Care Regimes Research Articles

The Baby and the Bathwater: Class Analysis and Class Formation after Deindustrialisation

Abstract This paper is an edited version of the Deutscher Memorial Lecture delivered in November 2023 which expands upon The Next Shift: The Fall of Industry and the Rise of Health Care in Rust Belt America. It develops an account of the productivity limits of interpersonal service work more firmly rooted in Marxism and argues that the separation of social reproduction from production is primarily economic rather than political. This theoretical device is then deployed to argue that there is indeed a global ‘crisis of care’. This crisis is triggered not only by destabilisation of earlier care regimes, but also the encounter between the productivity limit and new forms and expanding volume in demand for care. Finally, this crisis is linked to the new global sociology and politics of gender and sexuality. Methodologically, the paper argues for renewed attention to the empirical specificity of proletarianisation processes, rather than ‘class abstractionism’.

A randomized controlled trial comparing two antenatal care regimes in the management of mild to moderate gestational diabetes in a low-middle income country.

The prevalence of gestational diabetes mellitus (GDM) in the Indian subcontinent has increased exponentially, especially after new diagnostic criteria. Identifying women who need close monitoring is a challenge. Ultrasound has been used to guide therapy but its use in the management of GDM has been used indiscriminately due to paucity of information. The use of ultrasound to guide the number of antenatal visits for adequate glycemic control has not been researched adequately. There is also a need to contrive antenatal care strategies that can obtain optimal neonatal outcomes without burdening the health system in low-middle income countries (LMIC). Our study was to compare pragmatic standard management of GDM with an ultrasound-guided regime (USGR) to prevent neonatal complications to ensure optimal care. A randomized controlled trial was done in a tertiary hospital between May 2019 and September 2021 in South India. Five hundred and eighty-eight women were randomized to a standard regime or USGR. χ2 and t-test were used to compare outcomes. Maternal and neonatal outcomes between standard and ultrasound USGR showed no significant difference in outcomes. Fetuses in USGR with AC ≥ 70th centile had macrosomia (3.59% vs 26.67%, P < 0.001), increased severity of diabetes (2.97% vs 16.67%, P < 0.001), 3rd- and 4th-degree perineal tear (2.95% vs 27.27%, P < 0.001). The increased number of visits did not decrease adverse outcomes. This small well-designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in the treatment of women with GDM.

COVID-19 hits care homes: A cross-national study of mortality rates

The COVID-19 outbreak, which most severely impacted older citizens, served as a stress test for residential eldercare facilities. The mortality rates of care home residents varied widely across countries in 2020 before vaccinations became available. Why have some countries been better (or less) able to protect their older citizens in care homes? This article examines the role of specific characteristics of national systems of residential care in enhancing or weakening the capacity of these systems to protect their residents from the pandemic and seeks to draw some lessons for the future. Because the mortality rate in care homes strongly correlates with the overall infection rate within the community, this article adopts an innovative approach to conceptualize and measure the protection capacity of national residential care systems more specifically – that is net of mortality rates within the community. The study makes important contributions to the care policy field. The traditional care regime typology fails to explain cross-national variations in the protective capacity of care homes. Governmental spending on long-term care systems certainly matters for protective capacity but we find that a factor previously neglected by care regime scholars also matters. More specifically, we show that the pattern of staff organization affects protective capacity. Our findings call for a rethinking of care systems in the face of future pandemics.

Struggles over elder care in South Africa

ABSTRACT This paper examines the tensions and struggles over elder care that are happening in South Africa between family caregivers, care workers and the state. These struggles are experienced and expressed at the familial and community level but are best understood by examining how the state has de-funded facilities in favour of ‘ageing in place’ without any additional investment in community and home-based care support. The findings reveal that stresses on unpaid and paid carers are expressed in terms of individual failings and interpersonal conflict rather than through a socio-political contextual lens. These findings contribute to how a familialist care regime impacts the everyday personal relationships between paid and unpaid carers of older persons.

