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Selected AbstractsFactors associated with continued smoking during pregnancy: analysis of socio-demographic, pregnancy and smoking-related factorsDRUG AND ALCOHOL REVIEW, Issue 1 2002G. PENN Abstract This study investigated the characteristics associated with smoking during pregnancy. A total of 7836 pregnant women were surveyed between 1992 and 1999 in England. Of these 27% were smoking during pregnancy. Pregnant women were more likely to smoke if they were less educated, living in rented accommodation, in unskilled manual or unemployed groups, and single or had a partner who smokes. Analysed by logistic regression, whether or not a pregnant women has a partner and, if so, his smoking status, was by far the biggest predictor of the pregnant woman's current smoking status. Thus, compared with women with partners who never smoke, the odds ratio (OR) of smoking during pregnancy for women with a partner who smokes was 2.3 (1.9,2.7) while those with no partner had an OR of 4.8 (3.8,6.0). For women exposed to passive smoke at home or at work the OR was 2.5 (2.1,3.0). Housing tenure was the most important socio-demographic predictor. Thus pregnant women living in rented council housing were nearly twice as likely (OR 1.93;1.63,2.29) as those buying their own home to be current smokers. The number of women who continued to smoke during pregnancy increased 10-fold from the least to the most deprived group. These findings highlight the importance of tobacco control strategies that address pregnant women's life circumstances and broader inequalities as well as those that focus on individual smoking behaviour. [source] A national stroke quality register: 12 years experience from a participating hospitalEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007P. Appelros Registration of all hospitalized stroke patients is practiced in Sweden in order to assess care quality. Data in this register, Riks-Stroke (RS), may be biased due to incomplete registration. The purpose of this paper was to report changes in stroke outcome in relation to fluctuations in registration. Patients registered in RS at a hospital during the period 1994,2005 were analyzed. Case fatality at 28 days, living conditions, and activities of daily living (ADL) performance at 3 months were correlated to the number of patients registered and follow-up frequency. A total of 4994 stroke cases were registered during the period. A high annual registration rate was significantly correlated to a high case fatality ratio. A low annual follow-up rate was associated with a low proportion of patients living in their own home without any need of help. Quality parameters are sensible for selection bias, which make them difficult to compare over time and between hospitals. We suggest that by weighing outcome data against stroke severity, safer conclusions may be drawn. Additionally, hospitals considering setting up quality registers should make every effort to attain complete case ascertainment at all times, including patients managed outside the hospital, in order to avoid selection bias. [source] From retirement village to residential aged care: what older people and their families sayHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2007Julianne Cheek PhD BEd DipT Abstract The majority of older Australians, some of whom live in retirement villages, wish to remain living in their own home, receiving care in the community when their health and/or other circumstances change. Current statistics show that 3.7% of people aged 65 years and over live in a retirement village in Australia. However, residential aged care will still be required for some highly dependent members of the older population. This qualitative Australian study examined the transition into residential care from one form of community housing, the retirement village. In-depth interviews with 33 older people and 48 family members were conducted to illuminate the key issues and factors which influence the move of older people from retirement villages to residential aged care. Analysis of the data revealed the move to be influenced by: health-related crises; the creation of doubt as to ability to cope in the retirement village; the need for more or different care or support services; the desire for independence; assumptions about being able to move into the residential aged care facility co-located with the retirement village; availability of a place; navigating the system; and desirable aspects of a residential aged care facility. The findings of the study provide a description of the transition process from the perspectives of those directly affected, and contribute to the development of best practice in the provision of support to residents living in retirement villages and the community in general. [source] ,Home comes first': housing and homemaking in Finnish civic educational films during 1945,1969INTERNATIONAL JOURNAL OF CONSUMER STUDIES, Issue 5 2009Minna LammiArticle first published online: 6 AUG 200 Abstract This article focuses on how the ideals of housing and homemaking were presented in post-war civic educational films in Finland. The films chosen for the article pertain to housing on a wide scope. The analysis shows that the ideals of good homes appeared to be remarkably consistent in the Finnish educational short films. The most important objective was to guide citizens towards careful household management and saving. Through rationalizing home economics, consumers were able to buy their own home. The ideal housewife had a positive attitude towards technology and rational household management. While the short films instructed people towards temperate and sensible consumption, they also created space for ordinary people to envision new