Specific Types Of Care Research Articles

Понятие и содержание права детей на заботу, или В чем заключается родительский долг?

Introduction. Despite all the evidence and, at first glance, the simplicity of caring for children (anyone can formulate their opinion about what it should include), its content is not understandable, clear, and the same for everyone. The study of the responsibility of parents to take care of children is highly relevant, since upbringing and caring for children are the main tasks of the parental role and are of great importance for the development and well-being of children. First of all, it is necessary to determine which specific types of care are an integral part of parental duty. This can cover aspects such as children’s physical health (nutrition, sleep, hygiene), emotional and psychological well-being (support, love, understanding), as well as education and development (study, socialization, skill development). The purpose of the study was to identify the problems of understanding child care and formulate the authors’ concept of care and its content. Methods. Induction, deduction, analysis, and formal legal methods were of crucial importance for obtaining the results. Results. Systematized the factors about which a parent should be constantly concerned about children; identified a set of actions that a parent should perform in connection with the care of minor children; defined the benefits for the child that form the content of care. The authors’ definition of child care is given. Conclusions. Taking care of children is a parent’s right and duty. The right and duty are independent elements of the legal status of an individual. The right and duty are an analogy to a positive legal responsibility as the encouragement for necessary behavior.

Multilingual communication in Speech Language Therapy

Multilingualism can both enrich and complicate interactions in health care. Several studies (Ferguson, 2002; Jacobs, 2017) point out that language differences between care providers and patients can lead to less access to and lower quality of care. More specifically, challenges regarding communication, mutual understanding and shared decision making are often present (Cox & Maryns, 2021; Schouten et al., 2017) in health care situations. A specific type of care where communication is both instrument and goal of therapy is Speech language therapy (SLT). This profession offers guidance for people who experience difficulties with communication. In the daily practice of speech language therapists (SLTs) clients are vulnerable in their communication in different ways (Blackstone, 2015). For example, in multiethnic cities in the Netherlands many people have limited language proficiency in Dutch and they can also have a communication disorder These converging communication vulnerabilities form a challenge for SLTs. Several studies within the field of SLT have been performed to improve the diagnosis and treatment of complex multilingual cases (Hyter & Salas-Provance, 2023), but little research has been done on the actual interaction during those multilingual encounters (Hand, 2006). Although SLTs are experts in communication, experiences from the work field indicate that these professionals often feel less competent when interacting with multilingual clients or their parents (Lagendijk, 2021). As these situations occur very often in SLT practice and are quite complex due to interfering communication vulnerabilities, they need to be critically explored. The current PhD study LIMINA (Logos In Multilingual InterAction) aims to gain insight into multilingual communication in Speech language therapy in order to enhance inclusive care. By carrying out various research methods (discourse analysis, in depth interviews, focus groups and design based research) different perspectives in the SLT setting are being explored. Data from the actual interaction will be compared and synthesized with the perspectives of clients and professionals in order to create a kaleidoscopic view. Moreover, the project intends to design a practical intervention in co-creation with representatives from the work field in order to enhance inclusive communication in SLT care. For the purpose of the first sub study, students of the Rotterdam University of Applied Sciences collected transcripts from conversations between SLTs and parents, representing their underaged children. Two datasets were composed for the current analysis: a) transcripts of intake sessions (n = 15) and b) transcripts of test results discussions (n = 18). Parents have diverse linguistic backgrounds and most of the conversations took place in Dutch, without an interpreter. By performing a critical discourse analysis (Ten Thije, 2001) multilingual interactions are currently being reconstructed in order to gain insight in patterns, structures and (un)successful actions. Preliminary results show that both SLTs and parents use several interactional strategies for inclusive multilingualism (Backus, 2013) during consults. Mostly supporting materials, such as reports, were used by the SLT to facilitate the verbal interaction; especially during the test result discussions. Also gesturing, writing and drawing were often used as strategies to facilitate the conversation. In five (out of fifteen) intake sessions no strategies were used during interaction. These parents were considered to be sufficiently fluent in the Dutch language by the researchers who analyzed the transcripts. In none of the test result discussions (n = 18) an interpreter was present to enhance understanding. First conclusions regarding inclusive multilingualism in SLT care reveal that although participants choose different ways to support their verbal message, this does not guarantee an adequate transfer of knowledge within the institutional setting of Speech language therapy. Specific conversational goals from both SLTs and parents were often not achieved during the intake sessions and test results discussions. This seems to correspond with the earlier reported experiences of SLTs (Lagendijk, 2021) and underlines the importance of the current study. The present poster gives a textual and graphical overview of the research design for the overarching PhD study LIMINA. The indicated colors represent the different sub studies and the image shows an authentic fragment of a resolved misunderstanding between a parent and a speech language therapist. Furthermore, the poster provides a table of preliminary results concerning the interactional strategies used by SLTs and parents during institutional encounters.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Corneal sampling at the heart of cooperation between professionals

