Different Types Of Care Research Articles

Family caregivers’ accounts of caring for a family member with motor neurone disease in Norway: a qualitative study

BackgroundMotor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis, respiratory failure. MND care is demanding, complex and involves a variety of care tasks. Family members may experience significant and enduring strain. We conducted a qualitative study to understand more about family caregivers’ work and sense of responsibility, exploring family caregivers’ accounts of caring for a family member with MND.MethodsWe recruited and interviewed a total of 25 participants from Norway, including 17 current and eight bereaved family caregivers. Drawing on theories of care by Corbin and Strauss, we analysed the data by a theoretical reading of the material to identify different types of care work.ResultsWe found that caregivers were engaged in five lines of care work that could be parallel or closely interconnected: i) immediate care work; ii) seeking information and clarity about the disease; iii) managing competing obligations; iv) maintaining normality; and v) managing external resources and assistance. Caregivers’ priorities were shaped by their interactions with the person with MND, available assistive devices, the development of the illness, and utilisation of paid care. Care work had a symbolic and moral meaning for caregivers, and was associated with self-worth and respect from others. Caregivers tried to balance their own expectations and others’ expectations without being overwhelmed by care work.ConclusionsA changing and potentially chaotic situation for family caregivers may compromise their capacity to utilise supportive services. Using the lines of work as a framework to assess caregivers’ preferences and priorities, health professionals may tailor assistance and support to family members caring for persons with MND.

Differences in Perceived Need for Medical, Therapeutic, and Family Support Services Among Children With ASD.

Identifying racial and ethnic differences in perceived need for treatment among families of children with autism spectrum disorder (ASD) will improve understanding of disparities in care seeking. We described racial and ethnic differences in perceived need for services that children with ASD and their families frequently use. We conducted bivariate analyses of racial and ethnic categories and perceived need for 6 common services used by children with ASD as found in the 2005 to 2006 (n = 2123) and the 2009 to 2010 (n = 3055) National Survey of Children With Special Health Care Needs data sets. Multivariate logistic regressions within concatenated data sets were conducted to examine associations between racial and ethnic category and perceived service needs while controlling for predisposing, enabling, and child factors. Compared with caregivers of white non-Hispanic children with ASD, caregivers of Hispanic children reported less need for prescription medications in adjusted multivariate analyses. Caregivers of black non-Hispanic children with ASD reported less need for prescription medications and for child and family mental health services than caregivers of white non-Hispanic children. Both English-speaking Hispanic caregivers and black non-Hispanic caregivers reported greater need for occupational, speech, and physical therapy than white non-Hispanic caregivers. No racial or ethnic differences were found in perceived need for specialty medical care or respite care. Caregivers of children with ASD from different racial and ethnic backgrounds may differentially perceive need for different types of care. Their perceptions may in turn affect how they prioritize and seek care, independent of their child's specific needs.

A Longitudinal Study of Transitions Between Informal and Formal Care in Alzheimer Disease Using Multistate Models in the European ICTUS Cohort

BackgroundWe aimed to describe longitudinal patterns of care in community-dwelling European patients with Alzheimer disease (AD), and determine patient-, caregiver-, and country-related predictors of transitions across different care levels. MethodsTwo-year follow-up data from ICTUS cohort (1375 patients with AD, 12 countries) were analyzed using multistate Markov models to describe transitions across states of care and identify their predictors. ResultsOf the patients, 61.3% stayed in the same state during follow-up, and only 9.5% experienced ≥2 changes between states. Six-month transition probabilities were 11% for informal to formal care and 13% for formal to informal care (in the community). Older age, male gender, poorer cognitive and behavioral scores, and country of residence were associated with transitioning from informal to formal care, but only country of residence was associated with the reverse transition. DiscussionChanges between different types of care were rare during follow-up, and country factors in particular influenced these transitions.

Do Women Still Care? Cohort Changes in US Women's Care for the Ill or Disabled

Increases in women’s labor-force participation and the time families spend at work have reduced the time families have available to care for one another. Recent evidence suggests that responses to these challenges vary for different types of care. While time spent on housework has declined, time devoted to care of children has increased. This paper examines cohort changes in another form of unpaid work, care for ill or disabled friends or family members, and assesses the influence of employment, attitudes, and need for care on age and cohort trends in carework. Using data from the National Longitudinal Surveys, we estimate age and cohort differences in carework among women born between 1922 and 1952. We find a decline in overall levels of carework among more recent birth cohorts of women. However, we do not find cohort changes in the probability that women will provide more intense levels of care, defined as nine or more hours of care per week. The amount of illness and disability among family members partially reduces differences between cohorts, but women’s employment and attitudes about work and family do little to clarify changing patterns of care. Overall, our findings suggest that, even after the large-scale social changes of the twentieth century, women will continue to provide carework when necessary. Thus, the real concern for families is not whether ill or disabled members will have care, but rather, whether their careworkers receive the institutional support required to successfully balance paid and unpaid work.

Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study.

Policy makers struggling to protect the 153 million orphaned and separated children (OSC) worldwide need evidence-based research on the burden of potentially traumatic events (PTEs) and the relative risk of PTEs across different types of care settings. The Positive Outcomes for Orphans study used a 2-stage, cluster-randomized sampling design to identify 1,357 institution-dwelling and 1,480 family-dwelling orphaned and separated children in 5 low- and middle-income countries (LMICs) in sub-Saharan Africa and Asia. We used the Life Events Checklist developed by the National Center for Posttraumatic Stress Disorder to examine self-reported PTEs among 2,235 OSC ages 10-13 at baseline. We estimated prevalence and incidence during 36-months of follow-up and compared the risk of PTEs across care settings. Data collection began between May 2006 and February 2008, depending on the site. Lifetime prevalence by age 13 of any PTE, excluding loss of a parent, was 91.0% (95% confidence interval (CI) = 85.6, 94.5) in institution-dwelling OSC and 92.4% (95% CI = 90.3, 94.0) in family-dwelling OSC; annual incidence of any PTE was lower in institution-dwelling (23.6% [95% CI = 19.4, 28.7]) than family-dwelling OSC (30.0% [95% CI = 28.1, 32.2]). More than half of children in institutions (50.3% [95% CI = 42.5, 58.0]) and in family-based care (54.0% [95% CI = 50.2, 57.7]) had experienced physical or sexual abuse by age 13. Annual incidence of physical or sexual abuse was lower in institution-dwelling (12.9% [95% CI = 9.6, 17.3]) than family-dwelling OSC (19.4% [95% CI = 17.7, 21.3]), indicating statistically lower risk in institution-dwelling OSC (risk difference = 6.5% [95% CI = 1.4, 11.7]). Prevalence and incidence of PTEs were high among OSC, but contrary to common assumptions, OSC living in institutions did not report more PTEs or more abuse than OSC living with families. Current efforts to reduce the number of institution-dwelling OSC may not reduce incidence of PTEs in this vulnerable population. Protection of children from PTEs should be a primary consideration, regardless of the care setting.

Torn between dual roles: the experiences of nurse-family members when a loved one is hospitalised in a critical condition.

To understand and interpret the experiences of nurse-family members when a family member or loved one is hospitalised in a critical condition. Having a family member hospitalised with a critical illness is a traumatic stressor, often with long-term sequelae. Providing holistic care for family members who are also nurses makes the provision of care more complex because of their professional expertise; yet few studies have explored this issue. In this descriptive study, qualitative data were collected using a questionnaire and analysed using van Manen's (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) six-step approach. Twenty nurse-family members completed an online questionnaire in June 2013. Qualitative findings from 19 participants were included in the analysis. The phenomenological analysis approach described by van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) was used to describe and interpret nurse-family member experiences. Nurse-family members experience significant dual role conflicts between their personal and professional personas due to their specialised knowledge, need for watchfulness and competing expectations. Our findings describe how dual role conflicts developed and were managed, and reveal the resultant emotional toll and psychological distress as nurse-family members struggled to resolve these conflicts. Nurse-family members require a different type of care than general public family members, yet their unique needs are often unmet, leading to increased anxiety and distress that could potentially be minimised. An increased awareness and emphasis on the nurse-family member experience can ensure health care professionals are better placed to provide appropriate and targeted care to minimise distressing dual role conflicts. There is a need for targeted and specialised communication appropriate to each nurse-family members' needs and level of understanding, and to clarify expectations to ensure nurse-family members' professional knowledge and skills are recognised and respected without being exploited.

Social inequalities in self-reported refraining from health care due to financial reasons in Sweden: health care on equal terms?