opportunities for consumption. [source] Special acute care unit for older adults with Alzheimer's diseaseINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2008Maria E. Soto Abstract Objective To describe the cognitive, functional, and nutritional features of patients admitted to a Special Acute Care Unit (SACU) for elderly patients with Alzheimer's disease (AD). Methods One-year observational study of patients with AD and other related disorders hospitalized in the SACU, Department of Geriatrics, Toulouse university Hospital during 2005. A comprehensive neurocognitive and non-cognitive geriatric assessment was performed. Data on full clinical evaluation, nutritional status, activities of daily living (ADL), gait and balance disturbance, behavioural and psychological symptoms (BPSD), and sociodemographics were recorded. Results Four-hundred and ninety-two patients were assessed. Their mean age was 81.1,±,7.7, the mean length of stay was 10.7,±,6.3 days, 62% were female, 63.9% were admitted from their own home and 30.4% from a nursing home. Eighty percent of patients had probable Alzheimer's disease or mixed dementia, less than 20% had other causes of dementia. Results of their comprehensive assessment showed a mean mini-mental state examination of 14.5,±,7.4; a mean total ADL score of 3.7,±,1.7. Seventy-seven percent had gait or balance disturbances; 90% of patients presented an unsatisfactory nutritional status. The most common reason for admission was BPSD. Conclusion AD complications are responsible for many acute admissions. Elderly patients suffering from dementia represent a population with unique clinical characteristics. Further randomised clinical trials are needed to evaluate the effectiveness of Special Acute Care Units for patients with AD and other related disorders. Copyright © 2007 John Wiley & Sons, Ltd. [source] Quality of life of older people in residential care home: a literature reviewJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 2 2009Diana TF Lee MSc, PRD (HCE) Aim., To integrate the research evidence on quality of life of older people living in a residential care home setting. Background. Residential care is provided for older people who are unable to live in their own home due to various health and social reasons. A number of studies have been published that have focused on diverse quality of life issues of residential care home elders. Consolidating the evidence from these studies may provide insights into enhancing quality of life of this particular group of older people. Design. A literature review of research evidence on quality of life issues among residential care home elders. Method. A systematic search of the literature published between 1994,January 2008 was undertaken to identify research evidence on quality of life of older people living in residential care home. Information about the study design, research objectives, study setting, sample characteristics, and key findings were extracted for comparison and integration. Three aspects about quality of life of the residential care home elders were identified: views of residential care home elders on quality of life, factors affecting quality of life of residential care home elders and methods to improve quality of life in residential care home elders. Results. Eighteen publications were identified. Older people perceived their ability to maintain independence, autonomy and individuality as the most important criteria for determining quality of life. Interventions designed to improve quality of life of older people living in residential facilities corresponded to these criteria. A range of interventions including a walking program, mental stimulation and environmental modification were proposed and evaluated to improve quality of life of residential care home elders. Among these interventions, environmental modification that targeted at improving the residential care homes and quality of services appears to be promising. Conclusion. Quality of life in residential care home elders is a complex issue that may be determined by the elders' independence, individuality and autonomy, and influenced by quality of residential care and facilities. Environmental modification appears to be a way to improve the quality of life of residential care home elders. Relevance to clinical practice. The knowledge of understanding quality of life of residential care home elders provides insights into the implementation of appropriate residential care services. Programs that aim to de-institutionalise the residential care home settings are important to the enhancement of residential care services. [source] Emergency hospital admissions in idiopathic Parkinson's diseaseMOVEMENT DISORDERS, Issue 9 2005Henry Woodford BSc Abstract Little is known about the hospital inpatient care of patients with idiopathic Parkinson's disease (PD). Here, we describe the features of the emergency hospital admissions of a geographically defined population of PD patients over a 4-year period. Patients with PD were identified from a database for a Parkinson's disease service in a district general hospital with a drainage population of approximately 180,000. All admissions of this patient subgroup to local hospitals were found from the computer administration system. Two clinicians experienced in both general medicine and PD then reviewed the notes to identify reasons for admission. Admission sources and discharge destinations were recorded. Data regarding non-PD patients was compared to PD patients on the same elderly care ward over the same time period. The total number of patients exposed to analysis was 367. There was a total exposure of 775.8 years and a mean duration of 2.11 years per patient. There were 246 emergency admissions to the hospital with a total duration