Presence Of Caregiver Research Articles

On the violation of hospitalized patients' rights: A qualitative study.

Nurses have always been known as an advocate for the rights of patients. The recognition of what is perceived as the violation of patients' rights can help nurses to understand patients' concerns and priorities. Thus, it helps nurses play their supportive roles more effectively. The aim of this study was to explore different dimensions of the violation of patients' rights. Data were collected utilizing unstructured interviews and field notes. Data analysis was conducted using the qualitative content analysis approach. Prolonged engagement, maximum variation sampling, and member check were among the factors which enriched the research. The sample consisted of 18 patients and 11 members of their families. They were purposively selected from two hospitals in Tehran during 2009-2012. The research was approved by the Ethics Committee of the university and hospitals. The patients' rights were violated in a variety of ways. There were three main dimensions to this issue: (a) care recession including deprivation of the caregiver's presence and the delay/lack of needed responses; (b) receiving mechanical care including superficiality, lack of emotion, and failure to understand the situation; and (c) being disrespected including humility and aggression. The patients and their families consider any shortcomings in relation to the patient and the quality of care as the violation of the rights. The findings of the study imply sensitizing managers toward providing appropriate conditions as well as educating nurses to observe patients' rights. It is suggested that the processes leading to the violation of patients' rights be discovered and prevented in the future.

Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study

BackgroundAssessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements.MethodsIn-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis.ResultsThe mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level.ConclusionsIn the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.

Ethical considerations for children\u2019s participation in data collection activities during humanitarian emergencies: A Delphi review

BackgroundChildren’s right to participate in data collection during emergencies has been widely recognized by humanitarian actors. However, participation in such activities can expose children to risk. Tensions have been noted between the right to participate and other principles, such as the imperative to ‘do no harm.’ With little evidence to inform guidance on addressing this tension, our study sought to identify expert consensus on whether and how children participate in emergency-related data collection activities.MethodsWe employed a three-round Delphi technique with a purposive sample of 52 child protection specialists. Respondents answered two open-ended questions in round one. A thematic analysis of responses generated a set of unique statements addressing the study questions. In the second round, respondents rated each statement on a five-point scale. In the final round, respondents reviewed the group’s average ratings for each statement with the option to revise their own ratings. A statement was said to have reached clear consensus when at least 90% of respondents agreed or strongly agreed with the statement.ResultsA total of 124 statements and 14 themes emerged from the thematic analysis, with 46.0% of statements reaching clear consensus in the third round. Respondents strongly supported children’s right to participate in data collection in humanitarian settings, while also recognizing that protecting children from harm may “over-ride” the participation principle in some contexts. Respondents identified capacity and contextual considerations as important factors influencing participation decisions, though they sometimes disagreed about how these factors should determine participation. Respondents also considered the role of individual child factors and the presence of caregivers in selecting child participants, and proposed best practice approaches for securing children’s safe and meaningful participation.ConclusionsWith almost half of statements reaching clear consensus, these findings reflect broad agreement within the sector about engaging children in data collection in emergencies. At the same time, points of ongoing debate around how to factor different risks into child participation decisions may indicate discordant practice. Further reflection is needed around how factors such as the phase of emergency, the existence of basic services, and cultural beliefs should influence whether and how children participate.

Caregiver's depressive symptoms and asthma control in children from an underserved community

ABSTRACTCaregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. Objective: To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Methods: Case-control study of 87 asthmatic children (aged 4–11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] <20 points) and controls were children with adequate asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers’ depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. Results: The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34–9.48], p = 0.01). Conclusions: Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.

The Long Road to Farewell: The Needs of Families With Dying Children.

Families of dying children are profoundly impacted by numerous interactions with health-care providers before, during, and after their child's death. However, there is a dearth of research on these families' direct, qualitative experiences with health-care providers. This study presents findings from interviews with 18 family members, predominantly parents, regarding their experiences with health-care providers during a child's terminal illness, from diagnosis to death. The importance of compassion emerged as a salient theme, manifested in myriad ways, and connected to participants' perception of caregiver presence in multiple domains. Families were likewise negatively affected by a wide variety of situations and behaviors that represented individual or institutional abandonment or nonpresence, and thus compounded the experience of loss. Specifics and implications for practice are explored.

