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ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success. [ABSTRACT FROM AUTHOR]

Background: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. Aim: We aimed to identify factors influencing maternal decision‐making about post mortem examination after late stillbirth. Methods: In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision‐making and the reasons for declining. We asked women if they would make the same decision again. Results: Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70–14.64) and Pacific (aOR 3.94 95% CI 1.47–10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14–7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Conclusion: Ethnic differences observed in women's post mortem decision‐making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. Methods: We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. Results: The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. Conclusions: We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. [ABSTRACT FROM AUTHOR]

Background Welfare for the disabled is becoming an important issue in China and care for people with intellectual disability is challenging because of the inadequacies in formal support and the social service system. Material and Method Based on ethnographic research in two villages in North China, this paper analyses the dilemmas of family care for people with intellectual disability. The essential data is the ethnographic record of three cases. Results Rural families strive to provide care through a set of arrangements and bear tremendous stress in the process. Conclusion Family care for people with intellectual disability in rural China has been increasingly challenged by the forces of labour migration, demographic changes and the ever-growing processes of commoditization. The role of the state has to be strengthened in welfare provision to balance the weakened family care ethos in transforming societies. [ABSTRACT FROM AUTHOR]

The ever-growing number of out-of-home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy ( Lombardy). Four dimensions of 'quality' are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as 'relational quality'. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well-being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment). [ABSTRACT FROM AUTHOR]

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample ( n = 179) that met screening requirements, including subjects with and without mild cognitive impairment ( Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale ( HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective. [ABSTRACT FROM AUTHOR]

Objective: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non‐Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. Design: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. Setting: Western New South Wales. Participants: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non‐Aboriginal; n = 28). Main outcome measures: Identified barriers and enablers and regional strategies for improving career pathways. Results: Aboriginal people interested in pursuing a career in health face barriers in: pre‐employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. Conclusion: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self‐determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members. [ABSTRACT FROM AUTHOR]

Through two separate studies involving 47 interviews inside 22 institutions in the capital markets and investment banking sector, we explore the levels of influence and sources of credibility for senior HR professionals, and examine the challenges they face in establishing credibility. We compare these findings against previous research, which has identified several determinants of HR's influence and credibility. Our findings confirm that HR's modest influence is contingent on the predispositions and convictions of key stakeholders, notably the CEO, but also depends on the decision being taken. We find that the basis for senior HR professionals' credibility is more individual than institutional, and that HR professionals and senior business managers differ in the priorities they assign to credibility determinants. Finally, the studies illuminate an enduring inherent tension for HR in establishing credibility, between servicing their internal clients' needs and retaining a level of independence. We reflect upon the transient nature of HR credibility in this sector and others. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia. Design: Multi‐centric population‐based prospective cohort study. Setting: Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts. Participants: Older adults (N = 3497) with mean age 79.8 years, 67.2% female. Measurements: Standardized interviews and questionnaires were used to assess self‐reported HI and VI at baseline and all‐cause dementia in 9 follow‐ups, spanning over 20 years. Methods: Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality. Results: HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04–1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90–1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81–1.46, p = 0.567). Conclusions: Hearing impairment is associated with an increased incidence of all‐cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long‐term risk of dementia. [ABSTRACT FROM AUTHOR]

In the present study, we examine socio‐cultural and practical aspects of human papillomavirus vaccination (HPVV) through a multi‐sited study of framings. We ask how HPVV is framed in the daily lives of vaccination‐aged Finnish girls and in school nurses' everyday work. We then mirror these framings against both each other and Finland's official vaccination campaign. Based on analysis of interviews with 24 nurses and 12 girls and the campaign materials, we argue first that the campaign frames vaccination as an individual, knowledge‐based decision reflecting the informed consent principle. Second, however, the vaccination is framed in the everyday lives of eligible girls through gendered social ties and as a gendered and cohort‐specific event pivoting around the needle prick. Third, HPVV is not primarily framed in the school nurses' work as preparing the girls for the vaccination decision by sharing official information but through trust‐based social relationships with the girls and their parents. We conclude that, as the vaccination is not an issue of individually reflected and knowledge‐based decision‐making for the two interviewed key groups, the official Finnish HPVV campaign and the undergirding informed consent principle drift into problems in their practical implementation. [ABSTRACT FROM AUTHOR]

