Home Supervision Research Articles

Effectiveness of digital home rehabilitation and supervision for stroke survivors: A systematic review and meta-analysis.

Stroke survivors often experience residual impairments and motor decline post-discharge. While digital home rehabilitation combined with supervision could be a promising approach for reducing human resources, increasing motor ability, and supporting rehabilitation persistence there is a lack of reviews synthesizing the effects. Thus, this systematic review and meta-analysis aimed to synthesize the effect of digital home rehabilitation and supervision in improving motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function among stroke survivors. Six electronic databases, grey literature, ongoing studies, and reference lists were searched for relevant studies. Two investigators independently reviewed titles, abstracts, screened full texts for eligibility and performed data extraction. Meta-analysis of 13 independent studies were grouped into four separate meta-analyses. The Grading of Recommendations, Assessments, Development and Evaluations (GRADE) tool was used for evaluating the overall quality of the evidence. Meta-analyses showed no statistically significant difference between intervention (digital home rehabilitation) and control groups (home training/clinic-based) of all outcomes including motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function. In the sub-group analysis digital home rehabilitation was associated with better quality of arm use (standardized mean difference = 0.68, 95% confidence interval: [0.27, 1.09], p = 0.001). This result indicated that digital home rehabilitation has similar effects and could potentially replace home training or clinic-based services. This review highlights better-targeted digital motor interventions to examine the effects of interventions further. The quality of evidence was moderate to high in motor and self-reported arm outcomes, and low for balance and quality of life.

PARTISIPASI MASYARAKAT DALAM PEMBUATAN RUMAH KACA (GREEN HOUSE) SEBAGAI SARANA PEMBENIHAN BERWAWASAN EKOEDUWISATA DI KEBUN BUAH BENDOSARI

The construction of a greenhouse as a nursery facility with an ecotourism perspective has been carried out at the Bendosari Orchard, Sumbersari Moyudan, Sleman. The purpose of making this greenhouse is as a means of seeding fruit plants which are a source of income for the Bendosari Orchard, namely guava and avocado and as a tourist attraction to attract more visits to the fruit garden. This research was carried out using the Rural Rapid Appraisal (RRA) approach with 6 stages, namely socialization, interviews, workshops on equalizing perceptions about fruit plant breeding using the grafting method and about greenhouses, surveys of prospective greenhouse construction locations, workshops on planning and building greenhouses and home supervision. glass. With this research, the perception and awareness of garden managers regarding fruit plant nurseries has increased as proven through questionnaires and the success of building a Greenhouse at the Bendosari Orchard. Apart from that, park managers have also realized the need to build greenhouses independently. The greenhouse that was built was made of galvalum, UV plastic and insect-proof glass. This is done to maintain ecological aspects in the greenhouse and in the Bendosari Orchard.

Incremental declines in independence associated with disease progression in early symptomatic Alzheimer’s disease (AD)

AbstractBackgroundAssociations between disease progression (DP) and health outcomes are poorly characterized in mild cognitive impairment (MCI) and mild AD (MILD). To address this, we examined the impact of DP on incremental changes in independent functioning over 18 months; baseline factors associated with DP were also explored.MethodsParticipants included amyloid‐positive participants assigned to placebo in EXPEDITION‐1/2/3 (solanezumab) and AMARANTH (lanabecestat) studies. DP defined as worsening ³5 (MCI1) or ³9 (MILD2) points on the Integrated Alzheimer’s Disease Rating Scale (iADRS). Endpoints included proportions of participants requiring home supervision (³1 hour) or unable to leave home independently (score <3) and change in total care partner time. Machine learning methods using penalized logistic regression and random forest identified factors associated with DP. Least squares mean change (LSMC) was estimated from mixed‐model repeated measures.ResultsOf 1884 participants (274 MCI, 1610 MILD), 56% of MCI and 63% of MILD participants met DP criteria over 18 months.Baseline AD medication use, greater care partner time, worse functional activities questionnaire (FAQ) score and CDR‐SB, higher iADRS, and lower BMI and MMSE increased odds of DP for MILD (Figure 1) but not for MCI.Proportion of participants with DP requiring home supervision (p<0.001; MILD only) and not leaving home independently (p<0.05; MCI&MILD) increased significantly at each post‐baseline visit over 18 months (Figure 2). DP in MILD only had significantly higher proportions of participants who could not be left home alone or travel outside of home independently vs no DP (p<0.05).In those with DP, total care partner time increased significantly from baseline to 18 months (LSMC: 46.0±12.5 hours/month for MCI and 73.2±5.5 for MILD) (Figure 3). For DP vs no DP, increased care partner time at 18 months was significantly higher for MILD (LSMC difference, 66.0±9.3 hours/month; p<0.001) but not for MCI.ConclusionsEarly symptomatic AD participants who progressed over 18 months had reduced independence and required more care partner time. Treatments that slow DP may preserve independence and reduce overall health care burden.

