Care Institutions Research Articles

Progress of rehabilitation in assisted living for mentally ill according to STAX-SA taxonomy.

The transition from institutional psychiatric care to community-based mental health services has resulted in the rapid development of assisted living services (AL) for mentally ill. Focus of the current study is to add internationally comparable evidence-based knowledge on the rehabilitation of AL residents by examining progression and mortality in relation to the level of service provided in AL units. This study utilized data gathered from a longitudinal study conducted in Finland during the years 2020 to 2022. A total of 340 health- and social care records of residents in AL services were examined over a 3-year study period. Progression (changes in AL service level) and mortality of AL residents were explored through the level of service provided in AL units, by applying the Simple Taxonomy for Supported Accommodation (STAX-SA). Progression was grouped into (1) progressed, (2) stable, and (3) regressed. During the 3-year study period progression was examined for 95.3% (n = 324) of the AL residents of which 18.8% progressed into less supported AL, 79.3% remained stable and 1.9% regressed into more supported AL. In the entire population (n = 340) mortality was 4.7%. AL residents progressed into less supported AL services rarely although they had similarities in clinical characteristics. This might indicate that the development of AL services has evolved into a more custodial type rather than rehabilitation. Progress of rehabilitation in AL services should be investigated further by examining AL resident characteristics in relation to the level of service and level of support provided in AL services.

Women, gender and drugs: between research and action.

This article is part of Harm Reduction Journal's special issue on harm reduction research in the francophone context and specifically the Harm Reduction Network (HARENE). After highlighting the history and current context of harm reduction for women in France, we present the results of four research studies addressing the links between gender and drugs which were presented in the book Espaces genrés des drogues. Parcours dans la fête, l'intimité et la réduction des risques ('Gendered Spaces of Drugs. A journey of intimacy, party and harm reduction'). This article is divided into three parts, each addressing a specific space: the space of institutional care, the intimate marital space, and the urban festive space. We begin by describing gender inequalities within harm reduction and care structures, by demonstrating how single-sex spaces facilitate the care of women, and how care professionals can perpetuate unequal gender norms in their relationship with a woman in a situation of addiction expressing a desire for pregnancy. Concerning the marital space, we highlight the reproduction of gender norms within socially included heterosexual couples who use drugs and are socially included, particularly concerning the choice of the intimate partner, the distribution of tasks linked to the purchase and sale of drugs, and parenthood. Finally, concerning the festive space, the article highlights the differentiated strategies of men and women in urban festive places, and the maintenance of a gendered order of festive places and drug consumption. This leads us to discuss the current issues of stigmatization of women drug users, and the initiatives put in place in the French context to promote harm reduction for women who use drugs.

Incentive based continuum of care for people living with HIV including orphan vulnerable children- the Delhi Model

