Heart failure management programmes in Europe

Background The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. Method A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Results Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Conclusion Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

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)

STRESS E REAJUSTAMENTO SOCIAL EM AUXILIARES DE ENFERMAGEM

O presente estudo teve por objetivos, levantar o perfil sócio-demográfico e cultural, de auxiliares de enfermagem, avaliar o grau e presença de sintomas de stress, avaliar e descrever reajustamento social tecendo relação entre variáveis relacionadas ao labor e o stress. Participaram desse estudo 126 auxiliares de enfermagem que cursavam técnico em enfermagem. Utilizou-se os instrumentos: a) questionário Sócio-demográfico e cultural; b) Escala de Reajustamento Social de Holmes-Rahe e c) Inventário de Sintomas de Stress de Lipp (ISSL). Os dados foram coletados em salas de aula, de três escolas técnicas da grande São Paulo e esses dados foram tratados estatisticamente pelos testes X² e r Person para as relações entre variáveis, com auxílio do programa SPSS versão 17. Os resultados indicaram uma predominância de pessoas do gênero feminino, casados, com idade mínima de 19 anos e máxima de 56 anos e com práticas religiosas católicas e evangélicas. Desses profissionais (79%) trabalhavam em um só emprego, com experiência na profissão de cinco anos e o setor com maior quantidade de profissionais foi o home care . A maioria dos profissionais exercia suas atividades no horário matutino, e estudava no horário noturno. O estudo indicou que 57,9% apresentaram grau de stress significativo. Dentro deste grau de stress significativo, 41,3% dos profissionais estavam na fase de resistência e 37,3% dos auxiliares com grau de stress significativo, apresentavam predominância de stress de natureza psicológica. Quanto ao reajustamento social, os auxiliares de enfermagem a maioria, que correspondia a 48,4% estava dentro da média, com chances razoáveis de adoecer, ou seja, apresentavam capacidade regular para adaptação aos eventos novos e desconhecidos que ocorrem durante a vida. Os resultados indicaram que os profissionais que apresentaram stress significativo obtiveram pontuação maior (média) na escala de reajustamento social, em comparação aos profissionais que não apresentaram stress, indicando que esses sujeitos tinham maior probabilidade de estarem adoecidos ou virem a adoecer.

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).

Influences on general practitioner prescribing with particular reference to community pharmacy

Influences on general practitioner prescribing of drugs continue to be of interest and importance as cost containment becomes central to Government health policy. This thesis employs a plurality of research methods including quantitative and qualitative survey techniques for example, questionnaires, interviews and prescription analyses to investigate some of the factors which may influence GP prescribing such as information sources, hospital consultants and in particular the community pharmacist. When the use and influence of drug information sources by GPs was examined, the community pharmacist was given a relatively low rating as a source but a high rating, similar to that of the consultant, for helpfulness. Influences are needed to improve prescribing and reduce the incidence of iatrogenic disease for the benefit of the patient. The education and expertise of pharmacists and their familiarity with local prescribing habits places them in a unique position to meet the needs of local GPs. As 96.5% of the public always or nearly always take their prescriptions to the same pharmacy, patient medication records, now kept by 77.5% of pharmacies, provide a valuable check on the appropriateness and safety of patients' medication. The barriers to the pharmacist's greater involvement were shown to be suspicion by GPs of pharmacists' motivation, isolation of many community pharmacists, difficulties in leaving the pharmacy for domiciliary visits, residential home care and GP practice meetings. These barriers must be lowered if the pharmacist is to have a greater influence and involvement. It was concluded that changes are necessary in pharmaceutical education, staff training, organisation and remuneration. Some changes in the targeting of remuneration to the pharmaceutical care services provided and registration of patients with pharmacies would contribute greatly to these aims.