Gendered Vulnerability in Necropolitical Bordering: Displaced Men’s Material and Affective Abandonment in Greece

The term vulnerability has become increasingly integral to humanitarian legislation, policies, discourse, and procedures in contexts of displacement. While people categorized as “vulnerable persons” are ostensibly entitled to specialized care, this categorization is widely used to divide people into those “legitimate” and “illegitimate” to receive basic rights and care. Critical feminist scholarship has highlighted how gender is the dominant lens through which vulnerability is constructed and recognized. This affects all people during displacement. However, here we address the implications of this framework for men’s experiences of displacement, exploring as a case study the issue of housing for displaced people in Greece. Drawing on our independent fieldwork and interviews with humanitarians and displaced men, we demonstrate how gendered conceptions of vulnerability are not only integrated into institutionalized immigration apparatuses but also circulate in the everyday discourses, practices, and affective economies that constitute the Greek care regime. The result is that a form of necropolitics is exercised against men, forcing them to reside in conditions of slow violence and permanent injury. We address the gendered nature of this necropolitics as well as the gender-specific consequences for men at Europe’s borders.

Treating Mycoplasma genitalium (in pregnancy): a social and reproductive justice concern.

Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring "collective sacrifices" in order to preserve antibiotic efficacy. 'Who should make the sacrifices?' and 'Who will most likely make them?' are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients - above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc.

Depends on whom you ask: Discordance in reporting spousal care between older women and men across European welfare states

PurposeWe aim to investigate systematic differences in reporting spousal care between caregivers and cared-for persons and their possible effects for the analysis of care regimes and correlation of care with health. Materials and methodsUsing information on care provided/received from the Survey on Health, Ageing and Retirement in Europe (SHARE), we estimate the prevalence of spousal care and discordance between caregivers and cared-for persons in the reporting of care among caregiving dyads. Multinomial regressions are used to estimate systematic differences in reporting spousal care. We then use multivariable logistic regressions to assess the association between discordance in reporting informal care and carer's self-rated health (SRH) and depression using the EURO-D scale. ResultsOnly 53.9 % of dyads report care that is confirmed by both spouses. Multinomial regressions show that agreement on care being provided/received is more common when women are caregivers, while men are likely to underreport when providing or receiving personal care. Prevalence of spousal care across care regimes is sensitive to who reports care. There is no effect on the association of care with SRH regardless of who identifies the carer, while the magnitude and statistical significance of the association between depression symptoms and care varies according to the choice of respondent. ConclusionsInformal care may be understated across Europe when relying solely on carer self-identification through description of tasks in surveys. From a policy standpoint, relying on self-identification of carers to access support or social benefits may potentially reduce the take-up of such benefits or support.

Impact of an evidence-based bundle on incontinence-associated dermatitis prevalence in hospital patients: A quasi-experimental translational study.

The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi-experimental pre-and post-study,conducted in 18 wards, was part of a larger implementation science study on incontinence-associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and August 2021 (post-intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three-in-one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre-intervention = 964, post-intervention = 933). A total of 343 (35.6%) pre-intervention patients and 351 (37.6%) post-intervention patients had incontinence. The prevalence of hospital-acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post-intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID-19 pandemic in the post-intervention group compared with the pre-intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital-acquired IAD, suggesting enduring effectiveness of the intervention.

Defamilization? Not for everyone. Unequal labour-market participation among informal caregivers in Europe

Growing care dependencies among the elderly due to population ageing in Europe challenge the labour-market participation of informal caregivers. While familiarized care regimes incentivize family caregiving by providing many cash-for-care-benefits, resulting in reduced labour supply, defamiliarized care regimes allocate more public spending to care infrastructure, alleviating the care responsibilities placed on family members. At the same time, care provision on the micro-level is distributed unequally across gender, age, and socioeconomic status. The question then emerges: Does the labour-market participation of informal caregivers vary between and within countries depending on the social-expenditure policy of welfare states? To answer this research question, a multilevel design was used, employing SHARE data and macro-indicators from OECD and Eurostat databases. The results reveal higher probabilities of labour-market participation for informal caregivers in general when social expenditures on formal care infrastructure are higher. However, labour-market participation was observed as being unequally distributed among the heterogeneous group of persons with and without caregiving duties. Women and individuals of lower socioeconomic status did not benefit from social expenditures in the same way as their counterparts, leading to lower levels of labour-market participation.