of stay of 4,257 days (mean, 17.3 days). These days were accounted for by 129 patients (mean age, 78 years; 48% male). PD was first diagnosed during 12 (4.9%) of the admissions. The most common reasons for admission were as follows: falls (n = 44, 14%), pneumonia (n = 37, 11%), urinary tract infection (n = 28, 9%), reduced mobility (n = 27, 8%), psychiatric (n = 26, 8%), angina (n = 21, 6%), heart failure (n = 20, 6%), fracture (n = 14, 4%), orthostatic hypotension (n = 13, 4%), surgical (n = 13, 4%), upper gastrointestinal bleed (n = 10, 3%), stroke/transient ischemic attack (n = 8, 2%), and myocardial infarction (n = 7, 2%). The mean length of stay for the PD patients on the care of elderly ward specializing in PD care was 21.3 days compared to 17.8 days for non-PD patients. After hospital admission, there was a reduction in those who returned to their own home from 179 to 163 and there was an increase in those requiring nursing home care from 37 to 52. Infections, cardiovascular diseases, falls, reduced mobility, and psychiatric complications accounted for the majority of admissions. By better understanding the way people with PD use hospital services, we may improve quality of care and perhaps prevent some inpatient stays and care-home placements. © 2005 Movement Disorder Society [source] Occupational performance in older stroke wheelchair users living at homeOCCUPATIONAL THERAPY INTERNATIONAL, Issue 4 2001Dr Denise T Reid Professor, Faculty of Medicine Abstract This research aimed to identify problems in occupational performance experienced by survivors of stroke who used a wheelchair, both from their perspective and from the perspective of their caregivers. Sixteen stroke survivors over the age of 65 years who had used a prescribed wheelchair for at least one year, who lived in their own home, who were able to participate in a conversational interview and who had a caregiver willing to participate comprised the sample. The Canadian Occupational Performance Measure (COPM) was used to identify occupational performance problems and to measure stroke survivors' and caregivers' perceptions of performance. The Functional Autonomy Measurement System (SMAF) was also used to evaluate the functional performance of stroke survivors from the caregivers' perspective. The frequency and type of problems identified by the COPM were descriptively analysed and compared for both groups. The results of Mann-Whitney U tests showed no differences in the frequency of self-care, productivity and leisure problems reported between the two groups. Within-group comparisons using the Wilcoxon Signed Ranks Test showed that stroke survivors identified significantly more self-care problems than productivity-type problems (p=0.001), and more leisure problems than productivity problems (p=0.013). Caregivers identified significantly more self-care problems than productivity problems (p=0.001). The most common self-care problems reported by both stroke survivors and caregivers were dressing and bathing. Results suggest a high level of functional disability among the stroke survivors. There was a significant correlation between the score on the SMAF Instrumental Activities of Daily Living subscale and the frequency of caregiver assistance (r=0.747, p=0.001). Addressing the perspectives of both stroke survivors who are wheelchair users and their caregivers in identifying occupational performance problems at home is important for occupational therapists for planning home-based intervention. Copyright © 2001 Whurr Publishers Ltd. [source] A survey of patients with self-reported severe food allergies in JapanPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 3 2008T. Imamura Food allergies have increased in recent years in Japan. Details of causative foods, places where anaphylaxis developed, and other allergic factors remain unknown, and we investigated them. A,questionnaire survey for the prevention of food allergies' was conducted using a nationwide group of patients with food allergies. A total of 1383 patients from 878 families (including 319 patients who experienced anaphylaxis) provided valid answers to the questionnaire. The average age of the first anaphylactic attack was 3.20 ± 6.327 yr. The most common allergens causing anaphylaxis were in order milk, eggs, wheat, peanuts, and soybeans, followed by sesame and buckwheat. The most common place where anaphylaxis developed was the patient's own home, followed by fast food restaurants, places visited, restaurants, and schools. In patients' own homes, fast food restaurants (buffet), places visited and schools, the most common allergens were milk, eggs, and wheat. In restaurants and accommodation facilities, eggs were the most common allergen followed by milk. As possible food allergies can cause anaphylaxis, it is necessary to provide precise information for consumers regarding packaged and processed foods. [source] Lifetime prognosis of schizophrenia: extended observation (more than 40 years) of 129 patients with typical schizophreniaPSYCHOGERIATRICS, Issue 2 2005Yosuke ICHIMIYA Abstract Background:, The excess mortality among patients with schizophrenia has been documented by epidemiological studies. These studies have shown that suicide accounts for most of this mortality. In contrast, the natural deaths of patients with schizophrenia have been commonly related to cardiovascular disease in these studies. Methods:, In this study, the clinical features of 129 patients with typical schizophrenia were examined in order to study the lifetime prognosis of patients with schizophrenia in Japan. These patients had their first visit to Kawagoe Dojinkai Hospital in 1963 and had been continuously observed for over 40 years. Results:, As at January 2003, the status of these 129 patients was categorized