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Sample records for home deliveries evidence

  1. 6. Home deliveries

    African Journals Online (AJOL)

    Sitwala

    using a conceptual framework so as to remove the. 14 possible confounding effect of this on education . Overall, it may not have been surprising that the number of years of schooling for mothers, the household income and distance were significant determinants for home deliveries given that this is plausible. In addition to ...

  2. 6. Home deliveries

    African Journals Online (AJOL)

    Sitwala

    PO Box 50110, Lusaka. Telephone: (+260) - 977-248033-mobile;. Telefax (+260) - 211-256181-office. E-mail: dmwewa@yahoo.co.uk. Conclusion: The association of home deliveries with access to health care suggests a need for structural response coupled with ethnographic studies to explore linked aspects of traditional.

  3. PERSISTENT MISSION HOME DELIVERY IN IBADAN ...

    African Journals Online (AJOL)

    facility or they may be integrated into the health system. Their role may include, in addition to birth attendance, bathing and massage, domestic chores, and provision of care during the later postpartum or postnatal period. PERSISTENT MISSION HOME DELIVERY IN IBADAN: ATTRACTIVE ROLE OF. TRADITIONAL BIRTH ...

  4. Essential newborn care after home delivery in Nepal.

    Science.gov (United States)

    Målqvist, Mats; Pun, Asha; Kc, Ashish

    2017-03-01

    Postnatal care of the newborn is essential in order to reduce neonatal mortality. Nepal has made great efforts to improve maternal and child health by focusing on accessibility and outreach over the past decades. This study aims to examine trends, over the past decade, in levels and equity of facility delivery rates and the provision of newborn care after home delivery in Nepal. Household-level data from the Demographic Health Surveys (DHS) 2006 and 2011 and the Multiple Indicator Cluster Survey (MICS5) from 2014 performed in Nepal was sourced for the study. Coverage rates of facility delivery and newborn care after home delivery were calculated and logistic regression models were used to ascertain inequity. Home delivery rate dropped from 79.2% in 2006 to 46.5% in 2014, a development showing an inequitable distribution, with a larger share of better-off families shifting to facility delivery. For those who still delivered at home there was an increased rate of early initiation of breastfeeding and adequate temperature control, but only 2.2% of women delivering at home received a home visit by a health professional in the first week of delivery. No inequity in receiving newborn care after home delivery could be detected. There have been significant improvements in facility delivery rates over the last 10 years in Nepal and postnatal care at home has improved. There is, however, an alarmingly low level of home visits during an infant's first week.

  5. Sociocultural determinants of home delivery in Ethiopia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kaba M

    2016-04-01

    Full Text Available Mirgissa Kaba,1 Tesfaye Bulto,2 Zergu Tafesse,2 Wassie Lingerh,2 Ismael Ali2 1Department of Preventive Medicine, School of Public Health, Addis Ababa University, 2Integrated Family Health Program, John Snow, Inc., Addis Ababa, Ethiopia Background: Maternal health remains a major public health problem in Ethiopia. Despite the government’s measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women.Objective: The study aims to identify determinants that sustain home delivery in Ethiopia.Methods: A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11.Results: Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited

  6. Cessation of electronic delivery of Microsoft software for home use

    CERN Multimedia

    2013-01-01

    Please note that electronic delivery of Microsoft software for home use is no longer available for reasons independent of CERN. The IT and FP departments are working on alternative solutions. Related links: http://cern.ch/go/microsoft-software-home-use.

  7. Low use of medication in home deliveries in the Netherlands

    NARCIS (Netherlands)

    Schirm, E; Tobi, H; de Jong-van den Berg, LTW

    2002-01-01

    Objectives: In view of the growing concern for de-medicalizing childbirth, the aim of this study is to give detailed figures on the use of medication during home deliveries in the Netherlands. Methods: A prospective study of medication use by 68 community midwives during 716 home births in the

  8. Predictors of Home Deliveries in Rakai District, Uganda | Nuwaha ...

    African Journals Online (AJOL)

    In order to identify independent predictors for home delivery, 211 women from 21 clusters, who had a delivery in the previous one year, were interviewed in Rakai District, Uganda, from June 2 to 30, 1997. Mothers answered questions regarding socio-economic, local, reproductive and self-efficacy variables and whether ...

  9. Determinants of Home Delivery among Women attending Antenatal ...

    African Journals Online (AJOL)

    To explore the determinants of home delivery after attending antenatal services, this study employed a cross-sectional design and a non-probability purposive sampling technique. Findings of the study revealed that, majority (74.1%) of the women predominantly between the ages of 25-35 years, (29±6.4) quit antenatal care ...

  10. Factors contributing to home delivery in Kongwa District, Dodoma ...

    African Journals Online (AJOL)

    Objectives: To determine factors contributing to home delivery in Kongwa District. Methods: A community-based cross-sectional study was conducted in September 2009 in which women of child-bearing age were interviewed. The variables mainly included: accessibility of maternal health care, practicing TBA's, existence of ...

  11. Factors associated with home deliveries in a low income rural ...

    African Journals Online (AJOL)

    Objectives: To determine the proportion of and factors associated with home deliveries in Nchelenge district, Zambia. Design: A population-based cross sectional study survey using simple random sampling was carried out among women (n=499) who attended immunization posts that were randomly selected.

  12. Home Visiting Service Delivery and Outcomes for Depressed Mothers

    Science.gov (United States)

    McFarlane, Elizabeth; Crowne, Sarah Shea; Burrell, Lori; Duggan, Anne

    2014-01-01

    Maternal depression influences home visiting engagement and outcomes. This article describes research which found that depressed mothers may be more likely to enroll in home visiting but are less likely to participate as long or as frequently as intended by programs. The authors found evidence of moderation (i.e., changes in the direction and…

  13. Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

    Science.gov (United States)

    Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T

    2015-01-01

    Hospice music therapy is delivered in both homes and nursing homes (NH). No studies to date have explored differences in music therapy delivery between home and NH hospice patients. To compare music therapy referral reasons and delivery for hospice patients living in NH versus home. A retrospective, electronic medical record review was conducted from a large U.S. hospice of patients receiving music therapy between January 1, 2006, and December 31, 2010. Among the 4,804 patients, 2,930 lived in an NH and 1,847 patients lived at home. Compared to home, NH hospice patients were more likely to be female, older, unmarried, and Caucasian. For home hospice patients, the top referral reasons were patient/family emotional and spiritual support, quality of life, and isolation. The most frequent referral reasons for NH hospice patients were isolation, quality of life, and patient/family emotional and spiritual support. Differences in music therapy delivery depended mainly on patients' primary diagnosis and location of care. Results suggest differences in referral reasons and delivery based on an interaction between location of care and patient characteristics. Delivery differences are likely a result of individualized assessment and care plans developed by the music therapist and other interdisciplinary team members to address the unique needs of the patient. Thus, it is important to have professionally trained music therapists assess and provide tailored music-based interventions for patients with different referral reasons and personal characteristics. This study also supports staffing decisions based on patient need rather than average daily census. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. The Consumers Characteristics Analysis of Low Temperature Home Delivery

    OpenAIRE

    Shu-Fang Lai

    2013-01-01

    Because of technological advancements and the popularity of the Internet, online shopping has become an important shopping channel for consumers. Because people increasingly eat out, more consumers shop online, and food products are collected from convenience stores, or frozen food home delivery services are used. This study used questionnaire surveys to analyze the consumption habits of residents who shop online for frozen foods in the urban areas of northern Taiwan (Taipei City and New Taip...

  15. Guidelines for audiology service delivery in nursing homes. Ad Hoc Committee on Audiology Service Delivery in Home Care and Institutional Settings. American Speech-Language-Hearing Association.

    Science.gov (United States)

    1997-01-01

    The increasing number of older adults in society as well as changing consumer preference and health care delivery systems have led to more frequent activity of audiologists in the delivery of services in nursing homes. The nursing home setting presents a number of challenges for the audiologist. It is anticipated that this document will provide audiologists with a comprehensive hearing management protocol and facilitate audiologists to confront the numerous challenges of the nursing home setting and provide quality audiology services.

  16. Home grocery delivery improves the household food environments of behavioral weight loss participants: results of an 8-week pilot study

    National Research Council Canada - National Science Library

    Gorin, Amy A; Raynor, Hollie A; Niemeier, Heather M; Wing, Rena R

    2007-01-01

    ... (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges...

  17. Mental health service delivery in long-term care homes.

    Science.gov (United States)

    Snowdon, John

    2010-11-01

    The prevalence of mental disorders in long-term care (LTC) homes is high, but quality and availability of mental health services to assess and help in management of cases have been criticized. Literature concerning mental health problems in LTC homes was reviewed, especially regarding models of mental health service delivery and factors that affect development, persistence and reduction of symptoms and distress. The advantages of consultation-liaison arrangements and of telepsychiatry were noted. Discussions led to development of recommendations aimed at improving mental health expertise and provision of assessment and intervention services in LTC homes in diverse countries. Prompt recognition of mental health problems among residents is required, with availability of a team working within the facility to deal with these problems. Commonly such multidisciplinary teams are formed by facility staff linking with visiting mental health professionals or services. Quality of care is also affected by the organization, attitudes and education within LTC facilities. Provision of optimal mental health care in LTC settings is dependent on adequate funding, availability of expertise and education, positive and caring attitudes, recognition of needs, and supportive teamwork. The latter should include cooperative links between well-resourced and under-resourced regions.

  18. Delivery of a national home safety equipment scheme in England: a survey of local scheme leaders.

    Science.gov (United States)

    Mulvaney, C A; Watson, M C; Hamilton, T; Errington, G

    2013-11-01

    Unintentional home injuries sustained by preschool children are a major cause of morbidity in the UK. Home safety equipment schemes may reduce home injury rates. In 2009, the Royal Society for the Prevention of Accidents was appointed as central coordinator of a two-year, £18m national home safety equipment scheme in England. This paper reports the findings from a national survey of all scheme leaders responsible for local scheme delivery. A questionnaire mailed to all local scheme leaders sought details of how the schemes were operated locally; barriers and facilitators to scheme implementation; evaluation of the local scheme and its sustainability. A response rate of 73% was achieved. Health visitors and family support workers played a key role in both the identification of eligible families and performing home safety checks. The majority of local scheme leaders (94.6%) reported that they thought their local scheme had been successful in including those families considered 'harder to engage'. Many scheme leaders (72.4%) reported that they had evaluated the provision of safety equipment in their scheme and over half (56.6%) stated that they would not be able to continue the scheme once funding ceased. Local schemes need support to effectively evaluate their scheme and to seek sustainability funding to ensure the future of the scheme. There remains a lack of evidence of whether the provision of home safety equipment reduces injuries in preschool children.

  19. ZEMCH toward the delivery of zero energy mass custom homes

    CERN Document Server

    2016-01-01

    In this book, leading international experts explore the emerging concept of the zero energy mass custom home (ZEMCH) – designed to meet the need for social, economic, and environmental sustainability – and provide all of the knowledge required for the delivery of zero energy mass customized housing and community developments in developed and developing countries. The coverage is wide ranging, progressing from explanation of the meaning of sustainable development to discussion of challenges and trends in mass housing, the advantages and disadvantages of prefabricated methods of construction, and the concepts of mass customization, mass personalization, and inclusive design. A chapter on energy use will aid the reader in designing and retrofitting housing to reduce energy demand and/or improve energy end‐use efficiency. Passive design strategies and active technologies (especially solar) are thoroughly reviewed. Application of the ZEMCH construction criteria to new buildings and refurbishment of old house...

