Special Care Programs Research Articles

Incidence of and Risk Factors for Low Birth Weight in Oman: A Population Based Study

The purpose of this study was to provide levels, t rends and determinants of low birth weight (LBW) in Oman using population based health survey data. The data for the study come from the 2000 Nat ional Health Survey of Oman. The sample consists of 977 singleton live births that occurred during five years before the survey date. The survey gathered data on birth weight from child health card. Univariate, bivariate and multivariate statistical techniques and tests were employed for data analysis. The incidence of LBW was observed to be 9% in Oman in 2000. LBW rate shows increasing trends in Oman. The results of both bivariate and mult ivariate analysis revealed that maternal low level of education, low income level, primipara, late and low ANC visits, preterm b irths, pregnancy complications and region of residence in A l-Batinah were significantly associated with the increased risk of LBW in Oman. Consanguinity shows insignificant marginal effect on LBW. In order to reduce the incidence of low b irth weight, health improvement strategies should focus on special care and intervention programs for high risk groups identified in the study.

Barriers to women's participation in inter-conceptional care: a cross-sectional analysis

BackgroundWe describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service.MethodsA secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program.ResultsAlthough common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation.ConclusionsActively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.

Daño cerebral sobrevenido: propuesta de definición, criterios diagnósticos y clasificación

Acquired brain injury is a heterogeneous clinical concept that goes beyond the limits of the classical medical view, which tends to define processes and diseases on the grounds of a single causation. Although in the medical literature it appears fundamentally associated to traumatic brain injury, there are many other causes and management is similar in all of them, during the post-acute and chronic phases, as regards the measures to be taken concerning rehabilitation and attention to dependence. Yet, despite being an important health issue, today we do not have a set of diagnostic criteria or a classification for this condition. This is a serious handicap when it comes to carrying out epidemiological studies, designing specific care programmes and comparing results among different programmes and centres. Accordingly, the Extremadura Acquired Brain Injury Health Care Plan working group has drawn up these proposed diagnostic criteria, definition and classification. The proposal is intended to be essentially practical, its main purpose being to allow correct identification of the cases that must be attended to and to optimise the use of neurorehabilitation and attention to dependence resources, thereby ensuring attention is provided on a fair basis.

Violencia Familiar: Programas de atención para hombres que ejercen violencia (HEV)

We introduce the current picture of psychosocial interventions with men devoted to eradicating violence against women, describing the special care program for men who exercise violence taking place in both the developed and the Third World countries for over thirty years. It also makes clear the different types of care ranging from strategies to promote non-violence, primary, secondary and tertiary prevention in its various forms, to the promotion of active involvement of non-violent people in actions to eradicate gender violence.

G-Protein-Associated Signal Transduction Processes Are Restored after Postweaning Environmental Enrichment in Ts65Dn, a Down Syndrome Mouse Model

Individuals with Down syndrome (DS) present cognitive deficits that can be improved by early implementation of special care programs. However, they showed limited and temporary cognitive effects. We previously demonstrated that postnatal environmental enrichment (EE) improved clearly, though temporarily, the execution of visuospatial memory tasks in Ts65Dn mice, a DS model bearing a partial trisomy of murine chromosome 16; but in contrast to wild-type littermates, there was a lack of structural plasticity in pyramidal cell structure in the trisomic cerebral cortex. In the present study, we have investigated the impact of EE on the function of adenylyl cyclase and phospholipase C as a possible mechanism underlying the time-limited improvements observed. Basal production of cyclic adenosine monophosphate (cAMP) was not affected, but responses to GTPγS, isoprenaline, noradrenaline, SKF 38393 and forskolin were depressed in the Ts65Dn hippocampus. In EE conditions, cAMP accumulation was not significantly modified in control animals with respect to nonenriched controls. However, EE had a marked effect in Ts65Dn mice, in which cAMP production was significantly increased. Similarly, EE increased phospholipase C activity in Ts65Dn mice, in response to carbachol and calcium. We conclude that EE restores the G-protein-associated signal transduction systems that are altered in Ts65Dn mice.