The Moderating Role of the DYX1C1 Gene in the Effect of Home Supervision on Chinese Children's Reading Achievements: Evidence from the Diathesis-Stress Model.

The current study aimed to explore whether susceptible children (with differences in DYX1C1 (dyslexia susceptibility 1 candidate gene 1) gene) are more likely to be influenced by either supportive or adverse home supervision in their reading achievements. Home supervision, reading achievements, and genotype data were collected from a total of 745 fourth and fifth grade children and their parents in Chongqing, China. The results showed that there was a significant interaction between the rs11629841 polymorphism of the DYX1C1 gene and home supervision on children's reading achievements. A further analysis based on the re-parameterized regression model showed that the interaction best fit a weak diathesis-stress model, which indicated that the home supervision had a stronger predictive effect on children's reading achievements among children with the susceptible genotype than children with a non-susceptible genotype in a more adverse environment rather than in a supportive environment. These results suggested that children carrying different genotypes may need targeted interventions and that their parents should emphasize home supervision to develop their children's reading skills.

The practice of social protection policies in China: a systematic review on how left-behind children's mental health can be optimised.

By discussing the mental health challenges faced by left-behind children, this article recommends or comments on existing social protection policies that can affect left-behind children's mental health at the micro-, meso- and macro-levels to holistically understand how a range of parties can jointly socially include left-behind children, a process which is conducive to the latter's mental health development. J.H. carried out a systematic review by searching through the English bibliographical databases Google Scholar, Web of Science and Scopus, in addition to Chinese bibliographic databases CNKI, Wanfang Data and VIP Chinese Science and Technology Periodicals. Here J.H. searched for the words ('social protection' OR 'socially protected') AND ('mental health' OR 'psychological wellbeing' OR 'mental problems' OR 'psychological problems') AND ('left-behind children' OR 'LBC' OR 'leftover children') AND ('China' OR 'Chinese'). Publication dates of the search results were limited to between 2010 and 2022. One of the primary problems encountered by left-behind children is their inadequate home supervision. A further study indicates that parental migration serves as a crucial risk factor for child depression. State-level provision of insurance programmes helps curtail these children's encounters of mental health challenges. Moreover, an improvement in family and school protection is essential when optimising the protection system for left-behind rural Chinese children from poor villages. It is necessary for upper-level government units to re-structure their lower-level counterparts to improve the local administration. This allows lower-level government units to exploit preferential policies, refine relevant regulations and policies on child protection, and facilitate the establishment of social organisations where local policies can be successfully implemented to socially include and protect left-behind children in villages. At the meso-level, community environment construction should be emphasised. At macro- and meso-levels, government authorities and social organisations should encourage the marketisation of hiring professional surrogate parents. At the micro-level, migrant parents should proactively take an initiative to contact their left-behind children via telecommunications.