Screening for Frailty and Sarcopenia Among Older Persons in Medical Outpatient Clinics and its Associations With Healthcare Burden

ObjectivesWith an aging population and increase in multimorbidity, the importance of screening for frailty and sarcopenia has become a public health priority. Several tools to do so exist. This study aimed to examine whether the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at-risk patients for negative health outcomes who would benefit from intervention. DesignThis is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to February 2016. MeasurementsFrailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires, respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson comorbidity index, and modified Barthel index were collected from chart review. ResultsA total of 115 patients 65 years old and older were screened. Of the sample, 44.3% (n = 51) of patients were sarcopenic, whereas 27.0% (n = 31) were classified as frail; 23.5% (n = 27) were both frail and sarcopenic; and 87.1% of frail patients were sarcopenic, whereas 47.1% of sarcopenic patients were frail. Sarcopenia and frailty were associated with a higher Charlson comorbidity index, higher likelihood of requiring a caregiver, more medical specialty follow-ups, polypharmacy, more than 2 hospital admissions within a year, a higher number of falls and falls with serious consequences. This affected their perceived health status with 50.0% of robust patients rating their health excellent compared with 19.6% of sarcopenic patients (P < .001), 9.7% of frail patients (P < .001) and sarcopenic and frail patients scoring the lowest with 3.7% (P < .001). ConclusionsThe prevalence of frailty and sarcopenia among older adults attending medical outpatient clinic is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls, and falls with serious consequences. Early identification of older adults at risk of adverse health outcomes would aid in instituting timely intervention to reduce healthcare burden and improve quality of life.

Associations between having an informal caregiver, social support, and self-care among low-income adults with poorly controlled diabetes.

Objective To determine whether the presence of an informal caregiver and the patient's level of social support are associated with better diabetes self-care among adults with poorly controlled diabetes. Methods Cross-sectional study using baseline data from 253 adults of age 30-70 with poorly controlled diabetes. Participants who reported receiving assistance with their diabetes from a friend or family member in the past month were classified as having a caregiver. We used multivariate linear and logistic regression models to evaluate the associations between having a caregiver and level of social support with five self-reported diabetes self-care behaviors: diet, foot checks, blood glucose monitoring, medications, and physical activity. Results Compared to participants with no informal caregiver, those with an informal caregiver were significantly more likely to report moderate or high medication adherence (OR = 1.93, 95% CI: 1.07-3.49, p = 0.028). When we included social support in the model, having a caregiver was no longer significantly associated with medication adherence (OR = 1.50, 95% CI: 0.80-2.82), but social support score was (OR = 1.22, 95% CI: 1.03-1.45, p = 0.023). Discussion Among low-income adults with poorly controlled diabetes, having both an informal caregiver and high social support for diabetes may have a beneficial effect on medication adherence, a key self-care target to improve diabetes control.

Common clinical dilemmas in left ventricular assist device therapy: A glimpse into current trends

Background&#x0D; Left ventricular assist device (LVAD) therapy has been thrust into the forefront of surgical treatment for advanced heart failure (HF). Despite advancements in survival and quality of life with these devices, the multi-disciplinary care for these patients remains far from standardized across institutions.&#x0D; Methods &#x0D; A survey of current practices in LVAD was carried out at the St. Jude Medical User’s meeting representing a variety of caregivers including cardiac surgeons, HF cardiologists, non-HF cardiologists, advanced practice providers and ventricular assist device coordinators, with representation from several continents. Utilizing an audience response system, eleven questions were asked related to the demographics of the audience, left ventricular assist device patient selection and patient management.&#x0D; Results&#x0D; A total of 120 audience members representing both transplant and LVAD centers, destination therapy only LVAD centers and non-implanting, shared care centers across a multitude of disciplines responded to the survey. Questions comprised of patient selection (body mass index, pre-existing renal failure, care giver presence and abstinence from substance abuse) and patient management (anticoagulation regimens, first line therapy for hemolysis, implantable cardioverter-defibrillator usage and route of preferred dialysis) issues.&#x0D; Conclusions&#x0D; LVAD technology will continue to change and improve with the next generation of pumps on the horizon. Progress cannot be made without pausing to understand the current state of technology, practice patterns and patient determinants of success. This survey underscores the lack of consensus regarding best practice principles and the need for an increased focus on care management for LVAD patients with collaborative, multi-institutional studies.

The transmission of attachment across three generations: A study in adulthood.

