Testimonials about Damages in Construction Resulting in Need for Rework–Cases in Sweden - Part 1

This is a study about damage resulting in rework in residential construction in Sweden. They are assorted under 13 headings that mention physical facts without taking a position on cause of the problem. This second part of the report presents information considering water freezing in the building envelope, water in the facades, stained facades, construction parts that not fulfil the system performance anticipated and also real disasters. Preparation before casting concrete takes care because any need for demolishment consumes considerable resources. In general, to avoid damage it is good to; have up to date knowledge about problems that emerge; have a leadership that favours commitment to a well-built product; and to follow up the details that are critical, like those that could result in leakage of water. We also think it is good to be open about things that go wrong. In case skill is missing, education would contribute to a better outcome and less need for rework. In case violation to any instruction or principle is the reason, it should be very clear who is responsible, and important to place responsibility with the person who can influence the outcome.

The changing role of monitored anesthesia care in the ambulatory setting.

BackgroundThe take-up of eHealth applications in general is still rather low and user attrition is often high. Only limited information is available about the use of eHealth technologies among specific patient groups.ObjectiveThe aim of this study was to explore the factors that influence the initial and long-term use of a Web-based application (DiabetesCoach) for supporting the self-care of patients with type 2 diabetes.MethodsA mixed-methods research design was used for a process analysis of the actual usage of the Web application over a 2-year period and to identify user profiles. Research instruments included log files, interviews, usability tests, and a survey.ResultsThe DiabetesCoach was predominantly used for interactive features like online monitoring, personal data, and patient–nurse email contact. It was the continuous, personal feedback that particularly appealed to the patients; they felt more closely monitored by their nurse and encouraged to play a more active role in self-managing their disease. Despite the positive outcomes, usage of the Web application was hindered by low enrollment and nonusage attrition. The main barrier to enrollment had to do with a lack of access to the Internet (146/226, 65%). Although 68% (34/50) of the enrollees were continuous users, of whom 32% (16/50) could be defined as hardcore users (highly active), the remaining 32% (16/50) did not continue using the Web application for the full duration of the study period. Barriers to long-term use were primarily due to poor user-friendliness of the Web application (the absence of “push” factors or reminders) and selection of the “wrong” users; the well-regulated patients were not the ones who could benefit the most from system use because of a ceiling effect. Patients with a greater need for care seemed to be more engaged in long-term use; highly active users were significantly more often medication users than low/inactive users (P = .005) and had a longer diabetes duration (P = .03).ConclusionInnovations in health care will diffuse more rapidly when technology is employed that is simple to use and has applicable components for interactivity. This would foresee the patients’ need for continuous and personalized feedback, in particular for patients with a greater need for care. From this study several factors appear to influence increased use of eHealth technologies: (1) avoiding selective enrollment, (2) making use of participatory design methods, and (3) developing push factors for persistence. Further research should focus on the causal relationship between using the system’s features and actual usage, as such a view would provide important evidence on how specific technology features can engage and captivate users.

A distinct group?the difficult-to-place patients?has appeared in connection with the reorganization process in psychiatry. There is no exact definition of this group, and only a few studies describe the patients in detail. The present study describes the characteristics, admission patterns, and need for care of a group of difficult-to-place patients in Roskilde County, Denmark. The patients were a sociodemographically marginalized group. Most of them were schizophrenics, and two-thirds had a dual diagnosis of alcohol or drug abuse. These patients functioned poorly and had a great need for care and help. As assessed with the CAN, the staff found a greater need for care compared with the patients' assessments with regard to the psychiatric disease, substance abuse, self-care, and problem behaviours. It is our hypothesis that it is the great number of needs in various domains?that is, the severe disabilities in addition to the patients' lack of insight into their need for care, problem behaviour, and alcohol and illicit drug abuse?that make these patients difficult to place in the community. But to be difficult to place in the community is not only something embedded in the patient alone. If relevant services were established, the term ?difficult to place? might be changed to ?severely disabled? psychiatric patients.

