in providing care to patients in PVS and monitoring their skills in feeding is needed to decrease the occurrence of pneumonia in this population. Relevance to clinical practice., Staff needs to be taught to monitor laboratory data and signs and symptoms of malnutrition and hydration deficit, and also be alert to early indicators of pneumonia in patients with PVS. [source] People with intellectual disability as neighbours: Towards understanding the mundane aspects of social integrationJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 5 2010Laura M. van Alphen Abstract Although people with intellectual disabilities (ID) are increasingly expected to relocate from traditional institutional care to ,regular' neighbourhood housing facilities and socially integrate in these neighbourhoods, little is known about how they are perceived and appreciated as neighbours. This paper reports on interviews carried out with 30 neighbours without ID who were neighbours of small-scale care facilities for people with ID. Interviews addressed the neighbours' everyday experiences of neighbouring in general, and neighbouring people with ID in particular. Neighbouring, for these informants, called for a fine balance between friendliness without over-involvement. While they were generally positive about their interactions with their neighbours with ID, it emerged that the formal nature of the care facility and the interaction style of some of the neighbours with ID often contravened informants' assumptions about neighbouring. Informants expressed concern about a possible lack of appropriate distance, reciprocity and accountability among their neighbours with ID. The nature of the care facility, with paid staff, often group activities, formal means of achieving the everyday small tasks which neighbours sometimes do for each other, and a high turnover of residents, all undermined the possibility of a typical neighbourly relationship. In conclusion, we suggest that integration of people with ID into everyday neighbouring relationships raises complex challenges for care organizations that need to find a balance between supporting the needs of people with ID they care for, adequate support and mediation for other neighbours when necessary, and all the while avoid becoming overly involved in neighbouring as a formal partner. Copyright © 2010 John Wiley & Sons, Ltd. [source] Institutional discharges and subsequent shelter use among unaccompanied adults in New York CityJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 1 2010Stephen Metraux This study empirically examines the link between homelessness and discharges from other institutions. An administrative record match was undertaken to determine rates of discharge from institutional care for 9,247 unaccompanied adult shelter users in New York City. Cluster analysis and multinomial logistic regression analysis was then used to assess associations between different types of institutional discharges and the likelihood of persons subsequently experiencing extended shelter stays. Results show that 28% of the cohort was discharged from institutional care within the 90-day period preceding their initial shelter entry, with different types of institutional discharge associated with differences in subsequent patterns of shelter use. Based on these findings, transitions from institution to the community are potentially a key intervention point for reducing homelessness and shelter use. © 2009 Wiley Periodicals, Inc. [source] Comprehensive health assessments during de-institutionalization: an observational studyJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2006N. Lennox Abstract Background People with intellectual disability (ID) leaving institutions pass through a transition stage that makes them vulnerable to inadequate health care. They enter into community care under general practitioners (GPs) who are often untrained and inexperienced in their needs. Specifically designed health reviews may be of assistance to both them and their new GPs as they go through that phase. Methods This research aimed to investigate the effectiveness of a specially designed health review, the comprehensive health assessment program (CHAP) health review, in a group of adults as they transitioned out of the care of the last institution for people with ID in Tasmania. There were 25 residents reviewed by their GPs. Results The CHAP reviews picked up a number of health conditions and stimulated health promotion activities. Some of the findings were: a high number of abnormal Body Mass Indexes (19/23), immunizations given (13/23), vision impairment reported (2/23), mental health issues recorded (4/23) and skin abnormalities described (17/23). There were 22 referrals made to other health professionals (Australian Hearing Service 4, dentists 3, optometrists 3, psychiatrists 2, neurologists 2, ophthalmologist 1, urologist 1, ultrasound 1, mammogram 1, family planning 1, physiotherapist 1, continence nurse 1 and respiratory physician 1). These were in addition to various requests for pathology. Conclusions The CHAP health review was effective in identifying a number of health issues in the population of people with ID as they transitioned out of institutional care into the general community. [source] Leadership and management skills of first-line managers of elderly care and their work environmentJOURNAL OF NURSING MANAGEMENT, Issue 6 2010FATHYA ABDELRAZEK PhD abdelrazek f., skytt b., aly m., el-sabour m.a., ibrahim n.& engström m.