Different Forms Of Care Research Articles

Health Behaviors, Care Needs and Attitudes towards Self-Prescription: A Cross-Sectional Survey among Dutch Medical Students

PurposeThere is a growing awareness of the potent ways in which the wellbeing of physicians impacts the health of their patients. The purpose of this study was to investigate the health behaviors, care needs and attitudes towards self-prescription of Dutch medical students, and any differences between junior preclinical and senior clinically active students.MethodsAll students (n = 2695) of a major Dutch medical school were invited for an online survey. Physical activity, eating habits, alcohol consumption, smoking, Body Mass Index, substance use and amount of sleep per night were inquired, as well as their need for different forms of care and their attitude towards self-prescription.ResultsData of 902 students were used. Physical activity levels (90% sufficient) and smoking prevalence (94% non-smokers) were satisfying. Healthy eating habits (51% insufficient) and alcohol consumption (46% excessive) were worrying. Body Mass Indexes were acceptable (20% unhealthy). We found no significant differences in health behaviors between preclinical and clinically active students. Care needs were significantly lower among clinically active students. (p<0.05) Student acceptance of self-prescription was significantly higher among clinically active students. (p<0.001)ConclusionsUnhealthy behaviors are prevalent among medical students, but are no more prevalent during the clinical study phase. The need for specific forms of care appears lower with study progression. This could be worrying as the acceptance of self-care and self-prescription is higher among senior clinical students. Medical faculties need to address students' unhealthy behaviors and meet their care needs for the benefit of both the future physicians as well as their patients.

Representações sociais de parteiras e benzedeiras sobre o cuidado

The study aimed at to apprehend the midwives and faith healers social representations. It is an exploratory study of qualitative approach accomplished in Brasília and the Entorno area, using the technique of semi-structured interview. Ten subjects took part on the study. The Alceste software was used as a resource to support the analysis of the interviews. The results point that different epistemological bases produce different social representations originating different forms of care. It is concluded that it is necessary an interaction of elements capable of re-unite the meaning of care in order to put the human back as the center of the humanization politics.

Long-term memories and experiences of childbirth in a Nordic context—a secondary analysis

The experience of childbirth is an important life experience for women. However, in-depth knowledge about long-term experiences is limited. The aim of the study was to describe women's experiences two to 20 years after birth. This study is a part of a meta-synthesis project about childbearing in the Nordic countries. Methodologically, the study was a secondary analysis performed on original data from three selected qualitative studies by the authors, in three Nordic countries, Finland, Iceland and Sweden, and in two different forms of care, birth centre care and standard maternity care. There were 29 participants, both primipara and multiparous women. The result from this study shows that women, in a long-term perspective describe childbirth as an encounter with different participants and the most important is with the midwife. The midwife is also important in connection to the atmosphere experienced during birth. The childbirth experience has a potential to strengthen self-confidence and trust in others or, on the contrary, it can mean failure or distrust. Impersonal encounters linger feelings of being abandoned and alone. This dimension is in particular demonstrated in the description of the woman who had given birth at standard maternity care. The conclusion of this study is that childbirth experience has a potential to strengthen self-confidence and trust in others or on the contrary failure or distrust. Maternity care should be organized in a way that emphasis this aspects of care.

Ethnicity, Families and Social Capital: Caring Relationships across Italian and Caribbean Transnational Families

Social capital theorists acknowledge that caring networks operating within and above all across households lie at the heart of families and communities. They also see these networks and family bonds as generally declining in contemporary society due to individualisation. However, there seems to be little empirical evidence documenting these processes in detail, particularly with regards to minority ethnic and transnational families. This article explicitly addresses reciprocal relationships in ethnic minority families, focusing on different forms of care circulating within transcultural and intergenerational family and kin networks. By doing so, this discussion reveals many nuances of family life and the processes by which cultural norms, values, attitudes and behaviour are transmitted, transformed and maintained across generations and geographical distance.

Topical umbilical cord care at birth.

Umbilical cord infection caused many neonatal deaths before aseptic techniques were used. To assess the effects of topical cord care in preventing cord infection, illness and death. We searched the Cochrane Pregnancy and Childbirth Group trials register (September 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2003). We also contacted experts in the field. Randomized and quasi-randomized trials of topical cord care compared with no topical care, and comparisons between different forms of care. Two reviewers assessed trial quality and extracted data. Twenty-one studies (8959 participants) were included, the majority of which were from high-income countries. No systemic infections or deaths were observed in any of the studies reviewed. No difference was demonstrated between cords treated with antiseptics compared with dry cord care or placebo. There was a trend to reduced colonization with antibiotics compared to topical antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord. Good trials in low-income settings are warranted. In high-income settings, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean. Quality of evidence is low.