RESUMO: O making-do se destaca porque representa um potencial para gerar outras perdas, como redução de segurança, problemas de qualidade, produtividade e retrabalho. O principal objetivo da pesquisa é analisar e investigar as perdas por making-do, relacionadas à de gestão da produção de três empresas de Goiânia, com a finalidade de identificar as categorias de perda e seus possíveis impactos. A pesquisa é classificada como quantitativa e qualitativa, também como aplicada e exploratória. Com base nisso, foram analisados dados durante as visitas técnicas em cada obra, dentre as quais se destaca a observação direta não participante, a aplicação de questionário e a análise documental. Em acréscimo foram realizados registros fotográficos das atividades produtivas com ocorrência de perdas, além da análise da organização do canteiro de obras dos empreendimentos em estudo. Os resultados deste estudo indicaram que a maioria das improvisações está relacionada ao planejamento de curto prazo, logística e projetos. No entanto, os impactos mais importantes desses tipos de perdas são a necessidade de retrabalho e perda de material. Como resultados detaca-se a importância do estudo das perdas relacionadas ao making-do, uma vez que gera outros tipos de perdas, e vai além do desperdício de materiais, evidenciando-se questões relacionadas à saúde e segurança da mão de obra e impactos no processo de produção como um todo. ABSTRACT: The making-do stands out because it represents a potential to generate other losses, such as security reduction, quality problems, productivity and rework. The main objective of the research is to analyze and investigate the losses by making-do, related to the management of the production of three companies of Goiânia, for the purpose of identifying the categories of loss and their possible impacts. The research is classified as quantitative and qualitative, also as applied and exploratory. Based on this, data were analyzed during the technical visits in each work, among which stands out the non-participant direct observation, the application of questionnaire and the documentary analysis. In addition, photographic records of the productive activities with the occurrence of losses were carried out, in addition to the analysis of the organization of the construction site of the projects in study. The results of this study indicated that most improvisations are related to short-term planning, logistics and projects. However, the most important impacts of these types of losses are the need for rework and loss of material. As a result, the importance of the study of the losses related to the making-do stands out, since it generates other types of losses, and goes beyond the waste of materials, evidencing issues related to the health and safety of the workforce and impacts in the process of Production as a whole.

Informal care and spousal caregiver’s burden in old age The ageing of the population creates an increasing demand for public long-term care (LTC). In order to keep the LTC system sustainable, policies are aimed at ‘ageing in place’ and residential care is limited. In this context, informal care has become a key issue for welfare policy. Informal care giving can have negative consequences. The decision to take up the care of someone close to you may lead to emotional, physical and financial stress, resulting in overburden. In old age, in particular for spouses, caregiver’s burden may be related to the caregiver’s own health impairments and declining quality of the relationship with the care recipient. This thesis focuses on two issues: the use of informal care (part A) and the burden on the spouse who provides care (Part B). Part A We answered the question: under what circumstances is informal care used? Data from the Longitudinal Aging Study Amsterdam is used. The Andersen-Newman model views use of care as result of decisions made by an individual, which are constrained by their position in society and the availability of care. The Informal Care Model applies this model to the perspective of the caregiver. We examined whether informal care use changed over the years and, if an older adult started to use personal care, whether the likelihood of receiving that care from the spouse, changed over the years. In one study, we analysed 9,585 observations from 3,574 respondents between 1995 and 2012 for whether informal care was used. In another study, we analysed observations from 221 independently living married respondents between 1995 and 2016 who used personal care for the first time. Results showed that next to the care need and predisposing and enabling factors, changing societal circumstances as well as the caregiver’s physical functioning and the spousal relationship quality determine informal care use. The proportion of older people using informal care was lower in the late 2010s than in 1992, while the proportion of older people using formal care increased somewhat. These findings are only in part due to changing individual characteristics of the older adults included in our study. Part B We answered our second research question: what determines spousal caregiver’s burden? We used data from the Older Persons and Informal Caregivers Survey—Minimum Data Set. As the Caregiver Stress Process Model describes, caregiver’s burden depended on multiple conditions; the need for care, hours of caregiving, secondary stressors, and buffers as the help from others and fulfilment with the caregiving tasks. We examined whether the model works differently for husbands and wives by using mediation and moderation effects with structural equation modelling. We used cross-sectional data of 1,611 couples. Additionally, we applied multilevel regression analysis on burden, stratified by gender, to study the impact of one-year duration of the caregiving situation on burden; 1,444 observations from 722 couples were analysed. Results showed that care need factors, hours of caregiving, and secondary stressors explain spousal caregiver’s burden; however, the mechanisms differed for men and women. Longer caregiving leads to higher burden, especially for wives. Wives reported a higher burden, had spouses with a greater care need, provided more hours of care a week, and more fitted the wear-and tear model than husbands. Conclusion Variation in informal care use and caregiving burden is explained by three types of factors related to both the care user and caregiver, their mutual relationship, and the societal context. The thesis also provides evidence that informal care is a highly gendered phenomenon. Female caregivers were disadvantaged in all conditions.