Against the background of Bowen and Ostroff's () human resource management ( HRM) process theorization, this study explores influences on individual employee perceptions of the visibility, validity, and procedural and distributive justice of performance appraisal in subsidiaries of multinational corporations, and at what levels these influences reside. The study adopts an embedded, multiple-case design with interview data from 33 managers and professionals in six subsidiaries of three corporations. The findings show that perceptions of the performance appraisal process are driven by a number of influences pertaining to the unit, relationship, and individual levels. Further, the study highlights differences and similarities of influences across four performance appraisal process features, and identifies overlaps and inter-linkages between the process features suggested by Bowen and Ostroff (). For practitioners, the value of our study lies in the identification of steps that can be taken to increase the likelihood that HRM practices are perceived positively and as intended by the organization. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Efforts to recruit and retain employees with disabilities are often tempered by employers' concerns over potential workplace accommodation costs. This study reports on accommodations requested and granted in intensive case studies of eight companies, based on more than 5,000 employee and manager surveys, and interviews and focus groups with 128 managers and employees with disabilities. Two unique contributions are that we analyze accommodations for employees without disabilities as well as for those with disabilities, and compare perspectives on accommodation costs and benefits among employees, their coworkers, and their managers. We find people with disabilities are more likely than those without disabilities to request accommodations, but the types of accommodations requested and the reported costs and benefits are similar for disability and non-disability accommodations. In particular, fears of high accommodation costs and negative reactions of coworkers are not realized; all groups tend to report generally positive coworker reactions. Multilevel models indicate granting accommodations has positive spillover effects on attitudes of coworkers, as well as a positive effect on attitudes of requesting employees, but only when coworkers are supportive. Consistent with recent theorizing and other studies, our results suggest the benefits from a corporate culture of flexibility and attention to the individualized needs of employees. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: Patients present to EDs with various medication‐related problems (MRPs). MRPs are also associated with ED care, occurring during ED presentation or shortly afterwards. The aim of the present study is to describe the prevalence and nature of MRPs that occur prior to, during or shortly after leaving ED. Methods: We undertook a prospective, observational study in nine Australian EDs. Blocks of 10 consecutive adult patients who were not seen by a pharmacist in ED and who presented at pre‐specified times were identified. Within 1 week of ED discharge, a pharmacist interviewed patients and undertook a medical record review to determine their medication history, patients' understanding of treatment, potential MRP risk factors and manage any identified MRPs. Results: A total of 904 patients were recruited: 14.8% aged ≥80 years, 18.9% taking more than eight regular medications; 581 MRPs were identified; 287 (49.4%, 95% confidence interval [CI] 45.3–53.5%) of moderate‐high significance. Most highly significant MRPs involved high‐risk medications, particularly strong opioids, insulin and anti‐coagulants. The most common types of MRPs were prescribing errors (46.8%), patient adherence/knowledge issues (31.2%) and adverse drug reactions (7.4%). Of all patients, 381 (42.1%, 95% CI 38.9–45.5%) had at least one MRP; 31.4% (95% CI 28.4–34.6%) had MRPs that could be identified or managed by screening at ED presentation and 12.4% (95% CI 10.4–14.8%) had MRPs that could be identified or managed by screening at ED discharge. Conclusions: Patients experienced a range of MRPs throughout the ED continuum of care. From these data, screening tools will be developed so that ED clinicians may identify patients at greatest risk of MRPs. [ABSTRACT FROM AUTHOR]

Rationale: Patients with complex care needs who frequently use health services often face challenges in managing their health and with integrated care, leading to frequent decision making. These complex care needs require a good understanding of health issues and their impact on daily life. As the decisional needs of this particular clientele have yet to be described in scientific literature, they warrant further study. Objectives: To assess the decision‐making needs of patients with complex care needs (PCCN) who frequently use health care services. Methods: We performed a multicenter cross‐sectional qualitative descriptive study in four institutions of the health and social services network of Quebec (Canada). We enrolled a convenience sample of PCCNs who frequently use health care services, health care providers, case managers, and decision‐makers. We conducted interviews and focus groups and investigated decisional needs according to the Ottawa decision support framework: roles played and desired in the decision‐making process, facilitators, and barriers. We conducted qualitative data collection and qualitative deductive/inductive thematic analysis within and across participating groups. Results: In total, 16 patients, 38 clinicians, six case managers, and 14 decision‐makers participated in the study. The decisional needs of this clientele are numerous, varied and different from those of the general population. We identified 26 decisional needs grouped under five themes. The most frequent decisions related to visiting the emergency department, moving to a nursing home, and adhering to a plan or treatment. In addition, we identified new themes such as patients' fear and mistrust of health professionals, differences of opinion between health professionals and health professionals' preconceived opinions of patients. Conclusion: We observed a wide range of types of decisions that patients face and differences in decision‐making needs across participating groups. Our results should inform future research on the development of a patient decision aid tool. [ABSTRACT FROM AUTHOR]

Purpose: Technology‐based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non‐nurses. Design: A mixed‐methods, pre‐post design with implementation of a new acute stroke telemedicine service. Methods: A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014–2017). Open‐ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses' semistructured interviews at the first telemedicine site (2010–2011) was completed to provide greater explanatory detail. Findings: Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non‐nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non‐nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships). Conclusions: Important factors for acute stroke telemedicine varied between nurses and non‐nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non‐nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required. Clinical Relevance: Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence‐based implementation strategies must be tailored over time, and between nurses and non‐nurses, to ensure initial uptake and ongoing use. [ABSTRACT FROM AUTHOR]