as follows: 27 patients were inpatients (mean age was 72.9 years), 20 patients were outpatients (mean age was 68.8 years), 2 patients were outpatients of another hospital, 20 patients had been admitted into nursing homes, 53 patients had passed away and 7 patients were missing. Clinical features were recorded for 44 (23 male patients with a mean age of 68.6 years and 21 female patients with a mean age of 64.2 years) out of the 53 patients who had passed away. The causes of death consisted of malignancy (13 cases), pneumonia (eight cases), heart failure (five cases), cerebral infarction (three cases), diabetes mellitus (three cases), cardiac infarction (two cases), ileus (two cases), asphyxia (one case), liver cirrhosis (one case), gastric ulcer (one case), heat stroke (one case), homicide (one case) and suicide (three cases). Two patients were discovered to have passed away alone at home. Conclusion:, The mean age of death was found to be lower than the life expectancy. However, only three patients committed suicide. These findings suggest that patients with schizophrenia may possess some biological vulnerability. Further study is needed to evaluate the effects of long-term antipsychotic medication. Clinically, medical checks for malignancy and care services for elderly patients are needed. Furthermore, in order to prevent future occurrences of patients dying alone in their own home, a social support system should be established. [source] Functioning and disability 6,15 years after traumatic brain injuries in northern SwedenACTA NEUROLOGICA SCANDINAVICA, Issue 6 2009L. J. Jacobsson Objectives,, To assess long-term functioning and disability after traumatic brain injury (TBI). Material and methods,, Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6,15 years post-injury. Results,, There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow-up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. Conclusions,, Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long-term disability. [source] Older patients and delayed discharge from hospitalHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2000Christina R. Victor BA M Phil PhD Hon MFPHM Abstract Older people (those aged 65 years and over) are the major users of health care services, especially acute hospital beds. Since the creation of the NHS there has been concern that older people inappropriately occupy acute hospital beds when their needs would be best served by other forms of care. Many factors have been associated with delayed discharge (age, sex, multiple pathology, dependency and administrative inefficiencies). However, many of these factors are interrelated (or confounded) and few studies have taken this into account. Using data from a large study of assessment of older patients upon discharge from hospital in England, this paper examines the extent of delayed discharge, and analyses the factors associated with such delays using a conceptual model of individual and organisational factors. Specifically, this paper evaluates the relative contribution of the following factors to the delayed discharge of older people from hospital: predisposing factors (such as age), enabling factors (availability of a family carer), vulnerability factors (dependency and multiple pathology), and organisational/administrative factors (referral for services, type of team undertaking assessments). The study was a retrospective patient case note review in three hospitals in England and included four hundred and fifty-six patients aged 75 years and over admitted from their own homes, and discharged from specialist elderly care wards. Of the 456 patients in the sample, 27% had a recorded delay in their discharge from hospital of three plus days. Multivariate statistical analysis revealed that three factors independently predicted delay in discharge: absence of a family carer, entry to a nursing/residential home, and discharge assessment team staffing. Delayed discharge was not related to the hypothesised vulnerability factors (multiple dependency and multiple pathology) nor to predisposing factors (such as age or whether the older person lived alone). The delayed discharge of older people from hospital is a topic of considerable policy relevance. Our study indicated that delay was independently related to two organisational issues. First, entry into long-term care entailed lengthy assessment procedures, uncertainty over who pays for this care, and waiting lists. Second, the nature of the team assessing people for discharge was associated with delay (the nurse-coordinated team made the fewest referrals for multidisciplinary assessments and had the longest delays). Additionally, the absence of a family carer was implicated in delay, which underlines the importance of family and friends in providing posthospital care and in maintaining older people in the community. Our study suggests that considerable delay in discharging older people from hospital originates from administrative/organisational issues; these were compounded by social services resource constraints. There is still much to be done therefore to improve coordination of care in order to provide a truly ,seamless service'. [source] The needs of older people with dementia in residential careINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2006Geraldine A. Hancock Abstract Background People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. Method The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high levels of needs. Two hundred and thirty-eight people with dementia were recruited from residential care homes nationally. Needs were identified using the Camberwell Assessment of Needs for the Elderly (CANE). Results Residents with dementia had a mean of 4.4 (SD 2.6) unmet and 12.1 (SD 2.6) met