‘Unlocking the cage door’: the spatiality of counselling

This paper examines the spatiality of counselling, focusing on ideas about positions, boundaries and spaces emerging from practitioners' accounts. Counsellors describe counselling as a practice within which the relative positions of self and other are explored and negotiated. To that end, counsellors adopt a contradictory position in relation to expertise, claiming to be experts in not being experts. Counselling transgresses bureaucratic boundaries between different forms of care, and normative boundaries of secrecy. In their place, counselling works with spatio-temporal, confidentiality and ethical boundaries, which are simultaneously concrete and specific, fluid and illusory. These boundaries create spaces within which the interplay of reality and fantasy can be explored. These spaces can be understood in terms of processes of exteriorizing the inner worlds of clients and interiorizing external spaces including those made available by counsellors and counselling services. The spatiality of care associated with counselling strategically invokes binary distinctions, for example, between reality and fantasy, but also disrupts dualistic conceptualizations of space in favour of an understanding of space as simultaneously real, imagined, material and symbolic.

Institutionalisation-index--a simple method to estimate direct treatment costs for institutionalised forms of community mental health care

Investigations of treatment costs are of increasing importance in community mental health care. Yet, they are often difficult and expensive to conduct. This study explores whether and, if so, to what extent direct treatment costs as paid by insurance companies and social welfare in the German health care system can be estimated through a simple Institutionalisation-Index. Based on the literature and clinical judgment, a simple Institutionalisation-Index was formed reflecting the degree of institutional protection in supported housing, long-term day care, partial hospitalisation and full hospitalisation programmes. As part of a comprehensive evaluation of a model institution for community mental health care in Berlin, actually paid treatment costs and Institutionalisation-Index (II) were identified for 1194 patients over a total period of 23 years and compared with each other. The Pearson correlation coefficient between II and paid costs was 0.97 (p < 0,001). In calculations for subgroups and different periods of time, II and costs were almost identical, too. The Institutionalisation-Index provides a sufficiently precise estimate of direct costs as paid by insurance companies and social welfare for different forms of care in community based institutions and hospitals. The II can be adjusted to incorporate further forms of community based care. In systems with similar funding arrangements, the simple method to establish a Institutionalisation-Index should facilitate cost analyses in community mental health care.

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A Dynamic Game-theoretic Model of Parental Care

We present a model in which members of a mated pair decide whether to care for their offspring or desert them. There is a breeding season of finite length during which it is possible to produce and raise several batches of offspring. On deserting its offspring, an individual can search for a new mate. The probability of finding a mate depends on the number of individuals of each sex that are searching, which in turn depends upon the previous care and desertion decisions of all population members. We find the evolutionarily stable pattern of care over the breeding season. The feedback between behaviour and mating opportunity can result in a pattern of stable oscillations between different forms of care over the breeding season. Oscillations can also arise because the best thing for an individual to do at a particular time in the season depends on future behaviour of all population members. In the baseline model, a pair splits up after a breeding attempt, even if they both care for the offspring. In a version of the model in which a pair stays together if they both care, the feedback between behaviour and mating opportunity can lead to more than one evolutionarily stable form of care.

Patient Participation in Decision Making at the End of Life as Seen by a Close Relative

The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors' manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients' participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted differed in the respective variations; this seemed either to promote or to impede the patients' opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient's personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process.

Best place of care for older people after acute and during subacute illness: a systematic review.

To assess the evaluative research literature on the costs, quality and effectiveness of different locations of care for older patients. A systematic review of evaluative research from 1988 using CRD4 guidelines. Twenty-five databases were searched, using processes developed specially for this review. Library OPACS, the Internet and research registers were also searched for relevant material. The final stage of the review was confined to randomised and pseudorandomised trials. Studies were selected for review by pairs of researchers working independently who then met to reach a decision. Analysis was predominantly descriptive; simple pooled odds ratios were used to explore some outcomes. Eighty-four papers from 45 trials were included. Firm conclusions were difficult to draw, except in relation to some outcomes for stroke units, early discharge schemes and geriatric assessment units. Few trials in this area have adequately addressed issues of patients' quality of life and costs to health services, social care providers, patients and their families. Despite considerable recent development of different forms of care for older patients, evidence about effectiveness and costs is weak. However, evidence is also weak for longer-standing care models. A substantial service evaluation agenda emerges from this review. This study also raises questions about the usefulness of systematic review techniques in the area of service delivery and organisation.