Chronic illness has a significant effect on quality of life, and a critical measure of health outcomes. Correlations between pain, depressive symptoms, fatigue, and physical function and their direct and indirect effects on quality of life were determined among 200 Thai older population with knee osteoarthritis using the Numeric Rating Scale, the Multidimensional Assessment of Fatigue, and the Thai Geriatric Depression Scale‐15. Physical function was investigated by using the Timed Up and Go test. Path analysis revealed significant negative direct paths from pain, depressive symptoms, fatigue, and Timed Up and Go test results to quality of life. Pain, fatigue, and the Timed Up and Go test results had indirect effects on quality of life, while depressive symptoms had no indirect effect on quality of life. Increases in pain, depressive symptoms, fatigue, and Timed Up and Go test results were associated with reductions in quality of life. An understanding of the complex relationship among these variables is beneficial for designing an appropriate intervention for improving quality of life among older people with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: Patients’ complaints have been highlighted as important for constructively improving healthcare services. In so doing, it may be important to identify disparities in experiences based on patients’ demographics, such as sex. Aim: To explore hospital recorded complaints addressing potential sex differences and whether complaints were reported by the patient or a relative. Methods: Quantitative study of all 835 closed patient complaints during 2013 at three mid‐sized hospitals in Sweden. The complaints were categorisation based on perceived quality theory and analysed using a probabilistic graphical model. The findings were validated through qualitative interviews. Findings: Female patients were more likely than male patients to report dissatisfaction with interpersonal issues, whereas male patients were more likely to report dissatisfaction with administration. If a complaint from a male patient had been reported by a relative, the matter was more likely to be interpersonal. Improvement suggestions were predominantly reported by staff. However, patients and relatives proved more likely than staff to report improvement suggestions when dissatisfied with interpersonal matters. Conclusion: Using a Bayesian network, this article suggests that complaints in health care should be more holistically understood and the factors should be viewed as interconnected. This article addresses complaints as an important source of identifying not only perceived healthcare deficiencies and sex disparities, but also improvement suggestions. [ABSTRACT FROM AUTHOR]

Abstract: This study addresses the relationship between children's participation and the protection and provision offered to them by social services in Sweden. It applies a theoretical framework for analysing child welfare that is anchored in the United Nations Convention on the Rights of the Child. How child participation may affect child protection and provision is examined empirically using case documentation from 2 municipalities. The main finding is that when children are not given voice or opportunity to influence the framing of what “the problem” is, the design of protection and care tends to be poorly matched to the actual problems documented in the child investigation and vice versa; when children can influence framing, this is associated with well‐matched protection and care. This suggests that traditional child welfare ethos, to the effect that protection should be of such overriding concern that children even should be protected from participation, is misguided. The study further illustrates the intrinsic problems with the family orientation of Swedish social services and its reliance on partnership with parents, which makes it difficult to live up to the Convention on the Rights of the Child. Incorporating child participation into existing service models can transform Swedish social services to an augmented child‐focused system that by ensuring participation also promotes protection and provision. [ABSTRACT FROM AUTHOR]

Background Decision aids can be used to support shared decision making ( SDM). A patient-oriented treatment decision aid ( DA) was developed for type 2 diabetes but its use by general practice staff appeared to be limited. Objectives To explore views of practice staff towards SDM and the DA. Design A mixed-methods study within the Dutch PORTDA-diab trial. Setting and participants Included were 17 practices with staff members who were responsible for routine diabetes care and had worked with the DA, and 209 of their patients. Methods Interviews were conducted focusing on applicability, usefulness and feasibility of the DA. Interviews were tape-recorded, transcribed verbatim and subjected to content analysis for identifying and classifying views. Patient-reported data about the use of the DA were collected. Associations between specific views and use of the DA were tested using Pearson point-biserial correlation. Results The majority of practice staff expressed positive views towards SDM, which was associated with making more use of the DA. Most of the staff expressed that the DA stimulated a two-way conversation. By using the DA, several became aware of their paternalistic approach. Some staff experienced a conflict with the content of the DA, which was associated with making less use of the DA. Conclusions The DA was considered useful by practice staff to support SDM. A positive view towards SDM was a facilitator, whereas experiencing a conflict with the content of the DA was a barrier for making use of the DA. [ABSTRACT FROM AUTHOR]