needs. Environmental and physical health needs were usually met. However, sensory or physical disability (including mobility problems and incontinence) needs, mental health needs, and social needs, such as company and daytime activities, were often unmet. Unmet needs were associated with psychological problems, such as anxiety and depression, but not with severity of dementia or level of dependency. Conclusion Mental health services and residential home staff need to be aware that many needs remain unmet and much can be done to improve the quality of life of the residents with dementia. Copyright © 2005 John Wiley & Sons, Ltd. [source] Multiprofessional collaboration promoting home care clients' personal resources: perspectives of older clientsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2008Sini Eloranta MNSc Home care can be decisive in supporting older people in the home environment. However, one professional in home care cannot take the whole responsibility for promotion alone; on the contrary multiprofessional collaboration is needed. The aim of the study is to describe the experiences of multiprofessional collaboration in promoting personal resources among older home care clients (75+ years) in Finland. The data were collected by unstructured interviews with 21 older home care clients. Their mean age was 83.5 years, ranging from 75 to 91, with 17 female and four male participants. Inductive content analysis was used to analyze the data. The interviewees described the work of professionals from four perspectives: expertise, communication, decision-making and responsibility. Multiprofessional collaboration promoted the personal resources of interviewees with physical, psychological and social support. This study showed that the professionals worked as being expert-oriented: in the multiprofessional collaboration, each expert took care of his/her own part of the client's situation. This included the risk,, that the client's overall situations remained uncharted. However, the client's overall situation is a very important aspect when professionals suppport older people living in their own homes as long as possible. This study revealed the need for developing collaboration skills between social and health care professionals so that the staffs serve the needs of aged clients better together. [source] Never-ending making sense: towards a substantive theory of the information-seeking behaviour of newly diagnosed cancer patientsJOURNAL OF CLINICAL NURSING, Issue 11 2007Eilis McCaughan BSc Aim., The aim of this paper was to report a study which explored the information-seeking behaviour of patients newly diagnosed with cancer in the immediate postdiagnosis period. Background., Information is an important tool for cancer patients. There is evidence that patients' information needs are not being adequately met and, in many cases, patients often do not recall much information at the time of diagnosis. Method., Using a grounded theory approach, a theoretical sample of 27 newly diagnosed patients was interviewed in their own homes. Data were analysed using grounded theory analysis procedures. Results., A substantive theory describing the transitions from ,being traumatized' by the diagnosis, through a phase of trying to ,take it on', through to ,taking control' is tentatively offered. It provides a theoretical framework to understand newly diagnosed cancer patients' changing, varied and continuing needs and their efforts to regain some control over their lives. Their information-seeking behaviour seemed a journey of ,never-ending making sense' with ongoing discovery and new information needs as they struggled with the effects of the disease and treatments. Conclusions., The processes and stages identified in this study provide nurses with a framework to assess the readiness of patients to receive information and to assist them in their efforts to regain some control over their disease and their lives. Relevance to clinical practice., Health professionals need to be aware of these stages, to be equipped to assess the need of individuals for information and support. [source] Home care with regard to definition, care recipients, content and outcome: systematic literature reviewJOURNAL OF CLINICAL NURSING, Issue 6 2003Bibbi Thomé MSc Summary ,,In spite of the fact that home care has grown considerably during the last few years and will continue to grow even more in the future, home care as a phenomenon and a concept is not clearly defined. ,,The aim of this study was to review the empirical literature for the description of home care as a phenomenon and as a concept, especially with regard to who the care recipients are, what actions and assessments are performed and what effects are achieved for the care recipient in terms of functional health status and quality of life (QoL). ,,Twenty-six relevant studies meeting the inclusion criteria and requirements for methodological quality were identified. ,,The phenomenon of home care is described through content, outcome and objectives. The content of home care involved a range of activities from actions preventing decreased functional abilities in old people to palliative care in advanced diseases. ,,The outcome had two different underlying foci: (1) for the benefit of the patient based on the assumption that being cared at home increases their QoL, (2) in the interests of the society, to minimize hospital care by moving activities to the home of the patient. ,,The objectives were found to be aiming at improving the QoL and/or maintaining independence, by means of actions and assessments, based on the patient's needs, undertaken to preserve and increase functional ability and make it possible for the person to remain at home. ,,In conclusion, home care as a phenomenon was the care