Evolutionary transitions in parental care in cichlid fish

Cichlid fishes (Cichlidae) are well suited for testing theories of the evolution of vertebrate parental care. These freshwater teleost fish provide parental care for their offspring, display many different forms of care and have interspecific variation in which sex stays with the young. Here, we assemble the first family–wide composite phylogeny based on morphological and molecular studies, and trace two sets of character evolution: form of care (substrate guarding and mouthbrooding), and sex of care–giver (biparental, female–only, and male–only). Mouthbrooding has evolved from ancestral substrate guarding with 10 to 14 transitions and 0 to 3 reversals. The data support hypothesized transitions in the sex of care–giver, with uniparental female care having arisen from biparental care 21 to 30 times with 0 to 10 reversals. There is also evidence that male–only care evolved once from biparental care. These transitions in parental care characters are the most numerous reported for any family of vertebrates and, to our knowledge, provide the first quantitative support for models of parental care evolution in fish.

Topical umbilical cord care at birth.

Umbilical cord infection caused many neonatal deaths before aseptic techniques were used. The objective of this review was to assess the effects of topical cord care in preventing cord infection, illness and death. We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register (Cochrane Library issue 4, 1997) and Medline. We also contacted experts in the field. Randomised and quasi-randomised trials of topical cord care compared with no routine care, and comparisons between different forms of care. Two reviewers assessed trial quality and extracted data. Ten studies were included, all from developed countries. No systemic infections or deaths were observed in any of the studies reviewed. Cord and other skin infections within six weeks of observation were not affected by use of antiseptics. There was a trend to reduced colonization with antibiotics compared to antiseptics and no treatment. Antiseptics prolonged the time to cord separation. Use of antiseptics was associated with a reduction in maternal concern about the cord. Simply keeping the cord clean appears to be as effective and safe as using antibiotics or antiseptics.

Involvement of relatives in the care of the dying in different care cultures: involvement in the dark or in the light?

The aim of this prospective study was to increase existing knowledge about the involvement of relatives in care of the dying and to shed light on the relatives' sense of coherence. Six relatives were followed via qualitative interviews during the patients' final period of life and after their deaths. The patients died in different forms of care: surgical department, nursing home, inpatient hospice ward, and at home. What the relatives had in common was that they had, in different ways, followed the patient from the first symptoms, through different forms of care, up until death. Some participated very actively in the care. Relatives' involvement in care can be described as involvement in the light or involvement in the dark. Involvement in the light is based on a trusting relationship between the family and the staff. Involvement in the dark is based on insufficient interplay and collaboration, in which the relatives are not seen or acknowledged by the staff, but instead must grope around in the dark when they try to support the patient. Rapid course of illness can be a risk factor for involvement in the dark. It seems that the relatives' sense of coherence was an important factor enabling them to be involved in the light. Humanistic care can constitute a buffer, thereby increasing the possibilities for relatives to be involved in the light.

The importance of care.

This paper is in three parts. In Part One we briefly explain that an unsophisticated form of utilitarianism--economic rationalism (ER)--has become dominant in many health systems. Its proponents argue that one of ER's most important effects is to increase consumer choice. However, evidence from New Zealand does not support this claim. Furthermore, the logic of ER requires the construction of systems which tend to restrict individual participation. In Part Two we argue that although some have advocated an 'ethic of care' in an attempt to counteract ER's utilitarianism, two decades of campaigning have had little influence on health policy. ER's pro-care adversaries have failed to make an impact because they have not developed a taxonomy of care--they have not established a language compatible with, or as powerful as, ER's. In Part Three, in an attempt to raise the conceptual and practical status of caring in contemporary health systems, we distinguish four different forms of care. In opposition to those who believe the 'ethic of care' can adequately direct health care practice, we demonstrate that care is a secondary notion. We show that in order for a carer to decide which form of care to adopt in different situations she requires a more powerful idea. We contend further that health care ought to be governed by a theory of health, and suggest that 'the foundations theory of health' should be adopted by planners searching for a more humane alternative to ER. We conclude that ER's dominance can and must be challenged. However, only those arguments which offer detailed theoretical analyses of health care, as well as meticulously derived practical policies, have any chance of success.

Case Management in the Care of the Severely Mentally Ill

Although there is little consensus regarding the precise meaning of case management in the care of long-term mental patients, the concept is widely endorsed and has assumed a central role in service planning [1]. This quotation points up the importance of case management for psychiatric care in the English-speaking countries, but not in Germany, where, as we shall show in what follows, deliberate effort has been practically nonexistent. The quotation, however, also points out that the concept of case management is used quite vaguely [2], and that the term is applied to sometimes quite different forms of care.