Background: Deep brain stimulation (DBS), a surgically based treatment for people living with Parkinson's disease (PD), can result in a significant improvement of motor symptoms. However, the broader impact of DBS and the changes it creates are not well understood. Greater understanding of the experiences and needs related to DBS would enable development of relevant outcome measures and supports. Objectives: To explore the lived experiences of people undergoing DBS for Parkinson's disease. Methods: A descriptive phenomenological study was undertaken exploring experiences, perspectives and outcomes with key stakeholders. Semi‐structured, audiotaped interviews were undertaken with people with PD who have had DBS, their family members and health professionals across four states and territories in Australia. Results: Perspectives and experiences of 14 people with PD undergoing DBS, 10 family members and 11 health professionals were analysed. Occupations emerged as a key aspect throughout the DBS experience. Two major themes captured the role of occupation in relation to DBS: Occupations as a barometer, where occupational experiences and performances shaped people's understanding of their condition, the impact of treatments and their overall adjustment; and Shifting occupational identity where the life transition of DBS altered the occupational experiences of relationships, volition, roles and responsibilities of people with PD and their family members. Conclusion: Occupational experiences and changes served as an important way for people with PD and their families to understand and communicate their experiences of PD and related treatments. There is an identified need for outcome measures and clinical education and interventions to reflect this. [ABSTRACT FROM AUTHOR]

Premastication is thought to be an adaptive behavior in the introduction of complementary plant-bassed food to infants. It arouses controversy, however, because of the potential for transmitting saliva-born infectious diseases. The aim of this study was to explore whether premastication by healthy caregivers was associated with children's health and behavior. The data were collected as part of the Maternal and Infant Nutrition and Growth study. From 8 cities in China, 1341 pairs of infants/toddlers and their caregivers were recruited. An interviewer-administrated questionnaire collected data on sociodemographic characteristics, feeding behaviors, and self-reported health status. Anthropometric measurements were taken and blood samples were collected for analysis of hemoglobin levels. The overall prevalence of premastication was 26.9% and varies from 14-43% among the 8 cities. Premastication was not associated with occurrences of illness or with the nutritional indicators of height-for-age Z score, weight-for-age Z score, weight-for-height Z score, head circumference Z score and hemoglobin ( P all >.05). Premastication occurred more often among infants who were raised by their parents ( P = .005), whose mothers' education was lower ( P < .001), who were subject to more concern from their parents ( P = .022), and whose parents thought their children had an obesity problem ( P = .001). Presmastication was not associated with food picky behaviors. Premastication is still a common feeding practice in China. More studies are needed to determine the biological, economic, and cultural benefits or harm from premastication. [ABSTRACT FROM AUTHOR]

Background In Singapore, employees aged 62-65 can continue to be employed if they meet the re-employment eligibility criteria. This policy, coupled with an ageing workforce, calls for age-friendly initiatives, specific to work-related challenges faced by older nurses. Aim To determine work-related challenges faced by older nurses. Methods A mixed method sequential explanatory study was conducted with nurses, aged 50 and above, working in a healthcare cluster in Singapore. In the quantitative phase, a questionnaire was administered to 534 nurses to elicit work-related challenges, then in-depth interviews with 30 nurses were carried out to help explain why certain tasks and work circumstances became harder. Results Results of the survey indicated that the top three challenges were coping with changes, working with computers and reading labels. Place of work, salary range, gender and race were significantly associated with different work-related challenges. Five themes emerged from the qualitative data: physical demands of work and workload, new technology, need for further education, working with younger nurses and in intercultural teams, and changing public expectations and professional image. Discussion and conclusion The study supports the current literature on the challenges older nurses face with technological advancement. However, older nurses in our study reported less aches and pain as compared to that reported elsewhere. There is a need for specific strategies that will address changes in work processes and environment in order to retain older nurses. Implications for nursing and nursing policy When devising age-friendly work improvement initiatives, it is important for nurse leaders to factor in the needs of nurses working in different care environments, who are of different ranks, or are from different ethnic backgrounds. [ABSTRACT FROM AUTHOR]

Objective To explore the food culture within faith communities ( FC) in order to examine the consumption of away-from-home foods, and to provide an evidence base for the future development of healthy away-from-home meal initiatives though FCs. Design and Sample A qualitative descriptive design informed by an ethnographic method of free listing was utilized. A purposive sample of 34 FC leaders from seven distinct FCs participated in this study. Results The top five salience scores for five research questions are considered in detail. Of note, food is provided at multiple FC events including at worship time and Bible or group study, but also as part of school, youth programming, and special events. The purposes of serving food were reported to be not only for modes of entertainment and fellowship but also for promoting attendance and providing basic nutrition needs. Conclusions Professionals practicing in public health, faith community nursing, or in community health nursing are apt to engage in focused dialogues regarding the multidimensional health problem of childhood obesity. This research study directs nurses to consider food culture as a dimension of importance, especially within FCs. Appreciating FC food culture is important because many families engage in the settings for years, decades, and possibly a life span. [ABSTRACT FROM AUTHOR]