  20. Home advantage in speed skating : Evidence from individual data

    NARCIS (Netherlands)

    Koning, RH

    Home advantage is a well-documented phenomenon in many sports. Home advantage has been shown to exist for team sports (soccer, hockey, football, baseball, basketball) and for countries organizing sports tournaments like the Olympics and World Cup Soccer. There is also some evidence for home

  1. The Consumers Characteristics Analysis of Low Temperature Home Delivery

    Directory of Open Access Journals (Sweden)

    Shu-Fang Lai

    2013-01-01

    Full Text Available Because of technological advancements and the popularity of the Internet, online shopping has become an important shopping channel for consumers. Because people increasingly eat out, more consumers shop online, and food products are collected from convenience stores, or frozen food home delivery services are used. This study used questionnaire surveys to analyze the consumption habits of residents who shop online for frozen foods in the urban areas of northern Taiwan (Taipei City and New Taipei City. We distributed and collected 548 questionnaires, of which 484 were valid. Descriptive statistics, a chi-square test, and logistics regression analysis were used to analyze consumer characteristics, as well as important influential factors. The research results indicated that most online shoppers were women, and the top 3 factors influencing their purchasing decisions were freshness, delivery convenience, and ordering convenience. Participants in the age group of 40-49 years old, living in the urban area of New Taipei City, without junior college education, and with less than 10,000 NTD monthly incomes, were less likely to purchase frozen foods using low-temperature logistics services.

  2. 'Home Plate' Evidence for an Explosive Past

    Science.gov (United States)

    2006-01-01

    This view of layers around the edge of a low plateau called 'Home Plate' inside Mars' Gusev Crater includes a feature that may be what geologists call a 'bomb sag' and interpret as evidence of an explosive event, such as a volcanic eruption. The layers seen here are generally straight and parallel except in the lower right, where they dip around a greyish rock that is about 4 centimeters (about 1.5 inches) in diameter. When layered deposits are struck by a falling rock while the layers are still soft, this type of pattern can be created. The rock might have been lofted by a volcanic burst or as part of the material ejected by the crater-forming impact of a meteorite. The panoramic camera (Pancam) on NASA's Mars Exploration Rover Spirit acquired the exposures for this image on Spirit's 754th Martian day (Feb. 15, 2006). This view is an approximately true-color rendering mathematically generated from separate images taken through all of the left Pancam's 432-nanometer to 753-nanometer filters.

  3. Using Customer-related Data to Enhance E-grocery Home Delivery

    OpenAIRE

    Giannikas, Evangelos

    2017-01-01

    $\\textbf{Purpose }$– The development of e-grocery allows people to purchase food online and benefit from home delivery service. Nevertheless, a high rate of failed deliveries due to the customer’s absence causes significant loss of logistics efficiency, especially for perishable food. This paper proposes an innovative approach to use customer-related data to optimize e-grocery home delivery. The approach estimates the absence probability of a customer by mining electricity consumption data, i...

  4. Home Delivery Medicament Program: access, inactivity and cardiovascular risk

    Directory of Open Access Journals (Sweden)

    Roque da Silva Araújo

    Full Text Available ABSTRACT Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (she stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample, diabetic (44% and dyslipidemic patients (31%.

  5. Technical Barriers, Gaps,and Opportunities Related to Home Energy Upgrade Market Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Bianchi, Marcus V.A. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2011-11-01

    This report outlines the technical barriers, gaps, and opportunities that arise in executing home energy upgrade market delivery approaches, as identified through research conducted by the U.S. Department of Energy's Building America program.

  6. Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Giri Sabitri

    2006-08-01

    Full Text Available Abstract Background About 98% of newborn deaths occur in developing countries, where most newborns deaths occur at home. In Nepal, approximately, 90% of deliveries take place at home. Information about reasons for delivering at home and newborn care practices in urban areas of Nepal is lacking and such information will be useful for policy makers. Methods A cross-sectional survey was carried out in the immunisation clinics of Pokhara city, western Nepal during January and February, 2006. Two trained health workers administered a semi-structured questionnaire to the mothers who had delivered at home. Results A total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3% and 100 (41.7% were unplanned. Only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8% mothers gave birth alone. Only 46 (16.2% women had used a clean home delivery kit and only 92 (38.3% birth attendants had washed their hands. The umbilical cord was cut after expulsion of placenta in 154 (64.2% deliveries and cord was cut using a new/boiled blade in 217 (90.4% deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1% deliveries. Birth place was heated throughout the delivery in 88 (64.2% deliveries. Only 100 (45.8% newborns were wrapped within 10 minutes and 233 (97.1% were wrapped within 30 minutes. Majority (93.8% of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%. Sixteen (10.8% mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2% newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for delivering at home were 'preference' (25.7%, 'ease and convenience' (21.4% for planned deliveries while 'precipitate labor' (51%, 'lack of transportation' (18% and 'lack of escort' during labor (11% were cited for the unplanned ones. Conclusion High-risk home delivery and

  7. Changing trends on the place of delivery: why do Nepali women give birth at home?

    Directory of Open Access Journals (Sweden)

    Shrestha Saraswoti

    2012-10-01

    Full Text Available Abstract Background Home delivery in unhygienic environment is common in Nepal. This study aimed to identify whether practice of delivery is changing over time and to explore the factors contributing to women’s decision for choice of place of delivery. Methods A community based cross sectional study was conducted among 732 married women of reproductive age (MWRA in Kavrepalanchok district of Nepal in 2011. Study wards were selected randomly and all MWRA residing in the selected wards were interviewed. Data were collected through pre-tested interviewer administered questionnaire. Chi-square and multivariate analysis was used to examine the association between socio-demographic factors and place of delivery. Results The study shows that there was almost 50% increasement in institutional delivery over the past ten years. The percentage of last birth delivered in health institution has increased from 33.7% before 10 years to 63.8% in the past 5 years. However, the place of delivery varied according to residence. In urban area, most women 72.3% delivered in health institutions while only 35% women in rural and 17.5% in remote parts delivered in health institutions. The key socio-demographic factors influencing choice of place of delivery included multi parity, teen-age pregnancy, less or no antenatal visits. Having a distant health center, difficult geographical terrain, lack of transportation, financial constraints and dominance of the mothers- in-law were the other main reasons for choosing a home delivery. Psychological vulnerability and insecurity of rural women also led to home delivery, as women were shy and embarrassed in visiting the health center. Conclusion The trend of delivery at health institution was remarkably increased but there were strong differentials in urban–rural residency and low social status of women. Shyness, dominance of mothers in law and ignorance was one of the main reasons contributing to home delivery.

  8. Evidence for discrete landmark use by pigeons during homing.

    Science.gov (United States)

    Mora, Cordula V; Ross, Jeremy D; Gorsevski, Peter V; Chowdhury, Budhaditya; Bingman, Verner P

    2012-10-01

    Considerable efforts have been made to investigate how homing pigeons (Columba livia f. domestica) are able to return to their loft from distant, unfamiliar sites while the mechanisms underlying navigation in familiar territory have received less attention. With the recent advent of global positioning system (GPS) data loggers small enough to be carried by pigeons, the role of visual environmental features in guiding navigation over familiar areas is beginning to be understood, yet, surprisingly, we still know very little about whether homing pigeons can rely on discrete, visual landmarks to guide navigation. To assess a possible role of discrete, visual landmarks in navigation, homing pigeons were first trained to home from a site with four wind turbines as salient landmarks as well as from a control site without any distinctive, discrete landmark features. The GPS-recorded flight paths of the pigeons on the last training release were straighter and more similar among birds from the turbine site compared with those from the control site. The pigeons were then released from both sites following a clock-shift manipulation. Vanishing bearings from the turbine site continued to be homeward oriented as 13 of 14 pigeons returned home. By contrast, at the control site the vanishing bearings were deflected in the expected clock-shift direction and only 5 of 13 pigeons returned home. Taken together, our results offer the first strong evidence that discrete, visual landmarks are one source of spatial information homing pigeons can utilize to navigate when flying over a familiar area.

  9. Home Delivery Medicament Program: access, inactivity and cardiovascular risk.

    Science.gov (United States)

    Araújo, Roque da Silva; Arcuri, Edna Apparecida Moura; Lopes, Victor Cauê

    2016-10-10

    to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%). verificar causas de inatividade no Programa Remédio em Casa, referidas por usuários de Unidade Básica de Saúde de São Paulo, comparando-as às registradas pelo programa e analisando-as no modelo teórico Conceito de Acesso à Saúde. estudo transversal entrevistando 111 usuários inativos; e documental, nos registros do programa. metade dos usuários desconhecia a condição de inatividade. Constatadas discrepâncias nas informações usuário versus programa, observando-se diferentes níveis de concordância: Falta de médico e funcion

  10. Cell mediated therapeutics for cancer treatment: Tumor homing cells as therapeutic delivery vehicles

    Science.gov (United States)

    Balivada, Sivasai

    Many cell types were known to have migratory properties towards tumors and different research groups have shown reliable results regarding cells as delivery vehicles of therapeutics for targeted cancer treatment. Present report discusses proof of concept for 1. Cell mediated delivery of Magnetic nanoparticles (MNPs) and targeted Magnetic hyperthermia (MHT) as a cancer treatment by using in vivo mouse cancer models, 2. Cells surface engineering with chimeric proteins for targeted cancer treatment by using in vitro models. 1. Tumor homing cells can carry MNPs specifically to the tumor site and tumor burden will decrease after alternating magnetic field (AMF) exposure. To test this hypothesis, first we loaded Fe/Fe3O4 bi-magnetic NPs into neural progenitor cells (NPCs), which were previously shown to migrate towards melanoma tumors. We observed that NPCs loaded with MNPs travel to subcutaneous melanoma tumors. After alternating magnetic field (AMF) exposure, the targeted delivery of MNPs by the NPCs resulted in a mild decrease in tumor size (Chapter-2). Monocytes/macrophages (Mo/Ma) are known to infiltrate tumor sites, and also have phagocytic activity which can increase their uptake of MNPs. To test Mo/Ma-mediated MHT we transplanted Mo/Ma loaded with MNPs into a mouse model of pancreatic peritoneal carcinomatosis. We observed that MNP-loaded Mo/Ma infiltrated pancreatic tumors and, after AMF treatment, significantly prolonged the lives of mice bearing disseminated intraperitoneal pancreatic tumors (Chapter-3). 2. Targeted cancer treatment could be achieved by engineering tumor homing cell surfaces with tumor proteases cleavable, cancer cell specific recombinant therapeutic proteins. To test this, Urokinase and Calpain (tumor specific proteases) cleavable; prostate cancer cell (CaP) specific (CaP1 targeting peptide); apoptosis inducible (Caspase3 V266ED3)- rCasp3V266ED3 chimeric protein was designed in silico. Hypothesized membrane anchored chimeric protein (rCasp3V

  11. Determinant factors of home delivery among women in Northern Ethiopia: a case control study.

    Science.gov (United States)

    Tsegay, Resom; Aregay, Alemseged; Kidanu, Kalayu; Alemayehu, Mussie; Yohannes, Gebrezigabiher

    2017-04-04

    Maternal mortality remains a major challenge to health systems worldwide. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop potentially life-threatening complications. Home delivery in this context can be acutely threatening, particularly in developing countries where emergency care and transportation are less available. This study identifies factors associated with home delivery in Tanqua-Abergele District, Tigray, northern Ethiopia. Unmatched case-control study was conducted in April 2014 in Tanqua-Abergele, Tigray, northern Ethiopia. Simple random sampling was employed to select study participants. Data were analyzed using SPSS 20. Multi variable logistic regression analysis was used to identify independent predictors of home delivery. A total of 275 women (92 cases and 183 controls) participated in the study, giving a response rate of 96.5%. Not owning a radio or television (AOR: 7.2, 95% CI: 2.7-19.3), not pursuing ANC visits at all (AOR: 10.4, 95% CI: 2.9-37.1) orhaving1-3 ANC visits only (AOR: 4.75, 95% CI: 1.69-13.31),poor knowledge of obstetric complications (AOR: 8.7, 95% CI: 2.3-32.9) and walking time greater than two hours to the nearest health center (AOR: 5.1, 95% CI: 1.2-20.7) were strong predictors of home delivery. Unable to meet the minimum requirement WHO of ANC service had a potential to give birth at home. Investing in infrastructure will contribute to improving maternal health. Having a different source of media (radio or television) could have a role in increasing the institutional delivery. Policy makers and other concerned bodies should give due attention to the fulfillment of infrastructure and educate women on the importance of institutional delivery.

