[Experiences of patients and family members during the stay on a nursing unit]

In 2004, the university hospital of Berne ran a pilot project with a Nursing Unit (NU). In this unit patients who no longer needed a close surveillance by physicians were cared for. They needed primarily complex professional nursing care which could not be provided by other hospitals, nursing homes, home care or family members. The nurses were responsible for the coordination of care. This qualitative study investigated experiences of patients and family members with the care concept of the NU. Thematically focused interviews were conducted with nine patients and five family members. Qualitative content analysis was used for data analysis. Results show that patients and family members mostly accepted the new care concept. They positively experienced the quiet and restful atmosphere, the patient-centred and continuous care by competent nurses, the education and the discharge planning. Some study participants reported missing information at the time of their transfer to the NU, insufficient assessments or unsuitable educational scripts. The study provides evidence to positive effects of a patient-centred care approach.

Increased Framingham Coronary Heart Disease Risk Score in dementia caregivers relative to non-caregiving controls

BACKGROUND: Elderly individuals who provide care to a spouse suffering from dementia bear an increased risk of coronary heart disease (CHD). OBJECTIVE: To test the hypothesis that the Framingham CHD Risk Score would be higher in dementia caregivers relative to non-caregiving controls. METHODS: We investigated 64 caregivers providing in-home care for their spouse with Alzheimer's disease and 41 gender-matched non-caregiving controls. All subjects (mean age 70 +/- 8 years, 75% women, 93% Caucasian) had a negative history of CHD and cerebrovascular disease. The original Framingham CHD Risk Score was computed adding up categorical scores for age, blood lipids, blood pressure, diabetes, and smoking with adjustment made for sex. RESULTS: The average CHD risk score was higher in caregivers than in controls even when co-varying for socioeconomic status, health habits, medication, and psychological distress (8.0 +/- 2.9 vs. 6.3 +/- 3.0 points, p = 0.013). The difference showed a medium effect size (Cohen's d = 0.57). A relatively higher blood pressure in caregivers than in controls made the greatest contribution to this difference. The probability (area under the receiver operator curve) that a randomly selected caregiver had a greater CHD risk score than a randomly selected non-caregiver was 65.5%. CONCLUSIONS: Based on the Framingham CHD Risk Score, the potential to develop overt CHD in the following 10 years was predicted to be greater in dementia caregivers than in non-caregiving controls. The magnitude of the difference in the CHD risk between caregivers and controls appears to be clinically relevant. Clinicians may want to monitor caregiving status as a routine part of standard evaluation of their elderly patients' cardiovascular risk.

Persistent versus transient depressive symptoms in relation to platelet hyperactivation: a longitudinal analysis of dementia caregivers

BACKGROUND: Depressive symptoms and caregiving stress may contribute to cardiovascular disease (CVD) via chronic platelet activation; however, it remains unclear whether this elevated activation constitutes a trait or state marker. The primary objective was to investigate whether persistent depressive symptoms would relate to elevated platelet activation in response to acute psychological stress over a three-year period. METHODS: Depressive symptoms (Brief Symptom Inventory) were assessed among 99 spousal dementia caregivers (52-88 years). Platelet P-selectin expression was assessed in vivo using flow cytometry at three time-points over the course of an acute stress test: baseline, post-stress, and after 14 min of recovery. Two competing structural analytic models of depressive symptoms and platelet hyperactivity with three yearly assessments were compared. RESULTS: Although depressive symptoms were generally in the subclinical range, their persistent elevation was associated with heightened platelet reactivity and recovery at all three-years while the change in depressive symptoms from the previous year did not predict platelet activity. LIMITATIONS: These results focus on caregivers providing consistent home care, while future studies may extend these results by modeling major caregiving stressors. CONCLUSIONS: Enduring aspects of negative affect, even among those not suffering from clinical depression are related to hemostatic changes, in this case platelet reactivity, which might be one mechanism for previously reported increase in CVD risk among elderly Alzheimer caregivers.