Utilization of needs assessments by decision makers: A comparative analysis of assessment methods

The major purpose of this study was to ascertain how needs assessment findings and methodologies are accepted by public decision makers in the U.S. Virgin Islands. To accomplish this, the following five different needs assessments were executed: (1) population survey; (2) key informants survey; (3) community forum; (4) rates-under-treatment (RUT); and (5) social indicators analysis. The assessments measured unmet needs of older persons regarding transportation, in-home care, and socio-recreation services, and determined which of the five methodologies is most costly, time consuming, and valid.^ The results of a five-way comparative analysis was presented to public sector decision makers who were surveyed to determine whether they are influenced more by needs assessment findings, or by the methodology used, and to ascertain the factors that lead to their acceptance of needs assessment findings and methodologies.^ The survey results revealed that acceptance of findings and methodology is influenced by the congruency of the findings with decision makers' goals and objectives, feasibility of the findings, and credibility of the researcher.^ The study also found that decision makers are influenced equally by needs assessment findings and methodology; that they prefer population surveys, although they are the most expensive and time consuming of the methodologies; that different types of needs assessments produce different results; and, that needs assessment is an essential program planning tool. Executive decision makers are found to be influenced more by management factors than by legal and political factors, while legislative decision makers are influenced more by legal factors. Decision makers overwhelmingly view their leadership style as democratic.^ A typology of the five needs assessments, highlighting their strengths and weaknesses, is offered as a planning guide for public decision makers. ^

A study of dual cultures in dyadic relations

Elderly caregiving, a fact of life for millions of Americans, has gained significance with the increase in the elderly population. Over 25 million family caregivers in the US, most of whom are women rearing their own children, care for severely ill or disabled family members. The increased flow of women into the labor force has caused this traditional role to be entrusted to hired caregivers, mainly home health aides. ^ This case study describes and explains the dyadic experiences of elderly Jewish clients and their Jamaican home health aides in a mixed-culture environment. The inquiry was conducted with a purposive sample of four dyads, their case manager, and the placement officer, all of whom were selected through a home care agency in Fort Lauderdale, Florida. Strategies of data collection including non-participant observation, interviews, document analysis, and researcher's journals. Data from verbatim transcription of interviews and field notes were coded, sorted into emic categories, and reduced as linkages were identified via cross-case comparison. Three major themes—mixed-culture experiences, relationship building and maintenance, and agency role perceptions—emerged from the interpretative analysis of the data. ^ Assertions from these findings include that dyads have established a range of relationships to meet their personal needs, expectations, and desires in these goal-driven relationships. Relationally, they have reached interactional synchrony with some achieving the ideal family-type bond. Cultural difference is but one of the many contextual variables in the home care environment, which has its own cultural norms and expectations. Conflicts transcend cultural difference and seemed more a factor of individual relational disposition. ^

Elder malnutrition: A meta analysis of studies using the nutrition screening initiative determine checklist

To demonstrate the extent of elder malnutrition risk in this country, a meta analysis of 30 studies that used the Nutrition Screening Initiative's "DETERMINE Your Nutritional Health Checklist" was conducted. The studies were divided into three categories: Elder Populations in Healthcare Related Systems (HS), Elder Meal Program Participants (MP), and General Community Residing Elder Population (GC). HS was sub-divided into Hospital Inpatient/Clinic Outpatient and Long Term Care/Home Care. The MP population were identified as Congregate or Home Delivered meal participants. Overall, results indicate that 63% of elders are at moderate (32%) or high (31 %) risk of malnutrition. Home Delivered Meal Participants and Hospital Inpatient/Clinic Outpatients are most likely to be at high risk of malnutrition (49.5% and 49.1%, respectively). Individuals least likely to be at high malnutrition risk are the General Community Residing Elder Population (17.5%) and Congregate Meal Participants (22.5%).