Psychosomatiek bij vluchtelingen

Psychosomatics in refugees Clinical experience in psychiatry shows the problem of somatizing patients, especially in the group of non-western migrants and refugees. A literature search of somatization in refugees shows a more differentiated view. Some studies report no difference in somatization between refugees and the general population, whereas others do. The majority of studies, however, indicate a high amount of somatic complaints in refugees, mostly of unknown origin. Potential, not mutually exclusive, explanations of this high number of somatic complaints in the refugee population include general psychopathology, specifically traumatisation, results of torture, and stigmatisation of psychiatric care. A specific care program should be constructed, directed at the treatment of somatization in refugees.

Rurality and Nursing Home Quality: Evidence From the 2004 National Nursing Home Survey

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Helping patients in cataract peri- and post-surgery: a simple intervention addressing anxiety.

The aim of this study is to propose patients a psycho educational intervention before, during and after a stay in a hospital to undergo a cataract surgery, in order to meet their doubts and fears. The objective is to find if by lowering the anxiety state, the suffering would be reduced and the quality in the rehabilitation process would be fostered (Hesbeen, 1996). The design chosen was a RCT (Randomised Control Trial A group of 160 individuals was assigned randomly to one of the 2 conditions: 80 to the experimental/intervention condition following a specific care program aiming at lowering anxiety, and 80 to an “attention/routine care” condition. The sample consisted of individuals who had a mean age of 72, SD 10.33, ranging from 24 to 95 years old, and 63.1% were females. Anxiety state decreased significantly after surgery in both intervention and attention groups but more intensively in the intervention group. A regression model explained 80% of the anxiety state score after surgery. The most significant predictor of anxiety state score after surgery was “belonging to the intervention/experimental group” (B = 0.712). These results confirm the claims that a simple, costless and almost timeless psycho educational procedure can decrease anxiety and improve patients’ experience of cataract surgery and recovery. Key words: Psycho educational interventions, hospital, cataract surgery, peri and post surgery anxiety

Specific care program for the older adults: Memory Clinics

Memory Clinics are interdisciplinary, specialized outpatient units for the early diagnosis of cognitive impairments and rare forms of dementia in the rapidly growing older population. At the Basel Memory Clinic, a team of neuropsychologists, geriatricians, neurologists, and psychiatrists use standardized procedures to comprehensively diagnose patients in the earliest possible stages of dementia or mild cognitive impairment. In collaborative efforts with family physicians and dementia care providing agencies, such as the Alzheimer's Association, patients and families are offered up-to-date pharmacologic and non-pharmacologic treatment options and educational and counseling services. These efforts aim to maintain the quality of life of both patients and caregivers as long as possible and to delay nursing home placement which accounts for the majority of costs associated with dementia.

Health-Related Quality of Life and Blood Pressure Control in Hypertensive Patients with and without Complications

INTRODUCTION:The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL)OBJECTIVE:This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications.MATERIALS AND METHODS:Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 ± 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher’s Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into “with complications” (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and “without complications” (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics.RESULTS:In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143±18/84±11 and 144±21/93±11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128±17/75±13 and 128±15/83±11mmHg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the “with complications” group and from 78% to 50% in the “without complications” group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher’s Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher’s Questionnaire showed no differences in these scores.CONCLUSION:Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.

