Prescribing of Psychoactive Drugs for Older People in Nursing Homes: An Analysis of Treatment Culture

Background There is increasing interest in how culture may affect the quality of healthcare services, and previous research has shown that ‘treatment culture’—of which there are three categories (resident centred, ambiguous and traditional)—in a nursing home may influence prescribing of psychoactive medications. Objective The objective of this study was to explore and understand treatment culture in prescribing of psychoactive medications for older people with dementia in nursing homes. Method Six nursing homes—two from each treatment culture category—participated in this study. Qualitative data were collected through semi-structured interviews with nursing home staff and general practitioners (GPs), which sought to determine participants’ views on prescribing and administration of psychoactive medication, and their understanding of treatment culture and its potential influence on prescribing of psychoactive drugs. Following verbatim transcription, the data were analysed and themes were identified, facilitated by NVivo and discussion within the research team. Results Interviews took place with five managers, seven nurses, 13 care assistants and two GPs. Four themes emerged: the characteristics of the setting, the characteristics of the individual, relationships and decision making. The characteristics of the setting were exemplified by views of the setting, daily routines and staff training. The characteristics of the individual were demonstrated by views on the personhood of residents and staff attitudes. Relationships varied between staff within and outside the home. These relationships appeared to influence decision making about prescribing of medications. The data analysis found that each home exhibited traits that were indicative of its respective assigned treatment culture. Conclusion Nursing home treatment culture appeared to be influenced by four main themes. Modification of these factors may lead to a shift in culture towards a more flexible, resident-centred culture and a reduction in prescribing and use of psychoactive medication. 

A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

Background
The OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.

Methods
The OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.

Results
Despite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.

Conclusions
The OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. 

Integrated Housing Approach for Riyadh’s hot arid Climate: solutions from the desert vernacular

Thesis (Master's)--University of Washington, 2016-06

The Lived Experience of People with Mental Health and Substance Misuse Problems: Dimensions of Belonging

Introduction: People with co-occurring mental health and substance misuse problems are among the most excluded in society. A need to feel connected to others has been articulated in the occupational science literature although the concept of belonging itself has not been extensively explored within this paradigm. This paper reports findings from research that explored the meaning and experience of belonging for four people living with dual diagnosis in the United Kingdom. Method: Researchers employed an interpretative phenomenological approach to the study. Four semi-structured interviews were carried out. The interviews were guided by questions around the meaning of belonging, barriers to belonging and how belonging and not belonging impacted on participants’ lives. Data analysis facilitated the identification of themes across individual accounts and enabled comparisons. Findings: Data analysis identified four themes – belonging in family, belonging in place, embodied understandings of belonging and barriers to belonging. Conclusion: The findings add further insights into the mutable nature of belonging. A link between sense of belonging and attachment theory has been proposed, along with a way to understand the changeable and dependent nature of belonging through ‘dimensions of belonging’.

Sentiment classification with case-base approach

L’augmentation de la croissance des réseaux, des blogs et des utilisateurs des sites d’examen sociaux font d’Internet une énorme source de données, en particulier sur la façon dont les gens pensent, sentent et agissent envers différentes questions. Ces jours-ci, les opinions des gens jouent un rôle important dans la politique, l’industrie, l’éducation, etc. Alors, les gouvernements, les grandes et petites industries, les instituts universitaires, les entreprises et les individus cherchent à étudier des techniques automatiques fin d’extraire les informations dont ils ont besoin dans les larges volumes de données. L’analyse des sentiments est une véritable réponse à ce besoin. Elle est une application de traitement du langage naturel et linguistique informatique qui se compose de techniques de pointe telles que l’apprentissage machine et les modèles de langue pour capturer les évaluations positives, négatives ou neutre, avec ou sans leur force, dans des texte brut. Dans ce mémoire, nous étudions une approche basée sur les cas pour l’analyse des sentiments au niveau des documents. Notre approche basée sur les cas génère un classificateur binaire qui utilise un ensemble de documents classifies, et cinq lexiques de sentiments différents pour extraire la polarité sur les scores correspondants aux commentaires. Puisque l’analyse des sentiments est en soi une tâche dépendante du domaine qui rend le travail difficile et coûteux, nous appliquons une approche «cross domain» en basant notre classificateur sur les six différents domaines au lieu de le limiter à un seul domaine. Pour améliorer la précision de la classification, nous ajoutons la détection de la négation comme une partie de notre algorithme. En outre, pour améliorer la performance de notre approche, quelques modifications innovantes sont appliquées. Il est intéressant de mentionner que notre approche ouvre la voie à nouveaux développements en ajoutant plus de lexiques de sentiment et ensembles de données à l’avenir.

