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Selected Abstracts,We didn't know it would get that bad': South Asian experiences of dementia and the service responseHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2003Alison Bowes BA PhD Abstract The aim of the present paper was to examine some views and experiences of dementia among older South Asian people, as well as their families and carers, and to explore central issues of service support. Data were collected in Scotland through interviews with 11 professionals working with South Asian people with dementia, and four case studies of South Asian people with a diagnosis of dementia, as well as their families and carers. The case studies demonstrated overwhelmingly negative experiences of dementia, with poor quality of life, desperate needs for support, lack of access to appropriate services, little knowledge of dementia, and isolation from community and family life. The interviews with professionals described a strong demand for services, a need to develop awareness and knowledge about dementia in South Asian communities, and a need to promote more culturally sensitive, individually responsive services. Similarities between South Asian people and the non-South Asian population include stress on carers, increasing isolation, problematic diagnostic practices, lack of knowledge and demand for service support. Differences include limited use of non-National Health Service (NHS) support, dealing with later stages of dementia at home, particularly negative views about residential care, culturally based attitudinal differences and use of the term ,dementia' in English as neutral rather than stigmatising. The present authors suggest that there is little knowledge and experience of dementia in South Asian communities, as well as restricted access to appropriate services, despite the efforts of voluntary sector and NHS special projects. There is demand for services, especially at home. Services need to develop individual responsiveness for effective working in a diverse society. [source] Shift in the burden of cancer towards older people , a retrospective population-based studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2007S. Ahmad Summary Cancer is age-related. However, oncology and palliative medicine services focus on the needs of younger and middle-aged adults. This study examined trends in cancer deaths across age in Wales over the last 20 years. All Wales death certificates from 1981 to 2001 were examined for total and cancer deaths. Place of death and age were noted. Total deaths decreased from 35 015 in 1981 to 32 966 in 2001 while cancer deaths increased from 7369 (21.1% of all deaths) to 8292 (25.2%). Deaths due to cancer increased in the over 85 years from 9.1% to 13.1%, 75,84 years (17.1,25.2%), 65,74 years (25,35.7%), 45,64 years (33.5,40.4%) and fell from 18.3% to 16.1% in those under 44 years. Cancer deaths over 75 years increased from 33.6% of cancer deaths in 1981 to 50.1% in 2001. Cancer deaths in the community decreased from 2713 in 1981 to 2153 in 2001 and increased in hospital from 4398 to 5185 and care homes from 258 to 954. The increase in hospital cancer deaths is mainly because of 75,84 year olds (1207,1840), and the over 85 years (294,740). Half of all cancer deaths are now in those over 75 years. Cancer deaths have shifted from the community to hospital and care homes mainly because of cancer in older people. Services need to be developed to target this population. [source] Reported Barriers to the Implementation of Person-Centred Planning for People with Intellectual Disabilities in the UKJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2007Janet Robertson Background, Research in the US and UK has demonstrated the effectiveness of person-centred planning (PCP) for people with intellectual disabilities. However, it is important to acknowledge problems that arise when implementing PCP. This paper considers barriers to PCP reported during a longitudinal study of the impact of PCP. Methods, Person-centred planning was introduced over a 2-year period for 93 people of whom 65 had a plan developed. Information was collected regarding barriers to PCP every 3 months from key informants using self-completion questionnaires. Results, Barriers to PCP were widespread particularly in relation to: availability of trained facilitators; availability of services; lack of time and reluctance of people other than paid support staff to engage in the PCP process. Conclusions, Services need to be aware of potential barriers to PCP so that strategies can be developed to overcome them, the first of which should be the ongoing training and support of facilitators. [source] Mental health services for people with intellectual disability: challenges to care deliveryBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 2 2009Eddie Chaplin Accessible summary ,,This paper looks at how care is given to people with intellectual disability who have mental health problems. ,,The paper looks at care since Valuing People came out in 2001. ,,It shows there are not enough services for people with intellectual disability who have mental health problems. ,,It shows there are not enough services for people who have autism and mental health problems. ,,Lots of people feel that mainstream