Unmet health needs in patients with coronary heart disease: implications and potential for improvement in caring services

BACKGROUND: Improving the quality of health care services requires tailoring facilities to fulfil patients' needs. Satisfying patients' healthcare needs, listening to patients' opinions and building a closer provider-user partnership are central to the NHS. Few published studies have discussed cardiovascular patients' health needs, but they are not comprehensive and fail to explore the contribution of outcome to needs assessment. METHOD: A comprehensive self-administered health needs assessment (HNA) questionnaire was developed for concomitant use with generic (Short Form-12 and EuroQOL) and specific (Seattle Angina Questionnaire) health-related quality of life (HRQL) instruments on 242 patients admitted to the Acute Cardiac Unit, Nottingham. RESULTS: 38% reported difficulty accessing health facilities, 56% due to transport and 32% required a travelling companion. Mean HRQOL scores were lower in those living alone (P < 0.05) or who reported unsatisfactory accommodation. Dissatisfaction with transport affected patients' ease of access to healthcare facilities (P < 0.001). Younger patients (<65 y) were more likely to be socially isolated (P = 0.01). Women and patients with chronic disease were more likely to be concerned about housework (P < 0.05). Over 65 s (p < 0.05) of higher social classes (p < 0.01) and greater physical needs (p < 0.001) had more social needs, correlating moderately (0.32 < r < 0.63) with all HRQL domains except SAQ-AS. Several HRQL components were highly correlated with the HNA physical score (p < 0.001). CONCLUSIONS: Patients wanted more social (suitable accommodation, companionship, social visits) and physical (help aids, access to healthcare services, house work) support. The construct validity and intra-class reliability of the HNA tool were confirmed. Our results indicate a gap between patients' health needs and available services, highlighting potential areas for improvement in the quality of services

Do Editorial Policies Support Ethical Research? A Thematic Text Analysis of Author Instructions in Psychiatry Journals

Introduction: According to the Declaration of Helsinki and other guidelines, clinical studies should be approved by a research ethics committee and seek valid informed consent from the participants. Editors of medical journals are encouraged by the ICMJE and COPE to include requirements for these principles in the journal's instructions for authors. This study assessed the editorial policies of psychiatry journals regarding ethics review and informed consent. Methods and Findings: The information given on ethics review and informed consent and the mentioning of the ICMJE and COPE recommendations were assessed within author's instructions and online submission procedures of all 123 eligible psychiatry journals. While 54% and 58% of editorial policies required ethics review and informed consent, only 14% and 19% demanded the reporting of these issues in the manuscript. The TOP-10 psychiatry journals (ranked by impact factor) performed similarly in this regard. Conclusions: Only every second psychiatry journal adheres to the ICMJE's recommendation to inform authors about requirements for informed consent and ethics review. Furthermore, we argue that even the ICMJE's recommendations in this regard are insufficient, at least for ethically challenging clinical trials. At the same time, ideal scientific design sometimes even needs to be compromised for ethical reasons. We suggest that features of clinical studies that make them morally controversial, but not necessarily unethical, are analogous to methodological limitations and should thus be reported explicitly. Editorial policies as well as reporting guidelines such as CONSORT should be extended to support a meaningful reporting of ethical research.

EU Copyright Law in Support of European Research & Education

In this brief an explanation is given why Exceptions in copyright legislation are of great importance to the free flow of knowledge, essential to education and research in the European Union. At present the Freedom of access to knowledge for EU citizens is trapped in a complex web of national laws and local licensing arrangements. The current EU copyright law does not enable the vision of either a "Europe of knowledge" in the Bologna Process or of a "unified" European Research Area to be realised. To address this Exceptions and limitations harmonised to fit best practice are required to allow content to move digitally across Member States in support of education, research and libraries. Support for open content licensing by the European Parliament will strengthen authors’ rights, meet the needs of researchers, teachers and learners, and enable the free flow of knowledge in support of the "fifth freedom".