ABSTRACTBackground: Many people with Parkinson's disease (PD) (PwP) require care from either informal or formal carers, due to worsening symptoms. Carer strain is a recognised consequence of caring. However there are few data on the role and profile of informal carers and if this impacts on carer strain.Method: People with moderate to advanced PD, with an informal carer were invited to participate. Data regarding motor and non-motor symptoms of the participant, along with demographics, tasks and duration of caring and health issues of the carer were collected.Results: One-hundred and fifteen participants and their carer were recruited. Mean carer age was 70.7 years, 66.1% were female caring for a median of 16 hours per day. Over 80% provided help in housework and companionship activities, 63.2% with dressing and 49.1% with feeding. There was a significant relationship between disease stage and level of strain. Participant age, physical and cognitive disability were significantly associated with greater care need. High care need was associated with poor carer quality of life.Conclusions: The care needs of PwP are considerable. To reduce carer strain and improve quality of life, carers’ needs must be considered to enable them to carry on with their vital role.

Human population is aging. Therefore, considerable amount of attention has to be given to the problems specific to aging. Dementia is one of such problems. There is a strong relation between dementia and gait disorders. With aging the amount of people falling during standing, walking or climbing stairs dramatically increases. Because of this, the elderly people have a greater need for care and assistance and are more likely to be admitted to a nursing home after a fall, although they would like to stay at their own home and be independent. Although a number of researchers are dealing with this problematics so from the point of the medical diagnostics, as from view of possibility of integrating fall detection device into clothing, there are still unresolved problems on the area of providing safety of people with dementia.This contribution deals with the integration of a fall detection system being supplied by printed batteries into clothing, designed with medical function in mind for safety of elderly people and patients with dementia. The first part presents a fall detection and long-term motion monitoring system and considers its power consumption. Energy consumption will be considered based on an amount of current consumed by particular parts of fall detection and long-term monitoring system. The second part gives an overview of various batteries suitable to supply the fall detection and long-term motion monitoring system integrated into clothing, while the third part presents suggestions for fall detection and long-term motion monitoring system integration into clothing.

Implications of the diagnosis of locomotive syndrome stage 3 for long-term care

Introduction: at this critical moment of the COVID -19 pandemic, we observe the social withdrawal and the break from the routine of individuals in society, for people with disabilities who need adequate support and a routine of more intense and effective activities may feel a greater need for care and attention of family support for solving everyday problems. Objective: to identify factors associated with the impact of the pandemic on the quality of life of individuals with disabilities and their caregivers. Methods: a virtual survey was carried out with parents and caregivers of people with disabilities to identify the main factors associated with the impact of the Pandemic on daily life and social relationships between family and community. Results: of the parents and caregivers we had access to and answered the questionnaire, 90% are residents of the ABC region of São Paulo. Their children and adolescents with disabilities are between 4 and 18 years old. The main scores of caregivers on difficulties in care during the pandemic, 70% felt helpless at some point, 17% had difficulties in performing self-care activities, 42% had anguish and fear during the period, 83% have the greatest responsibility for household decisions, and about 50% can share those decisions. Conclusion: the main complaints about the care of people with disabilities during the COVID-19 pandemic are related to the feeling of fear and anguish that affects decision-making and family relationships, which influences self-care activities and mental health of this population.

