Daily Life Support Research Articles

Aging, Pensions and Long-term Care: What, Why, Who, How? Comment on "Financing Long-term Care: Lessons From Japan".

Japan has been aging faster than other industrialized nations, and its experience offers useful lessons to others. Japan has been willing to expand its welfare state with a long-term care (LTC) insurance to finance home care and nursing home care for frail elderly. As Ikegami shows, it created new facilities and expanded specialized staffing for home care, developed a country-wide assessment system and shifted responsibilities between the central and local authorities over that assessment and the determination of co-payments for LTC. Faced with rapid growth in demand for LTC, the government felt the need for new cost control measures. The Japanese experience illustrates that new social policies take time to develop. There is often a need to adjust. But there are also other lessons. The main one is that there is no direct relation between the degree of population aging and total health spending. While aging requires adjustments in the organization of care, and expanding LTC for frail elderly, international studies show there is no need to worry about the ‘unaffordability’ of aging. In this commentary, we have framed four "What, Why, Who, and How" questions about LTC to (re-)define the borderlines between public and private responsibilities for the range of activities for which some (but certainly not all) frail elderly as well as many non-elderly require support in daily life.

Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study

Objective:This study aimed to clarify visiting nurses’ perspectives on critical practices to ensure they could advocate for patients who prefer to die at home.Methods:Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis.Results:Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts.Conclusion:The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses’ unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients’ feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.

Analisis Hasil Uji PMT 150kV Pada Gardu Induk Cilegon Baru BAY KS 1

In this modern era, the need for electricity has become a primary need in both big cities and small cities, almost all of our daily life support equipment requires electrical energy. PLN as the only company engaged in the distribution of electrical energy researches in the field of maintenance, especially testing of PMT insulation prisoners. Based on IEV (International Electrotechnical Vocabulary) 441-14-20 stated that Circuit Breaker (CB) is a mechanical switching / switching equipment, which is able to close, drain and break the load current under normal conditions and is able to close, drain ( within a certain time period) and break the load current under specific abnormal conditions / disturbances such as short circuits. to be used as material for the PMT analysis. The minimum PMT isolation resistance limit at the operating temperature is calculated "1 kV = 1 MΩ". with a note of 1 kv = the magnitude of the phase voltage to the ground, allowable leakage current per kV = 1mA.

A literature review of factors associated with fatigue after stroke and a proposal for a framework for clinical utility

ABSTRACT Objective: Post-stroke fatigue (PSF) is a common and often disabling consequence of stroke, considered to be a complex multidimensional phenomenon. The present review sought to identify studies examining associations between PSF and at least one factor, with the objective of identifying factors that should be investigated in patients with PSF. Method: A search for research investigating PSF was conducted through PubMed, CINAHL and Psychinfo databases (19 October 2017), and included studies in English published during the last 15 years, with more than 10 stroke participants (>18 years old), fatigue assessed with quantitative measurements, and reported relationship with one or more associated factor/-s. Results: Overall, 281 papers were identified of which 34 were included in the final review. Demographics (gender, age), emotional health (depression, anxiety, coping strategy, and locus of control), clinical factors (sleep, pain, stroke characteristics, biological and immunological factors), social factors (social support, disabilities and functionality in daily life) and cognitive functions were found to be associated with PSF. A new framework is discussed, incorporating modifiability of PSF-related factors to heighten the clinical utility. Conclusions: Post-stroke fatigue is multidimensional phenomena with complex aetiology. Further studies are needed to investigate whether treating associated modifiable factors also can decrease PSF.

Need for structured healthcare organization and support for return to work after stroke in Sweden: Experiences of stroke survivors.