D3M: multicast listener mobility support mechanisms over distributed mobility anchoring architectures

The explosion in mobile data traffic is a driver for future network operator technologies, given its large potential to affect both network performance and generated revenue. The concept of distributed mobility management (DMM) has emerged in order to overcome efficiency-wise limitations in centralized mobility approaches, proposing not only the distribution of anchoring functions but also dynamic mobility activation sensitive to the applications needs. Nevertheless, there is not an acceptable solution for IP multicast in DMM environments, as the first proposals based on MLD Proxy are prone to tunnel replication problem or service disruption. We propose the application of PIM-SM in mobility entities as an alternative solution for multicast support in DMM, and introduce an architecture enabling mobile multicast listeners support over distributed anchoring frameworks in a network-efficient way. The architecture aims at providing operators with flexible options to provide multicast mobility, supporting three modes: the first one introduces basic IP multicast support in DMM; the second improves subscription time through extensions to the mobility protocol, obliterating the dependence on MLD protocol; and the third enables fast listener mobility by avoiding potentially slow multicast tree convergence latency in larger infrastructures, by benefiting from mobility tunnels. The different modes were evaluated by mathematical analysis regarding disruption time and packet loss during handoff against several parameters, total and tunneling packet delivery cost, and regarding packet and signaling overhead.

Utilising presence in places to support mobile interaction

Physical places are given contextual meaning by the objects and people that make up the space. Presence in physical places can be utilised to support mobile interaction by making access to media and notifications on a smartphone easier and more visible to other people. Smartphone interfaces can be extended into the physical world in a meaningful way by anchoring digital content to artefacts, and interactions situated around physical artefacts can provide contextual meaning to private manipulations with a mobile device. Additionally, places themselves are designed to support a set of tasks, and the logical structure of places can be used to organise content on the smartphone. Menus that adapt the functionality of a smartphone can support the user by presenting the tools most likely to be needed just-in-time, so that information needs can be satisfied quickly and with little cognitive effort. Furthermore, places are often shared with people whom the user knows, and the smartphone can facilitate social situations by providing access to content that stimulates conversation. However, the smartphone can disrupt a collaborative environment, by alerting the user with unimportant notifications, or sucking the user in to the digital world with attractive content that is only shown on a private screen. Sharing smartphone content on a situated display creates an inclusive and unobtrusive user experience, and can increase focus on a primary task by allowing content to be read at a glance. Mobile interaction situated around artefacts of personal places is investigated as a way to support users to access content from their smartphone while managing their physical presence. A menu that adapts to personal places is evaluated to reduce the time and effort of app navigation, and coordinating smartphone content on a situated display is found to support social engagement and the negotiation of notifications. Improving the sensing of smartphone users in places is a challenge that is out-with the scope of this thesis. Instead, interaction designers and developers should be provided with low-cost positioning tools that utilise presence in places, and enable quantitative and qualitative data to be collected in user evaluations. Two lightweight positioning tools are developed with the low-cost sensors that are currently available: The Microsoft Kinect depth sensor allows movements of a smartphone user to be tracked in a limited area of a place, and Bluetooth beacons enable the larger context of a place to be detected. Positioning experiments with each sensor are performed to highlight the capabilities and limitations of current sensing techniques for designing interactions with a smartphone. Both tools enable prototypes to be built with a rapid prototyping approach, and mobile interactions can be tested with more advanced sensing techniques as they become available. Sensing technologies are becoming pervasive, and it will soon be possible to perform reliable place detection in-the-wild. Novel interactions that utilise presence in places can support smartphone users by making access to useful functionality easy and more visible to the people who matter most in everyday life.

Desenvolvimento do Sistema de gestão da qualidade (NP EN ISO 9001:2008) na empresa Centi-Support

Dissertação de Mestrado em Gestão Integrada da Qualidade, Ambiente e Segurança

"Family Education and Support" program for families at psychosocial risk: the role of implementation process

This paper analyses the implementation characteristics of the Family Education and Support program, a theory-driven, needs-based, and evidence-based positive parenting program originally developed for the Andalusian family preservation services. The implementation process of 34 trials of the FAF program with 155 participants was analyzed. Cluster analyses were also performed to explore variability in implementation conditions from a comprehensive perspective. Results showed different implementation profiles that moderated the FAF effectiveness (namely lengthier interventions, higher program fidelity, and practitioners' positive perceptions and satisfaction with the program). The relevance of examining implementation process across several trials is discussed in order to distinguish core and non-core FAF components, as well as the need for combining faithful and adaptable implementations that guarantee the ecologic validity of evidence-based positive parenting programs.