Healthcare Staffs’ Experiences and Perceptions of Caring for People with Dementia in the Acute Setting: Qualitative Evidence Synthesis

Background Dementia is a global issue, with increasing prevalence rates impacting on health services internationally. People with dementia are frequently admitted to hospital, an environment that may not be suited to their needs. While many initiatives have been developed to improve their care in the acute setting, there is a lack of cohesive understanding of how staff experience and perceive the care they give to people with dementia in the acute setting. Objectives The aim of this qualitative synthesis was to explore health care staffs’ experiences and perceptions of caring for people with dementia in the acute setting. Qualitative synthesis can bring together isolated findings in a meaningful way that can inform policy development. Settings A screening process, using inclusion/exclusion criteria, identified qualitative studies that focused on health care staff caring for people with dementia in acute settings. Participants Twelve reports of nine studies were included for synthesis. Data extraction was conducted on each report by two researchers. Methods Framework synthesis was employed using VIPS framework, using Values, Individualised, Perspective and Social and psychological as concepts to guide synthesis. The VIPS framework has previously been used for exploring approaches to caring for people with dementia. Quality appraisal was conducted using Critical Appraisal Skills Programme (CASP) and NVivo facilitated sensitivity analysis to ensure confidence in the findings. Results Key themes, derived from VIPS, included a number of specific subthemes that examined: infrastructure and care pathways, person-centred approaches to care, how the person interacts with their environment and other patients, and family involvement in care decisions. The synthesis identified barriers to appropriate care for the person with dementia. These include ineffective pathways of care, unsuitable environments, inadequate resources and staffing levels and lack of emphasis on education and training for staff caring for people with dementia. Conclusions This review has identified key issues in the care of people with dementia in the acute setting: improving pathways of care, creating suitable environments, addressing resources and staffing levels and placing emphasis on the education for staff caring for people with dementia. Recommendations are made for practice consideration, policy development and future research. Leadership is required to instil the values needed to care for this client group in an effective and personcentred way. Qualitative evidence synthesis can inform policy and in this case, recommends VIPS as a suitable framework for guiding decisions around care for people with dementia in acute settings.

Applying a synthetic approach to the resilience of Finnish reindeer herding as a changing livelihood

Reindeer herding is an emblematic livelihood for Northern Finland, culturally important for local people and valuable in tourism marketing. We examine the livelihood resilience of Finnish reindeer herding by narrowing the focus of general resilience on social-ecological systems (SESs) to a specific livelihood while also acknowledging wider contexts in which reindeer herding is embedded. The questions for specified resilience can be combined with the applied DPSIR approach (Drivers; Pressures: resilience to what; State: resilience of what; Impacts: resilience for whom; Responses: resilience by whom and how). This paper is based on a synthesis of the authors’ extensive anthropological fieldwork on reindeer herding and other land uses in Northern Finland. Our objective is to synthesize various opportunities and challenges that underpin the resilience of reindeer herding as a viable livelihood. The DPSIR approach, applied here as a three step procedure, helps focus the analysis on different components of SES and their dynamic interactions. First, various land use-related DPSIR factors and their relations (synergies and trade-offs) to reindeer herding are mapped. Second, detailed DPSIR factors underpinning the resilience of reindeer herding are identified. Third, examples of interrelations between DPSIR factors are explored, revealing the key dynamics between Pressures, State, Impacts, and Responses related to the livelihood resilience of reindeer herding. In the Discussion section, we recommend that future applications of the DPSIR approach in examining livelihood resilience should (1) address cumulative pressures, (2) consider the state dimension as more tuned toward the social side of SES, (3) assess both the negative and positive impacts of environmental change on the examined livelihood by a combination of science led top-down and participatory bottom-up approaches, and (4) examine and propose governance solutions as well as local adaptations by reindeer herders as equally relevant responses to enhance livelihood resilience.