(2010) Journal of Nursing Management 18, 736,745 Leadership and management skills of first-line managers of elderly care and their work environment Aim, To study the leadership and management skills of first-line managers (FLMs) of elderly care and their work environment in Egypt and Sweden. Background, FLMs in Egypt and Sweden are directly responsible for staff and quality of care. However, FLMs in Sweden, in elderly care, have smaller units/organizations to manage than do their colleagues in Egypt. Furthermore, family care of the elderly has been the norm in Egypt, but in recent years institutional care has increased, whereas in Sweden, residential living homes have existed for a longer period. Methods, A convenience sample of FLMs, 49 from Egypt and 49 from Sweden, answered a questionnaire measuring leadership and management skills, structural and psychological empowerment, job satisfaction and psychosomatic health. Results, In both countries, FLMs' perceptions of their leadership and management skills and psychological empowerment were quite high, whereas scores for job satisfaction and psychosomatic health were lower. FLMs had higher values in several factors/study variables in Egypt compared with in Sweden. Conclusion and implications, The work environment, both in Egypt and Sweden, needs to be improved to increase FLMs' job satisfaction and decrease stress. The cultural differences and levels of management have an effect on the differences between the two countries. [source] Poverty, underdevelopment and infant mental health,JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2003LM Richter Abstract: Very great advances have occurred in disciplinary and professional knowledge of infant development and its influence on subsequent development. This expertise includes the ways in which early experiences affect the capacity of mature individuals for social adjustment and productive competence, and promising methods of intervention to promote infant mental health and prevent adverse sequelae of risk conditions. However, very little of this knowledge has been applied in work among infants and children living in conditions of poverty and underdevelopment. This lack of application continues despite the enormous threats to the well-being of infants and young children brought about by the combined effects of poverty and the AIDS pandemic, especially in southern Africa. Protein,energy malnutrition, maternal depression, and institutional care of infants and small children are cited as illustrative of areas in which interventions, and their evaluation, are desperately needed in resource-poor countries. An argument is made for the critical importance of considering and addressing psychological factors in care givers and children in conditions of extreme material need. An example is provided of a simple intervention model based on sound developmental principles that can be implemented by trained non-professionals in conditions of poverty and underdevelopment. [source] Fetal Alcohol Spectrum Disorders in Children Residing in Russian Orphanages: A Phenotypic SurveyALCOHOLISM, Issue 3 2006Laurie C. Miller Background: Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories. Methods: Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories. Results: Thirteen percent of children had facial phenotype scores highly compatible with prenatal alcohol exposure and 45% had intermediate facial phenotype scores. These scores correlated with maternal gravidity and age. At least 40% of mothers in whom history was available ingested alcohol during pregnancy; some also used illicit drugs and tobacco. Z scores for growth measurements corresponded to phenotypic score, as did the degree of developmental delay. Children with no or mild delay had significantly lower phenotypic scores than those with moderate or severe delay (p=0.04); more than 70% of children with high phenotypic scores were moderately or severely delayed. Conclusions: More than half of residents of the baby homes in Murmansk, Russia, have intermediate (45%) or high (13%) phenotypic expression scores suggesting prenatal exposure to alcohol. Despite good physical care, stable daily routine, availability of well-trained specialists, and access to medical care, these vulnerable children show significant growth and developmental delays compared with their institutionalized peers. [source] Health-Care Policy for Korean ElderlyNURSING & HEALTH SCIENCES, Issue 3 2002Young Hee Choi Due to advances in medicine and economic development, the percentage of Korean elderly is increasing markedly. If preparation is not made for the coming aged society, there is a possibility that the development of the Korean nation will be hindered. The increase in the number of the elderly is increasing the social/national burden of providing medical care for the elderly. Meanwhile, with the trend toward the nuclear family, the increase of female participation in social activities, and the increase of elderly who live alone, it is difficult for nursing homes alone to solve the problem of providing support for the elderly. Long-term medical treatment and care of the elderly has become the responsibility of both the government and society. Under these conditions, the Korean policy for elderly patients can be classified broadly into home care, community care, and institutional care. In order to prepare for the aged society, deficient facilities need to be supplemented and home care and community care need to be expanded so as to increase the communities' ability to support the elderly . Homes, communities, government and the private sector should work together to provide integrated welfare and health care to the elderly. [source] The