Influence of Pre- and Intraoperative Local Anaesthetic in Strabismus Surgery under General Anaesthesia in Adults.

As studies have shown a reduction in the occurrence of the oculocardiac reflex with the addition of local anaesthesia, we changed our care regime accordingly a few years ago. To promote and establish better patient care, we retrospectively analysed the files of our patients who underwent strabismus surgery from 2013 to 2021 in order to compare strabismus surgery under general anaesthesia with and without local anaesthetics in a routine clinical setting. Data from 238 adult patients who had undergone strabismus surgery could be extracted from the files: G1: n = 102, only general anaesthesia; G2: n = 136, preoperative application of tetracaine eye drops and intraoperative subtenon lidocaine/levobupivacaine in addition to general anaesthesia. We compared the two groups in regard to the frequency of oculocardiac reflex, the amount of atropine needed to treat, as well as the amount of antiemetic and analgesic medication given, and time spent in the recovery room. Mean age of G1 was 50 years and 52 years in G2. There was no significant difference between the kind of surgeries (recessions/resections), the number of patients who had undergone a reoperation, or the duration of the operations. Adding local anaesthetics resulted in significantly less occurrence of oculocardiac reflex (p = 0.009), a reduction in the need for atropine, analgesic, or antiemetic medication, as well as reduced time in the recovery room. As this increases patient safety and comfort and is cost-effective (less time in the recovery room), we recommend adding perioperative local anaesthesia to strabismus surgery performed under general anaesthesia.

Variable effects of exposure to ionic silver in wound-associated bacterial pathogens.

Silver compounds are used in wound dressings to reduce bioburden. Where infection is not rapidly resolved, bacteria may be exposed to sub-therapeutic concentrations of antimicrobials over prolonged periods of time. In this study, a panel of chronic wound bacteria, Pseudomonas aeruginosa (two strains), Staphylococcus aureus, and Escherichia coli, were exposed to silver nitrate on agar. Phenotypic characterization was achieved using broth microdilution sensitivity testing, a crystal violet biofilm assay, and a wax moth pathogenesis model. Repeated exposure to ionic silver did not result in planktonic phenotypic silver resistance in any of the test panels, although S. aureus demonstrated reversible increases in minimum bactericidal concentration. An ulcer-derived P. aeruginosa exhibited marked reductions in biofilm eradication concentration as well as significantly increased biofilm formation and wax moth killing when compared to the same progenitor. These changes were reversible, trending towards baseline measurements following 10 passages on silver-free media. Changes in virulence and biofilm formation in the other test bacteria were generally limited. In summary, phenotypic adaptation following exposure to ionic silver was manifested other than through changes in planktonic susceptibility. Significant changes in pseudomonas biofilm formation and sensitivity could have implications for wound care regimes and therefore warrant further investigation.

What do private providers of home care want? An analytical framework

ABSTRACT Private for-profit home care providers are key participants in European long-term care regimes. Yet, their policy preferences toward market making and market development remain under-researched. We present an analytical framework that identifies and explains those preferences. It outlines three key types of policies that shape home care markets: regulatory, financial and labour policies. We illustrate private providers’ views on those policies by reference to Ireland’s home care regime. Irish home care is a compelling case for this study. A major package of regulatory reforms is currently being introduced and private providers have outlined clear preferences about it. Our paper is based on interviews with 14 leading individuals involved in the home care sector. We find and explain how private providers wish to increase regulation over their activities; to split purchaser and provider roles; to reduce private forms of financing; and to expand the pool of labour available to them. We discuss how those preferences shed light on the political economic power dynamics that shape the Irish care regime. Our analytical framework may be applicable to other welfare markets at different stages of development and in other institutional contexts.

