Greater Need For Assistance Research Articles

Avaliação do nível de fragilidade em idosos participantes de um grupo de convivência

A Síndrome da Fragilidade é uma condição frequente em idosos e pode ser precursora de incapacidade e quedas. Os objetivos deste estudo foram avaliar o nível de fragilidade em idosos de um Grupo de Convivência (GC) e a relação entre fragilidade, incapacidade e quedas. Participaram do estudo 64 idosos, avaliados de acordo com o Fenótipo de Fragilidade, que é composto pelos indicadores: perda de peso não intencional, auto-relato de fadiga, diminuição da força de preensão, baixo nível de atividade física e redução da velocidade da marcha. Foi considerado frágil o idoso que apresentasse três ou mais critérios, pré-frágil quem apresentasse um ou dois e não-frágil nenhum. Foram utilizadas a escala de Atividades Instrumentais de Vida Diária (AIVD), a escala de Atividades Básicas de Vida Diária (ABVD) e questões sobre história de quedas e medo de cair. O teste Mann-Whitney U e o coeficiente de Spearman foram utilizados (a=0,05). Em relação ao nível de fragilidade, foram encontrados 21 idosos não-frágeis, 42 pré-frágeis e um frágil. Os idosos pré-frágeis apresentaram maior necessidade de assistência em ABVD (p=0,046) e AIVD (p=0,011), maior ocorrência de quedas (p=0,004) e medo de cair (p=0,007) que os não-frágeis. Foram encontradas associações significativas e fracas entre estas variáveis e o nível de fragilidade. Os resultados demonstram a importância de intervenções preventivas em idosos pré-frágeis e sugere que fragilidade e incapacidade são entidades distintas em idosos deste GC.

ICU nurses’ experiences and perspectives of caring for obstetric patients in intensive care: a qualitative study

The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. This study used a descriptive qualitative design. Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff.

Rural widows, economy and co-residence in the 18th and 19th centuries

Widows in the past have often been viewed either as poor and lonely or living under the control of their family members. The aim of this article is to show that the situation of widows in the 18th and 19th century Nordic countries does not necessarily correspond with these images. Law and custom provided landholding women with a certain amount of economic security in widowhood, and it seems to be relatively clear that women knew how to make use of their position. However, the frequency of co-habitation between mothers and children also indicates the creation and maintaining of mutually supportive strategies. The increasing stratification of 19th century society did on the other hand inflate the group of widows without property. As a result of running a household without a production element these widows had a greater need to launch their children into the labour market and therefore found themselves in greater need of assistance from the community in old age.

Effectiveness of Food Assistance Programs in Bangladesh

Bangladesh boasts a wide array of targeted food assistance programs that strive to achieve a number of important developmental objectives. Findings from the 2000 Household Income and Expenditure Survey suggest that these programs are reasonably well-targeted towards the poor. Most of the pro-poor targeting is due to targeting the poor within communities rather than central actions to target poor areas. However, any definitive conclusions about the ‘pro-poor’ nature of spending on these programs are clouded by the survey findings which suggest that a large share of the total resources devoted to these programs disappear before reaching their intended beneficiaries. If these ‘unaccounted-for’ benefits are in fact appropriated by the non-poor, the incidence of spending on these programs would likely be pro-rich. Greater efforts to channel a higher share of resources to regions with greater need of assistance and to improve monitoring systems to reduce leakage from the system are likely to yield high dividends.

