Getting the run around: accessing services for children with developmental co-ordination disorder

Background Accessing services for children with developmental co-ordination disorder (DCD) is frequently difficult for parents who have to navigate both health and education systems to find a diagnosis and appropriate interventions. Method A qualitative study design incorporating a phenomenological perspective was utilized to understand the nature of the experiences of these parents in attempting to access support for their children with DCD. Twelve parents, whose children attended the Kids Skills Clinic at the University of Western Ontario and were identified as having DCD, were interviewed by the second author. Interviews were transcribed verbatim and analysed using constant comparative method. Member checking, peer checking and code-recoding were carried out to enhance rigour in data analysis. Results A number of themes emerged focusing on the common problems experienced leading to occupational therapy referral. Parents' journeys to seek and access services for their children with DCD were characterized by a sense of maternal knowing, experience of frustration, trivialization of the problem, a sense of 'going it alone', and 'getting the run around'. Conclusions Implications for health and educational professionals working with children, in terms of recognition of DCD and referral for services, are described.

Urinary porphyrins as biomarkers for arsenic exposure among susceptible populations in Guizhou Province, China

Coal is widely used in PR China. Unfortunately, coal from some areas in Guizhou Province contains elevated levels of arsenic. This has caused arsenicosis in individuals who use arsenic-contaminated coal for the purposes of heating, cooking and drying of food in poorly ventilated dwellings. The population at risk has been estimated to be approximately 200,000 people. Clinical symptoms of arsenicosis may include changes of skin pigmentation, hyperkeratosis of hand and feet, skin cancers, liver damage, persistent cough and chronic bronchitis. We analyzed the porphyrin excretion profile using a HPLC method in urine samples collected from 113 villagers who lived in Xing Ren district, a coal-bome arsenicosis endemic area and from 30 villagers from Xing Yi where arsenicosis is not prevalent. Urinary porphyrins were higher in the arsenic exposed group than those in the control group. The correlation between urinary arsenic and porphyrin concentrations demonstrated the effect of arsenic on heme biosynthesis resulting in increased porphyrin excretion. Both uroporphyrin and coproporphyrin III showed significant increases in the excretion profile of the younger age (< 20 years) arsenic-exposed group, suggesting that porphyrins could be used as early warning biomarkers of chronic arsenic exposure in humans. Greater increases of urinary arsenic and porphyrins in women, children and older age groups who spend much of their time indoors suggest that they might be at a higher risk. Whether elevated porphyrins could predict adverse health effects associated with both cancer and non-cancer end-points in chronically arsenic-exposed populations need further investigation. (c) 2005 Elsevier Inc. All rights reserved.

Canadian province-building : the state as educator and entrepreneur in Alberta

This study provides an account and analysis of the development of systems of educational provision In capitalist democracies, especially in connection with the social origin and relative autonony of those systems. Using the case study of Athabasca University, a Canadian distance-education institution in the province of Alberta, the study is a critical work of historical sociology, in which the shifting social role of a system of educational provision during two transitions of a regional political economy is analyzed. Comparative observations are made in reference to other systems of educational provision and organizations, in particular the training department of a large Company based In the same region as the Unversity. The study explores the social origin and relative autonomy of systems of educational provision In relation to educational ideologies, which are themselves associated with social ideologies. Pierre Bourdieu's theoretical construction of "fields of power'' allows for a consideration of power as a relational phenomenon in the study. In other words, power is understood as being exercised in a way that simultaneously takes account of the power of other actors and groups. Fields of power also allow for an analysis of power as it is exercised at various levels of organizations and within society. The study is organized in two phases. First, an account is developed of the historical period in which the Unlversity and the Company were created, but especially the period of establishment for the Unlversity, 1970 - 75. Conclusions are offered concerning the causal associations between the historical antecedents that gave rise to the two organlzations. It is argued that both the University and the Company were established In part to enact the AIberta government's efforts to enhance Its powers within the Canadian federation (a process called province-building), The second phase is concerned with a more recent period of three years, 1993 - 95. By this time, province-building was not as significant a concern for policy-makers, and the organizational responses of the University and the Company reflected this shift. A divergence of practice is observed at the University and the Company, with actors at the Company encouraging the development of collectivist values for employees, while at the University no such overt strategy was followed, The study concludes that a consumerist model of education developed by the University in 1970 - 75 and expanded In 1993 - 95 contributed significantly to the institution's social origin and relative autonomy. The model was used as an Ideology in the earlier period and as a strategy In the later one, serving to forestall the institution's closure during both periods of crisis, though Ieading to ambiguous social outcomes. A consumerist model may on the one hand be progressive in that expanded access to educational opportunities is made possible. On the other hand, the consumerist model will tend increasingly to provide educational services to those social segments that already have access to educational opportunities.