Measuring the outcomes of ophthalmic healthcare: low vision rehabilitation

The measurement of health status and medical outcomes is becoming a major requirement for all providers of healthcare services. There is a need to measure the outcomes of healthcare, not only to demonstrate the effectiveness of care, but also to assess the relative (and possibly competing) worth of different forms of care. At the same time, there is a growing awareness of the limitations of clinical outcomes in contrast to those measured by patients themselves. There is, therefore, considerable interest in the use of generic and disease specific ‘Quality of Life’ (Qol) instruments. Within ophthalmic healthcare, clinical outcomes include, for example, measures of visual function or the gradings of images of ocular structure. Other outcome measures used may include specific disease scales or indices, including questionnaire measures of visual disability (e.g. the VF14, ‘Activities of Daily Vision Scale’ and TyPE scales, designed to assess the impact of cataract and cataract surgery on self-rated visual disability). In contrast to disease specific measures, generic measures are designed to provide an overall measure of an individuals health status. These measures are classified into profile measures (e.g. the SF36) or indices (e.g. the Rosser index or the EuroQol). There have been a number of studies which have evaluated the effectiveness of low vision rehabilitation, although these have mainly been small cross sectional surveys which have used a single definition of ‘success’, including for example, the visual acuity/visual performance achieved with the LVA or the usage of the LVA. More recently questionnaire approaches have been used to measure ‘success’, but as with clinical outcomes, the validity and reliability of the outcomes used has not been established. Given the considerable scale of the low vision population and the current debate about optimal models of low vision care, there is a pressing need to (1) define an appropriate set of outcome measures and (2) carry out randomised controlled trials comparing the effectiveness and cost-effectiveness of different forms of care. If we as clinicians fail to inform the debate about appropriate outcomes in ophthalmic healthcare, this may result in such care being incorrectly valued by others.

Measuring the outcomes of ophthalmic healthcare: low vision rehabilitation

The measurement of health status and medical outcomes is becoming a major requirement for all providers of healthcare services. There is a need to measure the outcomes of healthcare, not only to demonstrate the effectiveness of care, but also to assess the relative (and possibly competing) worth of different forms of care. At the same time, there is a growing awareness of the limitations of clinical outcomes in contrast to those measured by patients themselves. There is, therefore, considerable interest in the use of generic and disease specific ‘Quality of Life’ (Qol) instruments.Within ophthalmic healthcare, clinical outcomes include, for example, measures of visual function or the gradings of images of ocular structure. Other outcome measures used may include specific disease scales or indices, including questionnaire measures of visual disability (e.g. the VF14, ‘Activities of Daily Vision Scale’ and TyPE scales, designed to assess the impact of cataract and cataract surgery on self‐rated visual disability). In contrast to disease specific measures, generic measures are designed to provide an overall measure of an individuals health status. These measures are classified into profile measures (e.g. the SF36) or indices (e.g. the Rosser index or the EuroQol).There have been a number of studies which have evaluated the effectiveness of low vision rehabilitation, although these have mainly been small cross sectional surveys which have used a single definition of ‘success’, including for example, the visual acuity/visual performance achieved with the LVA or the usage of the LVA. More recently questionnaire approaches have been used to measure ‘success’, but as with clinical outcomes, the validity and reliability of the outcomes used has not been established. Given the considerable scale of the low vision population and the current debate about optimal models of low vision care, there is a pressing need to (1) define an appropriate set of outcome measures and (2) carry out randomised controlled trials comparing the effectiveness and cost‐effectiveness of different forms of care.If we as clinicians fail to inform the debate about appropriate outcomes in ophthalmic healthcare, this may result in such care being incorrectly valued by others.

Commentary: Sources of bias must be controlled

Taha and colleagues address an important clinical issue, postpartum and neonatal infection. They conclude that infection is reduced by a more thorough cleansing procedure before vaginal examination during labour, combined...

Differential costs of care in a mental deficiency hospital in Scotland.

In considering the cost of different forms of care for patients with mental deficiency there is a tendency to compare crude averages. Mental deficiency has many manifestations and occurs in people of widely differing degrees of physical ability and behaviour so that comparisons which do not take this into account are not meaningful. An attempt has been made to assess the cost of hospital care for different groups of patients and to show that there is a wide variation in the costs which arc normally expressed as an average. This average is often used to compare with the expenditure, say, in a hostel, when in fact those patients suitable for hostel care are at the lower end of the cost range. Again, whilst everyone would like to see patients dealt with in small groups, the extra cost this would involve is often overlooked. The analysis presented helps to clarify points such as these.