Search

The childcare system in Lithuania is going through extensive changes in order to ensure the preparation and assessment of people who want to care for or adopt a child, on-call guardians have appeared, care centres have started operating in all municipalities, a unified agreement of guardians (carers), on-call guardians, adoptive parents and community children has been approved, as has the GIMK training and counselling programme for nursing home workers. Individuals who want to become a child’s guardian are trained and evaluated, and mutual support groups have started being organised. This is one of the measures aimed at strengthening, supporting and providing assistance to guardians (care givers), and there is an opportunity to solve issues relating to child custody. There are more and more guardians (care givers) who face difficulties in communicating with the ward, their relationship is strained, and the child experiences learning and adaptation difficulties, as a result of which the guardianship process is becoming more and more complicated. The current problem is manifestations of non-constructive behaviour that arise in adolescence, which worsen if these problems are not solved. A frequent guardian (carer) turns to care centre specialists, social workers and psychologists for help. Children’s guardians (carers) need constant qualified assistance from specialists and the state, because only in this way can guardians properly and competently perform their duty and meet the child’s needs and interests. This article analyses the experience of a mutual support group for care givers, and presents a qualitative study. The results of the study confirm the effectiveness of this type of support, and allow us to predict and design other support measures for care givers. [ABSTRACT FROM AUTHOR]

Aim: Children with a visually impairment often face various challenges in their day-to-day skills. Oral hygiene maintenance is one major task for them. Such child has difficulty to live current normal life and demands of permission or healthy life. The present study aims to assess the oral health in children with visually impaired using oral health status assessment tool in Patna city. Methodology: A cross-sectional institutional survey was implicated among visually impaired children who attend special school in Patna city. A total of 180 visually impaired children were selected as per the inclusion criteria. Participant's parents gave written consent for the study. The oral hygiene practices of visually impaired children were recorded by teachers. Oral health assessment tool (OHAT) findings were recorded by the principal investigator. Results: Sixty-seven percent of children had gingival inflammation and 59.8% had normal tongue. 55.2% of children had 1–3 decayed or broken teeth and 16.1% had unhealthy natural teeth. 78.7% of children had change in oral hygiene. Conclusion: Oral health status of visually impaired child was very poor and gingivitis was also seen according to usage of oral hygiene assessment tool(OHAT). The sentence should be chaged as Oral health status of visually impaired child was very poor and gingivitis was also seen according to usage of oral hygiene assessment tool (OHAT). [ABSTRACT FROM AUTHOR]

Aim: Children with a visually impairment often face various challenges in their day-to-day skills. Oral hygiene maintenance is one major task for them. Such child has difficulty to live current normal life and demands of permission or healthy life. The present study aims to assess the oral health in children with visually impaired using oral health status assessment tool in Patna city. Methodology: A cross-sectional institutional survey was implicated among visually impaired children who attend special school in Patna city. A total of 180 visually impaired children were selected as per the inclusion criteria. Participant's parents gave written consent for the study. The oral hygiene practices of visually impaired children were recorded by teachers. Oral health assessment tool (OHAT) findings were recorded by the principal investigator. Results: Sixty-seven percent of children had gingival inflammation and 59.8% had normal tongue. 55.2% of children had 1-3 decayed or broken teeth and 16.1% had unhealthy natural teeth. 78.7% of children had change in oral hygiene. Conclusion: Oral health status of visually impaired child was very poor and gingivitis was also seen according to usage of oral hygiene assessment tool(OHAT). The sentence should be chaged as Oral health status of visually impaired child was very poor and gingivitis was also seen according to usage of oral hygiene assessment tool (OHAT). [ABSTRACT FROM AUTHOR]