Experiences of health professionals with nutritional support of critically ill patients in tertiary hospitals in Malawi

Background Nutritional support is a recognized determinant of outcome in critically ill patients. Development of critical care services in low-income countries has not been accompanied by certain appropriate ancillary services and interventions, such as adequate nutritional support. This study was designed to investigate the experiences of health professionals who have provided nutritional supportive care to critically ill patients admitted to two major central hospitals in Malawi, with the aim of identifying the common practices in nutritional support in these settings. Materials and Methods A cross-sectional study in which 50 health professionals working in intensive care and high dependency units, admitting both adult and pediatric patients, were interviewed using a semi-structured questionnaire. Data were coded and then analyzed using SPSS version 16.0. Responses between the two hospitals were compared using Fisher’s exact test. Results There was no difference in the composition of respondents from the two hospitals. About 60% of respondents had had experience with nutritional supplementation in their patients—mainly enteral. The most commonly used formulations were the “ready-to-use therapeutic feeds,” followed by modified milk. A high percentage of respondents (40%) reported having used dextrose solution as the sole nutritional supplement. Lack of in-service training, nonexistent nutrition protocols pertaining to acutely and critically ill patients, and a lack of clinical nutritionists were the major challenges identified. Conclusion Knowledge of nutrient supplementation was poor among the respondents. The use of ready-to-use therapeutic feeds was quite common, although there is no evidence of its effectiveness in care of acutely critically ill patients. There is a need to establish nutritional support teams in these tertiary hospitals. Clinical nutritionists would ideally help train and play leadership roles in such teams, who would be responsible for assessing patients for their nutritional needs, and ensuring that the feeds provided to patients are appropriate and adequate for their needs.

DIGITAL HISTORY: DESIGNING VIRTUAL ENVIRONMENTS THAT SUPPORT CRITICAL THINKING AND IDEA EXCHANGE, MOTIVATE AND ENGAGE USERS

Thesis (Master, Education) -- Queen's University, 2016-08-29 15:56:53.748

A test of basic psychological needs theory in young soccer players: Time-lagged design at the individual and team levels

Within the framework of basic psychological needs theory (Deci & Ryan, 2000), multilevel structural equation modeling (MSEM) with a time-lagged design was used to test a mediation model examining the relationship between perceptions of coaches’ interpersonal styles (autonomy supportive and controlling), athletes’ basic psychological needs (satisfaction and thwarting), and indicators of well-being (subjective vitality) and ill-being (burnout), estimating separately between and within effects. The participants were 597 Spanish male soccer players aged between 11 and 14 years (M = 12.57, SD = 0.54) from 40 teams who completed a questionnaire package at two time points in a competitive season. Results revealed that at the individual level, athletes’ perceptions of autonomy support positively predicted athletes’ need satisfaction (autonomy, competence, and relatedness), whereas athletes’ perceptions of controlling style positively predicted athletes’ need thwarting (autonomy, competence, and relatedness). In turn, all three athletes’ need satisfaction dimensions predicted athletes’ subjective vitality and burnout (positively and negatively, respectively), whereas competence thwarting negatively predicted subjective vitality and competence and relatedness positively predicted burnout. At the team level, team perceptions of autonomy supportive style positively predicted team autonomy and relatedness satisfaction. Mediation effects only appeared at the individual level.

Carers in the welfare state : on informal care and support for carers in Sweden

  The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I). Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II). The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II). The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84. In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III). Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV). In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm. In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.

Role of microfinance to support agricultural climate change adaptations in Indonesia: Encouraging private sector participation in climate finance