One of the most striking pieces of evidence in attachment research is that attachment security is transmitted from 1 generation to the next. Although there has been an enormous advance in the understanding of this process, this area of research suffers from some significant gaps, as for example the transmission across 3 generations when considering the 2 parents as well as the 2 couples of grandparents. The current study was designed to fill this gap in existing literature by investigating AAI attachment representations in the members of 3 generations, belonging to a total of 32 families, each including an adult offspring, both parents and the 4 grandparents (N = 224). Main findings show that the transmission across 2 generations was stronger in the presence of a female caregiver (either mother or maternal/paternal grandmother), and that across 3 generations was confirmed only in the presence of 2 female caregivers (grandmother to mother to offspring). Conversely, the transmissions across 3 generations with only 1 or no female caregiver were not confirmed. Last, experiencing 2 secure parents increased the likelihood of developing a secure state of mind with respect to attachment among offspring, mothers and fathers, 95% confidence intervals [3.52, 1,238.72], [1.67, 31.17], and [1.67, 19.98], respectively. These findings may have important theoretical implications related to the understanding of the factors involved in the continuity and discontinuity of attachment patterns across generations. (PsycINFO Database Record

Cohort profile for the Nurture Observational Study examining associations of multiple caregivers on infant growth in the Southeastern USA

PurposeChildcare has been associated with obesity in children in cross-sectional and longitudinal studies, although some observed no association. Few studies have focused on care during infancy, a period when children...

Self-reported Hydration in Diabetic and Hypertensive Elderly

Background: Although the importance of the hydration for health of diabetic and hypertensive elderly have been extensively exposed, there is little information about the self-reported hydration among this group. This study attempts to fill this gap in the literature by studying the self-reported hydration among elderly in Brazil. Methodology: It was conducted a cross-sectional study through interviews with 405 elderly attended at a Brazilian primary care for arterial hypertension and/or mellitus diabetes. The variables addressed were: gender, age in years, presence of caregivers in doctor visits, prevalence of chronic diseases and questions for the hydration assessment. Association Pearson’s chi-square test and a significance level of 5% were adopted. Results: The elderly that described feel thirst regularly (p=0.00), an appropriated water intake idea (p=0.00) and younger age (p=0.04), reported a higher water intake. The presence of the caregiver and older age (p=0.03); and older age assisted by a caregiver and drinking at least 6 glasses of water/day (p=0.02) were also associated. Conclusions: Thirst, appropriate intake idea, younger age and a caregiver for the older age were associated with the report of higher intake of water. Several factors may be associated with water intake and should be considered when analyzing strategies for hydration of the elderly.

Semantic Network Analysis of Online News and Social Media Text Related to Comprehensive Nursing Care Service

As comprehensive nursing care service has gradually expanded, it has become necessary to explore the various opinions about it. The purpose of this study is to explore the large amount of text data regarding comprehensive nursing care service extracted from online news and social media by applying a semantic network analysis. The web pages of the Korean Nurses Association (KNA) News, major daily newspapers, and Twitter were crawled by searching the keyword 'comprehensive nursing care service' using Python. A morphological analysis was performed using KoNLPy. Nodes on a 'comprehensive nursing care service' cluster were selected, and frequency, edge weight, and degree centrality were calculated and visualized with Gephi for the semantic network. A total of 536 news pages and 464 tweets were analyzed. In the KNA News and major daily newspapers, 'nursing workforce' and 'nursing service' were highly rated in frequency, edge weight, and degree centrality. On Twitter, the most frequent nodes were 'National Health Insurance Service' and 'comprehensive nursing care service hospital.' The nodes with the highest edge weight were 'national health insurance,' 'wards without caregiver presence,' and 'caregiving costs.' 'National Health Insurance Service' was highest in degree centrality. This study provides an example of how to use atypical big data for a nursing issue through semantic network analysis to explore diverse perspectives surrounding the nursing community through various media sources. Applying semantic network analysis to online big data to gather information regarding various nursing issues would help to explore opinions for formulating and implementing nursing policies.