provided by professionals to people in their own homes with the ultimate goal of not only contributing to their life quality and functional health status, but also to replace hospital care with care in the home for societal reasons; home care covered a wide range of activities, from preventive visits to end-of-life care. [source] An evaluation of a domiciliary respite service for younger people with dementiaJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2002Kader Parahoo RMN BA(Hons) PhD Abstract Rationale, aims and objectives There is a lack of respite services designed specifically for younger people with dementia. There is also a dearth of studies on the evaluation of domiciliary respite services for carers of people with dementia in general. This paper reports on the evaluation of a domiciliary respite service for carers of younger people with dementia, in one area in Northern Ireland, provided by a local branch of the Alzheimer's Society. Methods Using a qualitative approach, eight carers and their families were interviewed in their own homes about their views and expectations of the service, the benefits and problems they experienced, and other issues of relevance to them. Results Overall, they reported great satisfaction with the service. The way they used, and benefited from, the service differed for individuals. Most of them, however, gained respite in the form of help with bathing and dressing the person with dementia. Carers reported that they did not engage in social or recreational activities during the period of respite. Instead they used the respite time to catch up with household chores and shopping. Discussion and conclusions The benefits and concerns can only be understood from the perspectives of carers and in the context of their needs, values, beliefs and traditions. The insight gained can be used to inform future provision of services for this population. [source] Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary careJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2002S. M. Madigan Abstract Aim To examine the nature of all contacts between adult tube-fed patients and the dietetic service and to refine the current dietetic protocols to reflect the findings of the study with a view to improving patient care. Methods All adult patients referred to the Community Nutrition and Dietetic Service within a 6-month period were included in the study. Using a proforma developed from a retrospective case-note analysis, data were collected on the complications that prompted more frequent contacts than the department protocol. Data were analysed using the Statistical Package for the Social Sciences. Results The most common indication for home enteral feeding in this group of adult patients was a swallowing disorder resulting from a cerebrovascular accident (59.5%) followed by cancer (21.5%). There was a trend for cancer patients to need more intervention compared with those patients with other medical conditions. A significant difference was observed in the total contacts and telephone calls given to those patients in there own homes (P=0.019) and there was a trend towards more domicilary visits with this group. Conclusions The department protocols have been revised to include a planned review within 2,6 weeks of initial dietetic assessment in the community for those patients who were identified to have the greatest need. More intensive dietetic monitoring has clear implications for dietetic services in the community. [source] Meal patterns and meal quality in patients with leg ulcersJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2000U. Wissing Background Wound healing is a complex process, which requires adequate energy sources, proteins, and specific minerals and vitamins. If an individual is unable to get or to eat the nutrients required, the wound healing process might be disrupted. The aim of this study was to investigate food-related factors, meal patterns and meal quality in relation to nutritional status in elderly out-patients with leg ulcers. Methods Nutritional status was assessed by use of the Mini Nutritional Assessment in 70 patients living in their own homes. Fifty-six of the patients recorded actual meals and snacks over four consecutive days. Meal patterns and meal quality were evaluated with the help of a qualitative classification system, the Food Based Concept for Classification of Eating Episodes. Results Thirty-six patients were classified as well-nourished, 32 were at risk of malnutrition and two were malnourished. More patients in the risk group for malnutrition did not buy their own food, and usually ate alone. Incomplete Meals and Low Quality Snacks were the most common eating types. The patients at risk of malnutrition had significantly fewer prepared Complete Meals than the well-nourished patients. Conclusion The results show a diet and meal quality which hardly meets the requirements for nutrients that are important in wound healing, especially for those patients assessed at risk of malnutrition. [source] Developing services for the carers of young adults with early-onset psychosis , listening to their experiences and needsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2005J. SIN msc bsc (hons)-thorn bn bgs rmn The care-giving experience of carers of young adults with early onset psychosis is relatively unexplored. New carers are less likely to be engaged with local services for carers and families, than those more established in their caring role. Understanding the experience of these carers provides some valuable insight into the value of caring and in guiding service development. This paper reports on a study designed to explore carers' experiences of caring for a young adult diagnosed with a first psychotic episode and their needs in relation