To explore stroke survivors' experiences of healthcare-related facilitators and barriers concerning return to work after stroke. A qualitative study. Outpatient stroke rehabilitation unit at a University Hospital in southern Sweden. A convenient sample of 20 persons admitted to Skåne University Hospital for acute stroke care (median age 52 years), in employment of at least 10 h per week at stroke onset and having been referred to stroke rehabilitation within 180 days. The interviews were performed by focus groups, and the data were analysed by content analysis. Facilitating factors were a tailored rehabilitation content with relevant treatments, adequate timing and a structured stepwise return-to-work process. A lack of sufficient early healthcare information, rehabilitation planning and coordination were perceived as barriers. An early rehabilitation plan, a contact person, and improved communication between rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for families. Tailored rehabilitation content and a structured stepwise return-to-work process facilitated return to work. Insufficient structure within the healthcare system and lack of support in daily life were perceived barriers to return to work, and need to be improved. These aspects should be considered in the return-to-work process after stroke.

Factors Associated with Social Support Needs of Spouses of Patients with Cancer: Online Survey

Background: A means of assessing the social support needs of spouses of patients with cancer is not available in Japan, yet such individuals are at increased risk of developing psychological difficulties. Objectives: The present study aimed (1) to describe the social support needs of spouses of patients with cancer, and (2) to explore factors associated with social support needs of spouses of patients with cancer. Design: Spouses (n = 559) of patients with cancer were recruited by registered agents of an online survey company and completed a self-reporting, online questionnaire. Measurements: The questionnaires included demographic information and a tool to assess social support needs. Results: Factor analysis of social support needs of the spouses of patients with cancer indicated that (1) “social support needs regarding disease and treatment of patient” (54 items) comprised 3 factors (“medical condition and cure”, “daily life and social support”, “intimacy and employment”), and (2) “social support needs of spouse (19 items)” comprised 2 factors (“family psychological issues and social support” and “intimacy, employment and society”). The ANOVA and T tests showed that “younger age”, “under treatment”, and “cancer not cured: treatment stopped”, “PS1” and “PS 2-4”, the presence of “lung cancer”, and “recurrence/metastasis” were significant factors (all p < 0.05). Conclusions: The age of the spouse, treatment status, performance status, site of cancer, and recurrence/metastasis are important factors related to spousal needs for social support. Clinicians should assess these factors and the social support needs of spouses to provide appropriate support.

Impediment in Activity of Daily Living and Social Support for Rural Elderly Farmers Undergoing Nerve Block due to Low Back Pain

Purpose: This study is to investigate the low back pain, social support, impediment in daily living activities and to identify factors affecting impediment in elderly farmer’ daily living activities. Methods: The participants were 128 elderly farmers who had received nerve block. Data were collected using a structured questionnaire from February to March, 2018. They were analyzed using t-test, ANOVA, pearson’s correlation coefficient, and linear multiple regression. Results: The score of low back pain was 6.27±1.69 (10 points), that of social support 2.92±0.76 (1~5 points), and that of impediment in activity of daily living 2.01±0.82 (0~5 points). Factors affecting impediment in activity of daily living were found to include age (p=.017), daily hours of farm work (p<.001), fear for the nerve block (p<.001), low back pain (p<.001), and social support (p<.001); the explanatory power of these variables was 58.8%. Conclusion: This study has found the controllable factors affecting impediment in activity of daily living among the rural elderly engaging in farm work include low back pain, social support, and daily farming hours. Therefore, to reduce impediment in activity of daily living among them, it is necessary to develop nursing interventions that can improve impediment in activity of daily living through reduction of daily farming hours using local resources. It is also desirable to improve their health status by reducing low back pain, and develop and apply social supports with health education programs that fit the local resources and the needs of the rural elderly.

Daily life support through “mutual aid” in the community-based integrated care system from the perspective of primary health care

Daily life support through “mutual aid” in the community-based integrated care system from the perspective of primary health care

Smartphone-based ecological momentary assessment and intervention in a blended coping-focused therapy for distressing voices: Development and case illustration

Common approaches to the psychological treatment of distressing voice hearing experiences, such as cognitive behavioural therapy, aim to promote more adaptive cognitive, emotional and behavioural responses to these experiences. Digital technologies such as smartphones show promise for supporting and enhancing these treatments by linking immediate therapeutic settings to the context of daily life. Two promising technologies include ecological momentary assessment and intervention (EMA/I), which may offer a means of advanced assessment and support in daily life, and inform the tailoring of interventions to suit individual needs. In this study, a highly novel intervention approach was developed involving four face-to-face sessions with a psychologist blended with EMA/I between sessions in order to improve coping with distressing voice hearing experiences. The authors describe the background and development of this approach along-side a single case illustration, which supported feasibility and acceptability. This study details how digital technologies such as EMA/I may be used in future as clinical tools to enhance standard psychological treatments and clinical care of people with persisting and distressing experiences.