Utilization of needs assessments by decision makers : a comparative analysis of assessment methods

The major purpose of this study was to ascertain how needs assessment findings and methodologies are accepted by public decision makers in the U. S. Virgin Islands. To accomplish this, the following five different needs assessments were executed: (1) population survey; (2) key informants survey; (3) community forum; (4) rates-under-treatment (RUT); and (5) social indicators analysis. The assessments measured unmet needs of older persons regarding transportation, in-home care, and sociorecreation services, and determined which of the five methodologies is most costly, time consuming, and valid. The results of a five-way comparative analysis was presented to public sector decision makers who were surveyed to determine whether they are influenced more by needs assessment findings, or by the methodology used, and to ascertain the factors that lead to their acceptance of needs assessment findings and methodologies. The survey results revealed that acceptance of findings and methodology is influenced by the congruency of the findings with decision makers' goals and objectives, feasibility of the findings, and credibility of the researcher. The study also found that decision makers are influenced equally by needs assessment findings and methodology; that they prefer population surveys, although they are the most expensive and time consuming of the methodologies; that different types of needs assessments produce different results; and, that needs assessment is an essential program planning tool. Executive decision makers are found to be influenced more by management factors than by legal and political factors, while legislative decision makers are influenced more by legal factors. Decision makers overwhelmingly view their leadership style as democratic. A typology of the five needs assessments, highlighting their strengths and weaknesses is offered as a planning guide for public decision makers.

Ser cuidador de paciente com acidente vascular cerebral: histórias não contadas

The present study aimed to understand the experience of being a family caregiver of a patient with Cerebrovascular Accident (CVA). The relevance of the study is to prove existence of a large number of caregivers of incapacitated patients, due to the CVA and it is not an academic research object, according to the literature. It is a qualitative research, which the guiding principle is the oral history of life, according to the theoretical foundation and operating of Meihy. Therefore, the following steps were highlighted: the target community, composed of all family caregivers of CVA patients; the colony, composed by family caregivers of CVA patients assisted by Home Care Service (HCS) of the Hospital José Pedro Bezerra (HJPB), in the city of Natal/RN; the network was composed of six caregivers who met the criteria for inclusion, and as zero point the first volunteer group. The population was composed of all family caregivers of patients attended by the HCS, of the HJPB having been addressed through interviews. For the empirical research there was the consent of that institution and approval by the Ethics Committee in Research of the Federal University of Rio Grande do Norte as CAAE 24569413.0.0000.5537 and, above all, with the acquiescence of employees in participating in the investigation, signing an informed consent. Of the empirical material, five categories of analysis were identified: the sense of being a caregiver; what has changed in the life of the caregiver; the feelings emerge in the relationship of care; the distance from family and friends; difficulties faced by the caregiver. The results show that the caregiver's life goes through profound transformations within the family as well as in all spheres of life. For the caregivers, assuming the care of a relative with CVA means renunciation and donation, compromising sometimes the individual projects and the family as a whole. In addition, they point out the confrontation of difficulties within the the assistance and humanization in healthcare, information, physical and emotional overload, as well as financial problems. Despite all the adversities that compromise the caregiver's life, it was possible to identify attitudes of resilience among caregivers, making them their daily life less strenuous and with more lightness. It is expected, therefore, that this research can contribute to a better orientation of professionals with the caregivers

Validação do instrumento dos indicadores observáveis da qualidade do cuidado em instituições de longa permanência para idosos

The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach’s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as “unchanged” in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach’s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance –SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It´s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

A atenção à crise e o apoio matricial: analisadores da estratégia atenção psicossocial