Feasibility and acceptability of at-home play kits for middle school physical activity promotion during the COVID-19 pandemic

BackgroundSchools are central to providing opportunities for youth physical activity (PA), however such opportunities were limited during the COVID-19 pandemic. Identifying feasible, acceptable, and effective approaches for school-based PA promotion amid pandemic-related barriers can inform resource allocation efforts in future circumstances necessitating remote instruction. The aims of this study were to: (1) describe the pragmatic, stakeholder-engaged and theory-informed approach employed to adapt one school’s PA promotion efforts to pandemic restrictions, leading to the creation of at-home “play kits” for students, and (2) assess the feasibility, acceptability, and preliminary effectiveness of this intervention.MethodsIntervention activities occurred in one middle school (enrollment: 847) located in a Federal Opportunity Zone in the Seattle, WA area, with control data from a nearby middle school (enrollment: 640). Students at the intervention school were eligible to receive a play kit during the quarter they were enrolled in physical education (PE) class. Student surveys were completed across the school year (n = 1076), with a primary outcome of days/week that the student engaged in ≥ 60 min of PA. Qualitative interviews (n = 25) were conducted with students, staff, parents, and community partners, and focused on play kit acceptability and feasibility.ResultsDuring remote learning play kits were received by 58% of eligible students. Among students at the intervention school only, students actively enrolled in PE (versus not enrolled) reported significantly more days with ≥ 60 min of PA in the previous week, however the comparison between schools was not statistically significant. In qualitative interviews, most students reported the play kit motivated them to participate in PA, gave them activity ideas, and made virtual PE more enjoyable. Student-reported barriers to using play kits included space (indoors and outdoors), requirements to be quiet at home, necessary but unavailable adult supervision, lack of companions to play outdoors, and inclement weather.ConclusionsA pre-existing community organization-school partnership lent itself to a rapid response to meet student needs at a time when school staff and resources were highly constrained. The intervention developed through this collaborative response—play kits—has potential to support middle school PA during future pandemics or other conditions that necessitate remote schooling, however modifications to the intervention concept and implementation strategy may be needed to improve reach and effectiveness.

Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer

BackgroundSymptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC.MethodsIndividuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention.DiscussionThis study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial.Trial registrationRecord not yet public

Habeas Corpus and COVID-19: In the Midst of a Viral Pandemic, Can the "Great Writ" Provide Home Supervision to At-Risk Plaintiff Inmates?

Habeas Corpus and COVID-19: In the Midst of a Viral Pandemic, Can the "Great Writ" Provide Home Supervision to At-Risk Plaintiff Inmates?

Randomized trial of the feasibility of ED-initiated school-based asthma medication supervision (ED-SAMS)

BackgroundWhile using an inhaled corticosteroid (ICS) in the weeks after an ED visit reduces repeat visits, few children receive a needed prescription. Because a prescription may not be filled or used, dispensing ICS at discharge and supervising its use at school could overcome both barriers until follow-up care is established. To assess the feasibility of such an intervention, we conducted a pilot study among elementary-age school children with persistent asthma who were discharged from the ED following an asthma exacerbation.MethodsEligible children were randomly assigned to ED-dispensing of ICS with home supervision or ED-dispensing of ICS with home and school supervision. The primary outcomes were ability to recruit and retain participants, ability to initiate school-supervised medication administration within 5 days of discharge, and participant satisfaction.ResultsDespite identifying 437 potentially eligible children, only 13 (3%) were enrolled with 6 being randomized to the intervention group and 7 to the control group. Eleven (85%) randomized participants completed the 90-day interview (primary outcome) and 8 (62%) completed the 120-day interview (safety endpoint). Four (67%) intervention participants started their school regimen within 5 business days and 2 started within 6 business days.ConclusionWhile our pilot study did not meet its recruitment goal, it did achieve its primary purpose of assessing feasibility before undertaking a larger, more intensive study. Several major recruitment barriers need to be mitigated before EDs can successfully partner with schools to establish supervised ICS treatment.Trial registrationClinicalTrials.gov, NCT03952286. Registered 16 May 2019,

Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda

BackgroundWhile maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder’s perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement.MethodsThe convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse.ResultsThere was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities.ConclusionThe study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country’s maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality.