Closing the Gap: Young People's Views on Learning at School

The UK has been criticised for its inequitable education system, as student outcomes are strongly linked to parental socio-economic status. Children and young people experiencing poverty are less likely than their better off peers to leave school with good grades, which can perpetuate disadvantage in later life. The attainment gap between children and young people experiencing poverty and their better off peers in the UK is widening, despite an increasing media and policy focus in this area. Poverty-related educational inequality is a complex area and there is no conclusive evidence in what works to reduce its effects. While there is a plethora of research on the impact of poverty on education, very little of it includes the voice of children and young people and/or the psychological impact of poverty on learning. The importance of hearing the views of children and young people is central to educational psychology, as is social justice and facilitating access to the curriculum for all students. The barriers presented by the experience of poverty to learning are thus vital for educational psychologists to address. This study used qualitative methods to explore the learning journey of Key Stage 3 (age 12-13) young people experiencing poverty in an English coastal borough. Questions from the Little Box of Big Questions 2 were used as a tool in semi-structured interviews, in addition to questions devised by the researcher. Young people discussed aspects of their lives that enabled them to learn at school, and aspects that presented barriers to learning. The research used Positive Psychology, taking a strengths based approach to explore the skills young people thought they brought to education, skills they would like to develop, and how they could be supported in this. The study has highlighted themes that, if addressed, could potentially raise the attainment of children and young people experiencing poverty.

Are we positively or negatively affected? : A study on how people react to food-related communication messages

Background- Communication messages today are all about influencing and persuading people. Two main types of messages can be seen when studying the healthy food trend on Instagram and how it is impacting attitude formation and change; these two are positive and negative messages. However, different communication messages are not the only deciders of attitude formation and change. There is one more significant factor that impacts attitude formation and change; this factor is identification with the message sender. Purpose- The purpose of this thesis is to identify whether positively or negatively themed messages on Instagram have a stronger impact on a person's attitudes regarding healthy food consumption. We will further examine if identification with the message sender additionally impacts attitude formation and change. Method- In order to fulfill the purpose of the thesis we used a qualitative research approach. We conducted interviews with 40 respondents that belonged to our main target group. Furthermore we conducted a robustness check with six respondents. All 46 respondents included in the qualitative study were Instagram users, and all the respondents in the main target group were students. Findings and Conclusion- After analyzing the empirical results together with suitable theories, some main conclusions could be drawn. The study demonstrated that positive communication messages are the preferred message type on Instagram. We further conclude that identification with the message sender does indeed have an additional impact on attitude formation and change. Based on this study we can say that communication messages and identification with the message sender work together in forming and changing attitudes regarding healthy food on Instagram. Practical Implications- This thesis gives valuable indications to companies, organizations and decision makers in order to direct marketing practices in terms of communication messages on social media, particularly Instagram. Moreover it gives insights for managers to be able to create communication messages that correspond to the expectations of the society. Keywords- Communication messages, attitude formation and change, identification with the message sender.