Predictors of mortality in the mentally-impaired institutionalized aged

IntroductionThe physical limitations experienced by people with chronic pain (CP) produce a greater need for care and assistance, most of which is provided by an informal caregiver (IC). Despite the key role ICs play in the everyday lives of individuals living with CP, knowledge about their experiences and needs is limited. We aimed to address this limitation by exploring the experiences of IC of people with CP.MethodsThis is a qualitative descriptive study using semistructured interviews. Participants were 12 ICs purposively chosen from the Unit of Pain at the University Hospital in Cádiz. Individual interviews were recorded, transcribed verbatim and analysed following thematic analysis.ResultsWe developed one overarching theme ‘Becoming a secondary actor of one's own life’ and three themes: 1. Key elements that shape a caregiver's experiences; 2. It's the hand that life dealt me; 3. The burden of being a caregiver and coping strategies.ConclusionsThis study's findings highlight how the CP impacts IC lives. Being an IC for a relative with CP became the most important role in the IC's life, to the point of casting a shadow over their own needs. Besides, participants felt not having other options but to keep going with that role. Yet, the context was essential in shaping the experiences as caregivers and the burden derived from caregiving. In this line, differences related to gender roles were found in the narratives of participant women and men.Patient or Public ContributionParticipants were purposively chosen from the Unit of Pain at the University Hospital ‘Puerta del Mar’ who attended the consultation accompanying their relatives. All the eligible participants were approached by the clinician. After this initial approach by the clinician, one of the researchers met the potential participant and they went to a quieter place in a clinical setting for the interview, before which the participant was shown a letter with more comprehensive information about the study and its aim. The participants were left alone to read and think carefully before giving their written informed consent. Participation was voluntary and the subjects received no financial contribution for their time.

To evaluate the effects of Medicare's prospective payment system and Medicaid's preadmission regulations on long-term care, we constructed clinical profiles in 1982 and 1986 of about 500 randomly selected patients from each of three types of facilities: nursing homes with relatively high proportions of Medicare patients (high-Medicare nursing homes; n = 23), traditional nursing homes (n = 19), and home health agencies (n = 18). Data were obtained directly from the care givers on the medical problems, problems requiring skilled nursing, and functional problems of these representative patients from 12 states. For Medicare patients in high-Medicare nursing homes, the prevalence of medical problems and problems requiring skilled nursing increased substantially, whereas the prevalence of functional problems remained relatively unchanged. For example, from 1982 to 1986 there was a marked increase in the frequency of tube feedings (21 to 29 percent), oxygen use (6 to 14 percent), urinary tract infection (7 to 13 percent), and diastolic hypertension (1 to 10 percent), but not difficulty in eating (48 to 51 percent) or speaking (28 to 29 percent). In contrast, in traditional nursing homes there was an increase in the prevalence of functional disability, but virtually no change in that of problems requiring medical and skilled nursing care. In home health care the functional care needs of Medicare patients increased significantly, and there was a slight increase in the prevalence of problems requiring medical and skilled nursing care. We conclude that from 1982 to 1986 the needs of patients in long-term care increased substantially. This trend appears to result from Medicare's prospective payment system, which encourages earlier hospital discharge to long-term care settings, and from Medicaid's policy of de-institutionalization. Meeting this greater need for care will be costly. We require a better system of reimbursing for long-term care and ensuring its quality.

Parkinson’s Disease (PD) is mainly known for its motor symptoms. However, it can also involve the impairment of certain cognitive functions (memory, attention, visuospatial skills, etc.), and is associated with a lower quality of life among people with PD and those closest to them. As the disease progresses, there is a greater need for care, which is generally provided by informal caregivers. This briefing is aimed at organisations and specialists interested in applying a combined intervention of cognitive rehabilitation for people with PD and psychoeducation for their family caregivers at their centres. The goal is to improve the cognitive functions and quality of life of people with PD and their families. Involving families can provide an integrated approach to the rehabilitation process and strengthen the benefits for people with PD, while at the same time offering strategies for fostering better quality of life among caregivers.

2 Ambulance non-conveyance time