  12. Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems.

    Science.gov (United States)

    Elzey, Mark J; Fudin, Jeffrey; Edwards, Eric S

    2017-09-01

    Naloxone reversal of opioid-induced respiratory depression outside of medical facilities has become more prevalent because of the escalating opioid epidemic in the USA. Take-home naloxone for treatment of opioid emergencies is now being recommended by numerous federal, state, and professional organizations. Areas covered: The scope of the opioid overdose epidemic is reviewed along with practical, clinical, regulatory, and usability considerations for take-home naloxone routes of administration currently available and associated delivery systems. Specific opioid-related factors are discussed in detail with emphasis placed on life-threatening respiratory depression and naloxone antagonism. A clinical overview, including pharmacokinetic and FDA approval information for each take-home naloxone product is discussed in detail as well as the impact of take-home naloxone in the community. Finally, given these products are to be used in a panic-stricken, life-threatening opioid emergency, an analysis of available usability data is provided with proposed directions for further study. Expert opinion: Based on the available clinical evidence, auto-injectable naloxone should be the preferred administration route for take-home naloxone treatment until additional safety, efficacy, and comparative outcomes data are available for unconventional routes of administration that unequivocally provide equal or superior results.

  13. Compliance With Legal Age Restrictions on Adolescent Alcohol Sales for Alcohol Home Delivery Services (AHDS)

    NARCIS (Netherlands)

    van Hoof, Joris Jasper; van den Wildenberg, Esther; de Bruijn, Dorien

    2014-01-01

    Purpose: Alcohol availability is an important predictor of alcohol use in adolescents and its negative consequences. Within this study, we zoomed in on availability through alcohol home delivery services (AHDS) by measuring compliance with the legal age limit in this sector. Methods: Two methods

  14. Home Delivery and the Impacts on Urban Freight Transport : A Review

    NARCIS (Netherlands)

    Visser, J.G.S.N.; Nemoto, T.; Browne, M.

    2014-01-01

    This review paper discusses the latest developments in internet shopping, home delivery and the potential impacts on city logistics and alternative vehicle use. The review has illustrated the rapid changes during the past few years and the potentially important impacts on patterns of transport

  15. 4. Home Deliveries Not a Safe Alternative in the Developing World

    African Journals Online (AJOL)

    Esem

    continues to be the leading cause of maternal death in low-resource settings, representing an estimated. 34% of maternal deaths in Africa. Most hemorrhage ... vaginal fistula formation following prolonged labour. This is especially so following delivery after prolonged labour at home that ends up with an intervention at a ...

  16. Technical Barriers, Gaps, and Opportunities Related to Home Energy Upgrade Market Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Bianchi, M. V. A.

    2011-11-01

    This report outlines the technical barriers, gaps, and opportunities that arise in executing home energy upgrade market delivery approaches, as identified through research conducted by the U.S. Department of Energy's Building America program. The objective of this report is to outline the technical1 barriers, gaps, and opportunities that arise in executing home energy upgrade market delivery approaches, as identified through research conducted by the U.S. Department of Energy's (DOE) Building America program. This information will be used to provide guidance for new research necessary to enable the success of the approaches. Investigation for this report was conducted via publications related to home energy upgrade market delivery approaches, and a series of interviews with subject matter experts (contractors, consultants, program managers, manufacturers, trade organization representatives, and real estate agents). These experts specified technical barriers and gaps, and offered suggestions for how the technical community might address them. The potential benefits of home energy upgrades are many and varied: reduced energy use and costs; improved comfort, durability, and safety; increased property value; and job creation. Nevertheless, home energy upgrades do not comprise a large part of the overall home improvement market. Residential energy efficiency is the most complex climate intervention option to deliver because the market failures are many and transaction costs are high (Climate Change Capital 2009). The key reasons that energy efficiency investment is not being delivered are: (1) The opportunity is highly fragmented; and (2) The energy efficiency assets are nonstatus, low-visibility investments that are not properly valued. There are significant barriers to mobilizing the investment in home energy upgrades, including the 'hassle factor' (the time and effort required to identify and secure improvement works), access to financing, and the

  17. Using Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal.

    Directory of Open Access Journals (Sweden)

    Nadine Seward

    Full Text Available Globally, puerperal sepsis accounts for an estimated 8-12% of maternal deaths, but evidence is lacking on the extent to which clean delivery practices could improve maternal survival. We used data from the control arms of four cluster-randomised controlled trials conducted in rural India, Bangladesh and Nepal, to examine associations between clean delivery kit use and hand washing by the birth attendant with maternal mortality among home deliveries.We tested associations between clean delivery practices and maternal deaths, using a pooled dataset for 40,602 home births across sites in the three countries. Cross-sectional data were analysed by fitting logistic regression models with and without multiple imputation, and confounders were selected a priori using causal directed acyclic graphs. The robustness of estimates was investigated through sensitivity analyses.Hand washing was associated with a 49% reduction in the odds of maternal mortality after adjusting for confounding factors (adjusted odds ratio (AOR 0.51, 95% CI 0.28-0.93. The sensitivity analysis testing the missing at random assumption for the multiple imputation, as well as the sensitivity analysis accounting for possible misclassification bias in the use of clean delivery practices, indicated that the association between hand washing and maternal death had been over estimated. Clean delivery kit use was not associated with a maternal death (AOR 1.26, 95% CI 0.62-2.56.Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.

  18. Using Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal.

    Science.gov (United States)

    Seward, Nadine; Prost, Audrey; Copas, Andrew; Corbin, Marine; Li, Leah; Colbourn, Tim; Osrin, David; Neuman, Melissa; Azad, Kishwar; Kuddus, Abdul; Nair, Nirmala; Tripathy, Prasanta; Manandhar, Dharma; Costello, Anthony; Cortina-Borja, Mario

    2015-01-01

    Globally, puerperal sepsis accounts for an estimated 8-12% of maternal deaths, but evidence is lacking on the extent to which clean delivery practices could improve maternal survival. We used data from the control arms of four cluster-randomised controlled trials conducted in rural India, Bangladesh and Nepal, to examine associations between clean delivery kit use and hand washing by the birth attendant with maternal mortality among home deliveries. We tested associations between clean delivery practices and maternal deaths, using a pooled dataset for 40,602 home births across sites in the three countries. Cross-sectional data were analysed by fitting logistic regression models with and without multiple imputation, and confounders were selected a priori using causal directed acyclic graphs. The robustness of estimates was investigated through sensitivity analyses. Hand washing was associated with a 49% reduction in the odds of maternal mortality after adjusting for confounding factors (adjusted odds ratio (AOR) 0.51, 95% CI 0.28-0.93). The sensitivity analysis testing the missing at random assumption for the multiple imputation, as well as the sensitivity analysis accounting for possible misclassification bias in the use of clean delivery practices, indicated that the association between hand washing and maternal death had been over estimated. Clean delivery kit use was not associated with a maternal death (AOR 1.26, 95% CI 0.62-2.56). Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.

  19. Pharmaceutical care and home delivery of medication to patients with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Begoña San José Ruiz

    2015-01-01

    Full Text Available Objectives: To describe the implementation of a new model face to face and remote pharmaceutical care with home delivery of tyronsine kinase inhibitors medicines for patients with chronic myeloid leukemia. Methods: Patients with chronic myeloid leukemia were selected to start this new model of care. Four characteristics were taken into account for the choice: chronicity of the disease, frequency of doctor visits, pharmaceutical care value and conservation of tyronsine kinase inhibitors medicines at room temperature. Results: Out of 68 patients with chronic myeloid leukemia and treated with tyronsine kinase inhibitors, 42 were selected due to the frequency of their hematologist visits. An introductory letter and a questionnaire about their preferences were sent to these patients.Sixteen of them expressed their desire to participate. The legal department designed a confidentiality contract, as well as a model of informed consent. A logistic distribution model based on defined routes and timetables was established. Prior to inclusion, pharmaceutical care was performed in a face to face consultation and the communication way was established for the followings remote consultations. Home delivery had a monthly cost of 13.2 € (including VAT per patient. All the patients who started this program continue in it. To date, 5 deliveries per patient have been conducted Conclusions: It is possible to establish an alternative model of pharmaceutical care with home delivery of medication, keeping the pharmacist-patient relationship, avoiding travel, ensuring the confidentiality and rationalizing the stocks

  20. Home grocery delivery improves the household food environments of behavioral weight loss participants: Results of an 8-week pilot study

    Directory of Open Access Journals (Sweden)

    Niemeier Heather M

    2007-11-01

    Full Text Available Abstract Background Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Methods Overweight participants (N = 28; BMI = 31.7 ± 3.6 kg/m2; 89.3% women, 47.9 ± 9.5 years were randomly assigned to 8-weeks of standard behavioral weight loss (SBT or to SBT plus home food delivery (SBT+Home. SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Results Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01 and number of foods that were high in fat (p = .002. While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08. Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Conclusion Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

  1. Home grocery delivery improves the household food environments of behavioral weight loss participants: results of an 8-week pilot study.

    Science.gov (United States)

    Gorin, Amy A; Raynor, Hollie A; Niemeier, Heather M; Wing, Rena R

    2007-11-14

    Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Overweight participants (N = 28; BMI = 31.7 +/- 3.6 kg/m2; 89.3% women, 47.9 +/- 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

  2. Home grocery delivery improves the household food environments of behavioral weight loss participants: Results of an 8-week pilot study

    Science.gov (United States)

    Gorin, Amy A; Raynor, Hollie A; Niemeier, Heather M; Wing, Rena R

    2007-01-01

    Background Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Methods Overweight participants (N = 28; BMI = 31.7 ± 3.6 kg/m2; 89.3% women, 47.9 ± 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Results Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Conclusion Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes. PMID:18001469

  3. Compliance With Legal Age Restrictions on Adolescent Alcohol Sales for Alcohol Home Delivery Services (AHDS)

    OpenAIRE

    van Hoof, Joris Jasper; Van Den Wildenberg, Esther; de Bruijn, Dorien

    2014-01-01

    Purpose: Alcohol availability is an important predictor of alcohol use in adolescents and its negative consequences. Within this study, we zoomed in on availability through alcohol home delivery services (AHDS) by measuring compliance with the legal age limit in this sector. Methods: Two methods were used: (1) mystery shopping in which 21 underage AHDS beer orders were placed and received and (2) mystery calls in which 30 AHDS were called and questioned. Results: In the mystery shopping study...

  4. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study.