mental health services are not good enough for people with intellectual disability. Lots of people feel mainstream services could be better. ,,The paper looks at how people can get help and support in their local area and not having to move away to get help. ,,The paper looks at what services might be needed in the future. What can be done to make services better? ,,The people who pay for services are called commissioners. They should think about how they can make local services better for with intellectual disability and mental health problems. ,,Commissioners should work more together with those who support people with intellectual disability to improve services. ,,People with intellectual disability should be happy with the services they have in their local places. ,,Services need to remember that people change as they get older. ,,Services need to remember that what people want. This can change when they get older. Summary The commissioning and provision of mental health services for people with intellectual disability is often complex and characterised by different service delivery models. This paper looks at the current situation 7 years after the White Paper, Valuing People (From words into action: London learning disabilities strategic framework, Department of Health, London), within the context of the National Service Framework for Mental Health (Establishing responsible commissioner; draft guidance. HSC draft, Department of Health, London). It sets out to illustrate problems faced in providing local services in the United Kingdom for those with intellectual disability and other neurodevelopmental disorders. This paper proposes new ways of working and introduces the concept of a neurodevelopmental model designed to address gaps and inequalities within services by offering solutions that embrace joint working. [source] ,You can't go without a fag . . . you need it for your hash',a qualitative exploration of smoking, cannabis and young peopleADDICTION, Issue 1 2004Amanda Amos ABSTRACT Aims To examine the relationship between smoking tobacco and cannabis use among smokers in their mid-to-late teens. Design and participants Two qualitative studies in Scotland. One study used semistructured paired interviews involving 99 16,19-year-old smokers, the other comprised eight focus groups involving 46 15,16-year-old smokers. Measurement The interviews and focus groups explored the role and meaning of smoking in the participants' lives, smoking histories and future cessation intentions and how these related to other aspects of their lives, particularly cannabis use. Findings Cannabis use was regarded as an important and enjoyable aspect of many of the participants' lives. Importantly, cannabis use and cigarette smoking were linked inextricably. Several reported how smoking joints had been a ,gateway' to smoking cigarettes. While most wanted to quit smoking cigarettes, cannabis use reinforced their cigarette smoking and few wanted to stop using cannabis. Conclusion National studies need to be conducted to examine how widespread the problem identified is and tobacco control initiatives and smoking cessation treatment services need to consider urgently how to overcome the barrier that a desire on the part of young people to continue cannabis smoking poses to achieving a reduction in tobacco use. [source] Developing an assessment tool for evaluating community involvementHEALTH EXPECTATIONS, Issue 1 2005Jane South BA RGN MA Abstract Background, Current UK policy has resulted in greater requirements for public and patient participation in health service planning and decision making. Organizations and services need to be able to monitor and evaluate the effectiveness and quality of their community involvement processes, but there are few appropriate evaluation tools or sets of indicators available. This paper reports on work within Bradford Health Action Zone to develop a self-assessment tool for organizations on community involvement. Methods, A multi-agency working group developed the tool. A literature search was undertaken and evaluation resources were reviewed. A set of benchmarks for community involvement in regeneration was utilized in developing the assessment areas. A range of individuals with expertise on community involvement practice and performance management was consulted. The tool was then piloted in two primary care trusts prior to final modifications. Results, The process resulted in the production of Well Connected , a self-assessment tool on community involvement designed for organizations to assess their progress and identify areas for improvement. A scoring system assesses evidence of a strategic approach to community involvement, good practice throughout the organization, and a range of opportunities and support. Feedback from the pilots revealed that the tool had facilitated assessment of the strengths and weaknesses of organizational practices. Conclusion, The paper discusses some of the methodological challenges pertaining to the measurement of community involvement. Notwithstanding those challenges, it is argued that Well Connected provides a robust and practical framework that health organizations and their partners can use to assess practice. [source] Public Health Nurses and the delivery of quality nursing care in the