Background: Delhi State AIDS Control Society (DSACS) addressed critical integration of services for Orphan and Vulnerable Children (OVC) in context of HIV. They bridged the policy and implementation divide by formulating a multisectoral-strategy in April 2012, creating a model of "Continuum-of-Care for People-Living with HIV (PLHIV), OVC & Children-Affected-by-HIV (ChABH)” in Delhi. With input from the National Commission for Protection of Child Rights, DSACS sensitized political and administrative machinery about needs and challenges related to HIV/AIDS. DSACS developed an incentive-based system for Antiretroviral Therapy (ART) adherence, incorporating safeguards and robust monitoring. Delhi Government's sustained financial commitment and DSACS programmatic-innovation provide a scalable blueprint for India and global initiatives. Description: This ongoing Delhi Government's scheme focuses on household-economic-strengthening of PLHIV as an incentive for broader behaviour change based-on specific eligibility conditions. Beneficiaries fall into four categories: PLHIV, including children on ART; double orphan HIV positive children (OCI); destitute children living with HIV/in institutional care (DCI); and double orphan ChABH in community-based care in Delhi. Category-wise fixed-monthly financial assistance is released to beneficiaries via direct-bank-transfers leveraging Aadhaar-platform to eliminate corruption. Adherence to treatment is mandatory to continue cash-transfers. Linkages with other schemes established to maximize impact. Lessons learned: In its 11-year evolution, Delhi model has grown from 1110 to 6467 beneficiaries, including 6383 PLHIV, 34 double OCI, 50 DCI, and 27 double orphan ChABH, with 5875 (90.8%) currently active excluding beneficiaries who expired (n=328), migrated/ transferred out of Delhi (n=115), opted-out ART/or lost-to-follow-up (n=135), and 14 CABA who turned major. Steady progress and 98% ART adherence mark positive outcomes. DSACS eased eligibility criteria in 2018, facilitating hurdle-free enrollment, while responding to cost-inflation by enhancing financial assistance, showcasing program adaptability. Achieving >95% ART adherence has significantly boosted survival rates, underscoring program's positive impact on beneficiary health. The scheme's INR 14,69,35,600 expenditure in 2022-23, just 0.13% of Delhi Health Department's plan-outlay, signals a cost-effective investment. Extrapolating this nationally would represent 1.5% of India's Health Ministry's current plan-outlay. Conclusion/next steps: This innovative model is implementable on large-scale in India and around the globe but requires not only financial commitment but also coordinated efforts, policy adjustments, and collaboration between various stakeholders.

Profiles of Primary School Children’s Sports Participation and Their Motor Competencies

Background/Objectives: Children participate in various organized and informal physical activities (PAs) in their leisure time, presenting diverse objectives and environments for motor and social development. However, current research often focuses on specific, mostly organized activities, overlooking the complexity of participation across different settings. This study aimed to (1) identify groups of children with similar characteristics based on their participation in five organized and informal sports activities and (2) examine how the groups differ regarding gender, age, BMI, motor competencies (MCs), and attendance in institutionalized care at school. Methods: The study included n = 1717 1st and 2nd graders (M = 7.60 years, SD = 0.59, 50.7% girls) and n = 1319 3rd and 4th graders (M = 9.46 years, SD = 0.57, 49.4% girls) from the “EMOKK” study, funded by the Swiss National Science Foundation. Data were collected via parent questionnaires on leisure sports participation, and MCs were assessed using MOBAK-1-2 and 3-4 tests. Latent profile analyses (LPAs) and univariate ANOVAs were used to identify group differences. Results: A three-profile LPA model best fits the data, revealing differences in participation across individual and team sports, optional school sports, free play on the school playground, and informal activities during leisure time. Children involved more in team sports (profiles: allrounder and very active sportsperson) participate more in informal play and present better MCs than children participating mainly in individual sports (profile: individual sportsperson). Girls were predominantly in the individual sports profile, while boys were more evenly spread across all groups. These findings highlight the importance of designing targeted interventions that promote participation in both organized and informal sports, particularly for children with lower levels of PA. Conclusions: Children show different patterns of engagement in different interrelated organized and informal leisure PA contexts. These specific patterns and the children’s MCs should be taken into account for the targeted promotion of PAs during leisure time.

Aging in place or aging out of place? Family caregivers' perspectives on care for older Pakistani migrants in Norway.

The aging population in Europe is increasing, with growing ethnic diversity among older individuals due to migration. Public policies emphasize 'aging in place' to address financial challenges and reduce the burden on the healthcare system. However, research often overlooks the heterogeneity among older people, especially non-European migrants. Also, research on family caregivers' role in enabling 'aging in place' for older relatives with migrant backgrounds is limited, despite many older non-European migrants' preference for family care in comparison to long-term institutional care. This study aims to explore the experiences and perspectives of family caregivers in the context of formal and informal care and their preferences regarding the place of care for older family members with migrant backgrounds, particularly the Pakistani Ahmadiyya community in Norway. Eighteen semi-structured individual interviews and two group interviews were conducted in Urdu and English with nineteen female family caregivers of older relatives, ages 25-62, residing in Norway. The analysis yielded three main themes: (1) "Nursing homes are not for the ones who love their parents", (2) Preferences for home with the possibility of sharing care, and (3) Mismatch between family care needs and formal care. Family caregivers' perception of health services has a decisive impact on their older relatives' demand and use of formal health services, emphasizing the need for trust. Even though home care services were seen as a viable option, they should be adapted so that the family caregivers can use them and feel supported in enabling 'aging in place' for older migrants.