Caregivers of Patients With Left Ventricular Assist Devices

How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers' psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients' post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support-defined morbidity events. We retrospectively reviewed and recorded social workers' clinical assessments of adult patients implanted with durable continuous-flow LVADs as bridge to transplant, destination therapy, or bridge to decision from January 2010 to December 2014. Associations between caregiver characteristics and patient mortality and morbidity events were analyzed using Kaplan-Meier curves and Cox proportional hazards regression. Patient follow-up time was calculated as the time from hospital discharge until the earliest among death with LVAD, transplant, or the last day of the study (December 31, 2015). Patients were censored for death with LVAD at the time of transplant or the last day of the study. A total of 96 LVAD recipients were included in this study. Having a caregiver who understands the severity of the illness and options available to the patient (as determined and documented by the social worker; P=0.01), a caregiver who has identified a backup plan (P=0.02), and a caregiver who is able to provide logistical support (P=0.04) significantly mitigated risk of death. The risk of death for an LVAD patient was also significantly lower among those who have at least 1 adult child who lives within 50 miles (P=0.03) and those who have an extended family who can care for the patient (P=0.03). The risk of death was 3.1× more likely among patients who live alone compared with those who do not live alone (P=0.04). No caregiver characteristics were significantly associated with morbidity. This exploratory, hypothesis-generating study suggests that mortality after LVAD placement is impacted by caregiver understanding of patient severity of illness and caregiver presence. This study provides initial evidence to support further work in understanding the associations between caregivers and LVAD patients, as well as interventions that may improve patient outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02248974.

Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation

Purpose: To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke.Methods: A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates.Results: Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8 ± 23.6 versus 72.9 ± 20.3; p < 0.01), although both groups achieved a minimal clinically important difference. After controlling for age, gender, admission Functional Independence Measure, and length of hospital stay, caregiver availability explained 1.3% of additional variance, with the final model explaining 41.3% of total variance for functional ability at discharge (F (5,174) = 26.21, p < 0.001).Conclusions: The presence of a caregiver at time of discharge from inpatient rehabilitation is predictive of significantly higher functional ability at discharge in individuals with severe stroke.Implications for rehabilitationThe availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke.The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.

Comprehensive Geriatric Assessment (CGA) and ONCO-Mpi Predict Mortality in Diffuse Large B-Cell Lymphoma (DLBCL) in the Elderly: A Retrospective Evaluation in a Single Center Experience

DLBCL is the most common type of non-Hodgkin lymphoma and it usually affects elderly patients, with a median age at diagnosis of 70 years and an incidence that rises with increasing age. Nevertheless patients > 70 years are rarely included in clinical trials and the management is often different according to local practice. A pre-treatment evaluation based on Performance Status (PS) or comorbidity index is not sufficient to identify patients suitable for treatment with curative intent.We retrospectively reviewed 93 patients with newly diagnosed DLBCL, ≥65 years old , treated from January 2009 to December 2015 at Veneto Institute of Oncology-IRCCS (median age 76 years, range 65-96). Twenty-eight patients (28) were older than 80 years. All but one received at least first line treatment. All patients were evaluated with CGA at diagnosis, based on Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Cumulative Illness Rating Scale (CIRS). According to these variables they were classified into three categories named ’fit’, ’vulnerable’ and ’frail’. In addition, a cancer-specific modified multidimensional prognostic index (MPI), called Onco-MPI, was calculated for all patients. Onco-MPI score identify three risk score categories (low, moderate and high risk) that predict one-year mortality in older cancer patients. Onco-MPI was calculated according to a validate algorithm as a weighted linear combination of the following CGA domains: age, sex, ADL, IADL, PS, mini-mental state examination, body mass index, CIRS, number of drugs and the presence of caregiver. Cancer sites were also included in the model.Other features analyzed included clinical characteristics, treatment management and outcomes.In our cohort 48% of patients were at advanced Ann Arbor stage (III-IV) with intermediate-high or high risk IPI score in 31%. In 61% of patients we observed extranodal disease, mainly Waldeyer’s ring and gastrointestinal tract. First line treatments received included R-CHOP (38%), R-COMP (R-CHOP with non-pegylated liposomial doxorubicin - 23%), R-CVP (14%), R-CEOP (3%), high dose methotrexate (4 patients with primary central nervous system lymphoma), R-VACOP-B (3%), R-Bendamustine in 2 patients and radiotherapy alone was used in 5 patients. Sixty-eight patients (84%) completed the planned cycles of immunochemotherapy. In this group 48,5% required dose reduction for subsequent cycles of treatment because of side effects, in particular hematological toxicities of grade 3-4 or neurological toxicities. In 23 chemotherapy-treated patients initial doses were reduced according to CGA . We observed, after first line therapy, complete response in 63% and partial response in 21%, 8% of patients experienced a disease progression at the end of treatment and 8% died during first line therapy because of lymphoma progression. At time of diagnosis 49% of patients were considered fit at CGA, 16% vulnerable and 35% frail. According to onco-MPI 24 patients (26%) were at low risk of one year mortality, 31 (33%) at medium risk and 38 (41%) at high risk. With a median follow up of 41,1 months the overall survival (OS) of our cohort is 55,9% (95% CI 25,3-56,9). OS correlates with CGA ( 84,4% in fit patients, 31,2 % in vulnerable and 28,1% in unfit, p< 0,001) and Onco-MPI score seems to discriminate our cohort for one-year mortality (95% in low risk, 77% in moderate and 63% in high, p<0,01). OS also correlates with anthracycline administration (67,8% vs 33,3%, p<0,001) as well as the use of consolidation radiotherapy after chemotherapy induction ( 75% vs 49,3%, p <0,01).Our retrospective, single Center experience demonstrates that elderly DLBCL need a multidimensional evaluation at diagnosis in order to identify patients candidate to treatment with curative intent. CGA confirm its role for choosing correct management. Also Onco-MPI can be a useful tool even if more data are needed in lymphoma patients. DisclosuresNo relevant conflicts of interest to declare.