Objectives To describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Design Mixed-methods study based on semistructured interviews. Setting U.S. nursing homes (N = 20) from five CMS regions ( III, IV, VI, VIII, IX). Participants Family members of nursing home residents (N = 41). Measurements Family member responses to closed- and open-ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision-making, knowledge of risks and benefits, and informed consent. Results Fifty-four percent of family members felt highly involved in decisions about behavior management. Forty-two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty-six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. Conclusion Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue. [ABSTRACT FROM AUTHOR]

Aims To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. Methods The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 ( DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. Results The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. Conclusions We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology. [ABSTRACT FROM AUTHOR]

Background: Communication is an integral part of nursing practice not just only for therapeutic reasons but also for sharing information. Nurses working in intensive care experience challenges when communicating with patients who are mechanically ventilated due to lack of knowledge and skill. These challenges infringe on the patients' rights to receive information and as such they may impact negatively on the patients' outcomes. Aim: This study determined the existing knowledge and skills of intensive care nurses working with mechanically ventilated patients in Botswana. Methods: A retrospective descriptive and explorative research design with a quantitative approach was used to audit patients' records. This was augmented by further interviewing nurses for their knowledge and skills when communicating with ventilated patients within the two intensive care units in Botswana. The American Association of Critical Nurses Synergy Model was used to guide the study. One hundred and fifty ‐ nine (159) patients' files were audited and 50 nurses chosen by purposive sampling completed a self ‐ administered 42 ‐ item questionnaire. Statistical Package for Social Sciences version 10 and Microsoft Excel were used to analyse the data. Results: Assessment of patients' ability to communicate was recorded in more than 90% of files audited. Four per cent (4%) of the respondents only communicated essential information and no other strategies or devices were used to aid communication. Conclusion: Communication with ventilated patients can be quite challenging to nurses working in the intensive care unit. There is a need for communication skills training to ensure that all nurses working with mechanically ventilated patients are properly trained, equipped and capable of communicating effectively with the patient. Implications for nursing and health policy: A greater understanding of communication dynamics with the intensive care unit with patients who are mechanically ventilated is crucial to enable nurses to improve their care and improve patients' comfort. Incorporating communication in the nursing standards would ensure that patients are treated with dignity which would help improve patient outcomes. [ABSTRACT FROM AUTHOR]

Context Although many studies have demonstrated the benefits of mentoring in academic medicine, conceptual understanding has been limited to studies performed in North America and Europe. An ecological model of mentoring in academic medicine can provide structure for a broader understanding of the role of culture in mentoring. Objective The goal of this study was to explore the role of culture in the development and maintenance of mentoring relationships within the context of the University of Malawi College of Medicine. Methods A qualitative study using in-depth, semi-structured interviews and thematic analysis was conducted to explore the meaning of mentorship at the study institution. Criterion sampling was used to identify and recruit medical students, interns, registrars and faculty members. Study team members developed a codebook through open coding and applied it to all interview transcripts. Thematic analysis was used to identify and categorise themes according to an ecological model. Results A total of 46 participants from two major centres in Malawi were interviewed. Themes were identified within three domains: the intrapersonal; the interpersonal, and the institutional. Intrapersonal themes included Malawian politeness, mentoring needs, and friendliness and willingness to help. Interpersonal themes included understanding the role of the mentor, respect for elders, personal and professional boundaries, and perceptions of others. Institutional themes included the supervisor versus mentor, time pressures, tension about the scope of training, and the mentoring cycle. Conclusions This study highlights the strengths of and challenges imposed by culture to the provision of mentoring relationships at the study institution. It also highlights the central role of culture in mentoring and proposes an updated model for mentoring in academic medicine. This model can inform future research on mentoring and may serve as a model in the larger effort to provide faculty development in mentoring across sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Aims Most people who quit smoking for a short term will return to smoking again in 12 months. We tested whether self-help booklets can reduce relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design A parallel-arm, pragmatic individually randomized controlled trial. Setting Smoking cessation clinics in England. Participants People who stopped smoking for 4 weeks after receiving cessation treatment in stop smoking clinics. Intervention Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75-1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for relapse and using strategies to handle urges to smoke were less likely to relapse. Conclusions In people who stop smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to smoking did not reduce relapse. [ABSTRACT FROM AUTHOR]