Becoming Eligible for Long-Term Care Insurance in China Brought More Ageing at Home: Evidence from a Pilot City.

Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people's choice of places of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries' choice of places of ageing-institution or home-before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person's probability of choosing home as her place of ageing even before she received any benefit by around 16 percentage points, and this positive impact was larger for those insured of higher education level or of higher disability grade. By bring more ageing in place, the LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program like who could receive subsidies, family values, and family members' engagement in labor market could all work together to shape the substitution pattern between home and institutional care.

The prevalence of wordings on Adverse Childhood Experiences in child welfare assessments in a sample of young people in secure institutional care

ABSTRACT In Sweden, young people with behaviours considered norm-breaking and destructive by society are placed in secure institutional care. While these young people’s behaviour is frequently debated, there is little knowledge about their family and home conditions. This study aims to identify writings (i.e. wordings, sentences, etc.) referring to Adverse Childhood Experiences (ACEs) in child welfare assessments of a sample (n = 84) of young people placed in secure institutional care. The documentation was analysed by applying manifest quantitative content analysis using ACEs established in previous research as deductive categories. In addition, wordings related to the legal grounds for placement were also identified. The analysis shows that the burden of child abuse and household dysfunction is large in the sample. Compared to population-based prevalence studies, the current study presents much higher numbers, with almost 90% of the cases containing writings with reference to at least one ACE category and 38–50% referring to four or more. The findings constitute an important contribution to research on young people in secure care, by adding knowledge about adversity during childhood as a crucial part of these young people’s needs and challenges.

Intervention with institutional caregivers for the purpose of supportive education for disadvantaged children: 3C

IntroductionChildren in institutional care may have limited access to educational opportunities compared to children in parental care. Improving and enriching the educational practices of these children is important for their well-being. In this study, the Child Development, Communication and Care (3C) Training Program was prepared by the researchers. The 3C education approach emphasizes early childhood development and education. Particular focus is on the use of communication techniques in the education of young children. Our goal with 3C is to increase caregivers’ knowledge of child development and support them to communicate effectively with children. Through this curriculum framework, children are encouraged to interact effectively and empathically with others. Therefore, the curriculum framework emphasizes understanding emotions and building trusting relationships as key components in the holistic development of young disadvantaged children.MethodsA quasi-experimental design with pre-test-post-control group was used in the study. 16 sessions of 3C were applied to the personnel in the experimental group via distance education. Data were collected from the participants before and after the start of the training program by using the Child Education Competence Scale-Parent Form, Personal Information Form, and Training Evaluation Questionnaire.ResultsAs a result, significant differences were obtained between the experimental and control groups in favor of the group receiving training (z = 3.57, p<0.05). Accordingly, it can be said that 3C contributes to the holistic development of the child.DiscussionIt is hoped that such work could enhance the developmental outcomes of young children in institutional care and improve the quality of early childhood education.

Institutionalised Pre-School Childcare and Reported Maltreatment: A Survey in East Germany

Child abuse increases the risk of adult mental health problems. Limited research explores the association of early institutional childhood care in the GDR with experienced childhood abuse and mediates anxiety and depression in adulthood. The sample includes N=1743 individuals born in the GDR (1949-1983). In multi-group path analyses (stratified men/women), we analysed the influence of pre-school care as a predictor and experienced child abuse (CTS) as a mediator variable for anxiety (GAD-7) and depression (PHQ-9) in adulthood. There are no direct effects of pre-school care on anxiety and depression. Childhood trauma significantly affected current mental health (women β=0.253-0.610; men β=0.092-0.439). Analyses suggest no link between early institutional care and childhood abuse. Considering other contextual factors in childcare is crucial for establishing population-wide prevention strategies for child safety.