    Science.gov (United States)

    Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C

    2015-09-11

    Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women's preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. We conducted ten focus group discussions (n = 100) with women of reproductive age (15-45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. Our findings show that women's lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. Our findings suggest a need to empower women with decision-making skills

  5. Impact of organic mercury exposure and home delivery on neurodevelopment of Amazonian children.

    Science.gov (United States)

    Marques, Rejane C; Bernardi, José V E; Cunha, Mônica P L; Dórea, José G

    2016-08-01

    In the transitioning Amazon, we addressed birth environment (home vs hospital) and associated perinatal organic-Hg exposures: methylmercury (MeHg) from maternal fish consumption and ethylmercury (EtHg) from pediatric Thimerosal-containing vaccines (TCVs) taken systematically during hospital delivery. We studied 365 children in relation to linear growth at 60 months and neurodevelopment (milestone achievements, Bayley Scale of Infant Development/BSID at 24 months, and Stanford-Binet intelligence tests at 60 months). Mothers delivered in hospitals vs those gave birth at home had significantly (pchildren had significantly (pchildren (4.6μg/g). Hospital-born children also had significantly earlier (pchildren (1.5 vs 24.1days respectively) and higher (pchildren with BSID (MDI or PDI) scores children, no impact on neurodevelopment was observed. Copyright © 2016 Elsevier GmbH. All rights reserved.

  6. Home visitation programs: An untapped opportunity for the delivery of early childhood obesity prevention

    Science.gov (United States)

    Salvy, Sarah-Jeanne; de la Haye, Kayla; Galama, Titus; Goran, Michael I.

    2016-01-01

    Background Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: 1) short duration and low intensity; 2) late timing of implementation, when children are already overweight or obese; 3) intervention delivery limiting their accessibility and sustainability; and 4) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes. Objective This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention. Conclusion The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (1) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health due to socio-economic and structural conditions; (2) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (3) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention. PMID:27911984

  7. Public health delivery systems: evidence, uncertainty, and emerging research needs.

    Science.gov (United States)

    Mays, Glen P; Smith, Sharla A; Ingram, Richard C; Racster, Laura J; Lamberth, Cynthia D; Lovely, Emma S

    2009-03-01

    The authors review empirical studies published between 1990 and 2007 on the topics of public health organization, financing, staffing, and service delivery. A summary is provided of what is currently known about the attributes of public health delivery systems that influence their performance and outcomes. This review also identifies unanswered questions, highlighting areas where new research is needed. Existing studies suggest that economies of scale and scope exist in the delivery of public health services, and that key organizational and governance characteristics of public health agencies may explain differences in service delivery across communities. Financial resources and staffing characteristics vary widely across public health systems and have expected associations with service delivery and outcomes. Numerous gaps and uncertainties are identified regarding the mechanisms through which organizational, financial, and workforce characteristics influence the effectiveness and efficiency of public health service delivery. This review suggests that new research is needed to evaluate the effects of ongoing changes in delivery system structure, financing, and staffing.

  8. Practice, Problems and Power in "Internationalisation at Home": Critical Reflections on Recent Research Evidence

    Science.gov (United States)

    Harrison, Neil

    2015-01-01

    In a period when international flows of higher education students are rapidly increasing and diversifying, this paper reviews recent research evidence about the experiences of "home" students--those who are not mobile and study in their home nation. This is situated within the concept of "internationalisation at home", which…

  9. Accelerating the Delivery of Home Performance Upgrades through a Synergistic Business Model

    Energy Technology Data Exchange (ETDEWEB)

    Schirber, Tom; Ojczyk, Cindy

    2016-04-11

    Achieving Building America energy savings goals (40% by 2030) will require many existing homes to install energy upgrades. Engaging large numbers of homeowners in building science-guided upgrades during a single remodeling event has been difficult for a number of reasons. Performance upgrades in existing homes tend to occur over multiple years and usually result from component failures (furnace failure) and weather damage (ice dams, roofing, siding). This research attempted to: A) understand the homeowner's motivations regarding investing in building science based performance upgrades; B) determining a rapidly scalable approach to engage large numbers of homeowners directly through existing customer networks; and C) access a business model that will manage all aspects of the contractor-homeowner-performance professional interface to ensure good upgrade decisions over time. The solution results from a synergistic approach utilizing networks of suppliers merging with networks of homeowner customers. Companies in the $400 to $800 billion home services industry have proven direct marketing and sales proficiencies that have led to the development of vast customer networks. Companies such as pest control, lawn care, and security have nurtured these networks by successfully addressing the ongoing needs of homes. This long-term access to customers and trust established with consistent delivery has also provided opportunities for home service providers to grow by successfully introducing new products and services like attic insulation and air sealing. The most important component for success is a business model that will facilitate and manage the process. The team analyzes a group that developed a working model.

  10. Rurality and Nursing Home Quality: Evidence from the 2004 National Nursing Home Survey

    Science.gov (United States)

    Kang, Yu; Meng, Hongdao; Miller, Nancy A.

    2011-01-01

    Purpose of the Study: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. Design and Methods: 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…

  11. 20 CFR 219.61 - Evidence of where the employee had a permanent home.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Evidence of where the employee had a... RAILROAD RETIREMENT ACT EVIDENCE REQUIRED FOR PAYMENT Other Evidence Requirements § 219.61 Evidence of where the employee had a permanent home. The Board will ask for the following evidence to establish the...

  12. Does Working from Home Work? Evidence from a Chinese Experiment

    OpenAIRE

    Nicholas Bloom; James Liang; John Roberts; Zhichun Jenny Ying

    2013-01-01

    A rising share of employees now regularly engage in working from home (WFH), but there are concerns this can lead to "shirking from home". We report the results of a WFH experiment at Ctrip, a 16,000-employee, NASDAQ-listed Chinese travel agency. Call center employees who volunteered to WFH were randomly assigned either to work from home or in the office for nine months. Home working led to a 13% performance increase, of which 9% was from working more minutes per shift (fewer breaks and sick ...

  13. At-home and in-group delivery of constraint-induced movement therapy in children with hemiparesis: a systematic review.

    Science.gov (United States)

    Durand, Emilie; Plante, Pascale; Pelletier, Andrey-Anne; Rondeau, Johanie; Simard, Frédérique; Voisin, Julien

    2017-11-10

    Constraint-induced movement therapy (CIMT) is increasingly recognized as an effective therapy for children with hemiparesis. However, the effectiveness of CIMT outside the standard rehabilitation protocol in clinical settings is less known. The aim of this systematic review was to investigate the effectiveness of CIMT conducted at home or in a group. We searched CINAHL, PubMed and ScienceDirect in August 2017 to select articles of studies investigating the impact of CIMT performed at home and in a group on affected upper-limb ability, occupational performance, and quality of life of children. Quality was evaluated with the PEDro scale. Among 374 reports of studies, 30 met the criteria; 15 examined CIMT at home and 15 in a group. CIMT with the 2 delivery models, at home or in a group, had a positive effect on the affected upper-limb ability and occupational performance. The quality of evidence was high for both these outcomes. However, the evidence was weaker and the results too limited to conclude on the impact on quality of life. The data also suggested that the glove may not be the best type of constraint. CIMT performed at home or in a group may be a promising intervention for rehabilitation for children with hemiparesis, but more studies on the impact on quality of life are warranted. Copyright © 2017. Published by Elsevier Masson SAS.

  14. Workers' experiences of crises in the delivery of home support services to older clients: a qualitative study.

    Science.gov (United States)

    Sims-Gould, Joanie; Byrne, Kerry; Beck, Christina; Martin-Matthews, Anne

    2013-02-01

    In the provision of care to older clients, home support workers regularly confront, avert, and manage crises. Semistructured interviews were conducted to explore the nature, type, and management of crises from the perspective of home support workers (N = 118) of older persons in British Columbia, Canada. The delivery of home health care occurs within a context of unpredictability related to scheduling, time constraints, variability of client need, and changing work environments. These events are experienced by 91% of home support workers and range from a serious medical incident (e.g., fall, death) to an interpersonal dilemma (e.g., client refusal of service, argument between worker and family member). Home support workers use a variety of strategies to manage these incidents. The analysis of crises enables us to better understand how agency and care policies may be more responsive to circumstances that challenge care work in home health settings.

  15. Correlates of preferences for home or hospital confinement in Pakistan: evidence from a national survey.

    Science.gov (United States)

    Javed, Sajid Amin; Anjum, Muhammad Danish; Imran, Waqas; Haider, Azad; Shiraz, Ayesha; Shaheen, Farzana; Iftikhar ul Husnain, Muhammad

    2013-06-24

    Despite the pregnancy complications related to home births, homes remain yet major place of delivery in Pakistan and 65 percent of totals births take place at home. This work analyses the determinants of place of delivery in Pakistan. Multivariate Logistic regression is used for analysis. Data are extracted from Pakistan Demographic and Health Survey (2006-07). Based on information on last birth preceding 5 years of survey, we construct dichotomous dependent variable i.e. whether women deliver at home (Coded=1) or at health facility (coded=2). Bivariate analysis shows that 72% (p≤0.000) women from rural area and 81% women residing in Baluchistan delivered babies at home. Furthermore 75% women with no formal education, 81% (p≤0.000) women working in agricultural sector, 75% (p≤0.000) of Women who have 5 and more children and almost 77% (p≤0.000) who do not discussed pregnancy related issues with their husbands are found delivering babies at home. Multivariate analysis documents that mothers having lower levels of education, economic status and empowerment, belonging to rural area, residing in provinces other than Punjab, working in agriculture sector and mothers who are young are more likely to give births at home. A trend for home births, among Pakistani women, can be traced in lower levels of education, lower autonomy, poverty driven working in agriculture sector, higher costs of using health facilities and regional backwardness.

  16. Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs in Rural Bangladesh: A Qualitative Exploration.

    Directory of Open Access Journals (Sweden)

    Bidhan Krishna Sarker

    Full Text Available Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA in rural areas of Bangladesh.This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community.The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities.The study findings provide us a better understanding of the reasons for preference for home delivery with TBA

  17. Home care and the new economy. Creating a new model for service delivery.

    Science.gov (United States)

    Sobolewski, S; Marren, J

    2000-01-01

    The strategy undertaken by the VNSNY for its survival has been to create a new service delivery model. The design of the SDM is based on a study of organizations, within and outside of health care, that face common challenges in the home health industry today: increased competition, declining reimbursement with escalating costs, and demands for improved outcomes and customer satisfaction. The model that emerged contained several important strategies in its design, including the alignment of team goals with organizational strategic objectives, restructuring teams as multidisciplinary units, redefining the work of teams to include practice improvement and supporting team learning, increasing members' accountability for team not individual performance. The SDM continues to evolve and improve during the process of implementation as lessons emerge from our experience with teams. Preliminary results indicate that the efforts have begun to show improvements in outcomes.

  18. Clean home-delivery in rural Southern Tanzania: barriers, influencers, and facilitators.

    Science.gov (United States)

    Shamba, Donat D; Schellenberg, Joanna; Penfold, Suzanne C; Mashasi, Irene; Mrisho, Mwifadhi; Manzi, Fatuma; Marchant, Tanya; Tanner, Marcel; Mshinda, Hassan; Schellenberg, David; Hill, Zelee

    2013-03-01

    The study explored the childbirth-related hygiene and newborn care practices in home-deliveries in Southern Tanzania and barriers to and facilitators of behaviour change. Eleven home-birth narratives and six focus group discussions were conducted with recently-delivering women; two focus group discussions were conducted with birth attendants. The use of clean cloth for delivery was reported as common in the birth narratives; however, respondents did not link its use to newborn's health. Handwashing and wearing of gloves by birth attendants varied and were not discussed in terms of being important for newborn's health, with few women giving reasons for this behaviour. The lack of handwashing and wearing of gloves was most commonly linked to the lack of water, gloves, and awareness. A common practice was the insertion of any family member's hands into the vagina of delivering woman to check labour progress before calling the birth attendant. The use of a new razor blade to cut the cord was near-universal; however, the cord was usually tied with a used thread due to the lack of knowledge and the low availability of clean thread. Applying something to the cord was near-universal and was considered essential for newborn's health. Three hygiene practices were identified as needing improvement: family members inserting a hand into the vagina of delivering woman before calling the birth attendant, the use of unclean thread, and putting substances on the cord. Little is known about families conducting internal checks of women in labour, and more research is needed before this behaviour is targeted in interventions. The use of clean thread as cord-tie appears acceptable and can be addressed, using the same channels and methods that were used for successfully encouraging the use of new razor blade.