Objectives To determine healthcare proxy involvement in decision-making regarding infections in individuals with advanced dementia. Design Prospective cohort study. Setting Thirty-five Boston-area nursing homes (NHs). Participants NH residents with advanced dementia and their proxies (N = 362). Measurements Charts were abstracted monthly (up to 12 months) for documentation of suspected infections and provider-proxy discussions for each episode. Proxies were interviewed within 8 weeks of the infection to determine their awareness and decision-making involvement. Factors associated with proxy awareness and discussion documentation were identified. Results There were 496 suspected infections; proxies were reached for interview for 395 (80%). Proxy-provider discussions were documented for 207 (52%) episodes, yet proxies were aware of only 156 (39%). Proxies participated in decision-making for 89 (57%) episodes of which they were aware. Proxy awareness was associated with antimicrobial use (adjusted odds ratio ( AOR) = 3.43, 95% confidence interval ( CI) = 1.94-6.05), hospital transfer ( AOR = 3.00, 95% CI = 1.19-7.53), infection within 30 days of death ( AOR = 3.32, 95% CI = 1.54-7.18), and fewer days between infection and study interview ( AOR = 2.71, 95% CI = 1.63-4.51). Discussion documentation was associated with the resident residing in a dementia special care unit ( AOR = 1.71, 95% CI = 1.04-2.80), the resident not on hospice ( AOR = 3.25, 95% CI = 1.31-8.02), more provider visits ( AOR = 1.71, 95% CI = 1.07-2.75), proxy visits of more than 7 h/wk ( AOR = 1.93, 95% CI = 1.02-3.67), and episode within 30 days of death ( AOR = 3.99, 95% CI = 1.98-8.02). Conclusion Proxies are unaware of and do not participate in decision-making for most suspected infections that NH residents with advanced dementia experience. Proxy awareness of episodes and documentation of provider-proxy discussions are not congruent. [ABSTRACT FROM AUTHOR]

Background The determination of risk factors for early childhood caries ( ECC) is important to the implementation of preventive and restorative measures. However, few studies have addressed the association between ECC and developmental defects of enamel ( DDE). Aims To investigate the association between DDE and ECC, controlling for socioeconomic factors and the presence of dental plaque. Design A cross-sectional study was carried out with 387 children aged two to 5 years during the National Immunisation Day held in 2010 in Diamantina, Brazil. Data were collected through clinical examinations and interviews with parents/guardians addressing socioeconomic indicators. Statistical analysis involved the chi-squared test and Poisson regression. Results The prevalence of DDE and ECC was 33.9% and 43.3%, respectively. Children with DDE had a greater prevalence rate of ECC ( PR: 1.325; 95% CI: 1.093-1.607). Early childhood caries was more prevalent among children with unsatisfactory oral hygiene ( PR: 2.933; 95% CI: 2.22-3.86), those who resided in rural areas ( PR: 1.267; 95% CI: 1.03-1.55) and those from families with a lower monthly household income ( PR: 1.501; 95% CI: 1.06-2.12). Conclusions The presence of ECC was associated with the occurrence of DDE in the primary dentition. Place of residence and monthly household income (socioeconomic indicators) and oral hygiene (behavioural factor) exerted an influence on the occurrence of ECC. [ABSTRACT FROM AUTHOR]

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio ( AOR) = 7.14; 95% confidence interval ( CI) = 4.17-12.5], unmarried ( AOR = 1.71, 95% CI = 1.04-2.79), long duration of club drug use during their life-time ( AOR = 1.76, 95% CI = 1.28-2.42) and severe acute intoxication after using club drugs during the past year ( AOR = 2.11, 95% CI = 1.07-4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female ( AOR = 1.79, 95% CI = 1.03-3.11) and had polydrug use during their lifetime ( AOR = 1.55, 95% CI = 1.01-2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China. [ABSTRACT FROM AUTHOR]

Background There is little information about pregnancy-related changes in alcohol use and factors contributing to changes among women with unwanted pregnancies. This study describes changes in alcohol use from before pregnancy recognition to during pregnancy and identifies important predictors of alcohol use severity among women with unwanted pregnancies. Methods Data are from the Turnaway Study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom were denied care because they were past the gestational limit of the facility where they were recruited and were still pregnant at the baseline interview, 1 week after termination seeking. Predictors of alcohol use severity (a latent variable) were identified. Results About 56% of the total sample reported any alcohol use the month before pregnancy recognition, with 23% reporting 6 or more drinks on an occasion. Among the total sample, 35% of those drinking before pregnancy recognition had quit and 20% had reduced 1 week after termination seeking. Among those denied terminations and still pregnant, 71% had quit and 14% had reduced. In a multivariate model predicting alcohol severity, younger age, still pregnant, 1 or more previous births, later gestation, childhood physical abuse, and marijuana and other drug use were associated with lower severity; having completed college, tobacco use, and recent physical violence were associated with higher severity. Conclusions The proportion of the total sample drinking before pregnancy recognition is similar to national samples of women of childbearing age, while the proportion binge drinking appears higher. Of women denied terminations, who were still pregnant, the proportion having quit is similar to other populations of pregnant women. More research is needed to examine whether pregnant women may be substituting alcohol for marijuana and other drugs. Interventions focusing on alcohol use severity during pregnancy may need to also focus on tobacco. [ABSTRACT FROM AUTHOR]