Telemedicine Distance Mentoring of Healthcare Students

The healthcare system is facing a challenge similar to other industries in maintaining an adequately trained home care workforce in a time when government funding for educational geriatrics programs is limited, and academic centers are emphasizing faculty productivity that may limit their time dedicated to teaching and training healthcare students. [See PDF for complete abstract]

Evaluation of the LBJ Hospital Ask Your Nurse Advice Line

This retrospective, case-control study investigated the effectiveness of the Houston, Texas Ask Your Nurse Advice Line (AYN) in diverting callers with non-emergent medical conditions away from the emergency department (ED). After asking callers a series of questions, AYN nurses evaluate the medical condition and make recommendations for appropriate care, e.g., home care, see a clinic physician, or visit the ED. To evaluate the AYN, the rate of caller ED visits before accessing the AYN for the first time was compared to the caller ED visit rate afterwards. The pre-post rate change was compared to that of a control group of similar caller age, race, gender, and insurance status drawn from a Harris County Hospital District HCHD database. ^ The treatment group (AYN caller) had a 66% reduction in ED visits after the first AYN call compared to an 18% drop in ED visits among control group subjects during the same time period. Study results were presented to HCHD staff on August 30th, 2007 and recommendations were made for future studies that would provide a basis for policy development. ^

Effective interventions for lowering HbA1C in African Americans with type 2 diabetes: A review

This synthesis of the literature provides descriptive analysis and outlines current self-management interventions for African Americans with type 2 diabetes. Specifically, this study describes and explores the design of those studies whose interventions have been shown to lower HbA1C levels in this population by at least 0.5% points, an improvement that provides approximately 10% reduction in long term complications from this disease.^ Results. In total, 37 articles were reviewed and 17 articles met inclusion criteria for analysis. Analysis of each study's methodology and results was performed and selected studies with interventions that resulted in improvements in HbA1C outcomes equal to 0.5% or greater for both group 1 and 2 were summarized by intervention type in table format. Descriptive analysis, outlining the number and characteristics of proximal and distal mediating components addressed in Group 1 studies, was performed in order to determine whether mediating components may have had some relation to effectiveness of intervention on outcome HbA1C. Descriptive analysis revealed that no particular design is substantially more effective than another among Behavioral studies although, there may be an advantage in using culturally sensitive, group interventions that address greater numbers of distal mediating components. Among Process studies, structured approaches (i.e. algorithm care and scheduled follow up), as well as utilization of specialty and group care are represented as effective for African American populations. ^ Conclusions. It may be summarized that by targeting behavior and addressing provider delivery (i.e. algorithm use, group care, home care, and provider follow up) in this population, a greater yield in outcome improvements may be accomplished. However, many gaps exist in a review process that stratifies results and focuses on identifying group specific intervention successes and failures. Further research in different populations will aid researchers and practitioners in discovering the best evidence, and identifying models that could be utilized in practice to achieve the best diabetes management for at risk groups.^

Social support, health status and health services utilization among the noninstitutionalized elderly: An analysis of the Supplement on Aging to the 1984 national health interview survey

The association between Social Support, Health Status, and Health Services Utilization of the elderly, was explored based on the analysis of data from the Supplement on Aging to the National Health Interview Survey, 1984 (N = 11,497) using a modified framework of Aday and Andersen's Expanded Behavioral Model. The results suggested that Social Support as operationalized in this study was an independent determinant of the use of health services. The quantity of social activities and the use of community services were the two most consistent determinants across different types of health services use.^ The effects of social support on the use of health services were broken down into three components to facilitate explanations of the mechanisms through which social support operated. The Predisposing and Enabling component of Social Support had independent, although not uniform, effects on the use of health services. Only slight substitute effects of social support were detected. These included the substitution of the use of senior centers for longer stay in the hospital and the substitution of help with IADL problems for the use of formal home care services.^ The effect of financial support on the use of health services was found to be different for middle and low income populations. This differential effect was also found for the presence of intimate networks, the frequencies of interaction with children and the perceived availability of support among urban/rural, male/female and white/non-white subgroups.^ The study also suggested that the selection of appropriate Health Status measures should be based on the type of Health Services Utilization in which a researcher is interested. The level of physical function limitation and role activity limitation were the two most consistent predictors of the volume of physician visits, number of hospital days, and average length of stay in the hospital during the past year.^ Some alternative hypotheses were also raised and evaluated, when possible. The impacts of the complex sample design, the reliability and validity of the measures and other limitations of this analysis were also discussed. Finally, a revised framework was proposed and discussed based on the analysis. Some policy implications and suggestions for future study were also presented. ^

Learning What Works: Demonstrating Practice Effectiveness with Children and Families Through Retrospective Investigation

Intensive family preservation services (IFPS), designed to stabilize at-risk families and avert out-of-home care, have been the focus of many randomized, experimental studies. Employing a retrospective “clinical data-mining” (CDM) methodology (Epstein, 2001), this study makes use of available information extracted from client records in one IFPS agency over the course of two years. The primary goal of this descriptive and associational study was to gain a clearer understanding of IFPS service delivery and effectiveness. Interventions provided to families are delineated and assessed for their impact on improved family functioning, their impact on the reduction of family violence, as well as placement prevention. Findings confirm the use of a wide range of services consistent with IFPS program theory. Because the study employs a quasi-experimental, retrospective use of available information, clinical outcomes described cannot be causally attributed to interventions employed as with randomized controlled trials. With regard to service outcomes, findings suggest that family education, empowerment services and advocacy are most influential in placement prevention and in ameliorating unmanageable behaviors in children as well as the incidence of family violence.