  19. Experiences with the privatization of home care: evidence from Denmark

    Directory of Open Access Journals (Sweden)

    Barbara Fersch

    2011-06-01

    Full Text Available Normal 0 21 false false false NO-BOK X-NONE X-NONE MicrosoftInternetExplorer4 st1\\:*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Vanlig tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Normal 0 false false false EN-GB X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Vanlig tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Processes of privatization in home care for the elderly in Denmark have primarily taken the form of outsourcing public-care provisions. The content and quality of services have in principle remained the same, but the providers of services have changed. The welfare state has continued to bear the major responsibility for the provision of elderly care, while outsourcing has allowed clients to choose between public and private providers of care. The major aim of

  20. Higher prices, higher quality? Evidence from German nursing homes.

    Science.gov (United States)

    Herr, Annika; Hottenrott, Hanna

    2016-02-01

    This study investigates the relationship between prices and quality of 7400 German nursing homes. We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, where we instrument prices to explain their effect on quality controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Descriptive analysis shows that prices and quality do not only vary across nursing homes, but also across counties and federal states and that quality and prices correlate positively. Second, the econometric analysis, which accounts for the endogenous relation between negotiated price and reported quality, shows that quality indeed positively depends on prices. In addition, more places in nursing homes per people in need are correlated with both lower prices and higher quality. Finally, unobserved factors at the federal state level capture some of the variation of reported quality across nursing homes. Our results suggest that higher prices increase quality. Furthermore, since reported quality and prices vary substantially across federal states, we conclude that the quality and prices of long-term care facilities may well be compared within federal states but not across. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Literature Review of the Evidence Base for a Hospice at Home Service

    OpenAIRE

    Stosz, Laura

    2008-01-01

    This literature review aimed to identify the evidence base for a hospice at home service at the end of life for facilitating death at home to narrow the gap between preference and reality. This study defines ‘hospice at home’ as hospice style care provided in the home environment; this means specialist palliative care, equipment and medication is available 24/7. However, services operating under this term are not uniform across the literature. Terms encountered in the literature that are used...

  2. The Home Environment and Disability-Related Outcomes in Aging Individuals: What Is the Empirical Evidence?

    Science.gov (United States)

    Wahl, Hans-Werner; Fange, Agneta; Oswald, Frank; Gitlin, Laura N.; Iwarsson, Susanne

    2009-01-01

    Purpose: Building on the disablement process model and the concept of person-environment fit (p-e fit), this review article examines 2 critical questions concerning the role of home environments: (a) What is the recent evidence supporting a relationship between home environments and disability-related outcomes? and (b) What is the recent evidence…

  3. Technology Solutions for Existing Homes Case Study: Accelerating the Delivery of Home-Performance Upgrades Using a Synergistic Business Model

    Energy Technology Data Exchange (ETDEWEB)

    None

    2016-04-14

    The Building America team NorthernSTAR investigated opportunities to use the massive customer networks of the home service industry as a means to connect homeowners to home-performance solutions. Home service companies could provide a pathway to advance building-science-guided upgrades by being in close proximity to homeowners when a decision-making moment is at hand. Established trust provides an opportunity for the company to deliver sound information and influence during a remodeling decision.

  4. Inflation protection from home-ownership : Long-run evidence

    NARCIS (Netherlands)

    Brounen, Dirk; Eichholtz, P.; Staetmans, S.; Theebe, Marcel

    2014-01-01

    This article examines the inflation hedging capacity of the private home. We employ unique long-term data for inflation, house price dynamics and rents for Amsterdam dating back to 1814, allowing us to study total housing returns in different inflation regimes and for varying investment horizons.

  5. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia

    Directory of Open Access Journals (Sweden)

    Titaley Christiana R

    2010-08-01

    Full Text Available Abstract Background Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. Methods A qualitative study using focus group discussions (FGDs and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery. Results The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services. Conclusions A comprehensive strategy to increase the availability, accessibility, and

  6. Why do some women still prefer traditional birth attendants and home delivery?: a qualitative study on delivery care services in West Java Province, Indonesia.

    Science.gov (United States)

    Titaley, Christiana R; Hunter, Cynthia L; Dibley, Michael J; Heywood, Peter

    2010-08-11

    Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province. A qualitative study using focus group discussions (FGDs) and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery. The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services. A comprehensive strategy to increase the availability, accessibility, and affordability of delivery care services should be considered in these West Java

  7. Tumour lineage-homing cell-penetrating peptides as anticancer molecular delivery systems.

    Science.gov (United States)

    Kondo, Eisaku; Saito, Ken; Tashiro, Yuichi; Kamide, Kaeko; Uno, Shusei; Furuya, Tomoko; Mashita, Masao; Nakajima, Kiichiro; Tsumuraya, Tomoyuki; Kobayashi, Naoya; Nishibori, Masahiro; Tanimoto, Mitsune; Matsushita, Masayuki

    2012-07-17

    Cell-penetrating peptides have gained attention owing to their promise in noninvasive delivery systems. Among the identified cell-penetrating peptides, the TAT peptide has been preferentially used for transduction into cells of diverse origins. However, this activity is nonselective between neoplastic and non-neoplastic cells. Here we describe artificial cell-penetrating peptides that are selectively and efficiently incorporated into human tumour cells, according to their lineage. Ten representative tumour lineage-homing cell-penetrating peptides were obtained by screening of a random peptide library constructed using messenger RNA display technology, and some of the isolates were further modified by amino-acid substitution. Their advantageous tumour cell-targeting ability is corroborated in an in vivo mouse model for imaging and growth suppression of metastatic xenoplant tumours. These cell-penetrating peptides are potentially useful for the efficient targeting of human neoplasms in a tumour origin-dependent manner, and provide a framework for the development of peptide-based anti-tumour technologies.

  8. Sexual orientation and childhood gender nonconformity: evidence from home videos.

    Science.gov (United States)

    Rieger, Gerulf; Linsenmeier, Joan A W; Gygax, Lorenz; Bailey, J Michael

    2008-01-01

    Homosexual adults tend to be more gender nonconforming than heterosexual adults in some of their behaviors, feelings, and interests. Retrospective studies have also shown large differences in childhood gender nonconformity, but these studies have been criticized for possible memory biases. The authors studied an indicator of childhood gender nonconformity not subject to such biases: childhood home videos. They recruited homosexual and heterosexual men and women (targets) with videos from their childhood and subsequently asked heterosexual and homosexual raters to judge the gender nonconformity of the targets from both the childhood videos and adult videos made for the study. Prehomosexual children were judged more gender nonconforming, on average, than preheterosexual children, and this pattern obtained for both men and women. This difference emerged early, carried into adulthood, and was consistent with self-report. In addition, targets who were more gender nonconforming tended to recall more childhood rejection. Copyright (c) 2008 APA.

  9. The impact of managed competition on diversity, innovation and creativity in the delivery of home-care services.

    Science.gov (United States)

    Randall, Glen E

    2008-07-01

    Reforming publicly funded healthcare systems by introducing elements of competition, often by allowing for-profit providers to compete with not-for-profit providers, is a strategy that has become commonplace in Western democracies. It is widely thought that the competitive forces of the marketplace will lead to greater efficiency, diversity and even innovation in the delivery of services. Between 1997 and 2000, a model of 'managed competition' was introduced as a major reform to the delivery of home-care services in Ontario, Canada. It was expected that by allowing greater competition within the home-care sector, this model would constrain costs and encourage provider agencies to become more innovative and creative in meeting service delivery needs. The purpose of this case study is to explore the impact of the managed competition reform on the for-profit and the not-for-profit organisations that provided rehabilitation home-care services, and, more specifically, to assess the extent to which the goal of greater diversity, innovation and creativity was achieved following implementation of the reform. A purposive sample of 49 key informants were selected for in-depth interviews, and a survey of the 36 organisations that provided rehabilitation home-care services and the 43 community care access centres that purchased services from these provider agencies was conducted. Data were collected between November 2002 and May 2003. Findings demonstrate that a combination of coercive, mimetic and normative isomorphic pressures have constrained diversity, innovation and creativity within the home-care sector. The implication is that the features that have traditionally distinguished for-profit and not-for-profit provider agencies from each other are rapidly disappearing, and a new hybrid organisational structure is evolving.

  10. The importance of time in referee home bias due to social pressure: evidence from spanish football

    OpenAIRE

    Picazo-Tadeo, Andr??s J.; Gonz??lez-G??mez, Francisco; Guardiola, Jorge

    2011-01-01

    The importance of time in referee home bias due to social pressure. Evidence from Spanish football Abstract: This paper analyses referee home bias due to social pressure with data from the matches played in the First Division of the Spanish football league between the 2002/03 and 2009/10 seasons. Finally, our main conclusion is that the time the referee has to make a decision does affect the final outcome; while there is no referee home bias when a free kick is awarded, in the case of book...

  11. Competing At Home To Win Abroad: Evidence From Japanese Industry

    OpenAIRE

    Mariko Sakakibara; Porter, Michael E.

    2001-01-01

    The study explores the influence of domestic competition on international trade performance, using data from a broad sample of Japanese industries. Domestic rivalry is measured directly using marketshare instability rather than employing structural variables such as seller concentration. We find robust evidence that domestic rivalry has a positive and significant relationship with trade performance measured by world export share, particularly when R&D intensity reveals opportunities for dynam...

  12. First Steps towards Evidence-Based Preventive Home Visits: Experiences Gathered in a Swedish Municipality

    Directory of Open Access Journals (Sweden)

    Charlotte Löfqvist

    2012-01-01

    Full Text Available The purpose of preventive home visits is to promote overall health and wellbeing in old age. The aim of this paper was to describe the process of the development of evidence-based preventive home visits, targeting independent community-living older persons. The evidence base was generated from published studies and practical experiences. The results demonstrate that preventive home visits should be directed to persons 80 years old and older and involve various professional competences. The visits should be personalized, lead to concrete interventions, and be followed up. The health areas assessed should derive from a broad perspective and include social, psychological, and medical aspects. Core components in the protocol developed in this study captured physical, medical, psychosocial, and environmental aspects. Results of a pilot study showed that the protocol validly identified health risks among older people with different levels of ADL dependence.

  13. What does the evidence really say about culture change in nursing homes?

    Science.gov (United States)

    Shier, Victoria; Khodyakov, Dmitry; Cohen, Lauren W; Zimmerman, Sheryl; Saliba, Debra

    2014-02-01

    Although nursing home culture change efforts are becoming more widespread, there have been few efforts to systematically compile the evidence related to the efficacy of culture change. This study uses an analytic framework to evaluate the existing evidence for the impact of culture change on nursing home quality. We focus on the nature and scope of culture change interventions, measurement of culture change and adherence to interventions, measurement of culture change outcomes, and the relationship between culture change and its outcomes. We conducted a comprehensive review of peer-reviewed and gray literature published between 2005 and 2012 to identify intervention evaluations that addressed at least one culture change domain. Of 4,982 identified publications, 625 underwent full review; 27 peer-reviewed and 9 gray literature studies met inclusion criteria. Studies varied widely in scope and outcomes. Most addressed more than one culture change domain; resident direction, home environment, and close relationships were most common. Few studies measured culture change implementation, but most used validated tools to measure outcomes. Although few studies reported negative outcomes, there was little consistent evidence of positive effects. Nursing home culture change remains an evolving field. Although culture change has clear face validity, the current evidence does not give providers sufficient information for selecting interventions based on the expectation of improving outcomes. Rigorous research on implementation and outcomes of culture change is needed to determine the specific impact of culture change on quality and to provide guidance to providers and policy makers.