The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury

Englander J, Cifu DX, Wright JM, Black K. The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury. Arch Phys Med Rehabil 2003;84:214-20. Objective: To ascertain the association between early computed tomography (CT) scan findings and the need for assistance with ambulation, activities of daily living (ADLs), and supervision at rehabilitation discharge and at 1 year after traumatic brain injury (TBI). Design: Prospective longitudinal design. Setting: Seventeen Traumatic Brain Injury Model Systems (TBIMS) centers. Participants: A total of 1839 adults with TBI admitted to TBIMS trauma centers with subsequent acute rehabilitation; 849 were followed to 1 year after injury. Interventions: Not applicable. Main Outcome Measures: Accumulated CT scan pathology from the first week after injury; FIM[trade ] instrument and Disability Rating Scale at rehabilitation discharge and 1 year after injury; and Supervision Rating Scale at 1 year. Results: Chi-square analyses showed that individuals with a midline shift greater than 5mm (lateral compression) were more likely to require the assistance of another person at discharge from acute rehabilitation with ambulation (29% vs 17%[ndash ]19%, P=.02), toileting (47% vs 33%[ndash ]38%, P=.05), lower-body dressing (57% vs 39%[ndash ]46%, P=.015), bladder continence (32% vs 19%[ndash ]23%, P=.03), and overall supervision (53% vs 44%, P=.0006) than patients with a midline shift of lesser degree. At 1 year, 57% of patients with a midline shift greater than 5mm on acute CT scans were being supervised in the home versus 30% to 39% of those with a shift of lesser degree (P=.003); there were no significant differences in the percentages of those needing assistance for ambulation or ADLs. The association of subdural hematoma with ambulation, self-care, and supervision needs was related to the degree of midline shift but not to the presence of subdural hematoma. Individuals with subcortical contusions were more likely to require assistance at rehabilitation discharge for ambulation (32% vs 18%, P[lt ].0001), lower-body dressing (61% vs 44%), toileting (52% vs 35%), bladder continence (34% vs 22%), and overall supervision (61% vs 44%) than those without subcortical contusions (P[lt ].0001). At 1 year, individuals with acute subcortical contusions were more likely to need assistance with ambulation (15% vs 8%, P=.004) and stair climbing (15% vs 9%, P=.03). Those with bilateral frontal (54% vs 46%, P=.009) or bilateral temporal (58% vs 46%, P=.03) contusions were more likely to need assistance with overall supervision at rehabilitation discharge, compared with those with unilateral or no cortical contusions. Conclusions: The presence of either a midline shift greater than 5mm or a subcortical contusion on acute CT scans is associated with a greater need of assistance with ambulation, ADLs, and global supervision at rehabilitation discharge. Patients with bilateral cortical contusions require more global supervision at rehabilitation discharge but no more supervision for ambulation and ADLs. These findings may aid health care professionals and potential caregivers in planning for rehabilitation and supervision needs after rehabilitation discharge and, to a lesser extent, at 1 year after TBI. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Perceptions of Community-Based Services Among African American and White Elders

Currently, researchers have an incomplete understanding of the factors and processes that influence the use of community-based services, particularly among groups known to be at high risk of poor health outcomes and in greater need of assistance, such as African Americans. Although service use involves attitudinal variables, researchers have often overlooked such factors. In this study, the authors conducted 12 focus groups to examine the perceptions of older African Americans and Whites toward community-based services. African Americans were more likely than their White counterparts to assess services positively, particularly senior citizen centers. Whites expressed less enthusiasm toward community-based services, citing a lack of comfort with services that they feel are used predominantly by African Americans, an insistence on self-reliance, and an appreciation for the availability of such services but a reluctance to use them.

