A Home from Hospital service for older people.

Current policy and practice emphasises much more than ever before a need for purchasers and providers to reduce appropriately the length of hospital stay. Consequently, a number of early discharge “schemes” have been developed. This paper presents the findings from an evaluation of a “home from hospital” (HFH) scheme. The HFH service provides a maximum of six weeks intensive domiciliary care for older people on their discharge from hospital. The aim of the service is to facilitate early discharge from hospital and to assist patients to regain independence. The study reported here elicited the views and perceptions of clients and professionals involved in the HFH scheme about the quality, efficiency and effectiveness of the service. Seventy-five clients were discharged from hospital to the HFH scheme during a two month period and those who consented to participate in the study were interviewed after discharge from the HFH service (n = 40). Participants had attended hospital for various conditions but the largest group were fracture patients. Hospital staff and community based professionals completed a questionnaire about the service. Overall, clients and professionals perceived the HFH scheme as a beneficial service, though some minor problems existed at an individual level. Clients’ dependency levels generally decreased during their time on the scheme. Research using a controlled design is necessary in order to draw firm conclusions about the cost-effectiveness of a HFH service. Overall, home-from-hospital appears to be an effective model of an early discharge scheme worthy of further attention.

El uso de la musicoterapia para la mejora de la comunicación de niños con Trastorno del Espectro Autista en Aulas Abiertas Especializadas

Los beneficios que aporta la musicoterapia en alumnos con Trastorno del Espectro Autista, han sido demostrados profusamente por los distintos autores, si bien carecemos de literatura suficiente sobre su utilización en las Aulas Abiertas Especializadas en colegios ordinarios (Aulas TEA). En este sentido, el objetivo del trabajo, ha consistido en analizar qué mejoras aporta la musicoterapia al desarrollo de la comunicación en los alumnos con Trastorno del Espectro Autista dentro de las Aulas Abiertas de los CEIPs de Castilla-La Mancha y la Comunidad Autónoma de Madrid. Para ello, se ha realizado una amplia revisión documental de fuentes de referencia y se ha entrevistado a los docentes responsables de las Aulas Abiertas Especializadas que utilizan actividades de musicoterapia como recurso en el aula. Se concluye el artículo manifestando, en primer lugar, la escasa integración de la musicoterapia en las aulas TEA (menos del 20% de los centros). En aquellas aulas que sí se programa con actividades de musicoterapia, los beneficios que ésta aporta se ven reflejados en un incremento claro de la intención comunicativa en los alumnos. Además, a la hora de planificar las actividades se tiene muy en cuenta conocer las preferencias y la historia musical del niño. No obstante, existen factores que impiden el aprovechamiento total de las posibilidades terapéuticas de la musicoterapia debido, especialmente a: a) una escasa formación del profesorado y b) un espacio inadecuado para poner en práctica una sesión de musicoterapia.

Competence in research planning in the fourth level of Spanish Secondary Education: a case study

In the last years, “Inquiry-Based Science Education” methodologies (IBSE) are being recommended by European institutions in order to improve the competence levels and the attitudes towards science of primary and secondary school students. Therefore, the aim of this study is to test the effectiveness of an IBSE methodology, the Methodology of Problem Solving as an Investigation (MPSI), for the teaching-learning process of planning of experiments in the fourth level of Spanish Secondary Education. By means of the students’ solutions for a series of open problems, the progress in the learning of the competences related to the planning of experiments has been analyzed, along with the influence of the methodology on the development of these competencies. The results show a students’ command from higher to lower levels on: emission of hypothesis, design of the experiment, qualitative analysis, identification of variables and reformulation of the open problem. Furthermore, the Methodology has contributed to an improvement of the scientific competence in the area of planning experiments.

An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland.