The demands of mitigation and adaptation policies are important to understanding a country’s climate change preparation by providing microfinance in the agricultural sector. This could be seen as a strategy to fight against the challenges of future food security. In 2014, Indonesia established climate change adaptation policies. This legislation aims to pave the way for making actions on climate change adaptation mainstream in national and local development planning. Public and private finance have supported the implementation of the climate actions. However, most funding is still used for mitigation. Adaptation finance needs support, especially in agriculture. This research paper studies opportunities for microfinance to play a role together with existing resources in supporting climate change adaptation in Indonesia. The data was acquired and analysed through a literature review, analysis of case studies and interviews with stakeholders in the climate change-related financial sector. The central findings regarding the opportunity for microfinance to contribute to the existing schemes in Indonesian climate change adaptation finance for agriculture are worthy of the result. This study found that adaptation finance is mostly used for indirect activities. Meanwhile, local communities, and farmers in particular, need directly targeted measures to adapt to climate change. An alternative approach is providing microfinance, insurance and capacity development for farmers to produce high quality agricultural products. This would contribute to optimizing the agri-food value chain, which supports socio-economic development of stakeholders, especially farmers. Hence, microfinance appears to be one potential solution to support direct climate change adaptation actions for the agricultural sector. However, this may not be strong enough to finance the entire needs for agricultural climate actions. Adaptation is contextual, so it has to be grounded in the needs of local communities. Microfinance needs public sectors support as well as other resources from the private sector. In the case of rapid response to disasters, which often destroy the agricultural sector, microfinance should be advantageous in supporting adaptation. However, in reality, it does not work, as it is prevented by regulations. So, this can be an area the public sector can support as a risk-taker as well as by providing initial funds and resources for scaling up efforts.

Parent sensitive support by paediatric nurses

Introduction The hospitalization of a child causes big changes in child and his family life. Parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectives: To define what family-centered care is, the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs and to identify the differences between parental support given by nurses in Belgium and Portugal. Methods and procedures The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion criteria. Second part is a focus group. The participants were pediatric nurses from Portugal and Belgium. Results family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. Conclusion Nurses should collect information which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children and take care of themselves. Nurses must create an environment where parents feel safe and have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

Parent sensitive support by paediatric nurses

Introduction The hospitalization of a child causes big changes in child and his family life. Parents often suffer from stress and anxiety. This can affect their relationship with the child. Because of the closeness to the parents, nurses have an important role in giving parents support so they can have more energy to support and take care of their children and in the inclusion of the family in the process of care Objectives: To define what family-centered care is, the needs of hospitalized children's parents and to identify the strategies and methods that the nurses use to give parental support adapted to the parent's needs and to identify the differences between parental support given by nurses in Belgium and Portugal. Methods and procedures The study exists out of two parts. First is an integrative review of literature. The search was performed using the databases MEDLINE, CINAHL , PubMed and Science Direct. 18 Articles were selected based on inclusion criteria. Second part is a focus group. The participants were pediatric nurses from Portugal and Belgium. Results family-centered care can be considered as a partnership between family and nurses. It has some general principles: information sharing, respect differences, negotiation and care in the context of the family. Parents have different needs: knowledge and communication, support, comfort, proximity and assurance. Parents cope with stress in different ways and nurses can support them while they are in the hospital. It is a nurse task to identify the stressors and know methods of emotional support, so she can protect the family structure. Nurses should always see the family as a path to the child, with whom the nurses should worry about taking care and meeting their needs. Conclusion Nurses should collect information which includes family relationships, cultural and religious habits and familiar dynamic. Parents need interpersonal emotional support. It is important for parents to be close to their children and take care of themselves. Nurses must create an environment where parents feel safe and have privacy. To create a therapeutic and professional relationship efficient communication is needed. Parents will experience less stress and anxiety.

The Support Educational Commitee Participation in the Pedagogical Approach of an Educational Integration

Educational services are essential to social and economical development of people, mainly to the progress of all sectors of society. Establishing actions that can promote the participation of various social groups is essential to improve their quality of life and building more respectful and fair human rights without any discrimination or exclusion. In recent years, the Costa Rican education system has undergone significant changes due to the pedagogical approach of inclusive education in which students with educational needs may require different support and specialized resources for training and development. For this, the Basic Educational Division of the Center for Teaching and Research in Education, generated a concern of investigating the participation of the Committee of Educational Support in the process of educational integration, thus, determine the functions performed in the educational context, under the rules of the 7600 Equal Opportunity Act for people with disabilities, which is the entity that corresponds to regulate access to education by identifying the support required for students with educational needs and, advice and trains, administrative staff in schools both public and private in the country. In addition, there is also a concern for exploring the role of the Special Education teacher for this Committee, as well as learning the perceptions of teachers and parents about the functions performed by the committee.