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The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent’s state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.

The Agendas of Tibetan Refugees: Survival Strategies of a Government-in-Exile in a World of Transnational Organizations Thomas Kauffmann New York: Berghahn, 2015, pp. 226 In The Agendas of Tibetan Refugees: [...]

The paper examines whether routine data from prisoners’ files is a useful basis to estimate prevalence rates of illicit drug use among prisoners. Medico-legal files of 190 younger (20–49 years) and 190 older (50–75 years) male prisoners from 13 prisons in Switzerland were analysed. Indications of illicit drug use were extracted based on recorded legal measures, notes from health care professionals, diagnoses related to the use of illicit substances, prescribed medications, other treatment indicators, and results from mandatory drug tests in prison. Estimated lifetime prevalence of illicit drug use based on those indicators is 50.0% for younger and 24.2% for older prisoners. Current cannabis use is an estimated 10.0% and current cocaine, opioids, or other drug use 4.7% for younger prisoners. Among older prisoners, prevalence of current cannabis use is an estimated 3.2% and of other drug use 0.5%. The paper concludes that analysing routine data is a reasonable alternative to surveys if prisoners’ files are kept more complete and concise and if data is collected for no other purpose than to benefit prisoners’ health.

Abstract.The study identified factors that make an evaluation of decision-making capacity (DMC) difficult for clinicians in their daily work. Semistructured interviews were carried out with 24 healthcare professionals from Switzerland and subsequently thematically analyzed. The challenges they faced when evaluating DMC stemmed from three main concerns: patient characteristics that impede DMC evaluation; differing opinions and consequences of DMC evaluation; and familial and legal situations that complicate such evaluations. Physicians must be adequately trained to evaluate DMC as it is closely related to basic ethical principles of respect for patients’ autonomy and beneficence. Extensive training on DMC evaluation and the legal concept of capacity should be part of pre- and postgraduate education.

•Denmark has renowned system of data governance for the reuse of health data.•Limitations related to data access for industry and foreign institutions exists.•The features of the Danish data landscape are embedded in its culture and history.•Emulating Danish health data policies elsewhere might be difficult.

Adequate sleep is essential for maintaining homeostasis, especially when recovering from an illness; however, studies have shown that sleep disruption and sleep deprivation are common in intensive care unit patients, including children who have sustained burn injury. The purpose of this study was to evaluate the effect of diphenhydramine (DPH) on sleep in pediatric intensive care unit burn patients using Myra Levine's Conservation Model as the organizing framework. For this study, secondary analysis of polysomnography data and retrospective chart review were used. Twelve DPH patients were pair matched in terms of morphine, midazolam, and methadone with 12 non-DPH patients. The data were analyzed using paired t-tests for each dependent variable and ?2analysis was used for frequency determinations. There was no difference in demographics between the two groups. DPH patients took 4.3 ± 1.6 minutes to fall asleep whereas non-DPH patients took 15.8 ± 1.6 minutes to achieve sleep onset (P= .06). Patients receiving DPH achieved 297.6 ± 29.9 minutes of total sleep time whereas those not receiving DPH achieved only 209.2 ± 29.9 minutes (P< .05). There was minimal difference in the mean percentage of sleep time in stages 3 and 4 between the two groups. The DPH group did have 50% more rapid eye movement sleep time compared with the non-DPH group. Even though DPH did not result in a statistical improvement in sleep quality, sleep quantity was increased in this study. More research is needed to find an effective sleep intervention in pediatric burn patients.

Motivation to change is a central component of successful psychotherapeutic treatment. It is however unclear how external pressures in court-mandated treatments interfere with a patient's internal motivation. This study sought to investigate service providers' and users' experiences with court-mandated psychotherapeutic treatment and its effects on a patient's motivation.