Looking Inside The Black Box

Intensive family preservation services (IFPS), designed to stabilize at-risk families and avert out-of-home care, have been the focus of many randomized, experimental studies. The emphasis on "gold-standard" evaluation of IFPS has resulted in fewer "black box" studies that describe actual IFPS service patterns and the fidelity with which they adhere to IFPS program theory. Intervention research is important to the advancement of programs designed to protect the safety of children, improve family functioning, as well as prevent out-of-home placement. Employing a retrospective “clinical data-mining” (CDM) methodology, this exploratory study of Families First, an IFPS program, makes use of available information extracted from client records to describe interventions and service patterns provided over a two year period. This study uncovers actual IFPS service patterns, demonstrates IFPS program fidelity, as well as reveals the usefulness of CDM as a social work research methodology. These findings are particularly valuable for program planning and treatment, policy development and evidence-based practice research.

Are Intensive Family Preservation Services Useful?: A Study in the United Kingdom

This evaluation of the first year of an Intensive Family Preservation Service in England is based on the analysis of eighty-six families: fifty-seven families who received the service and a comparison group of twenty-nine families who did not. The study considered whether the program was fulfilling its objectives of reducing the number of children and young people in the public care system; offering a safe, supportive service for children who need protection; integrating the program into family support services as a whole, and improving family functioning. The findings were complex to interpret. Child protection was improved but there was not a reduction in the number of children needing out of home care (indeed there was an increase) meaning that short term savings in costs could not be made. Nor were there lasting improvements in the children’s behavior. There were instead a number of more subtle, arguably more sensitive outcomes: parents’ capacity to tolerate their child’s behavior was greater and overall family functioning was better for most families who received the service. Also families were, on the whole, able to make better use of follow up services.

Promoting Family Continuity - Perspectives from Italy

In this essay I review a recent research study from Italy, “Le Radici nel Futuro – La Continuita’ della Relazione Genitoriale oltre la Crisi Familiare,” edited by Paola Dallanegra (2005). The contributors focus on “Spazio Neutro,” a multi-purpose child welfare agency in southern Italy that facilitates parent-child visiting and relationships between children placed in out-of-home care and their families. They delineate and illustrate, through comments from family members, selected principles and strategies for maintaining such continuity throughout the out-of-home placement.

Smart Spaces and Smart Objects interoperability Architecture (S3OiA)

The presented work aims to contribute towards the standardization and the interoperability off the Future Internet through an open and scalable architecture design. We present S³OiA as a syntactic/semantic Service-Oriented Architecture that allows the integration of any type of object or device, not mattering their nature, on the Internet of Things. Moreover, the architecture makes possible the use of underlying heterogeneous resources as a substrate for the automatic composition of complex applications through a semantic Triple Space paradigm. Created applications are dynamic and adaptive since they are able to evolve depending on the context where they are executed. The validation scenario of this architecture encompasses areas which are prone to involve human beings in order to promote personal autonomy, such as home-care automation environments and Ambient Assisted Living.

MULHERES IDEAIS: UMA ANÁLISE DO PROCESSO DE CONSTRUÇÃO E DE MANUTENÇÃO DAS REPRESENTAÇÕES SOCIAIS DAS ESPOSAS DE PASTORES BATISTAS DE CURITIBA, PR.

Entre instituições e atividades ligadas à igreja como reuniões de oração, cultos, ensaios de corais, ministério infantil, casa, filhos, vida conjugal, etc. está presente uma figura ainda não estudada pelas Ciências da Religião, a da esposa do pastor batista. O objetivo principal desta pesquisa foi o de analisar o processo de construção e de manutenção das representações sociais dessas mulheres. Para isso, no primeiro capítulo identificamos e analisamos as representações de gênero presentes na estrutura e no cotidiano eclesiástico da denominação e seus reflexos na elaboração e na conservação do perfil das esposas de pastores. No segundo capítulo realizamos uma análise do poder e do papel das instituições de formação teológica e ministerial da denominação batista como formas de idealização, de construção e de manutenção das representações sociais das esposas de pastores. Investigamos no terceiro capítulo as formas do trânsito das esposas de pastores entre os espaços públicos e privados - imbricados um no outro, e as formas em que o poder institucional atua nestes lugares. Para este fim, utilizamos o método etnográfico, observando as igrejas batistas selecionadas, aplicando questionários aos membros das igrejas, líderes institucionais e estudantes da Faculdade Teológica Batista do Paraná FTBP e realizando entrevistas semi-estruturadas com os pastores e suas esposas. As teorias das Ciências da Religião e Sociais nos proporcionaram o suporte teórico necessário para o desenvolvimento do texto e para a análise dos dados empíricos. (AU)

MULHERES IDEAIS: UMA ANÁLISE DO PROCESSO DE CONSTRUÇÃO E DE MANUTENÇÃO DAS REPRESENTAÇÕES SOCIAIS DAS ESPOSAS DE PASTORES BATISTAS DE CURITIBA, PR.

