Acceptability of home-assessment post medical abortion and medical abortion in a low-resource setting in Rajasthan, India : Secondary outcome analysis of a non-inferiority randomized controlled trial

Background: Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective: To investigate women's acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design: Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population: Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods: Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1: 1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main outcome measures: Women's acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results: 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future abortion. Significantly more women, 284 (82%), in the home-assessment group preferred home-assessment in the future, as compared with 188 (70%) of women in the clinic follow-up group, who preferred clinic follow-up in the future (p < 0.001). Conclusion: Home-assessment is highly acceptable among women in low-resource, and rural, settings. The choice to follow-up an early medical abortion according to women's preference should be offered to foster women's reproductive autonomy.

Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

Unlicensed personnel administering medications to older persons living at home : a challenge for social and care services

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge. AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis. RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients. IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

Point of View: Going Home: Far and Near

Nikky-Guninder K. Singh on going home to Punjab.

Fatores-chave na qualidade de sistemas de home broker : uma análise teórico-empírica

This work has as main objective the development of a key factors¿ model for the quality of Home Broker systems. An explanatory research was performed, based on a quantitative approach. To achieve this goal, some theoretical models of technology acceptance (TAM, TRA, TPB and IDT), reliability and quality of service were reviewed. It was proposed an extended key factors¿ model and developed a questionnaire, which was the research instrument used in this study. The questionnaire was applied over the Internet, from which was obtained a participation of 113 valid respondents, all of them users of Home Broker system. Once performed the data collection, statistical tests were used for the Factorial Analysis in order to achieve a definitive model. The key factors found were Perceived Usefulness, Perceived Ease of Use, Subjective Norms, Compatibility, Reliability and Relative Advantage. Some hypotheses from the model were also tested to investigate the relationship between the importance given to the factors and the resulting degree of satisfaction about quality of service. As a result of the study, a key factors¿ model for the quality of Home Broker systems was established, and identified that the factor Compatibility" has more explanatory power than the others."

R&D investment, international trade, and home market and competitiveness efects

We analyze the effects of R&D investment on international trade. The importance of studying this comes from the fact that one of the most important characteristics of modern industrial organization is that firms try to influence market behavior through strategic variables as R&D. Moreover international competition between firms is, more and more, also centered in R&D competition (besides output and price competition). With this in mind, we develop an oligopolist reciprocal-markets model where firms engage in R&D investment to achieve future reductions in marginal costs. We find ‘home market effects’ at the level of R&D investment, i.e.: firms located in countries that host a higher share of skilled-labor perform higher levels of R&D investment. As consequence, firms in these countries are more competitive than firms in other countries, and as such they can penetrate more easily foreign markets. As result of this ‘competitiveness effect’, countries where these firms are located run trade surplus, while countries where firms perform lower levels of R&D investment incur in trade deficits.

Home bias no mercado de capitais brasileiro : um estudo sobre a custódia de investidores em ações

A presente dissertação apresenta uma análise da concentração do portfólio de a-ções de investidores brasileiros nas próprias empresas onde trabalham com o intuito de observar se o Home Bias se aplica à amostra analisada. Nosso estudo foi reali-zado com uma amostra extraída da custódia de 86 clientes de uma corretora de va-lores mobiliários, sendo estes dados reais de mercado. Restringimos a seleção da amostra de forma que metade fosse de clientes que trabalham em empresas de ca-pital aberto e a outra metade não. Foi feita análise cross section de quanto os inves-tidores alocam em ações das empresas para a qual trabalham e verificou-se qual o percentual desta participação em seus portfólios, em comparação a uma amostra de controle de investidores que não trabalham nesta mesma empresa. Além destas a-nálises, separamos a amostra pelo valor total do portfólio e realizamos os mesmos estudos com estes dois grupos diferentes da amostra. Como uma análise de robus-tez, identificamos empresas listadas que não adotam a remuneração com ações como uma sub-amostra do estudo. Como resultado, encontramos evidências de que os funcionários investem significativamente mais (seja em proporção do portfólio ou em valores) em ações das empresas onde trabalham em relação aos demais inves-tidores, evidenciando um viés de familiaridade na tomada de decisão de investimen-tos.

GPON / FTTH: FTTH_fiber to the home

As redes de comunicação de nova geração, onde se incluem as tecnologias de fibra óptica, têm sido uma área na qual tem havido imensa investigação e desenvolvimento. As tecnologias de FTTx, em especial a FTTH, já são uma realidade em milhares de habitações em variadíssimos países. A presente dissertação descreve um estudo da tecnologia GPON - Gigabit Passive Optical Network - nas instalações da EMACOM, Telecomunicações da Madeira, Unipessoal, Lda. Inicialmente são enumerados os requisitos necessários, quer seja por parte dos clientes como dos fornecedores. Em seguida apresenta-se o padrão do ITU-T G.984, contendo as várias camadas, tais como a camada física e a camada de convergência de transmissão, abordando também a estrutura das tramas e as principais características do referido padrão. Depois é dado a conhecer ao leitor os elementos que constituem uma rede GPON, sejam estes equipamentos passivos ou activos. Seguidamente foi descrito o planeamento para o projecto proposto onde foram estudados os vários tipos de arquitectura utilizados pelo FTTH e definiu-se qual seria a melhor opção para a zona urbana considerada. Utilizou-se o ArcMap da ESRI Portugal - Sistemas e Informação Geográfica, S.A, criando uma base de dados e um esquema da própria rede num mapa da freguesia de São Martinho. Utilizou-se o AutoCad, onde foram elaborados vários sinópticos da rede da área escolhida, nos quais englobam a rede de alimentação, e a rede de distribuição. Toda a informação ilustrada nos sinópticos foi colocada numa folha de cálculo de Excel sendo mais rápida a sua pesquisa. Posteriormente, criou-se uma lista de material com as quantidades necessárias a utilizar para a sua implementação. Para verificar a viabilidade do projecto em termos de potência óptica foi efectuado um cálculo do balanço de potência. Assim, é considerada a ligação mais distante para averiguar se existe potência óptica suficiente para cobrir essa ligação. Caso seja viável, então os outros pontos de distribuição ópticos com distâncias inferiores também estarão suficientemente alimentados em termos ópticos. São ainda abordados os vários tipos de perdas nas fibras ópticas, as definições de link power e link loss budgets. Finalmente, foram efectuados testes de simulação com o programa OptiSystem simulando a ligação usada para o cálculo de potência podendo-se assim comparar valores e verificar o desempenho do sistema através do diagrama de olho obtido.