BackgroundThe main goal of the health care system in Sweden is good health and health care on equal terms for the entire population. This study investigated the existence of social inequalities in refraining from health care due to financial reasons in Sweden.MethodsThe study is based on 38,536 persons who responded to a survey questionnaire sent to a random sample of men and women aged 18-84 years in 2008 (response rate 59%). The proportion of persons who during the past three months due to financial reasons limited or refrained from seeking health care, purchasing medicine or seeking dental care is reported. The groups were defined by gender, age, country of origin, educational level and employment status. The prevalence of longstanding illness was used to describe morbidity in these groups. Differences between groups were tested with chi-squared statistics and multivariate logistic regression models.ResultsIn total, 3% reported that they had limited or refrained from seeking health care, 4% from purchasing medicine and 10% from seeking dental care. To refrain from seeking health care was much more common among the unemployed (12%) and those on disability pension (10%) than among employees (2%). It was also more common among young adults and persons born outside the Nordic countries. Similar differences also apply to purchasing medicine and dental care. The odds for refraining from seeking health care, purchasing medicine or seeking dental care due to financial reasons were 2-3 times higher among persons with longstanding illness than among persons with no longstanding illness.ConclusionsThere are social inequalities in self-reported refraining from health care due to financial reasons in Sweden even though the absolute levels vary between different types of care. Often those in most need refrain from seeking health care which contradicts the national goal of the health care system. The results suggest that the fare systems of health care and dental care should be revised because they contribute to inequalities in health care.

Medicine: a rethink? Are entrants to the profession and the way it is organised fit for purpose?

The health burden in most countries has changed. Although acute care is needed for trauma, acute illness and exacerbations of chronic disease, most of the burden is now long term. These patients need different approaches, with more emphasis upon supporting self-management, enhancing lifestyle changes, aiding compliance by shared decision-making and providing more convenient follow-up that appreciates the likelihood of multimorbidity. Integrated care will increasingly be offered from within the community. The current hospital- and doctor-centric focus needs to change to one where specialists work in the community as much as in hospitals and share this different type of care with others. For potential future doctors, the scientific basis of medicine will still underpin their unique role in diagnosis and prescribing, but they will need to understand these other changes and to be selected according to attributes compatible with their future role, and then be trained and assessed accordingly.

Social Role Specialization Promotes Cooperation between Parents

Biparental care of offspring is a widespread social behavior, and various ecological, life-history, and demographic factors have been proposed to explain its evolution and maintenance. Raising offspring generally requires several types of care (e.g., feeding, brooding, and defense), and males and females often specialize in providing different types of care. However, theoretical models of care often assume that care is a single variable and hence that a unit of care by the mother is interchangeable with a unit of care by the father. We hypothesize that the ability of one parent to provide all types of care may be limited by nonadditive costs or by sex-based asymmetries in the costs of particular care types. Using an individual-based simulation, we show that synergistic costs of investing in two tasks or negligible sex-based cost asymmetries select for task specialization and biparental care. Biparental care persists despite intense sexual selection and sex-biased mortality, suggesting that previous models make overly restrictive predictions of the conditions under which cooperation can be maintained. Our model provides a mechanistic underpinning for published models that show that the synergistic benefits of individuals cooperating can stabilize cooperation, both in the context of parental care and in other social scenarios.

Optimal administrative scale for planning public services: a social cost model applied to Flemish hospital care.

In choosing the scale of public services, such as hospitals, both economic and public administrative considerations play important roles. The scale and the corresponding spatial distribution of public institutions have consequences for social costs, defined as the institutions' operating costs and the users' travel costs (which include the money and time costs). Insight into the relationship between scale and spatial distribution and social costs provides a practical guide for the best possible administrative planning level. This article presents a purely economic model that is suitable for deriving the optimal scale for public services. The model also reveals the corresponding optimal administrative planning level from an economic perspective. We applied this model to hospital care in Flanders for three different types of care. For its application, we examined the social costs of hospital services at different levels of administrative planning. The outcomes show that the social costs of rehabilitation in Flanders with planning at the urban level (38 areas) are 11% higher than those at the provincial level (five provinces). At the regional level (18 areas), the social costs of rehabilitation are virtually equal to those at the provincial level. For radiotherapy, there is a difference of 88% in the social costs between the urban and the provincial level. For general care, there are hardly any cost differences between the three administrative levels. Thus, purely from the perspective of social costs, rehabilitation should preferably be planned at the regional level, general services at the urban level and radiotherapy at the provincial level.