The fallacy of integration:work and non-work in professional services

Many organisations are encouraging their staff to integrate work and non-work, but a qualitative study of young professionals found that many crave greater segregation rather than more integration. Most wished to build boundaries to separate the two and simplify a complex world. Where working practices render traditional boundaries of time and space ineffective, this population seems to create new idiosyncratic boundaries to segregate work from non-work. These idiosyncratic boundaries depended on age, culture and life-stage though for most of this population there was no appreciable gender difference in attitudes to segregating work and non-work. Gender differences only became noticeable for parents. A matrix defining the dimensions to these boundaries is proposed that may advance understanding of how individuals separate their work and personal lives. In turn, this may facilitate the development of policies and practices to integrate work and non-work that meet individual as well as organisational needs.

Public and private hospital services reform:an investigation in Iranian hospitals

This research aimed to present a model of efficiency for selected public and private hospitals of East Azerbaijani province of Iran by making use of DEA approach in order to recognize and suggest the best practice standards. In other words, its aim was to suggest a suitable context to develop efficient hospital systems while maintaining the quality of care at minimum expenditures. It is recommended for inefficient hospitals to make use of the followings: transferring, selling, or renting idle/unused beds; transferring excess doctors and nurses to the efficient hospitals or other health centers; pensioning off, early retirement clinic officers, technicians/technologists, and other technical staff. The saving obtained from the above approaches could be used to improve remuneration for remaining staff and quality of health care services of hospitals, rural and urban health centers, support communities to start or sustain systematic risk and resource pooling and cost sharing mechanisms for protecting beneficiaries against unexpected health care costs, compensate the capital depreciation, increasing investments, and improve diseases prevention services and facilities in the provincial and national levels.

The nature of the influence of parents on the education and occupational choice of school pupils

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Parenting a child with chronic illness as they transition into adulthood:a systematic review and thematic synthesis of parents’ experiences

Objective - To understand how parents view and experience their role as their child with a long-term physical health condition transitions to adulthood and adult healthcare services. Methods - Five databases were systematically searched for qualitative articles examining parents’ views and experiences of their child’s healthcare transition. Papers were quality assessed and thematically synthesised. Results - Thirty-two papers from six countries, spanning a 17-year period were included. Long-term conditions were diverse. Findings indicated that parents view their child’s progression toward self-care as an incremental process which they seek to facilitate through up-skilling them in self-management practices. Parental perceptions of their child’s readiness, wellness, competence and long-term condition impacted on the child’ progression to healthcare autonomy. A lack of transitional healthcare and differences between paediatric and adult services served as barriers to effective transition. Parents were required to adjust their role, responsibilities and behaviour to support their child’s growing independence. Conclusion - Parents can be key facilitators of their child’s healthcare transition, supporting them to become experts in their own condition and care. To do so, they require clarification on their role and support from service providers. Practice Implications - Interventions are needed which address the transitional care needs of parents as well as young people.