Home physiotherapists assisting follow-up treatment in cystic fibrosis: a multicenter observational study.

Inhaled therapies are relatively simple and easy to be managed however ineffective use of aerosols when self-administered may occur. We described variation of the number of clinic visits, lung function and number of antibiotic courses performed over 12 months in participants with cystic fibrosis (CF), when supervised or not by physiotherapists (PTs) at home. Participants in 8 Italian CF centers with a prescription of dry-powder antibiotic choose whether to be supervised at home (PT-FU) or not (non-PT-FU), in adjunct to routine clinic visits. PTs assisted participants with their inhaled therapies regimen and reviewed the airway clearance program in use. Mixed-effect regression models were fitted to evaluate the variation of selected endpoints over time. A total of 163 participants were included. Lung function declined over time in both groups, at higher extent in the non-PT-FU group at 6 months (-1.8, 95%CI: -4.4 to 0.7 % predicted), without reaching statistical significance, whereas in the PT-FU group only, nearly one visit less was recorded (p=0.027). Regardless the type of supervision adopted, the number of antibiotic courses did not change compared to the previous year. We counted 19/90 (21.1%) drop-out in the PT-FU, double compared to the group followed up at the clinics (p=0.065). Participants under a course of an inhaled antibiotic therapy showed a 1-year decline in lung function, whereas only the group receiving home supervision counted nearly one visit less at the CF center, whose clinical relevance should be further discussed.

Benefits of inspiratory muscle training under indirect home supervision in patients with human T-cell lymphotropic virus type 1

Abstract Introduction: The presence of human T-cell lymphotropic virus type 1 (HTLV-1) associated with neuropathy (myelopathy/tropical spastic paraparesis - HAM/TSP), can generate morphological and functional changes in the respiratory system. As a preventive therapeutic possibility for respiratory dysfunctions, it is expected that the already conceptualized inspiratory muscle training, when performed at home, can be a therapeutic resource that favors adherence to treatment. Objective: To evaluate respiratory muscle strength in patients with HTLV-1 after participating in a home respiratory muscle training protocol under indirect supervision. Method: This was a clinical, longitudinal, prospective, quantitative, and single-center trial approved by the Research Ethics Committee of the State University of Pará, opinion no. 2.695.505 and registered in clinical trials NCT03829709. Six HTLV-1 patients participated in a 5-week home respiratory muscle training protocol lasting 30 minutes daily through a linear load inspiratory muscle trainer. For the characterization of the imposed load, they were submitted to manovacuometry during pre (T0), peri (T3), and post (T5) treatment. Results: Six individuals completed the program, of which 83.33% were female and 16.66% male. With the application of respiratory muscle training, it was possible to achieve a significant increase (p < 0.011) of the maximum inspiratory pressure as shown when comparing T0 (66.8±12.58) to T5 (115.08±31.78). Conclusion: This study identified an increase in inspiratory muscle strength after HTLV-1 patients participated in a home muscle training protocol under indirect supervision.

Parental involvement in home-based education and children's academic achievement in China

Chinese children's academic achievement has consistently been found to relate to parental involvement. We surveyed 4,222 students in the 8th grade at 15 junior high schools in Hainan Province, China. The data were examined using correlation analysis followed by latent class analysis. The latent class dimensions of parental involvement in home- based education were parent–child communication, home supervision, homework help, emotional support, and parental expectations. A series of models were estimated specifying one through five latent classes. Four types of home-based parental involvement were identified: supportive, basic, strict, and disengaged. After determining the best fitting model, we tested our hypotheses with multiple analysis of variance of parents' socioeconomic status and the students' academic achievement by type of home-based parental involvement. There were, accordingly, significant differences for both socioeconomic status and their children's academic achievement. Scores for both achievement and socioeconomic status were highest among students with supportive home-based parent involvement, followed by those with basic, strict, and disengaged involvement, in descending order. The quantity and quality of parental involvement positively related to the children's academic achievement. We recommend that parents support their children's learning using high-quality communication and involve their children in democratic decision making.