Entre instituições e atividades ligadas à igreja como reuniões de oração, cultos, ensaios de corais, ministério infantil, casa, filhos, vida conjugal, etc. está presente uma figura ainda não estudada pelas Ciências da Religião, a da esposa do pastor batista. O objetivo principal desta pesquisa foi o de analisar o processo de construção e de manutenção das representações sociais dessas mulheres. Para isso, no primeiro capítulo identificamos e analisamos as representações de gênero presentes na estrutura e no cotidiano eclesiástico da denominação e seus reflexos na elaboração e na conservação do perfil das esposas de pastores. No segundo capítulo realizamos uma análise do poder e do papel das instituições de formação teológica e ministerial da denominação batista como formas de idealização, de construção e de manutenção das representações sociais das esposas de pastores. Investigamos no terceiro capítulo as formas do trânsito das esposas de pastores entre os espaços públicos e privados - imbricados um no outro, e as formas em que o poder institucional atua nestes lugares. Para este fim, utilizamos o método etnográfico, observando as igrejas batistas selecionadas, aplicando questionários aos membros das igrejas, líderes institucionais e estudantes da Faculdade Teológica Batista do Paraná FTBP e realizando entrevistas semi-estruturadas com os pastores e suas esposas. As teorias das Ciências da Religião e Sociais nos proporcionaram o suporte teórico necessário para o desenvolvimento do texto e para a análise dos dados empíricos. (AU)

A (R)EXISTÊNCIA DAS VOCACIONADAS AO MINISTÉRIO PASTORAL BATISTA: DESCORTINANDO A RELAÇÃO ENTRE AS PASTORAS BATISTAS DE SÃO PAULO E A NÃO FILIAÇÃO NA ORDEM DOS PASTORES BATISTAS DO BRASIL EM SÃO PAULO (OPBB-SP)

O contexto batista é predominantemente marcado por lideranças masculinas, destinando às mulheres apenas lugares e comportamentos socialmente estabelecidos, como a casa, o cuidado, a maternidade, a submissão, entre outras características que enfatizam a hierarquia de gênero. Mesmo diante do desenvolvimento econômico e da ocupação que as mulheres estão conquistando no campo público, a igreja e principalmente as igrejas batistas, permanecem fundadas em alicerces que exaltam o poder masculino em detrimento do lugar que deve ser ocupado pelas mulheres, ou seja, onde elas decidirem atuar. Caso elas decidam atuar num campo predominantemente masculino, terão que lidar com a desconstrução de um pensamento socialmente permeado de dominação masculina e com a árdua construção de um pensamento que vise a igualdade de gênero. O objeto desta pesquisa é o ministério pastoral feminino no contexto batista brasileiro. O texto analisa o discurso das Pastoras Batistas do Estado de São Paulo e o discurso dos líderes da Ordem dos Pastores Batistas de São Paulo (OPBB-SP) a respeito do ministério pastoral feminino e a não filiação de mulheres na OPBB-SP. A importância deste trabalho é a de demostrar as relações de micro poder existentes entre pastores e pastoras e concomitantemente as desigualdades dentro do contexto batista com relação ao ministério pastoral feminino. Essa afirmação se consolida por meio das análises das entrevistas semiestruturadas que realizei na pesquisa de campo, com sete pastoras batistas do Estado de São Paulo, bem como com três líderes da OPPB-SP. Esta é uma pesquisa qualitativa, em que foram analisados documentos oficiais da igreja, como pautas de convenções, atas, sites institucionais, periódicos e documentos não oficiais encontrados em redes sociais, blogs, jornais online, entre outros. Posso afirmar que as pastoras batistas estão se mobilizando para cumprir sua vocação, usando argumentos transcendentes que impedem qualquer pessoa de desafiar ou duvidar de seu chamado pastoral, pois: “O vento sopra onde quer; ouve-se o ruído, mas não sabes de onde vem, nem para onde vai. Assim acontece com aquele(a) que nasceu do Espírito.” (João 3.8).