Support System of Transnational Families in Guinzadan Bauo Mountain Province Philippines

This qualitative-descriptive research focusing on transnational families was conducted in Guinzadan, Bauko Mountain Province. Anchored on the Functionalist sociological theory and concepts on conflict theories, this study aims to describe the practices of the selected transnational families to establish what led to the new care regime in the structure of transnational family. Thus, this study looked into the conditions caused the moving out of the parent/s; the existing situations of transnational families; and the support system of these transnational families. Having identified the issues of transnational families, the researcher proposed a program to address the issues in the transnational families in this study. The findings show that the rise of transnational families in which the husbands or wives need to work in other countries modifies the structure of the family: households become fatherless or motherless while the grandparents, aunties, and uncles become the guardian or the head of the households. The condition of the households being left motherless or fatherless affirms the pervasiveness of transnational families, which in turn resulted in the new care roles, new parenting styles, and new support systems in the family structure. It is however interesting to note the patriarchal ideology as one of the enduring issues that run throughout the narratives of the informant; the kinship system as a push and pull factor of transnational families that strengthen their motivation to work abroad; and the functionalist theory that was manifested in the case of support system of these transnational families in maintaining the stability of the family as a primary institution. Consequently, an enrichment program for the community is needed to address the issues of transnational families, especially on the welfare of the children and the entire family.

Affective relatedness, temporalities, and the politics of care in a medical South-South partnership

Abstract For more than 50 years, Cuba has been one of the most important players in the field of international medical care in the Global South. Between 2013 and 2018, Cuba sent nearly 18,000 Cuban health professionals to Brazil within the framework of the More Doctors Program to assist during the Brazilian public health care system's state of emergency. This article focuses on local encounters and emergent socialities between Cuban physicians and Brazilian patients and medical staff. Their sensitive moments of interaction—with their embodied, emplaced, and political dimensions of past and present—hold the possibility of a fragile intersubjectivity that creates its own temporal and affective dynamics, undermining, for a moment, the prevalent care regimes.

Overview of popular cosmeceuticals in dermatology.

The eternal pursuit to prevent ageing and maintain a youthful appearance has resulted in a rapidly expanding cosmeceutical industry. Cosmeceutical products, particularly of natural origin, are in high demand due to claims of efficacy for signs of ageing and other skin conditions. Consumers often include cosmeceutical products in their skin care regime as they are readily available, and a more affordable option compared to prescription products. However, many cosmeceutical ingredients lack clinical evidence regarding their efficacy and safety as these products are not regulated by the U.S. Food and Drug Administration. This review provides a brief overview of several popular cosmeceutical ingredients with regards to their potential indications, targets and mechanisms of action.

Innovative Healing: Managing an Infected Non-Healing Chronic Ulcer with Panchvalkal Ointment

A wound that has not started to heal within 4 weeks, or not healed in 8 weeks is called a chronic, non-healing ulcer. Wounds such as varicose ulcers, diabetic foot ulceration, Pressure sores and other venous related lesions. These ulcers are frequently large, slow and non-healing painful erosions that come back time to time with signs of superimposed infection. Case history- A 50-year-old male presented to complaining of inflamed, painful and ulcerated lesion on the dorsum aspect on his left foot measuring 10 cm x 7 cm being present for nearly three months. His complaint was discharge and swelling of left leg. The diagnosis was infected non-healing chronic ulcer. Treatment strategy included topical application of Panchvalkal ointment and integrated care regime. The traditional Ayurvedic combinations in the form of Panchvalkal was used for wound healing. First the wound was cleaned with Panchvalkal Kwath, thereafter Panchvalkal ointment was applied twice a day, in combination with morning and evening dressing. In 90 days of regular therapy, the wound healed without any complications. The Case illustrate the potential beneficial effect of Panchvalkal ointment in chronic wounds, especially when conventional therapies are mostly unavailable or unsparing. The cure of the ulcer effectively highlights on how much there is need for involving traditional remedies in our daily medical practices to realize an optimum patient outcome. The patient’s complete recovery shows that using Panchavalkal ointment is effective for treating infected, non-healing chronic ulcers.

Pediatric Liver Transplantation: Selection Criteria and Post-transplant Medical Management.

Pediatric liver transplantation remains the gold standard for life-threatening acute and chronic liver diseases and multiple liver-based inherited metabolic defects. Advances in surgical techniques, better perioperative care and immunosuppression regimes have resulted in excellent long-term graft and patient survival. The success of pediatric liver transplantation does however bring the additional challenge of long-term patient outcomes including graft hepatitis-related fibrosis and suboptimal biopsychosocial outcomes. In this review, authors will explore the current landscape of pediatric liver transplantation including indications, timing of referral for liver transplantation, surgical techniques and long-term outcomes such as recurrence of pre-transplant liver disease, idiopathic graft hepatitis and biopsychosocial outcomes. Ultimately, early identification and management of potential issues long-term helps ensure our recipients achieve a "meaningful survival".