  14. The Health Home: A Service Delivery Model for Autism and Intellectual Disability.

    Science.gov (United States)

    Fueyo, Michael; Caldwell, Tim; Mattern, Sarah B; Zahid, Jahanara; Foley, Thomas

    2015-11-01

    Autism spectrum disorder (ASD) and intellectual disability (ID) are lifelong conditions with profound impact on the functioning of affected individuals and their families. Optimizing developmental outcomes requires a lifelong perspective on treatment. The patient-centered health care home (health home) model is currently used to improve health outcomes and care integration in a variety of chronic general medical and psychiatric conditions. The authors propose the health home model as a new conceptual framework from which to build systems of care for persons with ASD or ID and their families. The authors describe essential elements of a health home for these populations, which would be located in a behavioral health setting. They also describe an existing model of such a health home, the Center for Autism and Developmental Disabilities in Pennsylvania.

  15. Building America Case Study: Accelerating the Delivery of Home-Performance Upgrades Using a Synergistic Business Model, Minneapolis, Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    2016-04-01

    Achieving Building America energy savings goals (40 percent by 2030) will require many existing homes to install energy upgrades. Engaging large numbers of homeowners in building science-guided upgrades during a single remodeling event has been difficult for a number of reasons. Performance upgrades in existing homes tend to occur over multiple years and usually result from component failures (furnace failure) and weather damage (ice dams, roofing, siding). This research attempted to: A) Understand the homeowner's motivations regarding investing in building science based performance upgrades. B) Determining a rapidly scalable approach to engage large numbers of homeowners directly through existing customer networks. C) Access a business model that will manage all aspects of the contractor-homeowner-performance professional interface to ensure good upgrade decisions over time. The solution results from a synergistic approach utilizing networks of suppliers merging with networks of homeowner customers. Companies in the $400 to $800 billion home services industry have proven direct marketing and sales proficiencies that have led to the development of vast customer networks. Companies such as pest control, lawn care, and security have nurtured these networks by successfully addressing the ongoing needs of homes. This long-term access to customers and trust established with consistent delivery has also provided opportunities for home service providers to grow by successfully introducing new products and services like attic insulation and air sealing. The most important component for success is a business model that will facilitate and manage the process. The team analyzes a group that developed a working model.

  16. Evidence-based practice guidelines for prescribing home modifications for clients with bariatric care needs.

    Science.gov (United States)

    de Lange, Laura; Coyle, Emma; Todd, Helen; Williams, Cylie

    2018-01-05

    Home modifications maintain people's functional independence and safety. No literature exists to guide the prescription of home modifications for clients with bariatric care needs. With Australia's increasing obesity rate, more evidence is needed to support home modification prescribers. This study aimed to map Australian home modification prescribing practices for clients with bariatric care needs and to establish and evaluate a clinical resource for this prescription process. The study included two phases. Phase 1 conducted a cross-sectional survey of therapists practicing in Australia, and Australian industry partners who prescribe or install home modifications for clients with bariatric care needs. Phase 2 included design, implementation and evaluation of a clinical resource. Data were analysed with means and frequencies; multivariable regression analysis was used to explore prescribing habits. Therapists surveyed (n = 347) reported 11 different bariatric weight definitions. Less than 3% constantly or regularly prescribed home modifications for these clients; rails were most commonly prescribed. Many therapists (n = 171, 58%) 'never' or 'rarely' knew rail load capacity. Therapists' knowledge of rail load capacity was associated with previous experience prescribing home modifications (P = 0.009); rail manufacturer's advice (P = 0.016) and not using advice from builders (P = 0.001). Clinical resources were used by 11% (n = 26) of therapists to support their prescription, and industry sporadically relied on therapists to specify modification design requirements (n = 5, 45%). Post-implementation of a clinical resource increased consensus regarding understanding of the term bariatric and increased consultation with builders and manufacturers. There was a lack of consistency in bariatric terminology, uncertainty of rail load capacities and minimal use of clinical practice guidelines. Additional resources will assist with consistency in prescribing

  17. Air-to-Water Heat Pumps With Radiant Delivery in Low-Load Homes

    Energy Technology Data Exchange (ETDEWEB)

    Backman, C. [Alliance for Residential Building Innovation, Davis, CA (United States). Davis Energy Group; German, A. [Alliance for Residential Building Innovation, Davis, CA (United States). Davis Energy Group; Dakin, B. [Alliance for Residential Building Innovation, Davis, CA (United States). Davis Energy Group; Springer, D. [Alliance for Residential Building Innovation, Davis, CA (United States). Davis Energy Group

    2013-12-01

    Space conditioning represents nearly 50% of average residential household energy consumption, highlighting the need to identify alternative cost-effective, energy-efficient cooling and heating strategies. As homes are better built, there is an increasing need for strategies that are particularly well suited for high performance, low load homes. ARBI researchers worked with two test homes in hot-dry climates to evaluate the in-situ performance of air-to-water heat pump (AWHP) systems, an energy efficient space conditioning solution designed to cost-effectively provide comfort in homes with efficient, safe, and durable operation. Two monitoring projects of test houses in hot-dry climates were initiated in 2010 to test this system. Both systems were fully instrumented and have been monitored over one year to capture complete performance data over the cooling and heating seasons. Results are used to quantify energy savings, cost-effectiveness, and system performance using different operating modes and strategies. A calibrated TRNSYS model was developed and used to evaluate performance in various climate regions. This strategy is most effective in tight, insulated homes with high levels of thermal mass (i.e. exposed slab floors).

  18. Air-to-Water Heat Pumps With Radiant Delivery in Low-Load Homes

    Energy Technology Data Exchange (ETDEWEB)

    Backman, C. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); German, A. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); Springer, D. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States)

    2013-12-01

    Space conditioning represents nearly 50% of average residential household energy consumption, highlighting the need to identify alternative cost-effective, energy-efficient cooling and heating strategies. As homes are better built, there is an increasing need for strategies that are particularly well suited for high performance, low load homes. ARBI researchers worked with two test homes in hot-dry climates to evaluate the in-situ performance of air-to-water heat pump systems, an energy efficient space conditioning solution designed to cost-effectively provide comfort in homes with efficient, safe, and durable operation. Two monitoring projects of test houses in hot-dry climates were initiated in 2010 to test this system. Both systems were fully instrumented and have been monitored over one year to capture complete performance data over the cooling and heating seasons. Results are used to quantify energy savings, cost-effectiveness, and system performance using different operating modes and strategies. A calibrated TRNSYS model was developed and used to evaluate performance in various climate regions. This strategy is most effective in tight, insulated homes with high levels of thermal mass (i.e. exposed slab floors).

  19. Continuous subcutaneous delivery of medications for home care palliative patients-using an infusion set or a pump?

    Science.gov (United States)

    Menahem, Sasson; Shvartzman, Pesach

    2010-09-01

    The purpose of this study was to evaluate safety, feasibility, and efficacy of continuous drug delivery by the subcutaneous route through a solution bag connected to an infusion set compared with an infusion pump in a home palliative care setting. Patients in need of continuous subcutaneous medication delivery for pain control, nausea, and/or vomiting were recruited. The study was designed as a double-blind, crossover study. The patient was connected to two parallel subcutaneous lines running simultaneously, connected together to a line entering the subcutaneous tissue. One line is connected to an infusion set and the other to a pump. The infusion set included a 500-cc solution bag connected to a 1.5-m plastic tube containing a drip chamber controlled by a roller clamp that is gravity driven without hyaluronidase. Active medications were randomly assigned to start in either administration method and switched after 24 h. An independent research assistant evaluated symptom control and side effects at baseline and every 24 h for 2 days using a structured questionnaire. Another independent research assistant connected the lines after adding medications and evaluated technical and clinical failures. Twenty-seven patients were recruited, and of them, 18 completed the study. Incidents in fluid administration were more common through the infusion set (18 times) compared to the pump (only twice). On the other hand, no clinical significant change was noted in the average symptom levels and side effects when medications were given through the infusion set versus the pump. No local edema or irritation was observed in either way of administration. In a home palliative care setting with a medical staff on call for 24 h, using medications for symptom control can be considered to be infused to a fluid solution bag through an infusion set instead of using a syringe driver or a pump when there is a responsible caregiver to follow up on the fluid. Subcutaneous constant drug delivery

  20. Exploiting homing abilities of cell carriers: Targeted delivery of nanoparticles for cancer therapy.

    Science.gov (United States)

    Tiet, Pamela; Berlin, Jacob M

    2017-12-01

    Off target toxicities is one of the hallmarks of conventional chemotherapy as only a tiny percentage of the injected dose actually reaches the tumor(s). Numerous strategies have been employed in attempts to achieve targeted therapeutic delivery to tumors. One strategy that has received immense attention has been the packaging of these chemotherapeutics into nanoparticles and relying on the enhanced permeation and retention (EPR) effect for targeting. However, few, if any, nanoformulations have been used clinically that actually show enhanced drug delivery to tumors. There are a number of biological barriers to successful targeted delivery and nanoparticles large enough to theoretically benefit from the EPR effect predominantly accumulate in the liver and spleen after systemic administration. Nanoparticles that do reach the tumor will experience challenges such as difficulty penetrating deeply into tumors and rapid uptake by macrophages rather than tumor cells. In order to overcome this, researchers are investigating a new drug delivery system by utilizing T-cells, macrophages, or stem cells (Mesenchymal/Neural Stem Cells) and loading them with therapeutic nanoparticles for targeted delivery due to either their organotropic or tumor tropic migratory capabilities. By exploiting the migration and motility of these particular cells, researchers have delivered drug-loaded nanoparticles as well as nanoparticles for use in thermal ablation and magnetic field treatments, with the goals of decreasing off-target toxicities and increasing intratumoral distribution of the therapeutic payload. This is an inherently complex drug delivery system that requires optimization of multiple parameters - including cell type, payload, cell loading, release rate from nanoparticle and more - for success. Here we review recent advances and upcoming challenges for the field. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Understanding home delivery in a context of user fee reduction: a cross-sectional mixed methods study in rural Burkina Faso.