Academic stress in dental students: suggestions for care in university institutions

Stress is a challenging situation that is generated by the arrival of an unexpected or novel situation that is difficult to solve. Dental students are subjected to high stress loads. The purpose of this paper is to briefly review the most recent literature on this topic and to make suggestions on how to approach it according to this and the authors' experience.

THE IMPACT OF STIGMA ON THE WELLBEING OF CHILDREN IN KADUNA ORPHANAGES

Background: Orphans in sub-Saharan Africa, particularly Nigeria, face increasing challenges due to the HIV/AIDS epidemic, terrorism, and natural disasters, leading to a growing orphan population. In addition to the material hardships experienced by orphans, stigmatization remains a profound issue, exacerbating their medical, social, and psychological well-being. Stigma affects children’s self-esteem, mental health, social relationships, and access to opportunities, making it a critical area of concern for orphaned children in institutional care. This study investigates the impact of stigma on the well-being of children in orphanages in Kaduna, Nigeria, focusing on medical, social, and psychosocial aspects of their lives. Methodology: This cross-sectional descriptive study was conducted among 100 children living in orphanages across Kaduna. Data were collected through interviewer-administered questionnaires designed to capture socio-demographic data, medical conditions, behavioural patterns, stigma levels, and psychosocial status. The study also explored how these children cope with the stigma associated with being orphans. Results: The findings revealed a significant presence of stigma among the orphan population, with 9% of children reporting being stigmatized by peers. Although 83.3% of respondents indicated positive peer relationships, bullying affected 11.4% of the children. Medical issues were prevalent, with 53.7% of the children underweight and 46.7% not fully immunized. Behavioural disorders such as hyperactivity (27%) and enuresis (22.3%) were also common. Despite these challenges, 89.2% reported good self-esteem, although many employed maladaptive coping mechanisms, with 46.8% adjusting their goals to cope with their circumstances. Conclusion: The study highlights the pervasive impact of stigma on the well-being of orphans in Kaduna, contributing to psychological distress and health challenges. Addressing the stigma and its effects requires comprehensive intervention strategies that integrate medical, psychosocial, and educational support.

Exploring the equitable spatial planning on the accessibility of institutional elderly care in megacity: a study based on Chengdu, China

Exploring the equitable spatial planning on the accessibility of institutional elderly care in megacity: a study based on Chengdu, China

Medicine, illness and disease in the lordship of Ireland, 1177 to 1541 A.D.

The lordship of Ireland existed for 364 years from 1177 to 1541. Inhabited mostly by the English-of-Ireland, its medical infrastructure resembled contemporary England rather than Gaelic Ireland. The medical marketplace comprised physicians, surgeons, barber-surgeons, apothecaries and midwives, some organised into societies and guilds. Monastic infirmaries and hospitals, including leper hospitals, provided institutional care. Medical practice was rooted in classical medicine and the few Hiberno-English medical texts that survive attest to the use of bleeding, herbs and charms as treatments. Among many ailments leprosy was common, but the arrival of the Black Death bubonic plague pandemic of 1348 decimated the population of the lordship and contributed to its eventual decline. Using historical, archaeological and literary sources this paper analyses the experience of medicine, illness and disease among the people of the lordship of Ireland from the twelfth to the sixteenth centuries.