Intergenerational differences in social support for the community-living elderly in Beijing, China.

Background and AimsThe combination of the rapid process of social‐economic development, urbanization, and population ageing brings many challenges for care providers and quality of life of the community‐living elderly in Beijing, China. This research aims to understand the intergenerational differences of social support for the elderly in the socio‐cultural context of Beijing.Methods and ResultsTo answer this research question, we collected 30 semi‐structured in‐depth interviews from elders aged 60 and over in three communities in Beijing. The constant comparative method was used for analysis. The results show that the young‐old (people aged 60 to 74) received more formal social support and less informal social support compared to their parents' generation. The formal social support they received was not much different but they received less informal social support compared to the older‐old (people aged 75 and over) living in the same communities. The young‐old expect to receive more formal social support when they become the older‐old, as the informal social support from their children would be reduced due to the one‐child policy and socio‐cultural changes.ConclusionsIntergenerational differences of social support for the elderly do exist in the form of instrumental, financial, and emotional support. The findings help us understand how socio‐economic development and urbanization processes affect the daily life and social support of the community‐living elderly from different age groups, and also provides knowledge for improving the quality of life for the elderly in Beijing.

A Mismatch of Paradigms Disrupts the Introduction of Psycho-Educative Interventions for Families of Persons with SMI: An Interview Study with Staff from Community Services

Treatment and support of people diagnosed with severe mental illness in Sweden takes place in out-patient psychiatric services or municipality services. Most of the responsibility for support in daily life are provided by the close family. One crucial matter is how to support these families. This research project aimed to investigate the Swedish construction with shared responsibility between county psychiatric care and municipality social care for consumers with severe mental illness affects actions in municipalities in relation to family support. Ten representatives from five municipality settings were interviewed. Five semi-structured interviews were analysed using a thematic analysis. The following themes emerged; One overarching theme, “a mismatch of paradigms”, and sub-themes: (a) “accentuating differences”, (b) “doubts about including the entire family in the same session” and (c) “lack of a uniform family support policy”. We conclude that a shared mandate needs a dialogue between psychiatric and municipality services concerning this mismatch.

精神障害者の地域生活支援の在り方について : 相談支援事業所+(プラス)らiふの実践からの考察

精神障害者の地域生活支援の在り方について : 相談支援事業所+(プラス)らiふの実践からの考察

Acceptance and compliance of TTFields treatment among high grade glioma patients.

Tumor treating fields (TTFields) significantly prolong both progression-free and overall survival in patients with newly diagnosed glioblastoma (GBM). TTFields are delivered to the brain tumor via skin transducer arrays and should be applied for a minimum of 18h per day (≥ 75% compliance). This may cause limited acceptance by patients because of obstacles in daily routine. So far, there are limited data on factors influencing therapy acceptance and compliance. In this retrospective study, fourty-one patients with primary GBM or recurrent high grade glioma (rHGG) have been treated with TTFields in our department. Compliance reports were generated at the monthly routine check of the device. We investigated demographic data, stage of disease and therapy duration in regard to treatment compliance. Thirty percent of patients with primary diagnosis of GBM were informed about TTFields. Acceptance rate among these patients was 36%. In this study, TTFields were prescribed in newly diagnosed GBM patients (57%) and in rHGG. Mean treatment compliance was 87% in the total population independent of age, sex and stage of disease. Compliance was not negatively correlated with time on treatment. TTFields are effective in newly diagnosed GBM, therefore acceptance and compliance is important for GBM treatment. We experienced moderate acceptance rate for TTFields, which is influenced by factors such as social support, comorbidities and independence in daily life. Overall therapy compliance lies above 75% and is not influenced by age, sex, stage of disease or duration of therapy. Improved patient consultation strategies will increase acceptance and compliance for better outcome.