Grandfamilies: Grandchildren raised by grandparents. Impact on students and school services

Historically, some grandparents have had to assume the responsibility for raising their grandchildren. More recently, with increasing frequency grandparents are serving as full-time surrogate parents to their grandchildren.^ The term "grandfamily" was coined by this researcher to identify families where children are raised by grandparents. "Supergrands" are the grandparents and "grandkin" are children in these families.^ Supergrands who raise their grandkin tend to have elevated levels of stress that negatively impact their well-being. Grandkin tend to develop problems with attachment and establishing social networks, which can lead to poor psychological adjustment. School personnel believe grandkin evidence behavioral problems and occupy disproportionate amounts of their time each day. However, there is a dearth of data to support this belief.^ This study empirically investigated the impact of grandfamilies on students and school services. The results revealed grandkin experienced significantly greater levels of emotional and behavior problems than similar schoolmates. However, they were not referred for discipline problems in substantially larger numbers.^ These results indicate the practice of education should change to allow for the development and provision of social support procedures in schools. Social support will serve to buffer the stress, manifested in emotional and behavioral problems, encountered by children living with surrogate parents. A case study was presented along with a proposed intervention project that has potential to ameliorate the problems experienced by grandfamilies. ^

A Case Study of Health Tourism in the Jeju Province, South Korea

The United States Census Bureau (2006) reported that in 2005 more than 46 million Americans lacked health insurance, and that by 2019 national spending for health care would exceed $4.5 trillion (Centers for Medicare & Medicaid Services, 2010). Because those numbers are expected to increase, health tourists are seeking better opportunities for low-cost, high-quality treatment in other countries, plus the added benefit of experiencing foreign cultures. Health tourism is a rapidly growing market in both advanced and developing countries. The purpose of this study was to develop an applicable model of health tourism, the Jeju-Style Health Tourism Model, for Jeju Special Self-Governing Province, in the Republic of Korea (South Korea) and to provide other cities and countries with its implications. This study employed a focus group, indepth interviews, and content analysis to discover important factors in developing the model. The results suggested that four major sources must be executed together to maximize the benefits of health tourism development. On a foundation of natural resources, knowledge-based resources were most important (54.5%), followed by artificial resources (25.7%), and expenses-based resources (19.8%).

A comprehensive assessment of self -report experiences of adoptive parents of special needs children in Florida

Adoption of special needs children is now seen as a life long event whereby the adoptive child and family have unique needs. The need for postplacement resources throughout the life cycle of the adoption process is evident. This exploratory-descriptive research employed a random stratified cross-sectional design. The purpose of the study was to describe, identify, examine, and assess the relative influence of identified empirically and conceptually relevant variables of self-report experiences of adoptive parents of special needs children. Primary areas of exploration included: (1) adoptive children and families' characteristics, (2) postplacement service needs, utilization and satisfaction, and (3) adoptive parents' perceptions of their adoption experiences. A proportionate stratified random mail survey was used to obtain 474 families who had adopted special needs children from the 15 geographic districts which make up the state adoption social service agency in Florida. A 144-item survey questionnaire was used to collect basic information on demographic data, service provision, and adoption experiences. Four research questions were analyzed to test the effect the predictor variables had on willingness to adopt another special needs child, successful adoption, satisfying experience, and realism about problems. All four research questions revealed that the full model and the child's antecedent and the adoptive parents' intervening variable blocks were significant in explaining the variance in the dependent variables. The child's intervening variables alone were only significant in explaining the variance for one of the dependent variables. The results of the statistical analysis on the fifth research question and the three hypotheses determined that (1) only one postplacement service, crisis intervention, had a statistically significant impact on the adoptive parents' perceived level of satisfaction with the adoption experience; (2) adoptive parents who rate their adoption as successful are more likely to express a desire to adopt another special needs child; (3) the more adequate information on the child the adoptive parents perceived that they had prior to placement, the more they perceived they were realistic about the problems they would encounter; and (4) six specific postplacement services were found to be significant in predicting successful adoptions--crisis intervention, outpatient drug/alcohol treatment, maintenance subsidy, physical therapy, special medical equipment, and family counseling. Implications for the social work field and future research are discussed. ^