Introduction: Adherence is a multifactorial phenomenon. Usually geriatric patients will have multiple co morbidities because of which poly pharmacy results. This can adversely affect medication compliance. The purpose of our study is to identify various factors responsible for low medication compliance. Elderly people are usually affected with chronic illnesses like Hypertension, Diabates Mellitus, Dyslipidemia, Coronary artery diseases, Osteoarthritis, etc., All these diseases require long-term treatment. So, medication compliance is a very important factor which increases therapeutic outcome. Materials and Methods: The study subjects were assessed by using 15 item structured questionnaires as per indigenously modified Morisky Medication Adherence Scale (MMAS).Results: A total of 100 patients of geriatric age group were assessed for the level of compliance for long term medication. The compliance level was assessed by providing a 15-item structured questionnaire as per indigenously modified MMAS. The level of compliance was high in 82%, medium in 16% and low in 2% in the first visit. The level of compliance was again assessed during next review visit. The level of score during review visit was high in 74%, medium in 25% and low in 1%. Conclusion: The compliance to medication is adversely affected by complicated regimes, ignorance about the disease and complications, physical and economic problems. Geriatric patients especially have a tendency to stop taking drugs off their own when they consider their symptoms have been ameliorated. This can hinder the expected improvement in adherence in the review visit [ABSTRACT FROM AUTHOR]

Background: Thailand is a rapidly aging society, which places high demand on home health care services for the elderly. The shortage of health care workforce in rural areas is a crucial obstacle to the delivery of adequate home health care services. The appropriate skill-mix between multidisciplinary health team and care givers (CGs) is an attractive solution for improving home health care services in rural Thailand. This study assessed the potential of trained CGs to provide home health care services and projected what the optimal mix for a multidisciplinary home health care team in rural Thailand would be in 2030.Methods: Eleven pilot districts in Thailand were recruited for the study. Secondary data were collected along with surveys of home health care providers. A total of 130 care managers (nurses) and 351 care givers (CG) were recruited for the survey. Workload, skill-mix potential, and acceptance of care givers were assessed in the surveys. The results from secondary data and the survey were used to project the health workforce requirements in 2030.Results: It is projected that in 2030 the number of elderly living in rural areas will be 7,156,700 (27% of the projected rural population). Of this, 20.3% will be home-bound, 1.1% will be bed-ridden and 1.6% will need rehabilitation. The main members of the multidisciplinary health workforce involved in home health care were nurses, doctors, and physiotherapists. The home health care services that were provided by the multidisciplinary health workforce included patient assessment, development of a care plan and case conference, home visits, and teaching and supervision of CGs. The CGs were village health volunteers trained to carry out regular home visits to patients. The CGs provided assistance with the activities of daily living, basic health services, moral support to patients and relatives, and surveillance of the home environment during home visits. CGs were well accepted by both the health professionals and the patients. Projections showed that 16,094 nurses, 1,542 doctors, 1,022 physiotherapists and 50,148 CGs will be required in 2030 to meet the needs of the dependent elderly for home health care in rural Thailand.Conclusion: With the increased need for home health care services in the future, appropriate team work between the members of the multidisciplinary health team and the CGs in the community is the appropriate solution for likely shortages of health professional workforce. [ABSTRACT FROM AUTHOR]

The number of older people is increasing throughout the world. As individuals grow older, they are faced with numerous physical, psychological and social role changes that challenge their sense of self and capacity to live happily. There are several problems that are likely to make these golden sections of the population depressed and lonely leading to impaired quality of life among elderly persons especially if there seems to be a withdrawal of conventional sources of love, care and respect from the family and near ones. But with the right and timely Professional help of the Geriatric social workers the same phase can be altered for the dignified life, of the old people; to change into an opportunity for making new friends, developing new interests, discovering fresh ways of services, spending more time in fellowship with God to cheer up the golden age, to say that 'the life that ends well is the best end. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to understand the barriers that a particularly vulnerable sub-population of older adults experience in adhering to cancer treatments in rural eastern North Carolina. Qualitative descriptive interviews were completed with 16 individuals (8 cancer patients and their caregivers) about the challenges they face in adhering to cancer treatments. Three themes emerged based on the analysis which included transportation and financial barriers, and assistance that facilitated patients to adhere to treatment protocols. Transportation barriers were those associated with both the formal and informal systems. Financial barriers were related to costs associated with treatment. Participants also reported on ways in which adherence was facilitated via both formal and informal means. Our findings support those of previous research on treatment adherence and add information on the actions patients take in response to barriers that can negatively impact their disease trajectory. The knowledge gained can inform service providers about the issues in treatment adherence and help identify interventions that could support caregivers and patients to circumvent such challenges. [ABSTRACT FROM AUTHOR]