In mental health services over recent decades, the positive move away from hospital-based care to community-based services has entailed that people with higher levels of need are being supported by community mental health services. This paper begins by reviewing the literature on coercion in the field of community-based mental health care and treatment. It is argued that the lack of a critical understanding of the concept and how it is used by practitioners and agencies can have serious repercussions for the rights of service users. Using a quasi-experimental, longitudinal design, the authors then seek to test some of the ideas about coercion by comparing the activities of assertive outreach and community mental health teams in Northern Ireland, particularly the key ideas of perceived coercion, workers’ strategies and engagement with services. Key findings were that assertive outreach appeared to be more successful at reducing perceived coercion, minimizing the need for coercive strategies, engaging high-risk clients and reducing inpatient bed use. These findings are compared with other studies in this area. The authors also argue that there is a need for greater transparency in the way that practitioners use coercive measures and more explicit guidance is required in this crucial area of mental health practice.

Coercion in the Community: A Situated Approach to the Examination of Ethical Challenges for Mental Health Social Workers

Increasingly, mental health social workers in the United Kingdom and elsewhere in the world are employing coercive interventions with clients. This paper explores this trend in the context of community-based settings, using national and international research literature on this subject. It begins with a discussion about the complex, contested nature of ideas on coercion. The authors then explore debates about how coercion is perceived and applied in practice. They choose two forms of coercion*/informal types of leverage, and the legally mandated use of Community Treatment Orders*/to highlight the range of ethical problems and dilemmas that confront practitioners in this field. The authors conclude by developing a tentative, explanatory model to explain how and why mental health social workers should consider a more holistic, situated approach to help deal with ethical concerns about the use of coercion.

A healthy settings framework: an evaluation and comparison of midwives' responses to addressing domestic violence

Objectives: to compare and contrast how midwives working in either hospital- or community-based settings address domestic violence by evaluating their views on: prevalence of domestic violence; their role in addressing domestic violence; the acceptability of routine enquiry; and barriers encountered in asking clients questions about violence and abuse in pregnancy. Design: a postal survey questionnaire. Setting: Northern Ireland. Study population: 983 hospital and community midwives. Findings: overall, 488 midwives returned a completed questionnaire; a 57% response rate. Comparisons were made using descriptive, inferential statistics and cross-tabulation. Although there were significant differences between hospital- and community-based midwives in relation to domestic violence, both groups of midwives tended to underestimate its prevalence. Key conclusions: the findings suggest that midwives per se identify and respond to a fraction of the cases of domestic abuse in pregnancy, due to lack of confidence, education and training. This reinforces the need for both hospital and community midwives to gain further confidence and an understanding of the many psychosocial factors that surround domestic violence. Implications for practice: healthy settings theory can be used effectively to identify good practice with women who experience domestic violence. Effective investment for health care requires the gaps between hospital- and community-based practice to be bridged, and for work to be integrated.

Sleep complaints and risk factors for excessive daytime sleepiness in adult males in Northern Ireland

The prevalence of sleep complaints in Northern Ireland is unknown. Sleep disruption can result in excessive daytime sleepiness (EDS), with significant socioeconomic consequences. The aim of this study was to assess the prevalence of sleep complaints and to determine risk factors for EDS in a Northern Irish community. From an urban and rural community of 499 111 people, a random sample of 3391 adult men were sent a questionnaire by mail. Questions were asked regarding sleep, EDS and medical history. There were 2364 completed questionnaires returned (response rate 70%). The mean age of respondents was 46.0 years (range 18-91 years). 26.7% of men were not satisfied with their usual night's sleep and 68% of men woke up at least once during the night. Based on pre-defined criteria, 24.6% of the population had insomnia and 19.8% had EDS. The strongest risk factor identified for EDS was a history of snoring loudly (odds ratio 2.62; 95% CI 1.82-3.77). Other risk factors included ankle swelling, feeling sad or depressed stopping sleep, experiencing vivid dreams while falling asleep, waking up feeling unrefreshed and age > 35 years. The prevalence rates of sleep complaints and EDS in this community-based study is high, although this does depend directly on the criteria used to define insomnia and EDS. Recognition of risk factors for EDS may help to identify and treat those affected.