Initiated in 2009 by the Hospital, Patients, Health and Territories Act, the system of cooperation protocols between healthcare professionals aims, for patients, to reduce delays in accessing certain specific types of care. Paramedical staff, particularly nurses, trained to carry out certain activities in this context, hitherto exclusively performed by doctors, are developing increased skills and original career development opportunities. Threenurses from the Verdun/Saint-Mihiel hospital centre (55), involved for several months in a cooperation protocol in the field of corneal sampling, share their experience here.

Self-rated health and endogenous selection into primary care

This study assesses the causal effects of primary care utilization on subjective health status in Turkey using individual-level data from the 2012 Health Research Survey. Employing recursive bivariate ordered models that take into account the possibility that selection into healthcare might be correlated with the respondent's self-reported health status, we find that selection into primary care is endogenously determined and that the utilization of primary care significantly improves self-rated health after controlling for sociodemographics, socioeconomic status, health behaviors and risk factors, and access to healthcare. We show that the causal association between healthcare utilization and health status is robust to the use of objective measures of health and specific types of care, suggesting that the use of a single-item question on self-rated health and binary measures of preventive care utilization is valid.

The Critical View of Safety: Why It Is Not the Only Method of Ductal Identification Within the Standard of Care in Laparoscopic Cholecystectomy.

The Critical View of Safety: Why It Is Not the Only Method of Ductal Identification Within the Standard of Care in Laparoscopic Cholecystectomy.

Hospital perspectives on the end of life, the case of homeless people

The hospital is the last refuge for sick homeless people when their illness makes life on the street impossible. The teams often consider these patients as different, difficult and not easy to place in a specific type of care. In palliative care, fewer questions are raised as the patients are hospitalised for their terminal phase. The difficulties often lie in diagnosing the disease and recognising its seriousness and the patient's social situation.

What's the difference? Using descriptors to classify the care provided to children and adolescents with behavioral and emotional problems

More detailed information concerning the content of interventions for children with behavioral and emotional problems may help to improve their effectiveness. In this study, we made a distinction between “well-defined” and “poorly defined” interventions that were being provided in a catchment area. Well-defined interventions are included in the Dutch “Effective Youth Interventions” (EYI) database; poorly defined interventions are not. We aimed to assess (1) to what extent “well-defined” interventions had similar content, that is, could be grouped together, and (2) whether the proportion of those interventions that could be grouped was smaller for “well-defined” than for “poorly defined” interventions. The interventions were scored by professionals in terms of the degree to which the activities entailed in that intervention were covered by the 20 descriptors that represent that specific type of care. Those interventions with similar scores on descriptors were then grouped together. The percentage of interventions that could be grouped was then compared with that found in an earlier, comparable study concerning “poorly defined” interventions. “Well-defined” interventions could be classified into 19 groups; this represented a reduction in interventions of 44%, with the largest reduction found in those interventions within the main types “individual child support” and “family support.” This reduction was somewhat smaller than for the “poorly defined” interventions (52%), where the largest reduction was found in the main type “family support.” The descriptors then allowed interventions offered to children to be grouped within and across care organizations. In this way, we were further able to distinguish differences and similarities in the content of grouped interventions per main type of support.

'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians.

BackgroundProfessionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people with ID.This paper describes the shifts in care approaches and attitudes that relatives and professionals perceive as the death of a person with ID approaches, as well as the values underlying these shifts.MethodsA qualitative design was used to reconstruct the cases of twelve recently deceased people with ID. Relatives and professionals who were closest to the person at the end of their life were interviewed. Interviews were transcribed verbatim and data were analyzed inductively, using elements of thematic analysis.ResultsFive shifts were found: 1) adapting to a new strategy of comforting care, taking over tasks and symptom relief, 2) interweaving of emotional and professional involvement, 3) stronger reliance on the joint interpretation of signals expressing distress and pain, 4) magnified feeling of responsibility in medical decisions, 5) intensified caring relationship between ‘two families’: relatives and care staff.Six relational values were behind these shifts: ‘being there’ for the person with ID, ‘being responsive’ to the person’s needs, ‘reflection’ on their own emotions and caring relationships, ‘attentiveness’ to the ID person’s wishes and expressions of distress, ‘responsibility’ for taking joint decisions in the best interests of the person, and ‘openness to cooperation and sharing’ the care with others.ConclusionsEnd-of-life care for people with ID involves curtailing expectations of participation and skill acquirement, and an increase in teamwork featuring intensified comforting care, symptom management and medical decision making. Three caring relationships need to be fostered: the relationship with the person with ID, relationships among professionals and the relationship between relatives and professionals. ID care services should invest particularly in the emotional support and expertise level of care staff, and in the collaboration between relatives and professionals.

Evaluating hospital performance based on excess cause-specific incidence.

Formal evaluation of hospital performance in specific types of care is becoming an indispensable tool for quality assurance in the health care system. When the prime concern lies in reducing the risk of a cause-specific event, we propose to evaluate performance in terms of an average excess cumulative incidence, referring to the center's observed patient mix. Its intuitive interpretation helps give meaning to the evaluation results and facilitates the determination of important benchmarks for hospital performance. We apply it to the evaluation of cerebrovascular deaths after stroke in Swedish stroke centers, using data from Riksstroke, the Swedish stroke registry. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

Ранняя диагностика доброкачественной гиперплазии предстательной железы как фактор снижения третичной профилактики

Significant opportunities to increase economic efficiency in health care are associated with increased planned approach to the management of the volume and structure of care and patient flow. In 2010, the Research Institute of Urology in conjunction with the Government of the Voronezh region developed a regional program "Urology". The main objectives of which were: the reduction of morbidity, complications and disability in pa-tients with urological profile, improving the quality and accessibility of urological care to the population area. The essence of the program is to organize medical urological care according to the principles of prevention, standardization, quality control of the organization of care, optimizing the financial costs of the state of health care. In our work we have tried to move away from the principle of "negotiability" and to focus on the active identification of complaints by the survey population. The concept of preventive health care, implemented in the sub-program "Urology" in full compliance challenges of the day – simple, effective, does not cost much. On the example of BPH, it was shown that the introduction of such a system in any branch of medicine will allow maximum transfer care to a new level , away from the provision of assistance in uptake, the majority of accident and emergency assistance on a "detection", routine medical care, and accordingly to plan state assignment for each specific type of care, and as a result, plan on spending on health care , which will lead to the rational use of finance to health care, improve the quality and availability of specialized and high-tech care.

Determinants of Healthcare Costs in the Last Year of Life (TH316-A)