Assessment of an individual's functional status, as measured by activities of daily living (ADL), is an essential element in the diagnosis of HIV-associated neurocognitive disorders (HAND) but individuals with cognitive impairment may not accurately report ADL. We assessed agreement between self- and caregiver-reported ADL in HIV-positive persons. Antiretroviral therapy (ART)-naïve HIV-positive persons (n = 321) and HIV-negative controls (n = 134) in Rakai, Uganda, completed neurocognitive tests and an ADL questionnaire. Co-resident relatives ("caregivers") were independently administered the ADL questionnaire to determine their perception of the participant's ADL. The relationship between neurocognitive impairment and participant-caregiver agreement was assessed using kappa statistics. Regression was used to estimate adjusted prevalence ratios (AdjPR) of participant-caregiver agreement on disability scores. Relative to HIV-negative adults, HIV-positive participants scoring at least 1 standard deviation (SD) below the norm on 2 or more neurocognitive tests were classified as having mild neurocognitive impairment and those scoring at least 2 SD below the norm on 2 or more neurocognitive tests were classified as having moderate-to-severe. Mean age was 36 years (SD 8.9), and 53% of participants were male. The rate of ADL agreement between participants and caregivers was 77% for HIV-positive and 87% for HIV-negative participants (AdjPR = 0.89, 95% CI 0.81–0.97, p =.01). Among HIV-positive participants, 41% had moderate neurocognitive impairment, 15% had severe neurocognitive impairment, and 44% were normal. For moderate neurocognitive impairment, the rate of ADL agreement was 69% and for severe neurocognitive impairment, it was 66%. Compared to non-impaired HIV-positive participants (86% ADL agreement), ADL agreement was lower with moderate impairment (AdjPR = 0.89, 95%CI 0.81–0.98, p =.023) and severe impairment (AdjPR = 0.77, 95%CI 0.63–0.95, p =.014). Gender, education and CD4 count were not associated with ADL agreement. HIV-positive persons with neurocognitive impairment have lower agreement with caregivers' reports of ADL than HIV-positive persons without cognitive impairment. [ABSTRACT FROM AUTHOR]

The husbands of women undergoing mastectomy have been introduced as the patient’s primary caregivers. This research was conducted to investigate the lived experiences of Iranian Muslim husbands of women undergoing mastectomy. In this phenomenological research, 18 participants were interviewed, and Van Menan’s method of interpretation was used to interpret the data. 8 themes were extracted from the data analysis: physical problems, living in the shadow of fear and discomfort, and destiny is not blameless, modified roles, marital coldness, imposing a financial burden, spiritual care, and support failure. It is concluded that the husbands of these patients need comprehensive support, and the current support is not enough. [ABSTRACT FROM AUTHOR]

Objective: Progression of amyotrophic lateral sclerosis (ALS) depends on several factors linked to the disease. However, both the patient’s living place and care organization role need to be evaluated. Methods: We analysed the effect on survival of factors linked to ALS or the socio-geographical context in a prospective cohort of 203 patients followed between 2003 and 2011. Results: Patients were 97 females and 106 males with a mean age of 65.5 years. Survival was longer in younger patients, in case of upper limb involvement, longer time to diagnosis, and initially higher forced vital capacity. Non-invasive positive pressure ventilation (NIPPV) and percutaneous gastrostomy (PEG) failed to demonstrate benefit. Patients who lived at home had longer survival. The nature of non-medical organization at home statistically influenced survival, which was longer with an organized network than with an unorganized one and shorter in absence of non-medical organization. In patients with indication of PEG and NIPPV, the proposition was statistically different according to the care givers. Conclusions: Besides the natural history of ALS, survival depended on home organization and the presence or the nature of a home-care system. Home organization was an important factor of decision for NIPPV and PEG proposals. [ABSTRACT FROM AUTHOR]