caregiving context in institution-reared and family-reared infants and toddlers in RomaniaTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2007Anna T. Smyke Background:, We assess individual differences in the caregiving environments of young children being raised in institutions in Romania in relation to developmental characteristics such as physical growth, cognitive development, emotional expression, and problem and competence behaviors. Method:, Videotaped observations of the child and favorite caregiver in their ,home' environment were coded for caregiving quality, and this was related to child characteristics. Child emotional reactivity was assessed during responses to interactional tasks. Cognitive development was assessed from child responses to the Bayley Scales of Infant Development. Data regarding problem behaviors and competence were obtained from caregiver report. Children reared in institutions were compared on all of these measures to never institutionalized children to assist gauging degree of impairment. Results:, Children raised in institutions demonstrated marked delays in cognitive development, poorer physical growth, and marked deficits in competence. Individual differences in caregiving environment were associated with cognitive development, competence, and negative behavior among these young children being reared in institutions. Conclusions:, These data confirm previous findings regarding deficits associated with institutional care and extend our understanding of the impact of individual differences in caregiving quality on the development of young children in institutions. [source] Medicare-Certified Home Health Care: Urban-Rural Differences in UtilizationTHE JOURNAL OF RURAL HEALTH, Issue 3 2007Lacey Hartman MPP ABSTRACT:,Context:Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail.Purpose:To examine urban-rural differences in Medicare HHC utilization.Methods:The 2002 100% Medicare HHC claims and denominator files were used to estimate use of HHC and to make urban-rural comparisons on the basis of utilization levels within ZIP codes.Findings:Overall, the proportion of Medicare beneficiaries living in areas with little HHC utilization is relatively low. Rural elders, however, are more likely than their urban counterparts to live in such areas. Less than 1% of urban beneficiaries live in ZIP codes with no or low use of HHC, but over 17% of the most rural beneficiaries live in such areas.Conclusions:Continued monitoring of rural HHC utilization and access is important, especially as Medicare seeks to evaluate the effectiveness of payment increases to rural home health agencies. [source] A Neurobiological Perspective on Early Human DeprivationCHILD DEVELOPMENT PERSPECTIVES, Issue 1 2007Charles A. Nelson ABSTRACT,The number of children who are abandoned or orphaned around the world is rapidly increasing owing to war, AIDS, and poverty. Many of these children are placed in institutional settings for lack of individual or societal resources or because of long-standing cultural traditions. It has been known for over half a century that rearing children in institutional care characterized by profound sensory, cognitive, linguistic, and psychosocial deprivation can be deleterious to their development. This article examines the neural mechanisms that likely underlie the maldevelopment many institutionalized children experience. [source] Time use in Russian Baby HomesCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2008L. G. Tirella Abstract Background We investigated time use of Russian children residing in Baby Homes to document their opportunities and experiences during institutional care. Methods Time use of 138 non-special needs, randomly selected children (65 female vs. 73 male, age 1 month to 4 years) in Baby Homes in Murmansk, Russia, was analysed. Baby Home specialists were trained in time-use spot observation methodology. Each child was observed every 10 min for 5 h (31 observations/child; >4000 data points). At each observation, we coded: who the child was with, adult role, what the child was doing, location and vocalizations. Results Children spent 50% of their time alone, 27% with a caregiver, 15% with another adult, and 7% with another child. Infants spent significantly more time alone (65%) than toddlers (43%) or pre-schoolers (46%) [F(2,133) = 13.05, P < 0.0001]. Caregivers supervised children (58%), led group activities (16%), cared for individuals (14%), or were absent from the room (12%). Children spent the most time (32%) in activities of daily living; remaining time was spent in meaningful play (27%), non-purposeful activity (16%) or sleep (18%). The percentage of time spent in meaningful play significantly increased across age groups [infants 10%, toddlers 25%, pre-schoolers 36%, F(2,133) = 26.9, P < 0.001]. Infants (23%) and toddlers (20%) spent significantly more time than the older group (10%) in non-purposeful activity [F(2,133) = 26.9, P < 0.001]. In 12% of observations, an adult was speaking to the child, in 10% to the group, and <1% to another adult. Child vocalizations varied by age: infants 42% of observations, toddlers 56%, and pre-schoolers 59%. Older children directed more vocalizations to adults than younger children [F(2,133) = 24.47, P < 0.001]. Conclusion Time use of children residing in Baby Homes is limited by routinized schedules and care, at the expense of child-directed or interactive play with adults. Despite close proximity and living in group care, children's vocalizations and interactions with others are limited. [source] | |||||||||||||||||||||||||