Gender Differences in Parent-Child Coresidence Experiences

Gender differences in exchanges and parent-child relations for adult children residing in parent households are investigated using data from the National Survey of Families and Households. Daughters report doing more housework, and sons are more likely to pay room and board, but both exchanges are modest and are unrelated to each other and to the reported quality of parentchild relations. There are few differences between sons and daughters in parent-child relations and their predictors. Overall, coresidence appears to be more similar than different for adult sons and daughters. The empty nest has become normative for parents in middle adulthood, and leaving home is part of the transition to adulthood for postadolescent children. However, recent cohorts of young adults have delayed nest-leaving and increasingly returned to the parental home during periods of transition, economic hardship, or marital problems (Aquilino, 1990; Goldscheider & Goldscheider, 1994; Ward, Logan, & Spitze, 1992). These studies indicate that coresidence typically is a response to the needs of adult children, rather than caregiving for parents. It most commonly involves unmarried children living in the households of their parents, and about half of these children have never left the nest. Sons are more likely than daughters to delay nest-leaving or to return to the parental home (Aquilino, 1991b; Goldscheider & Goldscheider, 1994), but there are also indications that coresidence is more stable for daughters (Ward & Spitze, in press), suggesting that they have greater need for assistance or have more satisfying coresidence experiences. Thus, coresidence experiences may differ for sons and daughters (and for mothers and fathers). Gender shapes the central dimensions of family life, from the nature and quality of family relationships to the division of household labor. This is reflected in the literature on caregiving, which focuses on the particular efforts of daughters, but less attention has been given to gender differences in more common forms of involvement between parents and adult children, including coresidence. We focus on gender differences in the nature and quality of coresidence experiences-in particular, the implications of exchange relations for parent-child relations. This will further our understanding of an increasingly frequent arrangement that has implications for financial and psychological well-being. We also focus on responses of coresiding children, rather than parents, who have been the subject of much of the coresidence literature. We view exchange relations as a centerpiece of coresidence arrangements. Shared households may involve a variety of exchanges: housing and economic assistance; help with household tasks, health-related needs, and child care; and companionship and emotional support (Ward & Spitze, 1992). The equity of these exchanges likely affects the quality of parent-child relations. Although monetary payments or housework may be perceived as fair trade for housing assistance, they also may be a locus of conflict. For example, children may create more housework for parents, and parents may resent their freeloading (Goldscheider & Goldscheider, 1994). From the child's perspective, exchange may be more significant because of issues of autonomy and control. Coresident children may resent being treated like young children who are expected to help with housework, for example, and may consider other exchange expectations (such as paying room and board) inappropriate for close family ties. Thus, exchange relations are a potential source of conflict. This will affect the quality of parent-child relations, which is itself central to satisfaction with coresidence. Relations between parents and children are generally positive (Umberson, 1992), and coresident parents and children likely are self-selected in terms of relationship quality (Aquilino,1991a). However, any close and ongoing relationship may involve some strain, and elements of coresidence may heighten this (Ward & Spitze, 1992). …

Quality of Life and Health Service Use Among HIV-Infected Patients with Chronic Diarrhea

Health-related quality of life and the utilization of health resources are important components of the evaluation of patient outcome in HIV infection because medical problems are often progressive and debilitating, and treatment is palliative. We evaluated quality-of-life measures and resource utilization of patients with AIDS and/or CD4 lymphocytes < 200 who had symptoms of chronic diarrhea and compared them with similar patients with AIDS and/or CD4 lymphocytes < 200 without diarrheal symptoms. Annual charges were 50% higher for patients with chronic diarrhea ($24,567 versus $14,471 for the comparison group, p < 0.01). Higher charges for the patients with diarrhea were a result of more physician visits and diagnostic testing. Quality-of-life scores were poor for all patients, but deterioration over the year in role functioning (social activity, daily living, energy, cognition) and general health was clearly evident (p < 0.01) for the patients with chronic diarrhea. These patients also suffered significant work loss and reported greater need for assistance in the home. These data suggest that HIV-infected patients with diarrhea experience marked decreases in quality of life and that care for patients with chronic diarrhea is costly. Relatively little attention has been paid to this debilitating syndrome, and current treatment options rarely provide permanent relief. Research and innovation in this area are needed; an estimated 25-50% of HIV-positive individuals suffer from this symptom complex.

Local system responses to water shortage

Abstract Water shortages have become increasingly serious natural resource problems in recent years. In most cases local water systems are responsible for programs to reduce individual water use. The effectiveness of these organizations is related to their ability to obtain information and assistance from other organizations at the local, state, and federal levels. This paper examines the experiences of 28 local water systems in North Carolina in responding to water shortage. Results are based on detailed personal interviews with the main decision maker for each water system. Obstacles to effective water management are evaluated. Sources of information and assistance are identified. Attitudes of respondents about their experiences are analyzed. Smaller systems were found to face more problems in coping with water shortage. They are also in greater need of assistance and information from outside organizations.