Converging economies of care? Immigrant women workers across 17 countries and four care regimes.

This study analyses 17 care economies using 2016 Luxembourg Income Study data to contribute to extant debate regarding the ongoing utility of care regimes as a classificatory schema for cross-national comparison. Examining similarities and differences in the provision of low-status work in health, education, social work, and domestic services - the 'care economy' - the data reveal devaluation of the labour done by immigrant women care workers, net of national and regime-level variation. In addition, numerous similarities across liberal, corporatist, social democratic, and central and eastern European care regimes emerge, in terms of the overrepresentation of immigrant women in low status care work, and the disproportionate financial penalties these workers incur. Together, findings suggest that notwithstanding national and policy-specific differences, there has been considerable convergence across economies of care towards a 'migrant in the market' model of employment. Such large-scale evidence of this trend calls into question the ongoing efficacy of care regimes for national comparisons of migrant care work under conditions of neoliberal globalization.

Consistency of drug-resistant mutations in plasma and peripheral blood mononuclear cells of patients with treatment-naïve and treatment-experienced HIV-1 infection.

Genotypic drug resistance testing is cursrently recommended by the World Health Organization for all patients infected with human immunodeficiency virus type 1 (HIV-1) undergoing care or switching regimes due to failure with previous antiretroviral therapy (ART). Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who meet the criteria for free testing for genotypic drug resistance due to poor adherence in Henan Province may resume their previous regimens before resampling. Therefore, resistance testing based on plasma RNA can fail in a proportion of patients. Resistance testing based on peripheral blood mononuclear cells (PBMCs) is an alternative option. In this study, we investigated the differences in drug-resistant mutations (DRMs) between plasma HIV RNA and proviral DNA in treatment-experienced and treatment-naïve patients. Matched plasma RNA and proviral DNA samples of 66 HIV-1 infected treatment-naïve and 78 treatment-experienced patients were selected for DRM analysis and comparison. DRMs were detected in 27.3% (18/66) of treatment-naïve and 80.8% (63/78) of treatment-experienced samples. Resistance to at least one drug was detected based on analysis of plasma RNA and proviral DNA in 7.6% (5/66) and 9.1% (6/66) of treatment-naïve patients and in 79.5% (62/78) and 78.2% (61/78) of treatment-experienced patients, respectively. Furthermore, 61/66 (92.4%) of treatment-naïve patients showed concordant RNA and DNA drug resistance. When drug resistance was defined as intermediate and high, the concordance of drug resistance profiles of paired RNA and proviral DNA samples derived from treatment-naïve patients were up to 97.0% compared with only 80.8% (63/78) in treatment-experienced patients. Our data indicate that drug resistance testing based on plasma RNA or proviral DNA might be interchangeable in treatment-naïve patients, whereas plasma RNA-based testing remains the best choice for drug resistance analysis in patients with ART failure in clinical practice.

Third Agers in India: Empirical Evidence From Longitudinal Aging Study in India (LASI), 2017-2018.

Given that the ontological origins of the Third Age lie in the cultural logics of social class, consumer society and "habitus," a majority of its gerontological examination is qualitative in nature. We utilize the recently released Longitudinal Aging Study in India (2017-2018) and harness the time-use module to offer an empirical portrait of Third Agers in India. Considering that the aging scholarship in India has been often articulated in the empirical language of dependency, care regimes, and (economic) insecurity, we believe this examination allows us to shift the gerontological gaze from a risk perspective to one that is positive and affirmative. Following an exploratory factor analysis and nested linear regression, we corroborate the emergence of a "silver market" where educated, urban, affluent, and professionally qualified older Indians are the ones who are more likely to engage in active leisure pursuits. Noteworthy is the combined effects of wealth and professional education in determining who is ultimately able to "purchase" leisure in a highly segmented emerging senior market. In all, we conclude by discussing how these findings upend our cultural imagination around growing old in contemporary India.