Medications, youth therapeutic cultures and performance consumptions: a sociological approach

This article analyses performance consumptions among young people. The theme is explored along two main axes. The first concerns the social heterogeneity in this field, considered on two levels: the different purposes for those investments - cognitive/mental and physical performance; and the different social contexts - university and work - where performance practices and dispositions may be fostered. The second axis explores the roles of pharmacological and natural consumptions, and their interrelationship, in the dissemination of these practices. The empirical data for this analysis were drawn from an ongoing research project on performance consumptions among young people (aged 18-29 years) in Portugal, including both university students and young workers without university education. The results correspond to the stage of extensive research, for which a questionnaire was organised at a national level, using non-proportional quota sampling. On the one hand, they show that (a) there is a hierarchy of acceptance of consumptions according to their purposes, with cognitive/mental performance showing higher acceptance and (b) both pharmaceuticals and natural products are consumed for every type of performance investment. On the other, the comparison between students and workers introduces a certain heterogeneity in this general backdrop, both in terms of the purposes for their consumptions and their opting for natural or pharmacological resources. These threads of heterogeneity will prompt a discussion of the dynamics of pharmaceuticalisation within the field of performance, in particular how therapeutic cultures may be changing in terms of the way individuals relate to medications, expanding their uses in social life.

People and their past : is 'community archaeology’ the future?

This thesis looks at how ‘community archaeology’ ideals may influence an inclusive approach to Indigenous heritage management, ensuring Indigenous community power over processes to identify both past and present values of Country. Community archaeology was acclaimed by research archaeologists over a decade ago as a distinctive approach with its own set of practices to incorporate the local community’s perspectives of its past and current associations with place. A core feature of this approach in Australia is the major role the Indigenous community has in decisions about its heritage. Concurrently, considerable concern was being expressed that Indigenous heritage was not sufficiently addressed in environmental impact assessment processes ahead of development. Seen as absent from the process was the inclusion of Indigenous knowledge about both the pre- and post-contact story as well as any scientific advance in understanding an area’s Indigenous history. This research examines these contrasting perspectives seeking to understand the ideals of community archaeology and its potential to value all aspects of Indigenous heritage and so benefit the relevant community. The ideals of community archaeology build on past community collaborations in Australia and also respond to more recent societal recognition of Indigenous rights, reflected in more ethically inclusive planning and heritage statutes. Indigenous communities expressed the view that current systems are still not meeting these policy commitments to give them control over their heritage. This research has examined the on-the-ground reality of heritage work on the outskirts of Canberra and Melbourne. The case studies compare Victorian and ACT heritage management processes across community partnerships with public land managers, and examine how pre-development surveys operate. I conclude that considerable potential for achieving community archaeology ideals exists, and that they are occasionally partially realised, however barriers continue. In essence, the archaeological model persists despite a community archaeology approach requiring a wider set of skills to ensure a comprehensive engagement with an Indigenous community. Other obstacles in the current Indigenous heritage management system include a lack of knowledge and communication about national standards for heritage processes in government agencies and heritage consultants; the administrative framework that can result in inertia or silos between relevant agencies; and funding timeframes that limit possibilities for long-term strategic programs for early identification and management planning for Indigenous heritage. Also, Indigenous communities have varying levels of authority to speak for how their heritage should be managed, yet may not have the resources to do so. This thesis suggests ways to breach these barriers to achieve more inclusive Indigenous heritage management based on community archaeology principles. Policies for a greater acknowledgement of the Indigenous community’s authority to speak for Country; processes that enable and early and comprehensive ‘mapping’ of Country, and long-term resourcing of communities, may have been promised before. In this research I suggest ways to realise such goals.

A social and gender analysis of Northern Province, Zambia: Qualitative evidence that supports the use of a gender transformative approach

A qualitative social and gender analysis was carried out in June 2015 in Luwingu and Mbala Districts in Northern Province, Zambia. The research explored the norms and power relations at various institutional levels that constrain certain social groups from benefiting from programmatic investments aimed at improving livelihoods, health status, and food and nutrition security within the Irish Aid Local Development Programme (IALDP). This technical paper provides a summary of the research findings, lessons learned and suggests options for action the IALDP could consider to help bring about gender transformative change in the lives and livelihoods of poor and vulnerable people.

