Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

An investigation of the strategies used by organizations participating in the welfare-to-work network program and correlation of the strategies with the retention data to determine best practices for job retention among former welfare recipients

This ex post facto study (N = 209) examined the relationships between employer job strategies and job retention among organizations participating in Florida welfare-to-work network programs and associated the strategies with job retention data to determine best practices. ^ An internet-based self-report survey battery was administered to a heterogeneous sampling of organizations participating in the Florida welfare-to-work network program. Hypotheses were tested through correlational and hierarchical regression analytic procedures. The partial correlation results linked each of the job retention strategies to job retention. Wages, benefits, training and supervision, communication, job growth, work/life balance, fairness and respect were all significantly related to job retention. Hierarchical regression results indicated that the training and supervision variable was the best predictor of job retention in the regression equation. ^ The size of the organization was also a significant predictor of job retention. Large organizations reported higher job retention rates than small organizations. There was no statistical difference between the types of organizations (profit-making and non-profit) and job retention. The standardized betas ranged from to .26 to .41 in the regression equation. Twenty percent of the variance in job retention was explained by the combination of demographic and job retention strategy predictors, supporting the theoretical, empirical, and practical relevance of understanding the association between employer job strategies and job retention outcomes. Implications for adult education and human resource development theory, research, and practice are highlighted as possible strategic leverage points for creating conditions that facilitate the development of job strategies as a means for improving former welfare workers’ job retention.^

Review of the History and Current Status of Cell-Transplant Approaches for the Management of Neuropathic Pain

Treatment of sensory neuropathies, whether inherited or caused by trauma, the progress of diabetes, or other disease states, are among the most difficult problems in modern clinical practice. Cell therapy to release antinociceptive agents near the injured spinal cord would be the logical next step in the development of treatment modalities. But few clinical trials, especially for chronic pain, have tested the transplant of cells or a cell line to treat human disease. The history of the research and development of useful cell-transplant-based approaches offers an understanding of the advantages and problems associated with these technologies, but as an adjuvant or replacement for current pharmacological treatments, cell therapy is a likely near future clinical tool for improved health care.

Potential for Cell-Transplant Therapy with Human Neuronal Precursors to Treat Neuropathic Pain in Models of PNS and CNS Injury: Comparison of hNT2.17 and hNT2.19 Cell Lines

Effective treatment of sensory neuropathies in peripheral neuropathies and spinal cord injury (SCI) is one of the most difficult problems in modern clinical practice. Cell therapy to release antinociceptive agents near the injured spinal cord is a logical next step in the development of treatment modalities. But few clinical trials, especially for chronic pain, have tested the potential of transplant of cells to treat chronic pain. Cell lines derived from the human neuronal NT2 cell line parentage, the hNT2.17 and hNT2.19 lines, which synthesize and release the neurotransmitters gamma-aminobutyric acid (GABA) and serotonin (5HT), respectively, have been used to evaluate the potential of cell-based release of antinociceptive agents near the lumbar dorsal (horn) spinal sensory cell centers to relieve neuropathic pain after PNS (partial nerve and diabetes-related injury) and CNS (spinal cord injury) damage in rat models. Both cell lines transplants potently and permanently reverse behavioral hypersensitivity without inducing tumors or other complications after grafting. Functioning as cellular minipumps for antinociception, human neuronal precursors, like these NT2-derived cell lines, would likely provide a useful adjuvant or replacement for current pharmacological treatments for neuropathic pain.

A study of indicators discriminating between the recipients and non -recipients of the International Baccalaureate Diploma

This study examined relationships among variables in the Pre-International Baccalaureate (Pre-IB) Program admissions criteria and the Pre-IB Program course grades to discriminate between recipient and non recipient groups of the International Baccalaureate (IB) Diploma award. The study involved a multiracial sample of 142 IB Diploma graduates between the years 1992 and 1996 from one IB magnet school. The IB school is located within an urban high school of a predominantly Black student enrollment. A discriminant function analysis found that the highest correlations between predictors and the discriminant function were 9th- and 10th-grade mathematics and 10th-grade science course grades. Ninth-grade course grades of science, 9th-grade and 10th-grade course grades of English, foreign language, and social studies, and 7th-grade Iowa Tests of Basic Skills (ITBS) Reading Comprehension scores were also highly correlated to the discriminant function. The ITBS Battery and subscores of Vocabulary, Total Language, Total Work-Study, and Total Mathematics subscores in seventh grade and a grade point average from language arts, social studies, science, and mathematics in seventh grade were not highly correlated to the discriminant function. Recommendations were presented in the areas of curriculum and instruction, guidance services, student mentoring, and decision-making processes which would parallel the IB examination procedure and thereby enhance the alignment of the IB Program enabling more students to become recipients of the IB Diploma award. ^