    Science.gov (United States)

    De Allegri, Manuela; Tiendrebéogo, Justin; Müller, Olaf; Yé, Maurice; Jahn, Albrecht; Ridde, Valéry

    2015-12-11

    Several African countries have recently reduced/removed user fees for maternal care, producing considerable increases in the utilization of delivery services. Still, across settings, a conspicuous number of women continue to deliver at home. This study explores reasons for home delivery in rural Burkina Faso, where a successful user fee reduction policy is in place since 2007. The study took place in the Nouna Health District and adopted a triangulation mixed methods design, combining quantitative and qualitative data collection and analysis methods. The quantitative component relied on use of data from the 2011 round of a panel household survey conducted on 1130 households. We collected data on utilization of delivery services from all women who had experienced a delivery in the previous twelve months and investigated factors associated with home delivery using multivariate logistic regression. The qualitative component relied on a series of open-ended interviews with 55 purposely selected households and 13 village leaders. We analyzed data using a mixture of inductive and deductive coding. Of the 420 women who reported a delivery, 47 (11 %) had delivered at home. Random effect multivariate logistic regression revealed a clear, albeit not significant trend for women from a lower socio-economic status and living outside an area to deliver at home. Distance to the health facility was found to be positively significantly associated with home delivery. Qualitative findings indicated that women and their households valued facility-based delivery above home delivery, suggesting that cultural factors do not shape the decision where to deliver. Qualitative findings confirmed that geographical access, defined in relation to the condition of the roads and the high transaction costs associated with travel, and the cost-sharing fees still applied at point of use represent two major barriers to access facility-based delivery. Findings suggest that the current policy in

  2. Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

    OpenAIRE

    Jablonski, Anita; Ersek, Mary

    2009-01-01

    The purpose of this study was to determine the extent to which nursing home staff adhere to current evidence-based guidelines to assess and manage persistent pain experienced by elderly residents. A retrospective audit was conducted of the medical records of 291 residents of 14 long-term care facilities in western Washington State. Data revealed a gap between actual practice and current best practice. Assessment of persistent pain was limited primarily to intensity and location. Although pres...

  3. Economic evaluation of home-based telebehavioural health care compared to in-person treatment delivery for depression.

    Science.gov (United States)

    Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N

    2018-02-01

    Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to

  4. A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.

    Science.gov (United States)

    Clarkson, Paul; Davies, Linda; Jasper, Rowan; Loynes, Niklas; Challis, David

    2017-09-01

    Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings, including incremental cost-effectiveness ratios, when available, were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings, agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. Of the 151 articles retrieved, 14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses, seven were cost-effectiveness analyses, and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year (£6,696-£207,942 per quality-adjusted life-year). In four studies, interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. Occupational therapy, home-based exercise, and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications, behavior management, physical activity, and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway. Copyright © 2017 International Society for Pharmacoeconomics and

  5. Home

    Directory of Open Access Journals (Sweden)

    Rokeya Sakhawat Hossain

    2012-11-01

    Full Text Available A fiery feminist piece that argues that Indian women are all homeless; animals have homes but Indian women have none, because they have to depend on the mercy of their "keepers"; therefore, Indian women live a life worse than animals.

  6. Family Coaching as a delivery modality for evidence-based prevention programs.

    Science.gov (United States)

    Rotheram-Borus, Mary Jane; Swendeman, Dallas; Rotheram-Fuller, Erin; Youssef, Maryann K

    2017-08-01

    Family Coaching is proposed as a new delivery format for evidence-based prevention programs (EBPPs). Three recent developments in health promotion support the potential efficacy of Family Coaching: (1) renewed interest in integrated prevention programs for multiple risk factors and behavior changes, (2) broad and long-term impacts of family-based interventions, and (3) popular acceptance of "coaching" as a nonstigmatizing, goal-focused intervention strategy. Family coaches are community members and paraprofessionals trained in common elements of EBPP. Family Coaching has specific goals, is short term, and has definable outcomes. Coaches frame the program's goals to be consistent with the family's values, normalize the family's experience, assess their strengths, and help the family set goals and develop skills and routines to problem solve challenging situations. Broad dissemination of EBPP will be facilitated with delivery formats that are flexible to meet families' priorities and providers' desires and capacities to tailor programs to local contexts.

  7. Fiscal Decentralization and Delivery of Public Services: Evidence from Education Sector in Pakistan

    Directory of Open Access Journals (Sweden)

    Rauf Abdur

    2017-04-01

    Full Text Available Fiscal Decentralization is the devolution of fiscal assignments to lower governments for high growth and better delivery of public services. The current study covering the period from 1972 to 2009 is an attempt to find out the impacts of fiscal decentralization on public services deliveries in Pakistan. Public services are proxy by Gross enrollment at primary school level while fiscal decentralization by fiscal transfer and expenditure sides of devolution. Using time series data, it is found that the individual impacts of fiscal transfer are although insignificant but still support the theoretical proposition regarding fiscal decentralization and public services relationship while delegation of expenditure responsibilities helps in improving the gross enrollment at primary school level. Furthermore the study evident that complete delegation of fiscal responsibilities to lower governments enhance enrollment ratio in Pakistan.

  8. Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

    Directory of Open Access Journals (Sweden)

    Amos Grünebaum

    Full Text Available The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC, compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007-2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (<37 weeks and infants weighing under 2500 g. Hospital VBACS were the reference. Women with a planned home birth VBAC had an approximately 10-fold and higher increase in adverse neonatal outcomes when compared to hospital VBACS and hospital repeat cesarean deliveries, a significantly higher incidence and risk of a 5-minute Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4-20.39, p<.0001 and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13-24.29, p<.0001. Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

  9. Evidence for geomagnetic imprinting and magnetic navigation in the natal homing of sea turtles.

    Science.gov (United States)

    Brothers, J Roger; Lohmann, Kenneth J

    2015-02-02

    Natal homing is a pattern of behavior in which animals migrate away from their geographic area of origin and then return to reproduce in the same location where they began life [1-3]. Although diverse long-distance migrants accomplish natal homing [1-8], little is known about how they do so. The enigma is epitomized by loggerhead sea turtles (Caretta caretta), which leave their home beaches as hatchlings and migrate across entire ocean basins before returning to nest in the same coastal area where they originated [9, 10]. One hypothesis is that turtles imprint on the unique geomagnetic signature of their natal area and use this information to return [1]. Because Earth's field changes over time, geomagnetic imprinting should cause turtles to change their nesting locations as magnetic signatures drift slightly along coastlines. To investigate, we analyzed a 19-year database of loggerhead nesting sites in the largest sea turtle rookery in North America. Here we report a strong association between the spatial distribution of turtle nests and subtle changes in Earth's magnetic field. Nesting density increased significantly in coastal areas where magnetic signatures of adjacent beach locations converged over time, whereas nesting density decreased in places where magnetic signatures diverged. These findings confirm central predictions of the geomagnetic imprinting hypothesis and provide strong evidence that such imprinting plays an important role in natal homing in sea turtles. The results give credence to initial reports of geomagnetic imprinting in salmon [11, 12] and suggest that similar mechanisms might underlie long-distance natal homing in diverse animals. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Replicating Evidence-Based Practices with Flexibility for Perinatal Home Visiting by Paraprofessionals.

    Science.gov (United States)

    Rotheram-Fuller, Erin J; Swendeman, Dallas; Becker, Kimberly D; Daleiden, Eric; Chorpita, Bruce; Harris, Danielle M; Mercer, Neil T; Rotheram-Borus, Mary Jane

    2017-12-01

    Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%). Home visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants' growth (weight/height Z score) tended to be significantly better compared to the control condition. There are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean-American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.

  11. [Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study].

    Science.gov (United States)

    Côrtes, Clodoaldo Tentes; Santos, Rafael Cleison Silva Dos; Caroci, Adriana de Souza; Oliveira, Sheyla Guimarães; Oliveira, Sonia Maria Junqueira Vasconcelos de; Riesco, Maria Luiza Gonzalez

    2015-10-01

    Presenting methodology for transferring knowledge to improve maternal outcomes in natural delivery based on scientific evidence. An intervention study conducted in the maternity hospital of Itapecerica da Serra, SP, with 50 puerperal women and 102 medical records from July to November 2014. The PACES tool from Joanna Briggs Institute, consisting of pre-clinical audit (phase 1), implementation of best practice (phase 2) and Follow-up Clinical Audit (phase 3) was used. Data were analyzed by comparing results of phases 1 and 3 with Fisher's exact test and a significance level of 5%. The vertical position was adopted by the majority of puerperal women with statistical difference between phases 1 and 3. A significant increase in bathing/showering, walking and massages for pain relief was found from the medical records. No statistical difference was found in other practices and outcomes. Barriers and difficulties in the implementation of evidence-based practices have been identified. Variables were refined, techniques and data collection instruments were verified, and an intervention proposal was made. The study found possibilities for implementing a methodology of practices based on scientific evidence for assistance in natural delivery.

  12. CanSupport: a model for home-based palliative care delivery in India.

    Science.gov (United States)

    Yeager, Alyssa; LaVigne, Anna W; Rajvanshi, Ambika; Mahato, Birbal; Mohan, Ravinder; Sharma, Reena; Grover, Surbhi

    2016-07-01

    According to the 2014 WHO Global Atlas of Palliative Care, there is insufficient access to palliative care services worldwide, with the majority of unmet need in low- and middle-income countries. In India, there are major disparities in access to palliative care, with the majority of services being offered by non-governmental organizations (NGOs) scattered throughout the country. The barriers to expanding palliative care services in India are common to many lower- and middle-income countries-a lack of financial resources, a paucity of trained staff, and a focus on curative rather than comfort care. In this paper, we describe a model of palliative care being used by CanSupport, a non-governmental organization based in Delhi that was formed in 1996. They offer home-based services provided by multidisciplinary teams consisting of a physician, nurse, and social worker who are trained in palliative care. Data on patient demographics, services provided, and outcomes were collected retrospectively for patients treated by CanSupport for the year 2009-2010. Sources include CanSupport's population data and direct discussions with CanSupport staff. During the year 2009-2010, CanSupport served 746 patients, with an average of 10 home visits per patient. Only 29% of patients were referred from hospitals or physicians, with the rest being self-referred or referred from CanSupport's help line. Pain scales were administered on each visit and 31% of patients received morphine. Of the 514 patient deaths, 76% occurred at home and a majority of families received bereavement counseling for up to 6 months. CanSupport has shown that a home-based care model can be successful in India and is desired by patients at the end of life or with chronic illness. Their model of care saves the patients the cost of a hospital visit while still providing evaluation by staff with training in palliative care. In addition, the multidisciplinary nature of the teams allows for symptom management and

  13. Location-Routing Problem with Simultaneous Home Delivery and Customer’s Pickup for City Distribution of Online Shopping Purchases

    Directory of Open Access Journals (Sweden)

    Lin Zhou

    2016-08-01

    Full Text Available With the increasing interest in online shopping, the Last Mile delivery is regarded as one of the most expensive and pollutive—and yet the least efficient—stages of the e-commerce supply chain. To address this challenge, a novel location-routing problem with simultaneous home delivery and customer’s pickup is proposed. This problem aims to build a more effective Last Mile distribution system by providing two kinds of service options when delivering packages to customers. To solve this specific problem, a hybrid evolution search algorithm by combining genetic algorithm (GA and local search (LS is presented. In this approach, a diverse population generation algorithm along with a two-phase solution initialization heuristic is first proposed to give high quality initial population. Then, advantaged solution representation, individual evaluation, crossover and mutation operations are designed to enhance the evolution and search efficiency. Computational experiments based on a large family of instances are conducted, and the results obtained indicate the validity of the proposed model and method.