Factors Associated With Peer Victimization Among Adolescents in Taiwan

Adolescents who have experienced peer victimization face a higher risk of negative health outcomes. However, little is known about the factors that are associated with peer victimization among adolescents in Taiwan. The aim of this study was to examine the factors related to peer victimization among Taiwanese adolescents. A cross-sectional design was employed. Three hundred seventy-seven adolescents aged 13-16 years from seven middle schools in southern Taiwan were recruited as participants. Validated, self-reported questionnaires were used to gather data on demographic characteristics, resilience, peer relationship, parental monitoring, school connectedness, social support, and peer victimization. Logistic regression analysis was used to examine the factors that were related to peer victimization. About 17% (n = 64) of the participants experienced peer victimization during the previous 1-year period. Logistic regression analysis indicated that parental monitoring of daily life, school connectedness, and peer support were significant predictors of a reduced risk of peer victimization. The final model explained 23.1% of the total variance in less peer victimization and predicted 80.1% of peer victimization. School connectedness and peer support were identified as important factors facilitating the avoidance of peer victimization among adolescents in Taiwan. Healthcare providers and school personnel should consider school-based programs to improve school connectedness and to build an atmosphere of peer support to reduce peer victimization. Educating parents to monitor their adolescents' daily activities is also encouraged in concert with these school-based programs.

Intergenerational support, satisfaction with parent–child relationship and elderly parents’ life satisfaction in Hong Kong

ABSTRACTObjectives:This study examines in what exchange patterns that three types of intergenerational support are associated with elderly parents' life satisfaction, and whether elderly parents' evaluation on parent-child relationship plays a mediation role on those associations. Method: Data were drawn from Hong Kong Panel Survey for Poverty Alleviation. Respondents aged 65 and over were included ( N=504). Three types of support, namely, daily-living, financial, and emotional support were examined in four patterns-the over-benefited , under-benefited , reciprocal and no flow of exchange. A multivariable linear regression was applied to investigate the association between pattern of intergenerational exchange and life satisfaction, and mediation analysis was employed to examine the mediating role of satisfaction with parent-child relationship on their associations. Results: Elderly parents were less satisfied with their lives when they had no flow of exchange in daily-living support, and more satisfied when they were under-benefited in financial support, and over-benefited or reciprocal in emotional support. Elderly parents’ satisfaction with parent–child relationship mediated the association between exchange of emotional support and life satisfaction; but not the association between daily-living or financial support and life satisfaction. Conclusion: Different types of intergenerational support are associated with elderly parents’ life satisfaction in different patterns.

Feasibility of a wearable soft-robotic glove to support impaired hand function in stroke patients.

To investigate the feasibility of a wear-able, soft-robotic glove system developed to combine assistive support in daily life with performing therapeutic exercises on a computer at home (the HandinMind system). Feasibility study. Five chronic stroke patients with limitations in activities of daily living due to impaired hand function. Participants performed a usability test and several functional tasks with the HandinMind system across 2 sessions. Feasibility was measured using the System Usability Scale (SUS), Intrinsic Motivation Inventory (IMI) and performance times of the functional tasks. User acceptance measured by the SUS and IMI was scored high. The median SUS scores of sessions 1 and 2 were 80.0 (interquartile range (IQR) 70.0-88.8) and 77.5 (IQR 75.0-87.5), respectively, and the median IMI score was 6.3 points out of 7 points (IQR 6.2-6.3). Functional task performance was initially slower with the HandinMind glove compared with performance without the glove, but improved up to the level of performance without the glove across no more than 3 repetitions. Chronic stroke patients with impaired hand function were positive about the feasibility of the first prototype of the HandinMind system. How-ever, performance and ease of use of the system should be improved further in future development phases.

Parents' advice to healthcare professionals working with children who have spinal muscular atrophy.