1.To understand how patient- and service-level factors drive healthcare resource use in the last year of life.2.To raise awareness of the complex interactions of resource use in different care settings, and consider this when measuring the impact of palliative care services. To identify determinants of healthcare costs in different settings in the last year of life, and establish the relative importance of these cost determinants. A systematic literature review to elicit drivers of costs in the last year of life of adults. We searched Ovid EMBASE and Medline (until January 2011) using a highly sensitive search strategy. Inclusion criteria: 1) Populations affected by life-limiting or advanced progressive conditions and 2) evidence on dependent variables of costs or resource use. Limited to studies reporting original data from multivariate analyses. Only data applying to the last year of life were extracted from studies covering longer time spans. Assessment of the strength of evidence was based on the quality of contributing studies (modified Edwards score1) and the number and level of agreement between different studies assessing each cost driver. We identified 21 multivariate studies reporting resource use in the last year of life. Five were graded as low, 11 as medium, and five as high quality1. We distinguished evidence relating to overall costs, or specific types of care, such as hospital, home care, or nursing home costs:•Older age: reduced overall costs, but higher home care, nursing home, and hospice costs•Non-white ethnicity: lower overall, but increased hospital costs•Lower socioeconomic status: lower hospital, but higher home care, nursing home, and hospice costs.•Living alone: higher overall costs•Urban setting: increased overall costs•Poorer functional status, proximity to death, comorbid conditions: higher costs across settings•Palliative care interventions: decreased costs across settings, particularly in hospital.

A Respectable Scandal: Same-Sex Parenthood, Emotional Dynamics, and Social Change

Most of the scholarship and current literature on parental care focuses on its gendered costs and unbalances. Less attention is paid to the consequences of being excluded from this specific type of care—what we could call the right to parent. Gay and lesbian parents claiming their right to parent represents a momentous historical change: the increasing visibility of these parents is one of the most important components of such change. Emotional dynamics are key to this social change. Emotions constitute the link between doing parenting at the micro level of interactions and doing, or undoing, difference at the macro level of social structures; similarly, different ways to do parenting and to do gender must be taken into account if we want to grasp a truly comprehensive picture of the phenomenon of parenthood. This article draws on a wider study on different kinds of care and caregivers, whose aim is to offer a more inclusive interpretation and a more reliable discourse on family care and parenthood. Parenthood is still societally significant, but different ways to attain parenthood (biologically, through adoption, surrogacy, etc.) or to be a parent (single or in a couple, gay or heterosexual, married or unmarried, etc.) seem to mark a more important difference. While such difference can translate into inequality, this is now being challenged by these increasingly more visible parents. Our findings show that the divide between the categories of “parents” and “non-parents” dissolves the divide between the categories of “gay/lesbian” and “non-gay/lesbian.” Gay and lesbian parents produce social change by taking the sexuality out of gay, lesbian, bisexual, and transgendered (GLBT) politics in the mainstream arena. Same-sex parenthood may still be perceived by many as a “scandal,” but more and more as a respectable one.

Stigma, Barriers to Care, and Use of Mental Health Services Among Active Duty and National Guard Soldiers After Combat

This study examined rates of utilization of mental health care among active duty and National Guard soldiers with mental health problems three and 12 months after they returned from combat in Iraq. Stigma and barriers to care were also reported for each component (active duty and National Guard). Cross-sectional, anonymous surveys were administered to 10,386 soldiers across both time points and components. Mean scores from 11 items measuring stigma and barriers to care were computed. Service utilization was assessed by asking soldiers whether they had received services for a mental health problem from a mental health professional, a medical doctor, or the Department of Veterans Affairs in the past month. Risk of mental problems was measured using the Patient Health Questionnaire, the PTSD Checklist, and items asking about aggressive behaviors and "stress, emotional, alcohol, or family" problems within the past month. A higher proportion of active duty soldiers than National Guard soldiers reported at least one type of mental health problem at both three months (45% versus 33%) and 12 months (44% versus 35%) postdeployment. Among soldiers with mental health problems, National Guard soldiers reported significantly higher rates of mental health care utilization 12 months after deployment, compared with active duty soldiers (27% versus 13%). Mean stigma scores were higher among active duty soldiers than among National Guard soldiers. Active duty soldiers with a mental health problem had significantly lower rates of service utilization than National Guard soldiers and significantly higher endorsements of stigma. Current and future efforts to improve care for veterans should work toward reducing the stigma of receiving mental health care.

Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis

BackgroundAnalyses of utilization trends (cost drivers) allow us to understand changes in colorectal cancer (CRC) costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice), and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002.MethodsCohorts included patients aged 66+ newly diagnosed with adenocarcinoma of the colon (n = 52,371) or rectum (n = 18,619) between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC.ResultsCRC patients (mean age: 77.3 years; 44.9% male) used more resources than controls in every category (P < .001), with the largest differences seen in hospital days and home health use. Most resource use (except hospice) remained relatively steady over time. The initial phase was the most resource intense in terms of office and outpatient visits. Hospice use among patients who died of CRC increased from 20.0% in 1992 to 70.5% in 2004, and age-related differences appear to have evened out in later years.ConclusionUse of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.

Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1).

Most definitions of severe mental illness (SMI) are categorical and assign the patient to either SMI or not-SMI status. While this is useful for some purposes, it is a rather limited approach. The purpose of the present study is to develop a new method of addressing the issue of 'severity', and to develop a dimensional rather than a categorical approach. The paper reports on the acceptability, reliability and validity of a method developed to collect a standard set of data covering the majority of items specified in the academic and policy literature as characterising SMI. A single page form, Matching Resources to Care (MARC-1), containing most of the items used in definitions of SMI was used to collect data from community mental health staff about their current open caseload, in four co-terminous health and social services settings during a census week (n = 2139). In addition to the data from the four pilot sites, we conducted a substudy (n = 91), in which two raters rated the same cases during the same week. The MARC-1 scores were able to distinguish between patients in receipt, and those not in receipt, of specific types of community care (level of care, eligibility for care and statutory aftercare) (P < 0.001). The MARC-1 score was modestly but significantly correlated (r = 0.28) with the Global Assessment Scale (P < 0.001). The mean percentage inter-rater agreement for the MARC-1 score items was 87%. It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community.

Planning care for elderly people using the balance of care model.

Planning health and social services for client groups has become an integral part of the planning process within the United Kingdom. The Department of Health's microcomputer model--Balance of Care--attempts to analyse different policies for the care of the elderly and to assess the consequences of such policies in terms of the resources required. This paper shows how the model operates using data from a survey of elderly people in Northern Ireland. An attempt is also made to introduce economic principles into the decision making process. Attention is drawn to the economist's definition of costs and how this can differ from the public expenditure concept of costs. A further area of interest is the process of allocating people to specific types of care. The economic approach points to the need to make explicit valuations of the benefits of various services against a background of costs. Within this context, the Balance of Care model can be used to consider various scenarios and as such is a useful tool in the decision making process.

Needs for care among the long-term mentally ill: a report from the Camberwell High Contact Survey.

We report the results of a survey of the needs for items of care of 145 long-term users of psychiatric day-hospitals and day-centres in Camberwell. The overall ratio of met to unmet need was almost exactly 5:1. Need was shown to vary according to chronicity, degree of participation, and placement in day-hospital or day-centre. Specific areas of functioning and specific types of care were identified in which there was significant overprovision or underprovision. The utility of our measures, and their ability to identify clinically significant unmet need, are discussed.

Trends in the Organization of Mental Health Care in Portugal

In the past 25 years, 3 periods can be identified in the organization of mental health care in Portugal: decentralization of hospital, institutionalized care (1963-1971), integration of mental health into the general health services (1971-1984), and the present situation. Before 1963 the needs of the Portuguese people for mental health care were very poorly met through uncoordinated subsystems generally oriented toward the provision of very specific types of care and benefiting only limited groups of the population. Outpatient psychiatric care was exclusively curative, complying with the demands of patients or families and based on the classic biological-medical approach to therapy. By 1963 the principal subsystems providing ambulatory care at the community level were: (i) psychiatric consultation within the network of the social security medicosocial services for workers and their families; (2) private psychiatric facilities, used mainly by the upper socioeconomic classes; (3) outpatient services (dispensaries) at state mental hospitals and mobile teams providing psychiatric consultation in the country's larger towns; and (4) special services by private psychiatrists for state employees, and psychiatric care within the medical services offered by several public enterprises or organizations. Psychiatric inpatient care was provided by 5 large state mental hospitals, with about 3,700 beds, located in the Portuguese cities of Lisbon, Oporto, and Coimbra, and 6 large private psychiatric clinics (owned mainly by religious orders) with a total of 3,100 beds. In general, these mental hospital facilities offered a very undifferentiated and traditional type of institutional care.