to the development of an early intervention for psychosis service. A phenomenological approach was used. Eleven carers were given a semi-structured interview in their own homes. All of the carers in the study had a son with early onset psychosis. The outcome revealed that all carers were providing a comprehensive range of practical, emotional and financial support for their son including initiating and sustaining engagement between them and local mental health services. Many carers were felt to be invisible and silent partners in care and felt under-valued by mental health services. [source] Estimation of the day-specific probabilities of conception: current state of the knowledge and the relevance for epidemiological researchPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2006Courtney D. Lynch Summary Conception, as defined by the fertilisation of an ovum by a sperm, marks the beginning of human development. Currently, a biomarker of conception is not available; as conception occurs shortly after ovulation, the latter can be used as a proxy for the time of conception. In the absence of serial ultrasound examinations, ovulation cannot be readily visualised leaving researchers to rely on proxy measures of ovulation that are subject to error. The most commonly used proxy measures include: charting basal body temperature, monitoring cervical mucus, and measuring urinary metabolites of oestradiol and luteinising hormone. Establishing the timing of the ovulation and the fertile window has practical utility in that it will assist couples in appropriately timing intercourse to achieve or avoid pregnancy. Identifying the likely day of conception is clinically relevant because it has the potential to facilitate more accurate pregnancy dating, thereby reducing the iatrogenic risks associated with uncertain gestation. Using data from prospective studies of couples attempting to conceive, several researchers have developed models for estimating the day-specific probabilities of conception. Elucidating these will allow researchers to more accurately estimate the day of conception, thus spawning research initiatives that will expand our current limited knowledge about the effect of exposures at critical periconceptional windows. While basal body temperature charting and cervical mucus monitoring have been used with success in field-based studies for many years, recent advances in science and technology have made it possible for women to get instant feedback regarding their daily fertility status by monitoring urinary metabolites of reproductive hormones in the privacy of their own homes. Not only are innovations such as luteinising hormone test kits and digital fertility monitors likely to increase study compliance and participation rates, they provide valuable prospective data that can be used in epidemiological research. Although we have made great strides in estimating the timing and length of the fertile window, more work is needed to elucidate the day-specific probabilities of conception using proxy measures of ovulation that are inherently subject to error. Modelling approaches that incorporate the use of multiple markers of ovulation offer great promise to fill these important data gaps. [source] A survey of patients with self-reported severe food allergies in JapanPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 3 2008T. Imamura Food allergies have increased in recent years in Japan. Details of causative foods, places where anaphylaxis developed, and other allergic factors remain unknown, and we investigated them. A,questionnaire survey for the prevention of food allergies' was conducted using a nationwide group of patients with food allergies. A total of 1383 patients from 878 families (including 319 patients who experienced anaphylaxis) provided valid answers to the questionnaire. The average age of the first anaphylactic attack was 3.20 ± 6.327 yr. The most common allergens causing anaphylaxis were in order milk, eggs, wheat, peanuts, and soybeans, followed by sesame and buckwheat. The most common place where anaphylaxis developed was the patient's own home, followed by fast food restaurants, places visited, restaurants, and schools. In patients' own homes, fast food restaurants (buffet), places visited and schools, the most common allergens were milk, eggs, and wheat. In restaurants and accommodation facilities, eggs were the most common allergen followed by milk. As possible food allergies can cause anaphylaxis, it is necessary to provide precise information for consumers regarding packaged and processed foods. [source] Factors with independent influence on the ,timed up and go' test in patients with hip fracturePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2009Morten Tange Kristensen Abstract Background and Purpose.,Data on performance times for the ,timed up and go' (TUG) test with analyses of factors, that eventually could affect the result in patients with hip fracture, have not been published to date. The aims of the present study, therefore, were to assess normative reference values of TUG performances and determine the influence of individual and clinical factors on TUG-test scores in patients with hip fracture.,Method.,In this prospective, descriptive study, a total of 196 consecutive patients over the age of 60, and able to perform the TUG when discharged directly to their own homes from a specialized orthopaedic hip fracture unit, were evaluated. The association between TUG scores and categorical variables were examined, and linear regression was used to investigate the factors influencing performance times.,Results.,Univariate analysis showed significant differences between all categorical variables, except gender, but multivariate linear regression analyses showed that only a high