Qualitative systematic review: the unique experiences of the nurse‐family member when a loved one is admitted with a critical illness

To interpret and synthesize nurse-family member experiences when a critically ill loved one is admitted to hospital. Having a family member hospitalized in a critical condition is an important stressor. When the family member is also a nurse, the provision of care is more complex, yet little research exists on this issue. Systematic review using Thomas and Harden's approach to thematic synthesis of qualitative research. Primary studies were located by searching CINAHL, Proquest, Journals@Ovid, SCOPUS, Cochrane Library and Google Scholar. No date restrictions were applied due to a lack of relevant literature. All studies that met inclusion criteria were retrieved (n = 1717) and seven met the review aim. Following critical appraisal, seven studies from 1999-2011 describing the nurse-family member's experience were reviewed and synthesized. Six characteristics of the nurse-family member experience were identified: specialized knowledge; dual-role conflicts; competing expectations; building relationships; being 'let in'; and healthcare setting. Nurse-family members experience important stressors that can negatively affect their psychological health and experience as a healthcare consumer. Nurse-family members want a different type of care than other healthcare consumers. Acknowledging nurse-family members' specialized knowledge and dual role, keeping them fully informed and allowing them to be with the patient and feel in control can reduce their fear and anxiety. Further research is needed to develop a deeper understanding of the unique experiences, challenges and needs of nurse-family members to provide them with an enhanced level of care.

The ecology of medical care in Beijing.

BackgroundWe presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. MethodsA cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics.ResultsOn average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing.ConclusionsThis study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

Rehabilitation of 190 non-ambulatory children with cerebral palsy in structures of care or in liberal sector

AimsTo describe the rehabilitation of non-ambulatory children with cerebral palsy and to explore adjustability on their individual needs. Material and methodData described are extracted from an on-going national cohort study, following during 10years 385 children with cerebral palsy, aged from 4 to 10, Gross Motor Function Classification System IV and V. We analysed data from the first 190 patients (mean age 6years 10months (SD 2.0), 111 boys), focusing on physiotherapy, ergotherapy, psychomotility and speech therapy in medico-social and liberal sectors. ResultsIn medico-social sector, duration of paramedical care is significantly more important than in liberal sector (structure of care: median=4.25h/week, liberal sector: median=2.00h/week) (P<0.0001). More than 4 different types of care per week are given in medico-social sector, while in liberal sector children benefit from only 2 different types of care a week. In investigators opinion, rehabilitation in structures of care is 71.65% adapted as opposed to 18.75% in the liberal sector (P<0.001). Children level V have less time of rehabilitation than the others (P=0.0424). InterpretationRehabilitation of children with cerebral palsy who are not able to walk, with an objective to improve quality of life, is truly multidisciplinary and suitable in medico-social sector.

Effectiveness of different types of care for the peritoneal dialysis catheter exit site: a systematic review

Background Prevention of infection is considered essential for satisfactory maintenance of peritoneal dialysis. Infections of the peritoneal dialysis catheter tunnel and exit site are considered to be serious infections that may predispose patients to peritonitis and its consequences. Objective To evaluate and summarise the best available evidence on the effectiveness of care for the peritoneal dialysis catheter exit site. Inclusion criteria Types of participants Adult and paediatric patients receiving peritoneal dialysis Types of Interventions Antiseptics, topical antimicrobials agents, dressings and educational interventions Type of studies Randomised controlled trials Types of Outcomes Incidence of tunnel and exit site infection and peritonitis, caused by Staphylococcus aureus, Pseudomona aeruginosa, Haemophilus, Neisseria, Escherichia coli, etc. Search strategy All studies, published (in MEDLINE, CINAHL and COCHRANE databases) and unpublished, in English, Spanish, Portuguese and French, carried out between 1996 and February 2009 were retrieved. ,. Methodological quality The methodological quality of included articles was assessed by two independent reviewers using critical appraisal tools from the Joanna Briggs Institute. Data extraction Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute. Data synthesis Results were combined in meta-analysis where appropriate. Results Nine randomized controlled trials were included. In one study that compared the effectiveness of daily application of gentamicin cream with mupirocin, in the gentamicin group there were a total of 15 infections of the exit site compared to the mupirocin group where there were 29 infections (OR= 2.72; 95% CI 1.28-5.77); there were 22 incidences of peritonitis in the gentamicin group, compared to 28 incidences of peritonitis in the mupirocin group ( OR= 1.51; 95% CI 0.74-3.05). In three studies, patients received povidone-iodine and the control group received standard care. The overall results of the meta-analysis estimated an OR=0.83 with 95% CI 0.47–1.45 for the prevention of infection of the exit site and an OR=0.77 with 95% CI 0.44–1.36 for prevention of peritonitis. One study compared the effectiveness of chlorhexidine versus liquid soap, showing that there was a statistically significant lower exit-site infection rate in the group of patients that used chlorhexidine soap compared with the group that used pure liquid soap.(OR 0.35 with 95% CI 0.13-0.94). Another study compared povidone-iodine vs. chlorhexidine vs. sodium hypochlorite, and found no statistically differences between povidone and chlorhexidine and found no differences between the use of povidone and sodium hypochlorite. Another three studies compared mupirocina vs. standard care; mupirocina vs. fusidic acid; and fusidic acid vs. ofloxacin, and found no differences in reducing exit site infections or peritonitis. Conclusions Some interventions appear to be more effective than others in terms of peritoneal dialysis catheter exit site care. These advantages are related to a lower number of cases of exit site infection and, consequently, peritonitis. The application of an antiseptic to the peritoneal dialysis catheter exit site reduces infections and prevents the peritonitis that is a consequence of exit site infection; however, the results do not demonstrate the superiority of any one of povidone, chlorhexidine, hypochlorite or washing with soap.