Background: The spousal care givers of people with Parkinson's (PwP) have unique, first-hand information that is invaluable in the effective management of Parkinson's disease (PD). However, there is a dearth of research that specifically focuses on health professionals’ experiences of engagement with the spousal care givers of PwP.Methods: Interpretative phenomenological analysis (IPA) was used to describe and identify the meaning that health professionals working with PD (HPPs) gave to their engagement experiences with spousal care givers of PwP. Semi-structured interviews with a purposive sample of 12 HPPs were digitally recorded, transcribed verbatim and analysed for emerging themes.Results: Two major themes emerged from the interviews with HPPs: (i) the Philosophy of Care (PoC) is an Intrinsic Element in the Engagement Experience; and (ii) HPPs Expressed a Deep Appreciation of Partners’ Support of the PwP. HPPs experienced significant tensions and challenges in their engagements with the partners of PwP, as a result of the interaction between their lived reality and their PoC. They also appreciated greatly the caregiving provided by the partners. The insights gained have the potential to ease or resolve problematic tensions within the engagement process. [ABSTRACT FROM PUBLISHER]

Purpose: To generate an understanding of the opinions of key people associated with a program for older people transitioning from hospital back to the community and explore their thoughts around training family members to help provide physiotherapy.Method: A qualitative study using focus groups and semi-structured interviews was conducted. Participants included patients admitted to a transitional care program, their family members, physiotherapists working in transitional care and members of a consumer group from the health service where the transitional care program was based. Data were transcribed verbatim and a thematic analysis was conducted.Results: Four patients, four family members, four consumer group members and eight physiotherapists participated in this study. Three themes emerged: family members providing physiotherapy may improve outcomes for patients; training family members to provide physiotherapy should include key elements and be individualised; and involving family members in physiotherapy may impact positively and negatively on people and relationships.Conclusions: Older people transitioning from hospital to the community are at risk of functional decline and may receive very little physiotherapy. Training family members to assist with physiotherapy was perceived as a way to improve patient outcomes and relationships between patients and their family, although there were concerns raised about caregiver stress. Evaluation of the feasibility and effectiveness of this approach is warranted.Implications for RehabilitationOlder people transitioning from hospital to the community are at risk of functional decline and often receive very little physiotherapy.Training family members to assist with simple physiotherapy programs may increase the amount of physiotherapy patients transitioning from hospital to the community can receive and improve functional outcomes for patients.Stakeholders perceive that individualising a program to patient and family member needs is important.Involving family members in physiotherapy may not increase caregiver stress and may improve relationship dynamics between patients and family members. [ABSTRACT FROM AUTHOR]

Termination of parental rights (TPR) is one of the most important decisions made by the legal system. Due to the importance of the TPR legal process, it is essential to understand the risk and protective factors that influence TPR decisions and under which conditions these factors are most influential. This commentary begins with a brief review of the literature regarding TPR. Subsequently, the Ben-David article is reviewed, highlighting the strengths and challenges that emerge from the study. Future directions are then discussed, with a focus on several recent articles that should guide researchers in the TPR field. Finally, clinical implications for social service providers and agencies are explored, with particular attention to how the TPR literature can guide best practices in clinical work. [ABSTRACT FROM AUTHOR]

The present study was conducted on 120 elderly respondents of 60 years and above of both the sexes, selected through convenience sampling from two villages of Kendrapara district of Odisha. The findings of the study suggest that till now elderly people prefer to live with their family instead of any institution, as the family members (primarily spouse, daughter-in-law, who are considered as primary care giver) provide all types of support to them and the elderly mainly dependent upon them for their ADL and IADL activities. The findings also suggest that in spite of differences in attitude of two generations, members of family provide care to the elderly people and the relationship between care giver and care receiver is positive till date in rural areas of Odisha. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To review the published/reported experiences and views of parents’ whose child has had a tracheostomy. To date, no review has focused specifically on parents’ experiences and views of having a child with a tracheostomy. Methods: MEDLINE, CINAHL, PsycINFO and Embase were systematically searched from 1990 to 2012 and a review of reference lists was conducted. The review draws on articles where parents’ views of caring for their child's tracheostomy were either the sole focus of the research or where parental views of caring for their child's tracheostomy have been sought as a subsidiary aim. Studies relating to the aims of the review were examined using quality appraisal tools and in line with criteria for inclusion of studies. Studies were excluded if findings were about adults, studies that only focused on children's or sibling's views were not based on empirical work (e.g. literature reviews or expert commentary) or were not published in the English language. Findings were summarised under thematic headings. Results: The systematic database search identified 442 citations of which 10 were eligible for inclusion in the review. Of those 10 studies six were quantitative and four qualitative. Only one paper published qualitative data specifically on parents’ experiences about their tracheotomised child. The three main themes identified were parents’ experiences of caregiving, their social experiences and experiences of service delivery of having a child with a tracheostomy. Although parents encountered emotional and social challenges, some positive responses to these challenges were reported. Conclusion: This review identifies a lack of qualitative research on parents’ views of having a child with a tracheostomy. Issues surrounding parental management of tracheostomy require further investigation. This review has identified the need to elicit parents’ longitudinal experiences of having a child with a tracheostomy. [Copyright &y& Elsevier]