Role of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes

ObjectiveWith the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population. MethodsA total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study. Study questionnaires assessing patient knowledge and other variables were distributed and patient charts were reviewed retrospectively to obtain relevant clinical data. T-tests, one-way ANOVA and spearman correlation were used for analysis. ResultsMean A1c in our study was 10.5% and mean knowledge score was 10.1 out of 14. There was no significant correlation (r = 0.12, p = 0.26) between A1c and patients’ knowledge scores. Patients with more frequent blood sugar (BS) monitoring (3-4 times/day) had 2 points lower A1c (9.6 vs 11.6 %, 95% CI 0.2–3.7, p = 0.03) than those with 2 or less times/day. No significant difference in A1c between 3–4 checks/day vs >4 checks/day BS checks. Most patients reported ‘forgetfulness’ (19%) followed by ‘too time consuming’ (17.9%) as barriers to daily BS monitoring. There was no significant difference in A1c between pen or pump users (10.5 vs 10.2 %, p = 0.55). Surprisingly, those with home supervision had higher A1c than those without (10.7 vs 9.6 %, p = 0.04) while there was no significant difference between those with or without nurse supervision at school (10.6 vs 9.8 %, p = 0.33). Those reporting happy mood interestingly had higher A1c than those with sad/depressed mood (10.7 vs 9.4 %, p = 0.04). On multiple linear regression analysis, frequency of BS checks, home supervision and mood were the most significant predictors of A1c and altogether explained 20% of the variability in A1c. ConclusionFrequent BS monitoring is associated with lower A1c. Supervision at home and school did not improve A1c, but it was self-reported information. Mood did not affect A1c contrary to that reported in other studies.

Talking Back to ‘Family’, ‘Family Troubles’, and ‘the Looked-after Child’

‘Looked after’ is a term used in the UK to describe children who are the subject of ‘alternative care’ arrangements (i.e. in the care of a statutory authority), most often away from their birth parents. Within this potentially stigmatising context, this article presents a reanalysis of data from semi-structured interviews with 17 participants during three recent small-scale studies in Scotland. Juhila’s concept of ‘talking back’ to potentially stigmatising categories informs this analysis that explores participants’ understanding of, and responses to, three categorisations: the ‘family’, ‘family troubles’, and ‘the looked-after child’. Participants were young people with experience of home supervision, birth mothers of adopted children, or kinship carers. The analysis finds clear examples of ‘talking back’ to all three categories, including through a process that linked categories, such that accepting aspects of one potentially stigmatised identity helped to explain membership of another. This suggests a potential refinement of Juhila’s model. ‘Looked after’ was widely understood, but the term was seldom used by participants. There was evidence that participants ‘talked back’ to the idea of looked-after child by problematising its appropriateness in their circumstances, including home supervision and kinship care. In their discussions with researchers, these participants privileged biological understandings of ‘family’, affirming enduring links despite troubles and separations. The article concludes by identifying briefly some implications for policy and practice.

Sex at Home and Abusive Supervision at Work

Sex at Home and Abusive Supervision at Work

Safety and predictors of next-day discharge after elective transfemoral transcatheter aortic valve replacement