Managing competing philosophies with palliative care

Managing competing philosophies with palliative care

The Resident Classification System in Long-Term Care Institutions

The application for Health Information Technology can help staffs of long-term care institutions arrange daily care for residents and provide better personalized care services. In this study, we developed a Resident Classification System (RCS) through the concept of different types of care for resident assessment, including grading individuals in terms of the severity of five functional status assessment aspects of mental, movement, eating, excretion and medical treatment. Through the aid of RCS, residents can be classified into different types of care, and assessment results can assist care staffs in facilitating their work and delivering proper care to individual needs. We designed and built RCS through UML methodology for long-term care institutions. We not only can help care staffs understand the needs of residents, but also make personalized care plans and weekly schedules, so as to achieve the aims of comprehensive assessment and personalized care services. Moreover, resident care quality, care personnel work efficiency, and institution management efficiency can all be improved as a result of the completion of RCS.

Female Genital Mutilation, Cutting, or Circumcision

Female genital mutilation (FGM), female genital cutting, or female circumcision of women, the theme addressed in this special issue has many terms. The short form acronym FGM is understood by most, and it does contain the notion that we are talking about a traditional practice that is harmful. The practice affects women in diaspora as well as African countries, and men are involved as decision makers and attitude changers. Cutting is a neutral term, and circumcision is a more traditional terminology. Each term carries a certain value. But the practice is the same regardless of name. In order to understand the tradition, assist women who have undergone it, and promote action against it, it is important to have solid knowledge. This knowledge is partly medical and partly social. Thus, research based on a multitude of methods is warranted. This special issue is indeed a combination of social science and medical research on different aspects of the practice, that is also a genital health hazard for women. The special issue addresses FGM from different angles and geographical places. Somalis are heavily affected as well with the most extensive form of FGM, and several studies presented are from Somalia or about Somalis elsewhere. There is a paper on health provider issues from Somalia that reveals how health workers may view the practice in a country where cutting is the norm (Lazar et al.). The other side of the issue in Somaliland, the care needed by clients, is described in another paper (Fried et al.). But also in West Africans, where most practice less extensive forms of FGM, its gender aspects is addressed, as the studies from the Gambia and Sierra Leone demonstrate (Kaplan et al. and Bjalkander et al.). In Sierra Leone, as in other countries, there are some difficulties encountered in how to assess the types and magnitude of FGM. The phenomenon of FGM is important to gynaecologists for several reasons. Firstly, as it is a harmful practice that affects women, OB/GYN professionals may want to participate in initiatives that lead to its abandonment. As this is a topic that many people feel strongly about, some work on but fewer actually know how to handle, several articles in this issue may assist those who want to do their share in defining appropriate community interventions that they may want to engage in. The review of strategies presented here and the paper on attitude change are important contributions to the know-how literature. Some may think that harm reduction is a way forward, and others claim that full abandonment is the only way (Gele et al.). Secondly, as this harmful practice is associated with health risks that OB/GYN professionals have to manage, many OB/GYN face problems when delivering babies of women who have undergone FGM, yet others have to provide different types of care to alleviate the problem, especially the obstetric consequences and their management. This special issue provides evidence for the harmful effects (Berg, Underland). As there may be an increased attempt to medicalize the cutting, and requests for doctors to involve themselves in “harm reduction” strategies, it is important that OB/GYN and nursing professionals are also fully aware of the reasons for wanting to be cut, male and female resistance to change, and knowledge about how harmful this practice is (Isman et al.). The issue of harm reduction is indeed controversial, as the bottom line message is to end the practice altogether. If one thinks that taking one step at a time and involving professionals in the procedure will eventually eliminate the practice, it may violate the very reason for medical people to practice “do no harm.” This is an issue that should be transparent and heavily debated everywhere. To perform FGM for “harm reduction” may as well turn into yet another profit operation for some health workers, because consumers ask for it. To have solid evidence on the damage done to women is therefore important. The systematic meta-analysis paper in this issue is the best of that knowledge (Johansen et al.). This special issue tries to link some evidence and experience from the social sciences into clinical obstetrics and gynaecology. We, as OB/GYN doctors, know that culture, social position, and gender also form our work environments, cause disease and complications are determinants for choices we and our patients make. Therefore, we hope you will enjoy this issue and join the growing group of colleagues who take this practice seriously as a step to a better health for girls and women everywhere. Johanne Sundby R. Elise B. Johansen Birgitta Essen