Background: Stroke is the disease with the highest costs for hospital care and also after discharge. Early supported discharge (ESD) has shown to be efficient and safe and the best results with well-organised discharge teams and patients with less severe strokes. The aim is to investigate if very early supported discharge (VESD) for stroke patients in need for on-going individualised rehabilitation at home is useful for the patient and cost effective. Methods/design: A randomized controlled trial comparing VESD with ordinary discharge. Inclusion criteria: confirmed stroke, >18 years of age, living within 30 min from the stroke unit, on day 2 0-16 points on the National institute of health stroke scale (NIHSS) and 50-100 points on the Barthel Index (BI), with BI 100 then the patient can be included if the Montreal Cognitive Assessment is < 26. Exclusion criteria are: NIHSS >16, BI < 50, life expectancy < 1 year, inability to speak or to communicate in Swedish. The inclusion occurs on day 4 and in block randomization of 20 and with blinded assessor. Primary outcome: levels of anxiety and depression. Secondary outcomes: independence, security, level of function, quality of health, needs of support in activities of daily living and caregiver burden. Power calculation is based on the level of anxiety and with a power of 80%, p-value 0.05 (2 sided test) 44 persons per group are needed. Data is gathered on co-morbidity, re-entry to hospital, mortality and a health economic analysis. Interviews will be accomplished with a strategic sample of 15 patients in the intervention group before discharge, within two weeks after homecoming and 3 months later. Interviews are also planned with 15 relatives in the intervention group 3 months after discharge. Discussion: The ESD studies in the Cochrane review present hospital stays of a length that no longer exist in Sweden. There is not yet, to our knowledge, any study of early supported discharge with present length of hospital stay. Thus it is not clear if home rehabilitation nowadays without risks, is cost effective, or with the same patient usefulness as earlier studies. [ABSTRACT FROM AUTHOR]

Introduction: Care givers of patients with severe mental disorders have been shown to be under heavy stress burden that reflect itself through various heterogenous psychiatric symptoms that may mimic PTSD with associated negative impact on interpersonal relations and work performance Objectives: to assess the prevalence of PTSD symptoms among care givers of patients with severe mental illness Methods: 70 patients care givers of sevely mentally ill patients compred to control 70 care giver of patients with chronic debilitating medical illness were recruited from outpatient of the university hospital outpatient facilities, random selection. Severe mental illness was defined by Global assessment of function GAF score above 50 and duration exceeding 2 years. Both groups were subject to Zarit burden interview to assess stress burden and post traumatic stress diagnostic scale PDS to assess PTSD symptomats Results: 43% of care givers of severly mentally patients showed moderate to severe burden on the Zarit scale compared to only 10% among care givers of medically ill patients, this difference was statistically significant (p<0,001). Among care givers of severly mental patients showedmoderate to severe score on post traumatic stress diagnostic scale compared to 0% among those taking care of medically ill patients. this differencewas statistically significant (p<0,001) Conclusions: Stress burden among care givers of patients with severe mental illness is high and may manifest symptoms of post traumatic disorder. This highlight the importance of particular psychological support and assessment among care givers of patients with sever mental illness. [ABSTRACT FROM AUTHOR]