The National Policy on Mental Health is characterized as a territorial - political community , and it has the Psychoso cial Care Strategy (Eaps) as guideline for the proposal and the development of their actions. In its design, CAPS is idealized to be a strategic equipment within the Psychoso cial Care Network/RAPS. Matricial support and at tention to the crisis constitute strategic areas of action of CAPS in its replacement mission , and as it is g uided by the scope of deinstitutionalization, those are essential to the success of these services. We argue that sustain crises in existential territories of life is a condition for the effectiveness of psychosocial care and, ultimately, to the sustainability of its Reform. In this direction, the matricial support tool reveals a territorial supporter, intercessory and powerful in building a psychosocial care to the crisis. Recognized as one of the major challenges by the Brazilian Ministry of Health, forward these fronts materializes for workers in their mi cropolitical crafts. Our research arises as an investment toward empower them , and aimed to understand the operationalization of attention to the crisis and matricial support in a CAPS II, in the view of its workers . Besides, it aims to examine such practi ces forward the principles and purposes of Psychosocial Care Strategy. Inspired by the research - intervention and by the political and social ideas of Institutiona l Analysis, we offer a space for reflection and exchange, by implicational interviews , enablin g workers to launch them in analysis of practices in the EAPs view. We have done a documentary consulting CAPS Technical Project, and a return stage to the institution, by organizing workshop and conversation groups with CAPS workers. The results have show n that there are institutional logics in competition on that service. When operating the logic risk, some difficulties in sustaining most intense crisis situations were identified, the psychiatric hospital internment is used as a facility, particularly in view of some cases, in which the aggressiveness of the person in crises becomes aggressive, and when the brackets SAMU, the CAPS III and Comprehensive Care Beds do not respond satisfactorily to their users requests. Order weaknesses were indicated in this thesis as macropolitical and micropolitical interfering in network support. The matricial actions were identified as a powerful intercessor resource in crisis care appeared weakened, and indicates little porosity in the relationship between the Service and the territory where it takes place. Noticed by the logic of home care, without operate primarily as a knowledge exchange device, we saw capture points in the logic of assistance with ambulatoriza tion production of CAPS, welfare practices and "ext empore " . T he E APs , although it emerge s as a guiding, it is not seen to workers as effective practice. On the one hand, the results signaled that the attention to the crisis and the matricial actions are developed without tenacious connection with the purposes of EA Ps, on the other hand, successful cases were indicated with the main leads to conducting wire of intersectoral actions to the powerful bonds and to the participation of user in their care process es , indicating insurgent forces tha t intend by traditional lo gic .

Utilizing ICT to prevent loneliness and social isolation of the elderly. A literature review

Ageing of the population is a worldwide phenomenon. Numerous ICT-based solutions have been developed for elderly care but mainly connected to the physiological and nursing aspects in services for the elderly. Social work is a profession that should pay attention to the comprehensive wellbeing and social needs of the elderly. Many people experience loneliness and depression in their old age, either as a result of living alone or due to a lack of close family ties and reduced connections with their culture of origin, which results in an inability to participate actively in community activities (Singh & Misra, 2009). Participation in society would enhance the quality of life. With the development of information technology, the use of technology in social work practice has risen dramatically. The aim of this literature review is to map out the state of the art of knowledge about the usage of ICT in elderly care and to figure out research-based knowledge about the usability of ICT for the prevention of loneliness and social isolation of elderly people. The data for the current research comes from the core collection of the Web of Science and the data searching was performed using Boolean? The searching resulted in 216 published English articles. After going through the topics and abstracts, 34 articles were selected for the data analysis that is based on a multi approach framework. The analysis of the research approach is categorized according to some aspects of using ICT by older adults from the adoption of ICT to the impact of usage, and the social services for them. This literature review focused on the function of communication by excluding the applications that mainly relate to physical nursing. The results show that the so-called ‘digital divide’ still exists, but the older adults have the willingness to learn and utilise ICT in daily life, especially for communication. The data shows that the usage of ICT can prevent the loneliness and social isolation of older adults, and they are eager for technical support in using ICT. The results of data analysis on theoretical frames and concepts show that this research field applies different theoretical frames from various scientific fields, while a social work approach is lacking. However, a synergic frame of applied theories will be suggested from the perspective of social work.

Migrant women’s employment in paid reproductive work through the crisis: the case of Italy (2007-2012)

Paid reproductive work, especially in the case of cleaning and home-care for elderly people, is an important sector for foreign women in Italy. For this reason, since the beginning of the current economic crisis, scholars have wondered about the impact of the recession on migrant domestic workers. They have looked particularly at possible competition with Italian women entering the sector for lack of better alternatives. Our paper takes this discussion a step further by assessing the overall changes affecting migrant women in the Italian labour market, 2007-2012. We will look at how their position has been transformed, by taking both an ethnic perspective, in relation to Italian women, and a gender perspective, in relation to migrant men. By way of a conclusion, the argument will be made that there is a substantial lack of competition between Italian and foreign women in the care and domestic sector due to differences in their earnings, hours of work and activities.