Oral health conditions and activities of daily living in an elderly population in Brazil

Abstract Objective: To analyze the relationship between the oral health status and functional capacity in performing basic activities of daily living of a population of elderly persons. Method: A cross-sectional population-based study with 441 individuals aged 60 years or over both genders was performed in the municipality of Macaíba, Rio Grande do Norte. From intraoral epidemiological examination, the degree of caries attacks (CPO-D index), periodontal condition (CPI and PIP indexes), the use and need for dental prosthesis and the presence of oral lesions were evaluated. Independence in Activities of Daily Living was used to evaluate functional capacity. Socioeconomic and demographic characteristics were surveyed using a structured questionnaire. Results: Oral health variables were subjected to factor analysis, which resulted in four indicators. There was no association between these indicators and the functional capacity of the elderly. Gender, age, presence of caregiver, dominant area of residence, time of last visit to the dentist, type of care sought during such visit and self-perception regarding prosthesis replacement were significantly associated with oral health indicators. Conclusion: Given the non-identification of the effect of functional capacity on the oral health of the elderly, the time of measurement of the events investigated should be considered. It is suggested that dependency among the elderly occurs at different times from when the consequences of oral problems are observed, considering the cumulative effects of a previous history of invasive dental care.

Rehabilitation Profiles of Older Adult Stroke Survivors Admitted to Intermediate Care Units: A Multi-Centre Study.

BackgroundStroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units.MethodsWe performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis. We also proposed a practical decision tree for patient’s classification in clinical practice. We analyzed differences between profiles in functional improvement (Barthel index), relative functional gain (Montebello index), length of hospital stay (LOS), rehabilitation efficiency (functional improvement by LOS), and new institutionalization using multivariable regression models (for continuous and dichotomous outcomes).ResultsAmong 384 patients (79.1±7.9 years, 50.8% women), we identified 3 complexity profiles: a) Lower Complexity with Caregiver (LCC), b) Moderate Complexity without Caregiver (MCN), and c) Higher Complexity with Caregiver (HCC). The decision tree showed high agreement with cluster analysis (96.6%). Using either linear (continuous outcomes) or logistic regression, both LCC and MCN, compared to HCC, showed statistically significant higher chances of functional improvement (OR = 4.68, 95%CI = 2.54–8.63 and OR = 3.0, 95%CI = 1.52–5.87, respectively, for Barthel index improvement ≥20), relative functional gain (OR = 4.41, 95%CI = 1.81–10.75 and OR = 3.45, 95%CI = 1.31–9.04, respectively, for top Vs lower tertiles), and rehabilitation efficiency (OR = 7.88, 95%CI = 3.65–17.03 and OR = 3.87, 95%CI = 1.69–8.89, respectively, for top Vs lower tertiles). In relation to LOS, MCN cluster had lower chance of shorter LOS than LCC (OR = 0.41, 95%CI = 0.23–0.75) and HCC (OR = 0.37, 95%CI = 0.19–0.73), for LOS lower Vs higher tertiles.ConclusionOur data suggest that post-stroke rehabilitation profiles could be identified using routine assessment tools and showed differential recovery. If confirmed, these findings might help to develop tailored interventions to optimize recovery of older stroke patients.