Emergency calls and need for emergency care in patients looked after by a palliative care team: Retrospective interview study with bereaved relatives

BackgroundDuring the last stage of life, palliative care patients often experience episodes of respiratory distress, bleeding, pain or seizures. In such situations, caregivers may call emergency medical services leading to unwanted hospital admissions. The study aims to show the influence of our palliative care team to reducing emergency calls by cancer patients or their relatives during the last six month of life.MethodsFifty relatives of deceased patients who had been attended by our palliative care team were randomly selected. Data was obtained retrospectively during a structured interview. In addition to demographic data, the number of emergency calls made during the final six months of the patient's life, the reason for the call and the mental compound score (MCS-12) of the caregivers was registered.ResultsForty-six relatives agreed to the interview. Emergency calls were placed for 18 patients (39%) during the final six months of their lives. There were a total of 23 emergency calls. In 16 cases (70%) the patient was admitted to the hospital. Twenty-one (91%) of the calls were made before patients had been enrolled to receive palliative care from the team, and two (9%) were made afterwards. The mean mental compound score of the caregivers at the time of the interview was 41 (range 28–57). There was a lack of correlation between MCS-12 and number of emergency calls.ConclusionEmergency calls were more likely to occur if the patients were not being attended by our palliative care team. Because of the lack of correlation between MCS-12 and the number of emergency calls, the MCS-12 cannot indicate that acutely stressful situations triggered the calls. However, we conclude that special palliative care programs can reduce psychosocial strain in family caregivers. Therefore, the number of emergency calls may be reduced and this fact allows more palliative patients to die at home.

Comorbidity and dementia

Epidemiological data suggest a strong association between aging, dementia and comorbidity such as cancer, chronic renal failure or undernourishment. These chronic conditions may lead to invasive diagnosis procedures as well as to difficult therapeutic management. When they occur in elderly patients with cognitive disorders or dementia, physicians and caregivers should apply specific care program. For example, if an adjuvant chimiotherapy is discussed for an old demented patient with cancer, informed consent and details about the treatment program should be carefully provide. At the onset of a chronic disease, the assessment of its prognosis as well as its impact on the autonomy or quality of life is particular when the patient is also demented. We discuss the specific characteristics about management of demented elderly patients who require high risk treatment because of severe and lethal diseases.

Screening for developmental problems at primary care level: a field programme in San Isidro, Argentina

Information on prevalence and type of problems of psychomotor development (PPD) is necessary for implementation of specific care programmes at field level. With the purpose of obtaining this information, a screening test, the Prueba Nacional de Pesquisa (PRUNAPE) for PPD was implemented in three health centres in San Isidro, a city near Buenos Aires, attended by different socio-economic groups: centres A and B were located in the inner city, and C in a middle-class area. The test was administered by three previously trained paediatricians to 839 apparently healthy children aged 0-5 years. The failure rates were 24%, 19% and 16% in centres A, B and C respectively (20% in total). Out of the 170 children failing the test and referred to hospital for diagnosis and treatment, only 96 complied and went through a series of studies carried out by a previously prepared multidisciplinary team. With the exception of children who failed the Battelle test [classified as Global Developmental Delay (GDD)], final diagnoses were classified according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition: GDD (60 children), pervasive developmental disorders (11), communication disorders (10), motor disorders (6, of whom 2 were with cerebral palsy), attention deficit disorders (5), attachment disorders (2), normal children (3). Co-morbidity was present in 22 affected children. Forty-three per cent of children failing the test did not attend hospital or did not complete studies because of major social and family problems, the family not living in the area, or the parents preferring to consult their own paediatrician. Health centres and children not selected in a randomised way, and a significant proportion of them not complying with the indication of hospital referral were major sources of bias, so that PPD prevalences, positive and negative predictive values should be interpreted with great caution. Further studies accounting for these sources of bias are needed to confirm the observed prevalence of PPD. Training of health personnel, at hospital and health centre level, priority settings, and operational research to evaluate effectiveness of treatments and care delivery systems at field level are necessary in Argentina for optimal use of limited healthcare resources.

Survey of Special Patient Care Programs at U.S. and Canadian Dental Schools

This article describes the results of a survey of U.S. and Canadian dental schools regarding the delivery of dental care to special needs patients. The purposes of the fifteen-item survey were to identify the percentage of dental schools that operate special patient care (SPC) clinics, gain information as to how care is being provided in those clinics, and identify how this patient population is managed in institutions without designated SPC clinics. Forty percent of the respondent institutions had designated SPC clinics. Institutions without SPC clinics tend to mainstream these patients into their predoctoral clinics or refer them to residency programs such as GPR or pediatric programs within their university.