'Expanding Horizons': investigating the Glasgow 2014 legacy for young people in the East End of Glasgow

The recent staging of Glasgow 2014 drew universal praise as the ‘Best Games Ever’. Yet the substantial undertaking of hosting the Commonwealth Games (CWG) was sold to the nation as more than just eleven days of sporting spectacle and cultural entertainment. Indeed, the primary strategic justification offered by policymakers and city leaders was the delivery of a bundle of positive and enduring benefits, so-called ‘legacy’. This ubiquitous and amorphous concept has evolved over time to become the central focus of contemporary hosting bids, reflecting a general public policy shift towards using major sporting mega events as a catalyst to generate benefits across economic, environmental and social dimensions, on a scale intended to be truly transformative. At the same time, the academy has drawn attention to the absence of evidence in support of the prevailing legacy rhetoric and raised a number of sociological concerns, not least the socially unequitable distribution of purported benefits. This study investigated how young people living in the core hosting zone related to, and were impacted upon, by the CWG and its associated developments and activities with reference to their socio-spatial horizons, the primary outcome of interest. An ‘ideal world’ Logic Model hypothesised that four mechanisms, identified from official legacy documents and social theories, would alter young people’s subjective readings of the world by virtue of broadening their social networks, extending their spatial boundaries and altering their mind sets. A qualitative methodology facilitated the gathering of situated and contextualised accounts of young people’s attitudes, perceptions, beliefs and behaviours relating to Glasgow 2014. In-depth interviews and focus groups were conducted before and after the Games with 26 young people, aged 14-16 years, at two schools in the East End. This approach was instrumental in privileging the interests of people ‘on the ground’ over those of city-wide and national stakeholders. The findings showed that young people perceived the dominant legacy benefit to be an improved reputation and image for Glasgow and the East End. Primary beneficiaries were identified by them as those with vested business interests e.g. retailers, restaurateurs, and hoteliers, as well as national and local government, with low expectations of personal dividends or ‘trickle down’ benefits. Support for Glasgow 2014 did not necessarily translate into individual engagement with the various cultural and sporting activities leading up to the CWG, including the event itself. The study found that young people who engaged most were those who had the ability to ‘read’ the opportunities available to them and who had the social, cultural and economic capital necessary to grasp them, with the corollary that those who might have gained most were the least likely to have engaged with the CWG. Doubts articulated by research participants about the social sustainability of Glasgow 2014 underscored inherent tensions between the short-lived thrill of the spectacle and the anticipated longevity of its impacts. The headline message is that hosting sporting mega events might not be an effective means of delivering social change. Aspirant host cities should consider more socially equitable alternatives to sporting mega events prior to bidding; and future host cities should endeavour to engage more purposefully with more young people over longer time frames.

Small-scale fishing in Central American indigenous people: governance, tenure and sustainable management of marine resources

This research develops four case studies on small-scale fisheries in Central America located within indigenous territories. The ngöbe Bugle Conte Burica Territory in the south of Costa Rica, the Garífuna territory in nueva Armenia Honduras, the Rama territory in Nicaragua and the ngöbe Bugle territory in Bocas del Toro, Panamá. This is one of the first studies focusing on indigenous territories, artisanal fisheries and SSF guidelines. The cases are a first approach to discussing and analyzing relevant social and human rights issues related to conservation of marine resources and fisheries management in these territories. The cases discussed between other issues of interest, the relationships between marine protected areas under different governance models and issues related to the strengthening of the small-scale fisheries of these indigenous populations and marine fishing territories. They highlight sustainability, governance, land tenure and access to fishing resources, gender, traditional knowledge importance and new challenges as climate change.