Study on Factors Affecting Life Satisfaction of the Disabled Seniors

본 연구는 장애노인의 실태를 통해 제 특성을 파악하고 전반적인 삶의 만족도에 어떠한 요인이 영향을 미치는지 검증하여 장애노인의 삶의 질 향상을 위한 제언을 하는데 목적이 있다. 이를 위하여 한국보건사회연구원이 수행한 2014년 장애인실태조사 원 자료를 활용하였으며 분석대상은 65세 이상 장애노인 3,181명이다. 자료 분석을 위해 기술통계를 제시하고 삶의 만족도 영향요인 분석을 위해 로지스틱회귀분석을 수행하였다. 분석결과, 성별, 연령, 배우자유무(인구학적 요인), 가구소득, 주택소유여부, 수급자여부, 공적연금 가입여부, 사회적 차별정도(사회·경제적 요인), 장애정도, 주관적 건강상태, 일상생활 도움필요정도, 일상생활 도와주는 사람유무, 도움충분 여부, 혼자외출가능여부, 교통수단이용 어려움 여부, 건강검진여부(장애 및 건강요인)가 삶의 만족도에 유의미한 영향을 미치는 요인이었다. 이러한 분석결과에 근거하여 본 연구에서는 장애노인 중 취약계층인 독거장애노인에 대한 돌봄서비스 등 집중적인 관심과 지원, 공·사적연금 등 다양한 소득보장을 위한 제도적 보완, 장애차별에 대한 사회적 인식 및 환경개선, 보건의료서비스 지원 및 건강관리체계 마련, 장애인복지와 노인복지의 통합적 서비스 제공, 보건과 복지의 통합적 서비스 제공 등을 제언하였다.This study is on understanding the reality of disabled seniors and investigation of factors that affect overall life satisfaction, making a proposal to improve their life quality. Situation data for the disabled, gathered by Korea Institute for Health and Social Affairs (KIHASA) in 2014, was used to perform the study, and the target group is 3,181 people with disability, above the age of 65. Descriptive statistics was presented for data analysis and logistic regression analysis was performed to investigate factors that affect life satisfaction. It was concluded from the analysis that gender, age, presence of spouse (demographic factors), house income, possession of house, presence of pensioner, registration to public pension plan, social discrimination (social-economical factors), level of disability, subjective health status, level f help needed for daily living, presence of care-giver, sufficiency of help, ability to go out by oneself, difficulty of using public transportations, and presence of medical checkups (disability and health factors.) make meaningful effects to life satisfaction of disabled seniors. Based on the derived results, this study suggests intensive interests and care-giving service for disabled seniors that live alone, institutional complementations to guarantee income security, including public or private pensions, improvements to social recognition and environments for discrimination of the disabled, organization of health and medical treatment service and health care system, comprehensive service provision to social welfare for both the disabled and seniors, and comprehensive service provision to both health care and social welfare.

The Effect of Bedside Interdisciplinary Team Conferences on Family & Caregiver Presence During Inpatient Rehabilitation

The Effect of Bedside Interdisciplinary Team Conferences on Family & Caregiver Presence During Inpatient Rehabilitation

Parental Presence During Treatment of Ebola or Other Highly Consequential Infection.

This clinical report offers guidance to health care providers and hospitals on options to consider regarding parental presence at the bedside while caring for a child with suspected or proven Ebola virus disease (Ebola) or other highly consequential infection. Options are presented to help meet the needs of the patient and the family while also posing the least risk to providers and health care organizations. The optimal way to minimize risk is to limit contact between the person under investigation or treatment and family members/caregivers whenever possible while working to meet the emotional support needs of both patient and family. At times, caregiver presence may be deemed to be in the best interest of the patient, and in such situations, a strong effort should be made to limit potential risks of exposure to the caregiver, health care providers, and the community. The decision to allow parental/caregiver presence should be made in consultation with a team including an infectious diseases expert and state and/or local public health authorities and should involve consideration of many factors, depending on the stage of investigation and management, including (1) a careful history, physical examination, and investigations to elucidate the likelihood of the diagnosis of Ebola or other highly consequential infection; (2) ability of the facility to offer appropriate isolation for the person under investigation and family members and to manage Ebola; (3) ability to recognize and exclude people at increased risk of worse outcomes (eg, pregnant women); and (4) ability of parent/caregiver to follow instructions, including appropriate donning and doffing of personal protective equipment.