OS SENTIDOS DO CUIDADO NO PARTO: UM ESTUDO INTERGERACIONAL

Esta pesquisa de abordagem qualitativa teve por objetivo estudar os sentidos atribuídos ao cuidado no parto e analisar como as diferentes práticas de cuidado em Obstetrícia estão presentes no discurso de mulheres de diferentes gerações de uma mesma família. Foram realizadas entrevistas abertas que se desenvolveram como conversas o que tornou possível o compartilhar de histórias e sentidos. A análise privilegiou os mapas dialógicos, e possibilitou visualizar os sentidos que as mulheres atribuíram às diferentes práticas de cuidado que receberam e os efeitos destas práticas na experiência de cada uma. A análise das entrevistas possibilitou identificar duas categorias: Os sentidos do cuidado durante o parto e Os sentidos atribuídos à vivência da dor do parto. Os resultados mostram o compartilhar de repertórios, diferentes tipos de assistência ao parto e de contexto nas vivências, e seus efeitos nos significados atribuídos.

Factors Associated With First Utilization of Different Types of Care for Alcohol Problems

The purpose of this research was to investigate whether factors associated with first obtaining care for alcohol problems vary by source of care. This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions to examine initiation of different types of care over a 3-year follow-up interval among individuals with baseline alcohol use disorders who had not previously obtained any care (n = 2,170). Three hierarchical, mutually exclusive types of care were compared: substance use disorder (SUD) specialty sources, general medical but no SUD specialty sources, and nonmedical sources only. Having injured oneself or someone else because of drinking was associated with initiating all three types of care. Additional factors associated with initiating care from SUD specialty treatment sources (vs. no care) comprised male sex, alcohol use disorder severity, major financial problems, and nondependent tobacco/drug use. Factors associated with initiating care from general medical but not SUD specialty sources (vs. no care) comprised marriage/cohabitation, college student status, number of medical conditions, and other substance dependence. Factors associated with obtaining care only from nonmedical sources (vs. no care) comprised low income and anxiety disorder. When direct comparisons were made among types of care, factors drawing individuals into general medical care for reasons not necessarily related to alcohol problems were those that primarily distinguished utilization of general medical sources from the other two types of care. Results support the importance of screening in general medical practice and student health services as an important means of identifying individuals in need of brief intervention or more intensive SUD treatment and reiterate the importance of nonmedical sources for individuals whose alcohol problems might never be addressed in routine medical visits.

Determinants of Obtaining Formal and Informal LTC across European Countries

The aim of this paper is to identify patterns of utilization of formal and informal long term care (LTC) across European countries and discuss possible determinants of demand for different types of care. Specific research questions are of the volume of different types of care and conditions under which care is undertaken. The latter include demographic factors, especially aging of the society, health status and limitations caused by poor health, family settings and social networking. The analysis indicates substantial differences in obtaining LTC across European countries depending on the tradition and social protection model that determine availability of institutional care and provision of informal care. In the Nordic-type countries with high state responsibility and high provision of institutional care, informal care is of less importance and - if received - it is mostly care provided from on irregular basis from outside the family. With growing needs for care, formal settings come in. Countries of the continental Europe are less unified with high share of people using formal settings of care, but also combining formal and informal care. In Mediterranean countries provision of informal care, including personal care, plays much greater role than formal LTC.