Context Medical students encounter situations during workplace learning in which they witness or participate in something unprofessional (so-called professionalism dilemmas), sometimes having a negative emotional impact on them. Less is known about other health care students' experiences of professionalism dilemmas and the resulting emotional impact. Objectives To examine dental, nursing, pharmacy and physiotherapy students' narratives of professionalism dilemmas: the types of events they encounter ('whats') and the ways in which they narrate those events ('hows'). Methods A qualitative cross-sectional study. Sixty-nine health care students (29 dentistry, 13 nursing, 12 pharmacy, 15 physiotherapy) participated in group/individual narrative interviews. Data were analysed using framework analysis (examining the 'whats'), linguistic inquiry and word count software (examining the 'hows' by dilemma type and student group) and narrative analysis (bringing together 'whats' and 'hows'). Results In total, 226 personal incident narratives (104 dental, 34 nursing, 39 pharmacy and 49 physiotherapy) were coded. Framework analysis identified nine themes, including 'Theme 2: professionalism dilemmas', comprising five sub-themes: 'student abuse', 'patient safety and dignity breaches by health care professionals', 'patient safety and dignity breaches by students', 'whistleblowing and challenging' and 'consent'. Using Linguistic Inquiry and Word Count ( liwc) software, significant differences in negative emotion talk were found across student groups and dilemma types (e.g. more anger talk when narrating patient safety and dignity breaches by health care professionals than similar breaches by students). The narrative analysis illustrates how events are constructed and the emotional implications of assigning blame (an ethical dimension) resulting in emotional residue. Conclusion Professionalism dilemmas experienced by health care students, including issues concerning whistleblowing and challenging, have implications for interprofessional learning. By focusing on common professionalism issues at a conceptual level, health care students can share experiences through narratives. The role-playing of idealised actions (how students wish they had acted) can facilitate synergy between personal moral values and moral action enabling students to commit and re-commit to professionalism values together. [ABSTRACT FROM AUTHOR]

Aims As a result of the accelerated growth of the elderly population, reconfiguration of families and member roles, and the increase of mental disorders, it is necessary to investigate the effects of this set of factors on the caregivers of patients with dementia in Mexico. Mental disorders of individuals have a negative impact on their physical and emotional quality of life, leading to greater dependence and making the caring experience a heavy burden. Several studies (none in Mexico) have used either the characteristics of the patient or caregiver to determine the burden, but few studies have included both profiles within a single study. The objective of the present study was to analyze the characteristics of the patients and caregivers associated with caregiver burden. Methods A multicenter study was carried out in six health institutions located in Mexico City, including 175 patients (and their caregivers) diagnosed with different types of dementia. We used the Spanish Caregiver Burden Screen. Descriptive analysis and logistic regressions were used to estimate the effect of the covariates on the caregiver burden. Results The results showed that patient variables have a greater impact on caregiver burden than caregiver-associated variables. Dysexecutive syndrome, sleep disorders, schooling and caregiver depression are associated with a higher level of caregiver burden. Conclusions Caregiver burden is a complex phenomenon. The results of the present study showed the need to implement multifactorial interventions targeting the caregiver to reduce the burden, strengthen the skills for patient management to avoid depression, improve patient health, and diminish functional dependence and future hospitalization. Geriatr Gerontol Int 2014; 14: 146-152. [ABSTRACT FROM AUTHOR]

Background People with intellectual disability ( ID) in the general population and people in prison experience unrecognised medical conditions and inadequate disease prevention. Among prisoners, those with an ID may be particularly disadvantaged. The aim of this study was to identify demographic, health and health-related characteristics of adult prisoners who screened positive for ID. Methods Cross-sectional data were collected via face-to-face administration of a structured questionnaire in seven prisons in Queensland, Australia, between 2008 and 2010. Participants were adult prisoners within 6 weeks of release from custody. We identified ID using a pragmatic screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and either (a) reported having attended a special school or (b) reported having been diagnosed with an ID were considered to have screened positive for ID. We compared the characteristics of participants who screened positive and negative for ID using univariable and multivariable logistic regression. Results Screening positive for ID was associated with younger age, identifying as Indigenous and lower educational achievement. Prisoners who screened positive for ID were more likely to have been diagnosed with medical conditions such as heart disease (odds ratio; 95% confidence interval = 2.1; 1.0-4.2) and hearing problems (2.2; 1.3-3.7), after adjustment for age, sex, education level and Indigenous status. Screen-positive prisoners were less likely to have received preventive care interventions such as testing for hepatitis A infection (0.4; 0.2-0.6), and immunisation for tuberculosis (0.4; 0.2-0.8). Prisoners with possible ID were more likely to be obese (1.7; 1.1-2.7). Conclusions Adult prisoners who screen positive for ID have worse health outcomes than their non-disabled peers. An improved understanding of physical health characteristics prior to release can direct treatment and support pathways out of the criminal justice system and inform transitional planning of health services for this profoundly disadvantaged group. [ABSTRACT FROM AUTHOR]