We sought to determine the predictors of next-day discharge (NDD) for selected patients undergoing elective transfemoral transcatheter aortic valve replacement (TF-TAVR). Techniques have rapidly evolved over the last several years to simplify TF-TAVR allowing for a subset of patients to be discharged the next day. Baseline and procedural characteristics, in-hospital and 30-day follow-up outcomes, complications and readmission rates of 100 TF-TAVR cases were assessed. Patients selected for NDD all met the following criteria: no procedural complications, same day ambulation, strong family support with home supervision, and access to our valve coordinator post discharge. There were 22 patients in NDD and 78 in later-day discharge (LDD) groups respectively. The mean length of stay was 3.4days for LDD. There were no significant differences in baseline, pre-procedural characteristics, or frailty indices of the two groups. However, there were more baseline oxygen dependent patients in LDD (p=0.004). Procedural characteristics included more balloon expandable valves (p=0.005), less fluoroscopy time (p=0.008), and higher use of moderate sedation (p=0.0001) in NDD group. There were more minor vascular complications (p=0.04) and new permanent pacemaker implantations (p=0.016) in the LDD group. There were no vascular complications, stroke or blood transfusions in the NDD group. The 30-day re-admission and mortality rates were similar in both groups. In logistic analyses only moderate sedation was a strong predictor of next day discharge after TF-TAVR (p=0.003). Carefully selected patients without complications following TF-TAVR can be discharged safely the next day.

Sleep comfort analysis using a part-based mixture model with nighttime infrared video

This work investigated a new challenging problem: how to analyze human sleep comfort which is an urgent problem in intelligent home and medical supervision, especially in intelligent temperature control of air conditioners. To overcome this problem, a novel part-based mixture model is proposed to estimate human sleep comfort. Unlike conventional human sleep comfort analysis using uncomfortable and expensive wearable-device, a remote infrared camera and a cheap temperature sensor are used to collect human sleep posture and real-time temperature information. Moreover, a robust sleep posture feature extraction method is firstly proposed to describe sleep comfort not matter human body is covered by a sheet or not. Experiments on a custom-made database demonstrated that the proposed method has promising performance for on-line human sleep comfort analysis.

A systematic review evaluating the impact of paid home carer training, supervision, and other interventions on the health and well-being of older home care clients.

Interventions to support and skill paid home carers and managers could potentially improve health and well-being of older home care clients. This is the first systematic review of interventions to improve how home carers and home care agencies deliver care to older people, with regard to clients' health and well-being and paid carers' well-being, job satisfaction, and retention. We reviewed 10/731 papers found in the electronic search (to January 2016) fitting predetermined criteria, assessed quality using a checklist, and synthesized data using quantitative and qualitative techniques. Ten papers described eight interventions. The six quantitative evaluations used diverse outcomes that precluded meta-analysis. In the only quantitative study (a cluster Randomized Controlled Trial), rated higher quality, setting meaningful goals, carer training, and supervision improved client health-related quality of life. The interventions that improved client outcomes comprised training with additional implementation, such as regular supervision and promoted care focused around clients' needs and goals. In our qualitative synthesis of four studies, intervention elements carers valued were greater flexibility to work to a needs-based rather than a task-based model, learning more about clients, and improved communication with management and other workers. There is a dearth of evidence regarding effective strategies to improve how home care is delivered to older clients, particularly those with dementia. More research in this sector including feasibility testing of the first home care intervention trials to include health and life quality outcomes for clients with more severe dementia is now needed.

A Meta-Analysis of the Relationship Between Learning Outcomes and Parental Involvement During Early Childhood Education and Early Elementary Education

This meta-analysis examined the relationship between learning outcomes of children and educational involvement of parents during a unique period of early childhood education and early elementary education based on 100 independent effect sizes from 46 studies. Learning outcomes are academic achievement, and frameworks of parental involvement measure family involvement and partnership development. The relationship (with adjustment over frameworks and study features) indicated a strong and positive correlation (.509) between learning outcomes and parental involvement. Although types of parental (behavioral, personal, and intellectual) involvement and building institutional capacity demonstrated the greatest importance to the relationship, the role of parents (family involvement) was more important than the role of schools and communities (partnership development). For a strong relationship, behavioral involvement, home supervision, and home-school connection were the keys from family involvement, whereas capacity to engage parents, respectful and effective leadership in relation to families and children, and institutionalized authentic partnerships were the keys from partnership development.