pre-fracture function level, evaluated by the New Mobility Score (B = ,11), was independently associated with having a good TUG score, while older age (B = 0.49), having an intertrochanteric fracture (B = 7), performing TUG with a walker (B = 15), and performing TUG in the later postoperative period (B = 0.39) were independently associated with having a poorer TUG score.,Conclusions.,These preliminary normative reference values of TUG performances in patients with hip fracture can be used as references, to which individuals can expect to perform. Multivariate testing suggests that clinicians should use age, pre-fracture function, fracture type and walking-aid specific data when interpreting the TUG test results. Physiotherapists should be aware of this if TUG scores are to be used predictively or as an outcome measure in patients with hip fracture, especially in research. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Influence of Household Formation on Homeownership Rates Across Time and RaceREAL ESTATE ECONOMICS, Issue 4 2007Donald R. Haurin Homeownership rates equal the number of households that own homes divided by the number of households in the population. Differences in the propensity to form a household, therefore, may contribute to changes in homeownership rates over time in addition to long-standing racial gaps in homeownership. We examine these issues on an age-specific basis using data from the 1970 to 2000 public use microsamples of the decennial census. Results indicate that lower headship rates tend to reduce homeownership rates. This pattern is most notable for individuals in their early and mid 20s. For these individuals, declining headship rates between 1970 and 2000 reduced homeownership rates by three to five percentage points. Moreover, 2000 African American headship rates narrow white,black gaps in homeownership by roughly three percentage points, whereas 2000 Hispanic headship rates widen white,Hispanic gaps in homeownership by two to three percentage points. Thus, controlling for differences in headship behavior, white,black homeownership gaps are somewhat more severe than previously recognized, but the reverse is true for white,Hispanic gaps. [source] Children's participation in home, school and community life after acquired brain injuryAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2010Jane Galvin Aims:,This study aimed to describe participation at home, school and in the community of Australian children who had sustained an acquired brain injury (ABI). Parent ratings regarding the impact of cognitive, motor and behavioural impairments on participation were obtained. In addition, the influence of environmental factors on participation was investigated. Methodology:,This study used a cross-sectional design with convenience sampling to recruit 20 children who attended a rehabilitation review clinic between September 2006 and September 2007. Participants completed the Child and Family Follow-up Survey (Bedell, 2004) to describe the participation of their children in home, school and community settings. The CFFS was developed based on the International Classification of Function, and uses parent report to measure the impact of impairments and environmental factors on children's participation in home, school and community life. Results:,The children were reported to have the greatest participation restrictions for structured events in the community, and social, play or leisure activities with peers either at school or in the community. Children were least restricted moving about in and around their own homes. Conclusions:,This research describes difficulties encountered by Australian children with ABI in participating in community-based activities with their same aged peers. This study adds to the current literature describing patterns of participation of United States children who have sustained brain injuries, and provides useful information for Australian therapists to consider when addressing children's return to school and engagement with their peers following brain injury. [source] Where should people with dementia live?BRITISH JOURNAL OF LEARNING DISABILITIES, Issue 1 2008Using the views of service users to inform models of care Accessible summary We wanted to know what people with learning disabilities know about dementia. We asked service users what the word meant to them, if they knew anyone with dementia, and what it was like to share a house with someone who has dementia. We learnt that: ,Service users can know a lot about dementia. ,Living with someone with dementia can be really hard , and staff do not always, have enough time for everyone else. ,Services should think more about how dementia affects everyone , not just the person who has the dementia. Summary This paper reports on research that illuminates how people with a learning disability understand dementia and indicates the implications of these understandings for developing appropriate models of care. As this new policy and practice area struggles to provide appropriate and effective models of care for people with a learning disability and dementia, an awareness of service users' understandings of dementia leads to a number of important insights. The wider research programme from which this paper is drawn aims to identify best practice in supporting people with learning disabilities to stay in their own homes as they grow older and develop dementia. A combination of focus groups, ethnography and individual interviews were conducted at eight sites across England. Participants were people with a learning disability who had dementia, and those who have lived with someone with dementia. The findings have the potential to improve support to this population as they grow older. [source] | |||||||||||||||||||||||||||||||