A 4-Year Follow-Up of Very Old Patients Presenting with Frontal-Subcortical Dysfunction Compared with Alzheimer’s Disease Patients

Background: Frontal-subcortical clinical syndrome (FSCS) is frequently described in elderly patients and consists of specific alterations in cognition and motor functions. This clinical picture may be associated with a high level of dependence and a high mortality risk. Objective: We report the risks of institutionalization and death during a follow-up of 4 years in patients showing FSCS. Methods: The study was initiated in 1998 to compare FSCS patients showing postural and gait abnormalities with Alzheimer’s disease (AD) patients. Follow-up was conducted by means of telephone interviews with the patient’s general practitioner over a 4-year period (1998–2002). Results: Both institutionalization and mortality rates were significantly higher (p < 0.05) in the FSCS group compared to the AD group. Conclusions: The high risk of disability and death in FSCS patients suggests that they might require specific care programs that include stimulation in daily living activities in order to reduce the risk of institutionalization and to improve quality of life.

A magical dream: a pilot project in animal-assisted therapy in pediatric oncology.

For children with cancer, being hospitalized represents a great source of stress. Hospitalized children are not only deprived of their familiar and comforting world, but they must also face various and often painful treatments. They must quickly adapt to new people and to an environment that is very different from that of their homes. They have greater safety needs. Thus, it is important to offer these children concrete ways to better adapt to the stresses of hospitalization. Animal-assisted therapy, considered within this project as a novel approach to care, constitutes an interesting solution. It involves using the privileged relation between children and animals to foster the process of adaptation to illness and the hospital environment. The experience described in this article is a one-year pilot project completed on a pediatric oncology unit. A priori, an already very heavy workload, the vulnerability of the patients, and many constraints added to the concerns related to the presence of animals on a tertiary care unit. A postiori, the rigorous design and implementation process of the pilot project, the strong involvement and engagement of volunteers and professionals, the quality of the participating "therapeutic" dogs, the originality of the entire process, and the satisfaction of the patients and nursing staff contributed to its success and to establishing the basis for a permanent implementation of this special care program for children hospitalized with cancer.

714 Increased exercise capacity and quality of life in patients with chronic heart failure participating in an organized training and special care program

714 Increased exercise capacity and quality of life in patients with chronic heart failure participating in an organized training and special care program

Professional caregivers for patients with dementia: predictors of job and career commitment.

The purpose of this study is to identify what factors predict job and career commitment among professional caregivers working with patients with dementia. A secondary analysis was completed using data collected from 77 professional caregivers working in residential dementia special care programs. The findings suggest that professional caregivers' commitment to their jobs and careers is most closely related to their level of involvement in the interpersonal aspects of the work, the degree to which they feel personal growth or benefit, and the level of burden that their work generates. Strategies are suggested for improving job and career longevity among professional caregivers by enhancing attachment to patients and families, fostering professional identity and personal growth, and monitoring and managing professional caregiver burden.

Specialized foster care for medically complex, drug-exposed, HIV positive infants: The Baby Moms program

The nineteen eighties saw a rise in the number of medically complex infants, some HIV positive, entering foster care. Nationally, a variety of programs were developed in response to this situation, many of them at private agencies. The forces of more than a decade ago that contributed to the increased placements of these babies in foster homes continue to affect families today. This paper describes San Francisco's Baby Moms program, a specialized foster care unit in the City's Department of Human Services. Federal support created an external private agency-based project to support Baby Moms, the Fragile Infant Special Care Program, forging a unique private-public partnership. In addition to explaining the program model, descriptive characteristics of infants and mothers are presented. Lastly, we discuss the relevant practice and policy lessons learned.

Book Review: Special Care Programs for People with Dementia

Book Review: Special Care Programs for People with Dementia