Analysis of the Demands of Incumbent Kindergarten and Childcare Center Directors for the Director Qualification Program of the Integration of Early Childhood Education and Care Institutions: Focusing on Focus Group Interviews (FGI)

Analysis of the Demands of Incumbent Kindergarten and Childcare Center Directors for the Director Qualification Program of the Integration of Early Childhood Education and Care Institutions: Focusing on Focus Group Interviews (FGI)

Implementation Measures to Break the Gender Gap - a Scoping Review

Abstract Background For myocardial infarction, in-hospital lethality is still significantly higher in women than in men in Germany. Medical guidelines and nursing expert standards include recommendations for gender-sensitive care (GSC+), but it is unknown how these are implemented in health care practice. Research question: Which measures facilitate the implementation of GSC+? Methods Systematic literature research was conducted on Pubmed, web of science and CINAHL with adequate keywords connected with Boolean connectors. Results The initial literature search yielded a pool of 23,508 items. After removing irrelevant articles and duplicates 119 articles were included in the present scoping review. Among fifteen generated dimensions, which are summarized to six main dimensions (education, research & science, politics, LGBTQ+ care & education, institutions of care and career advancement), the included articles are related. Education is the dimension with the most identified articles. Key messages of main dimensions are that GSC+ • must be anchored in compulsory subjects of curricula; • must be considered in research. Researchers need to be aware and should follow a structured framework for generating sex-specific guidelines; • can get gain access to politics through purposeful lobby work; • in terms of LGBTQ+ care should be learnt from health care providers to LGBTQ+ people through case studies; • should be implemented strategical through change agents in institutions of care; • can be enhanced through aware women in leading positions, to implement GSC+ successfully. Conclusions The implementation of GSC+ has a positive impact on patient care and could reduce undesirable events or outcomes. To reach the implementation target the politics must set frame conditions and universities, science and health care providers have to integrate them. Moreover, the generation of evidence is important to promote GSC+ so that health care professionals have a defined work assignment for GSC+. Key messages • The research results provide a comprehensive overview of the existing literature on implementation measures of gender-sensitive care. • Healthcare providers are sensitized to gender-sensitive care so that patient care can be further improved.

Opportunities of Care at What Cost: Findings from a Qualitative Study Exploring Care Leavers Experiences of Residential Care Homes for Children in Thailand

The social problem of children’s homes in Thailand is a complicated one to address. Much of the research on this topic specific to Southeast Asia is relatively new, with many relevant articles published in the past 10 years. For over 80 years, research mainly from Eastern Europe has widely acknowledged the severe long-term cognitive, emotional and developmental effects on children raised in institutional care. However, to date, there has been very little published qualitative research addressing the lived experiences of Thai children growing up in children’s homes from the perspective of the care leavers themselves. This article seeks to learn more about the experiences and perspectives of those who spent their childhoods in institutional care and how they compare with international research on this topic. The results show complicated feelings towards their time in care, with the majority stating that despite the negative aspects, they would still choose a children’s home for themselves over staying in a village without access to secondary school. However, they unanimously expressed that they would not choose the same path for their own children.

Cross-country price comparison of institutional long-term care: In search of suitable data

Abstract Background In European ageing societies, the national expenditure on institutional long-term care (LTC) has been growing for decades, currently exceeding 1% of the GDP in many countries. At the same time, however, comparative analyses of (day) prices in the nursing and residential care facilities (NRCFs) are still lacking. The data reported by international databases vary substantially in the services they cover which makes cross-country comparisons very difficult. Methods We combine publicly available data from Eurostat (System of Health Accounts), OECD and national sources on the number of recipients of LTC in NRCFs, the number of beds in NRCFs and the expenditure on LTC in NRCFs in over 20 European countries. Our aim is to compute internationally comparable daily prices of LTC in NRCFs using gross-costing approach. We first validate the data by cross-checking and documenting which health care functions and providers are reported by each country. Second, based on that we identify countries with comparable data and, third, perform a cross-country comparison of the daily spending on LTC in NRCFs. Results The reported data vary substantially with respect to their coverage. For instance, while some countries include NRCFs for all disabled people at all ages, others focus only on the NRCFs for the elderly. The ways the beds and the recipients are counted also show substantial variation. Moreover, we found inconsistencies in the reported numbers not only between but also within countries. Conclusions The considerable cross-country diversity in the LTC provision within the NRCFs poses inevitable challenges to international standardised reporting. Our analysis shows, however, that at least some of the challenges can be overcome by, e.g. improving the consistency of the reported numbers at the country level. Key messages • A consistent definition application markedly improves the comparability of data on LTC in NRCFs. • Given the rising demand for and economic importance of the LTC sector standardised data on NRCF services are greatly needed.