To explore parents' advice to healthcare professionals working with children with spinal muscular atrophy (SMA). This study derives from a Swedish nationwide survey and uses content analysis to make inferences from answers to an open-ended question concerning parent's advice to healthcare professionals. Of eligible parents who had a child born in Sweden between 2000 and 2010, diagnosed with SMA type 1 or 2, and for whom respiratory support was considered in the first year of life, 61 participated in the study (response rate: 87%). Of these, 51 parents answered the question about advice to healthcare professionals working with children with SMA. More than half of the advice from parents was related to professional-family relations. The second most frequent type of advice related to two aspects of knowledge about SMA: desire that healthcare professionals possess knowledge, and desire that they provide knowledge. The parents also had advice concerning support in daily life, both to the parents and to the affected child. Other pieces of advice were related to organization of care and the parents' desire to be involved in the child's care. Parents advised healthcare professionals to increase their disease-specific knowledge, to treat the parents as experts on their child, and to treat the family with respect, particularly in situations where the child's case is used as an opportunity to improve healthcare professionals' competence. Increased practical support in daily life and a case coordinator is also among parents' advice to healthcare professionals.

Paretic versus non-paretic stepping responses following pelvis perturbations in walking chronic-stage stroke survivors

BackgroundThe effects of a stroke, such as hemiparesis, can severely hamper the ability to walk and to maintain balance during gait. Providing support to stroke survivors through a robotic exoskeleton, either to provide training or daily-life support, requires an understanding of the balance impairments that result from a stroke. Here, we investigate the differences between the paretic and non-paretic leg in making recovery steps to restore balance following a disturbance during walking.MethodsWe perturbed 10 chronic-stage stroke survivors during walking using mediolateral perturbations of various amplitudes. Kinematic data as well as gluteus medius muscle activity levels during the first recovery step were recorded and analyzed.ResultsThe results show that this group of subjects is able to modulate foot placement in response to the perturbations regardless of the leg being paretic or not. Modulation in gluteus medius activity with the various perturbations is in line with this observation. In general, the foot of the paretic leg was laterally placed further away from the center of mass than that of the non-paretic leg, while subjects spent more time standing on the non-paretic leg.ConclusionsThe findings suggest that, though stroke-related gait characteristics are present, the modulation with the various perturbations remains unaffected. This might be because all subjects were only mildly impaired, or because these stepping responses partly occur through involuntary pathways which remain unaffected by the complications after the stroke.

Impact of insomnia on self-perceived health in the elderly.

To investigate the association between self-perceived health, and sociodemographic and clinical factors in a sample of elderly outpatients in Rio de Janeiro. A sample of 345 elderly patients was assessed with an anamnesis, Lawton and Brody's Scale, Katz Index, Geriatric Depression Scale, Timed Up and Go Test, and Study of Osteoporotic Fracture Index. Logistic regression analyses were performed to investigate the predictors of self-perceived health. Risk of falls, frailty, functional performance on the Instrumental Activities of Daily Living, insomnia, and familial support were related to self-perceived health. Insomnia was the variable that strongly influenced self-perceived health (OR = 0.47, CI 95%: 0.28-0.80, p = 0.01) in our sample. The investigation of insomnia in the elderly should be routinely performed in primary care, because of the negative impact it imposes on the health of this population.

The Trunk Control Measurement Scale: reliability and discriminative validity in children and young people with neuromotor disorders.

This study investigated the intra- and interrater reliability of the Trunk Control Measurement Scale (TCMS) German version, with its subscores, in children with neuromotor disorders. Further, the discriminative validity of the TCMS was assessed by comparing the TCMS scores with the Functional Independence Measure for children. Bland-Altman analyses and intraclass correlation coefficients were applied to investigate reliability. The discriminative ability of the TCMS was evaluated with receiver operating characteristics. Ninety children (mean age 11y 5mo; range 5y-18y 11mo) participated for the reliability, and 50 for the discriminative validity study. The reliability proved to be excellent (intrarater: bias=0.57 points, 95% confidence interval [CI] -3.71 to 4.85; interrater: bias=-0.31 points, 95% CI -5.77 to 5.10). A change in the TCMS total score of six points (10%) can be considered a true change. The TCMS subscores appeared to be clinically relevant because children with less than around 80% of the static balance score, less than 55% of the dynamic reaching score, or less than around 35% of the selective movement control score needed support for daily life activities. The TCMS is a reliable and clinically relevant assessment for children aged 5 years and older with different neurological impairments.