This article focuses on the implementation of evidence-based parenting programmes (EBPPs) in a small sample of urban local authorities in England. The first part discusses the development of government policy, guidance and implementation issues. The second part presents findings from an exploratory study, which focused on the implementation of EBPPs in terms of programme eligibility, fidelity and intensity in six urban local authorities. Implementation was not necessarily in line with policy or guidance. Issues associated with programme fidelity along with concerns about sustainability as a result of cuts in funding are discussed and implications for policy and future research considered. [ABSTRACT FROM AUTHOR]

Background Heart failure is a serious chronic syndrome that is accompanied by significant physical and psychological burdens, resulting in poor quality of life. Aim To assess the quality of life of patients with severe heart failure and its correlation with patient demographic, socio-economic and clinical characteristics. Method We studied 199 patients with heart failure who were hospitalized in the Cardiology Department of three general hospitals of Greece during a 1-year period. Demographic and socio-economic data were obtained using a short questionnaire, while clinical data were obtained from medical record review. The assessment of the patients' quality of life was performed using Minnesota Life with Heart Failure Questionnaire ( MLWHFQ). Findings The mean MLWHFQ score was 62.7 (±20.3). Significantly lower quality of life was found in patients with diabetes mellitus (Coefficient beta (β) = 11.4; 95% Confidence Interval ( CI), 5.2-17.5), hypertension (β = 10.3; CI, 1.4-19.1), chronic renal failure (β = 13.9; CI, 5.9-21.9), chronic respiratory failure (β = 11.2; CI, 4.7-17.7), cancer (β = 12.3; CI, 2.3-22.4), psychiatric disease (β = 10.5; CI, 0.6-20.4) and those patients who were classified in New York Heart Association class IV (β = 10.6, CI = 4.1-17.0). Conclusions The average score of the MLWHFQ was high, and this reflects the poor quality of life of patients. Higher scores in specific patient groups show the negative influence of these factors in quality of life. The holistic care of patients with heart failure by a multidisciplinary team of healthcare professionals could improve their quality of life. [ABSTRACT FROM AUTHOR]

ABSTRACT Stress has been shown to deplete the self-regulation resources hypothesized to facilitate effective role functioning. However, recent research suggests that positive affect may help to replenish these vital self-regulation resources. Based on the revised Stress and Coping theory and the Broaden-and-Build theory of positive emotion, three studies provide evidence of the potential adaptive function of positive affect in the performance of roles for participants experiencing stress. Participants were students (Study 1), caregivers of children with illness (Study 2), and individuals recently diagnosed with HIV (Study 3). In cross-sectional analyses, using role functioning as an indicator of self-regulation performance, we found that positive affect was significantly correlated with better self-regulation performance, independent of the effects of negative affect. The effects were not as strong longitudinally, however, and there was little evidence of a reciprocal association between increases in positive affect and improvements in role functioning over time. The results provide some modest support for hypotheses stemming from the Broaden-and-Build model of positive emotion and revised Stress and Coping theory, both of which argue for unique adaptive functions of positive affect under stressful conditions. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Aphasia affects family members in addition to the individuals with the communication disorder. In order to develop appropriate services for the relatives of people with aphasia post-stroke, their rehabilitation goals need to be identified. Aim: The aim of the current investigation was to identify the rehabilitation goals that family members of individuals with aphasia have for themselves. Methods & Procedures: Forty-eight family members of adults with aphasia post-stroke participated in in-depth semi-structured interviews to identify the rehabilitation goals they had for themselves. All the interviews were transcribed verbatim and analysed using qualitative content analysis. Outcomes & Results: Analysis revealed seven categories of goals that the family members had for themselves: to be included in rehabilitation, to be provided with hope and positivity, to be able to communicate and maintain their relationship with the person with aphasia, to be given information, to be given support, to look after their own well-being, and to be able to cope with new responsibilities. A few participants reported that, at certain times during the rehabilitation process, they did not have any goals for themselves. Conclusions & Implications: This study highlights that family members of individuals with aphasia have a number of aphasia-related rehabilitation goals for themselves. In order to provide a family-centred approach to rehabilitation, health professionals, including speech-language pathologists, need systematically to identify and address family members' goals in light of the categories revealed in this investigation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which addresses research regarding French adult grandchildren who become the primary caregivers of their grandparents with dementia, and it mentions the burdens that are associated with caregiving tasks for French adult caregivers.