Perceptions of health care: perspectives from adolescents with physical disabilities and their parents

Patient satisfaction with health care is an important indicator of quality services and has been related to positive health outcomes. Because little is known about whether adolescents with physical disabilities are satisfied with the services they receive, the current study investigated the extent to which adolescents are satisfied with health care services, aspects of care adolescents identify as important to their satisfaction, similarities between adolescent and parent perceptions of care, and the relationship between adolescent perceptions of care and their intentions to adhere to treatment recommendations. Following recruitment from a pediatric health center, adolescents and their parents (n = 42) completed questionnaires to assess their perceptions regarding various aspects of health care services. Participants were very satisfied with services received; interpersonal aspects of care were very important to them. Adolescents’ satisfaction was not predictive of their intentions to adhere to treatment recommendations and their perspectives differed from those of their parents.

« Utilisation des services de santé chez les personnes âgées : association avec la maladie chronique et l’incapacité »

Diverses publications soulignent l'augmentation de l'espérance de vie et avec elle, le vieillissement mondial de la population. Ce processus se poursuivra à l'avenir, ainsi que son influence sur l’incidence et la prévalence de l'incapacité. Chez les personnes âgées, l’incapacité, les maladies chroniques et leur association constituent un sujet important dans le domaine de la santé publique en raison de l'effet qu'ils ont sur la demande des services de santé. Le but de ce mémoire est d’examiner quelle est la contribution respective des maladies chroniques et de l'incapacité dans l'utilisation des services de santé chez les personnes âgées et de leur interaction. Il s’agit de savoir si l'association entre la maladie chronique et l'utilisation des services de santé est modifiée par l’incapacité prenant en compte les caractéristiques de l'individu et son environnement. Ce travail est basé sur le modèle comportemental proposé par Andersen et Newman et le modèle du processus d’incapacité de Verbrugge et Jette. Pour répondre à l’objectif, nous utilisons les données du projet de recherche “ FRéLE ” (Fragilité, une étude longitudinale de ses expressions), réalisé durant la période 2010 -2013 auprès d’un échantillon de 1643 personnes âgées vivant dans la communauté au Québec. L’incapacité est évaluée à l’aide de deux indicateurs : les AVQ et les AVD. Les maladies chroniques sont mesurées par l’indice fonctionnel de comorbidité (IFC). La dépression est évaluée selon les critères de l’échelle de dépression gériatrique (EDG). L’état cognitif est mesuré par l'évaluation cognitive de Montréal (MoCA). Les facteurs de prédisposition comportent l’âge, le sexe, l’ethnicité et le niveau scolaire. Les facteurs facilitateurs incluent le revenu et le réseau social, ce dernier étant mesure par la présence ou non d’une personne de soutien et son lien avec la personne âgée. Divers modèles de régression sont adoptés pour identifier les facteurs statistiquement significatifs du modèle comportemental d’Andersen et Newman et du modèle du processus d’incapacité de Verbrugge et Jette. Nos résultats ont montré que, si le rôle des prédicteurs de l’utilisation varie en fonction du type de services de santé utilisé, l’utilisation s’accroît principalement avec le nombre de maladies chroniques. En ce qui concerne l’interaction entre la maladie chronique et l’incapacité, nos résultats ont révélé que l’interaction n’est statistiquement significative pour aucun des services analysés. Compte tenu de la diversité et les besoins de la population âgée, caractérisée par une prévalence élevée de maladies chroniques et d'incapacités, l’étude des facteurs impliqués dans l'utilisation des services de santé sera utile pour la mise en œuvre d’une offre de services, plus conforme aux besoins de cette population

Le sort des personnes atteintes de troubles mentaux très sévères et durables dans un réseau sans hôpital psychiatrique : étude de cas en Estrie, Québec, Canada

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.