Abstract Strengths and difficulties Lithuania

Abstract Background Most mental health disorders begin before the age of 18, peaking at 14.5 years (Solmi, 2022) and manifest as emotional and behavioural difficulties that are more frequent in institutional social care (ISC): former foster care recipients have higher rates of depression and PTSD than the general population (Pecora, 2009). The rate of children living in residential care facilities in Europe and Central Asia is double the global average (UNICEF, 2024). This study aims to assess and compare the mental health of children in ISC centers and regular high schools. Methods A cross-sectional study was conducted in ISC centres and high schools in 2022-2023. The sample size consisted of children aged 11-17 living in ISC (n = 49) or in families (n = 193). Online anonymous survey was applied to assess the prevalence of endured violence, substance use and measure mental health outcomes using the Strengths and Difficulties Questionnaire (SDQ-25). Results A total of 242 respondents (age mean 14.6, SD = 2.12) in ISC and families showed similar poor mental health rates (42% and 44%, respectively). Prosocial behaviour problems were exhibited more by boys (p < 0.05), whereas emotional symptoms were more common in families (p < 0.001): 90% normal SDQ-25 scores in ISC vs 60% in families. Enduring psychological (38% vs 60.2%) violence was more prevalent among children in families (p < 0.05); smoking - in ISC, alcohol use - in families (p < 0.05). In both groups enduring physical violence was associated with smoking and alcohol use (p < 0.05), and overall poor SDQ-25 results strongly correlated (p < 0.001, r = 0.815, r = 0.610, respectively) with hyperactivity. Conclusions A significant part of study participants reported poor mental health outcomes with most problems in relationships with peers. Mental health risk factors such as violence or substance abuse are associated with poor emotional wellbeing while being more common among children living with families. Key messages • Children living in ISC and in families demonstrate similar level of mental health problems. • Varying prevalence of substance abuse among children living in different settings highlights the importance of environmental factors when addressing the issue.

Language Development of Japanese Children Raised in Institutional Care.

Nurturing environments have a critical influence on children's language development. It is unclear to what extent nurturing environments in institutions influence children's language development. The present study investigated the early lexical development in Japanese children raised in institutional care (IC) (N = 86; 10-33 months; 37 boys) and compared their lexical skills to a large sample of age peers being raised in biological family care (BFC) (N = 1897; 937 boys) using vocabulary checklists. Our results present three main findings: (1) Japanese IC children did not exhibit a delay in productive vocabulary compared with BFC children, although their comprehensive vocabulary was delayed; (2) IC children who experienced maltreatment showed poorer vocabulary scores than non-maltreated IC children; (3) both the duration at the institution and the number of books read to them significantly predicted children's vocabulary scores. Our study suggests that the Japanese institutions included in the present study did not show a negative impact, at least on productive vocabulary, and may competently foster children's language development. We discussed the relationship between institutional environments and children's language development.

Analysis of the national structure of care provided to older people in Slovenia

Ageing in place has for many years been at the forefront of political goals for care provision for older people in Europe. The organization of care in terms of the national governing structure must therefore be continually observed to better understand the care actually offered and then used by older people. In this study, we examined the organization of social home care and institutional care across municipalities and administrative units in terms of what is offered to older people as formal care. Variation across municipalities and administrative units is observed with explorative cluster analysis and analysis of means of key dependent variables across clusters to better understand the variability in the care offered to older people in those municipalities and administrative units. The results show that while social home care is temporally available across several clusters of municipalities, and the affordability of social home care is also stable across clusters of municipalities, there are still municipalities where social home care has a limited time availability and municipalities where the out-of-pocket contribution to social home care delivery is nearly the twice the average of such contributions. In terms of institutional care, one can find administrative units with either a deficit or a surplus of placements of such care available.