communityJOURNAL OF CLINICAL NURSING, Issue 10 2008DipHE, Trish Markham MSc (Hons) Aim., The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. Background., Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. Method., A qualitative method using semi-structured interviews were conducted. Interviews were taped and content analysed. Findings., Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence-based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. Conclusion., Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. Relevance to clinical practice., This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence-based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment. [source] Outsourcing Oversight: A Comparison of Monitoring for In-House and Contracted ServicesPUBLIC ADMINISTRATION REVIEW, Issue 3 2007Mary K. Marvel The public sector contracting literature has long argued that outsourced services need to be and, in fact, are subject to a more elevated level of scrutiny compared to internally delivered services. Recently, the performance measurement and management literature has suggested that the twin themes of accountability and results have altered the management landscape at all levels of government. By focusing on performance monitoring, the implication is that monitoring levels for internally provided services should more closely approximate those for contracted services. The analysis provided here yields empirical comparisons of how governments monitor the same service provided in-house and contracted out. We find evidence that services provided internally by a government's own employees are indeed monitored intensively by the contracting government, with levels of monitoring nearly as high as those for services contracted out to for-profit providers. In contrast, however, we find strong evidence that performance monitoring by the contracting government does not extend to nonprofit and other governmental service providers, each of which is monitored much less intensively than when comparable services are provided internally. For such service providers, it appears that monitoring is either outsourced along with services, or simply reduced. [source] The urban and rural divide for women giving birth in NSW, 1990,1997AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2000Christine L. Roberts ABSTRACT OBJECTIVE: To examine trends in the pregnancy profile and outcomes of urban and rural women. METHODS: Data were obtained from the NSW Midwives Data Collection on births in NSW, 1990,1997. Associations between place of residence (urban/rural) and maternal factors and pregnancy outcomes were examined, including changes over time. RESULTS: From 1990 to 1997 there were 685,631 confinements in NSW and these mothers resided as follows: 76% metropolitan, 5% large rural centres, 8% small rural centres, 11% other rural areas and 1% remote areas. Rural mothers were more likely to be teenagers, multiparous, without a married or de facto partner, public patients and smokers. Births in rural areas declined, particularly among women aged 20,34 years. Infants born to mothers in remote communities were at increased odds of stillbirth and tow Apgar scores (all women) and small,for,gestational,age (SGA) (Indigenous women only). CONCLUSIONS: The profile of pregnant women in rural NSW is different from their urban counterparts and is consistent with relative socioeconomic disadvantage and possibly suboptimal maternity services in some areas. While increased risk of SGA is associated with environmental factors such as smoking and nutrition, the reasons for increased risk of stillbirth are unclear. Although there does not appear to be an increased risk of preterm birth for rural women this may be masked by transfer of high,risk pregnancies interstate. IMPLICATIONS: Maternity services need to be available and accessible to all rural women with targeting of interventions known to reduce low birthweight and perinatal death. [source] Public IP network infrastructure evolutions to support emerging digital video servicesBELL LABS TECHNICAL JOURNAL, Issue 2 2009Marc Verhoeyen Of all the services offered over a worldwide public network, digital video-based services, even at this early stage of development, are growing at such an astonishing rate that they will soon constitute the largest portion of Internet traffic. We are witnessing this today with the Internet television (TV) phenomenon, with YouTube, Netflix's online offering, and BBC's iPlayer serving as prominent examples. To optimize video-dominated networks with respect to the required transport capacity (and also to reduce the response time the end user experiences), these services need to be supported by new networking capabilities. Caching in conjunction with specific unicast and multicast techniques for ingress and egress traffic can achieve this goal. In this paper we discuss how, explicitly by using cache cooperation techniques, we can deal with heterogeneous content preferences among end users. The paper shows simulation results and discusses relevant parameters with respect to the Internet TV use cases mentioned. Finally, it provides an outlook on the longer term and demonstrates that investment in these new capabilities is future-safe. © 2009 Alcatel-Lucent. [source] | |||||||||||||||||||