  14. Factors associated with different types of birth attendants for home deliveries: an analysis of the cross-sectional 2010 South Sudan household survey

    Directory of Open Access Journals (Sweden)

    Ngatho S. Mugo

    2016-07-01

    Full Text Available Background: In South Sudan, birth deliveries attended by unskilled birth attendants put the mothers and their newborns at increased risk of perinatal morbidity and mortality. The aim of this study was to identify factors associated with delivery by unskilled birth attendants or by unassisted delivery. Design: We examined data for 2,767 (weighted total women aged 15–49 years who delivered at home 2 years prior to the South Sudan Household Health Survey 2010. Multinomial logistic regression analyses were used to identify factors associated with delivery by unskilled birth attendants or by unassisted delivery. Results: The prevalence of delivery by unskilled birth attendants was 19% [95% confidence interval (CI 17.0, 20.5], by skilled birth attendants (SBAs was 45% (95% CI 42.4, 47.0, and by unassisted delivery was 36% (95% CI 34.2, 38.6. After adjusting for potential confounders, the following factors were associated with the increased odds for unassisted delivery or delivery by an unskilled birth attendant: mothers with no schooling, who did not attend antenatal care (ANC during pregnancy, who had lower quality of ANC services, from poor households, or who had no prior knowledge about obstetric danger signs. Conclusions: We found that non-utilization of maternal health care services, such as ANC, was significantly associated with unattended birth delivery or delivery by unskilled health providers. The increased uptake of SBAs at delivery will require easier access to ANC services, health promotion on the importance and benefits of SBAs for delivery, targeting both mothers and their families, and the training and deployment of more SBAs across the country.

  15. The HAAPI (Home Arm Assistance Progression Initiative) Trial: A Novel Robotics Delivery Approach in Stroke Rehabilitation.

    Science.gov (United States)

    Wolf, Steven L; Sahu, Komal; Bay, R Curtis; Buchanan, Sharon; Reiss, Aimee; Linder, Susan; Rosenfeldt, Anson; Alberts, Jay

    2015-01-01

    Geographical location, socioeconomic status, and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP) was incorporated within a home exercise program (HEP) to improve upper-extremity (UE) functional capabilities poststroke. To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved. In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to UE rehabilitation were randomized to either (1) the experimental group, which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks, or (2) the control group, which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment (UE) were primary and secondary outcome measures, respectively, undertaken before and after the interventions. Both groups demonstrated improvement across all UE outcomes. Robotic + HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time. Additional research is necessary to determine the appropriate dosage of HMP and HEP. © The Author(s) 2015.

  16. Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes.

    Science.gov (United States)

    Murphy, Jane L; Holmes, Joanne; Brooks, Cindy

    2017-02-14

    There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia. We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users. The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.

  17. Pressure ulcers in nursing homes: does negligence litigation exceed available evidence?

    Science.gov (United States)

    Meehan, Marge; Hill, W Michael

    2002-03-01

    Nursing homes today face an increasing amount of oversight as they comply with regulations from federal, state, and local governments and agencies. The trend of judicial oversight, particularly in cases involving pressure ulcers, presents a unique set of challenges to the nursing home industry. The standards of care that are increasingly applied to establish the incidence of negligence in relevant cases are dependent on an under-researched area of the clinical phenomenon of skin breakdown within a frail elderly population. As the nursing home population continues to grow and resources are further strained, finding ways to best utilize resources becomes imperative. Consideration must be given to the growing body of evidence indicating that some patients are incapable of mounting a "normal" response to the physical forces responsible for the damage observed with pressure ulcers. Pressure ulcers have evolved to the status of being a synonym for neglect and/or abuse. Clinicians must focus on establishing a realistic and far more nuanced body of knowledge regarding pressure ulcers among the frail elderly.

  18. Five types of home-visit nursing agencies in Japan based on characteristics of service delivery: cluster analysis of three nationwide surveys.

    Science.gov (United States)

    Fukui, Sakiko; Yamamoto-Mitani, Noriko; Fujita, Junko

    2014-12-20

    The number of home-visit nursing agencies in Japan has greatly increased over the past 20 years since the Japanese government first introduced it in 1992 to meet the increased needs of home-bound elderly. Since then, home-visit nursing has come to serve for a variety of populations such as those with terminal-stage cancer, neurological diseases, psychiatric conditions, or children with chronic conditions; currently the number of agencies has reached 6,801 (as of April 2013). Yet little has been known about the details of their characteristics in terms of patient types or differences/similarities across regions. In this study, we developed a method to categorize home-visit nursing agencies throughout Japan based on their actual service delivery, in order to help improve healthcare policies allowing better services by those agencies. We performed a cluster analysis on data from two national databases (Survey of Institutions and Establishments for Long-term Care which is annually administered by the Ministry of Health, Labour and Welfare [dataset 1; n = 5,161] and Information Publication System for Long-term Care which is annually reported by home-visit nursing agencies to their respective prefectural governments [dataset 2; n = 4,400, matching rate to data set 1: 84.4%]), in addition to the results from our original nationwide Fax survey of the service delivery system of home-visit nursing agencies (dataset 3; n = 2,049 matching rate to data set 1: 39.3%). The cluster analysis suggested five categories for home-visit nursing agencies based on the type of service delivery system. For deciding of these categories, we held 13 panel discussions with specialists to confirm that the categorization of the home-visit nursing agencies appropriately reflected their actual delivery systems. The five categories were: nurse-centered (560, 10.9%), rehabilitation-centered (211, 4.1%), psychiatric-centered (360, 7.0%), urban-centered (1,784, 34.5%), and rural

  19. Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents.

    Science.gov (United States)

    Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan

    2015-11-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents" found on pages 30-39, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Explain the development and testing of the Evidence-Based Nursing Care Algorithm of

  20. Effects of Web-Based Support on Early Head Start Home Visitors' Use of Evidence-Based Intervention Decision Making and Growth in Children's Expressive Communication

    Science.gov (United States)

    Buzhardt, Jay; Greenwood, Charles R.; Walker, Dale; Anderson, Rawni; Howard, Waylon; Carta, Judith J.

    2011-01-01

    We investigated Early Head Start home visitors' use of evidence-based practices and the efficacy of a web-based system to support these practices. Home visitors learned to use 3 evidence-based practices: (a) frequent assessment of children's early communication for screening and progress monitoring, (b) 2 home-based language-promoting…

  1. Living in cold homes after heating improvements: Evidence from Warm-Front, England's Home Energy Efficiency Scheme

    Energy Technology Data Exchange (ETDEWEB)

    Critchley, Roger [Centre for Regional Economic and Social Research, Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB (United Kingdom); Gilbertson, Jan [Centre for Regional Economic and Social Research, Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB (United Kingdom)]. E-mail: J.M.Gilbertson@shu.ac.uk; Grimsley, Michael [Centre for Regional Economic and Social Research, Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB (United Kingdom); Green, Geoff [Centre for Regional Economic and Social Research, Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB (United Kingdom)

    2007-02-15

    Objective: To investigate explanatory factors for persistent cold temperatures in homes which have received heating improvements. Design: Analysis of data from a national survey of dwellings and households (in England occupied by low-income residents) that had received heating improvements or repairs under the Warm Front Scheme. Methods: Over the winters of 2001-02 and 2002-03, householders recorded living room and main bedroom temperatures in a diary. Entries were examined for 888 households, which had received high level heating interventions. Two hundred and twenty-two households were identified as occupying cold homes, with mean bedroom temperature below 16 deg. C or mean living room temperatures below 18 deg. C. Binary logistic regression was used to model dwelling and household features and then occupants' behaviour and attitudes in the 'cold homes' sub-set compared with the remainder of the high intervention group. Seventy-nine supplementary, structured telephone interviews explored reasons given for lower temperatures. Using graphical and tabular methods, householders preferring cooler homes were distinguished from those who felt constrained in some way. Results: Cold homes predominate in pre-1930 properties where the householder remains dissatisfied with the heating system despite major improvements funded by Warm Front. Residents of cold homes are less likely to have long-standing illness or disability, but more likely to experience anxiety or depression. A small sample of telephone interviews reveals those preferring lower temperatures for health or other reasons, report less anxiety and depression than those with limited control over their home environment. Their 'thermal resistance' to higher temperatures challenges orthodox definitions of comfort and fuel poverty.

  2. Ensuring evidence-based practices for falls prevention in a nursing home setting.

    Science.gov (United States)

    Gama, Zenewton A S; Medina-Mirapeix, Francesc; Saturno, Pedro J

    2011-07-01

    To evaluate the effectiveness of an ad hoc multifaceted program to improve structure, professional behavior, and outcomes related to falls prevention. Internal quality improvement cycle. Nursing home in Spain. An institution with 130 residents. Local building of quality criteria, audit and feedback, and a specific intervention to improve based on educational and sensitization activities and changes in the process and recording systems. Quality of falls prevention was assessed using reliable evidence-based criteria (4 of structure and 9 of process), at baseline and 6 months after a specific intervention to improve. Number of falls was recorded in a random sample (n = 60) of residents (≥ 65 years) during a 1-year follow-up and summarized fortnightly as an indicator analyzed using a statistical control chart. Baseline structure and fall prevention practices were poor. After the intervention, all structure criteria were present and 8 of 9 process criteria improved significantly. Thirty-two falls occurred 6 months before and 21 after the intervention started, showing a significant decrease in the fortnightly incidence (P < .01). Adherence to evidence-based recommendations was poor in our setting, but the internal quality improvement cycle was useful in ensuring safe practices and in achieving better outcomes. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  3. Improving Access to Institutional Delivery through Janani Shishu Suraksha Karyakram: Evidence from Rural Haryana, North India.

    Science.gov (United States)

    Salve, Harshal R; Charlette, Lena; Kankaria, Ankita; Rai, Sanjay K; Krishnan, Anand; Kant, Shashi

    2017-01-01

    In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. To assess the impact of JSSK on institutional delivery. A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery.

  4. Neighborhood and home food environment and children's diet and obesity: Evidence from military personnel's installation assignment.

    Science.gov (United States)

    Shier, Victoria; Nicosia, Nancy; Datar, Ashlesha

    2016-06-01

    Research and policy initiatives are increasingly focused on the role of neighborhood food environment in children's diet and obesity. However, existing evidence relies on observational data that is limited by neighborhood selection bias. The Military Teenagers' Environments, Exercise, and Nutrition Study (M-TEENS) leverages the quasi-random variation in neighborhood environment generated by military personnel's assignment to installations to examine whether neighborhood food environments are associated with children's dietary behaviors and BMI. Our results suggest that neither the actual nor the perceived availability of particular food outlets in the neighborhood is associated with children's diet or BMI. The availability of supermarkets and convenience stores in the neighborhood was not associated with where families shop for food or children's dietary behaviors. Further, the type of store that families shop at was not associated with the healthiness of food available at home. Similarly, availability of fast food and restaurants was unrelated to children's dietary behaviors or how often children eat fast food or restaurant meals. However, the healthiness of food available at home was associated with healthy dietary behaviors while eating at fast food outlets and restaurants were associated with unhealthy dietary behaviors in children. Further, parental supervision, including limits on snack foods and meals eaten as a family, was associated with dietary behaviors. These findings suggest that focusing only on the neighborhood food environment may ignore important factors that influence children's outcomes. Future research should also consider how families make decisions about what foods to purchase, where to shop for foods and eating out, how closely to monitor their children's food intake, and, ultimately how these decisions collectively impact children's outcomes. Copyright © 2016. Published by Elsevier Ltd.

  5. Tumor-Homing Cell-Penetrating Peptide Linked to Colloidal Mesoporous Silica Encapsulated (-)-Epigallocatechin-3-gallate as Drug Delivery System for Breast Cancer Therapy in Vivo.

    Science.gov (United States)

    Ding, Jie; Yao, Jing; Xue, Jingjing; Li, Rong; Bao, Bo; Jiang, Liping; Zhu, Jun-jie; He, Zhiwei

    2015-08-19

    Chemotherapy is the use of chemical drugs to prevent cancer cell proliferation, invasion, and metastasis, but a serious obstacle is that chemotherapeutics strikes not only on cancerous cells, but also on normal cells. Thus, anticancer drugs without side effects should be developed and extracted. (-)-Epigallocatechin-3-gallate (EGCG), a major ingredient of green tea, possesses excellent medicinal values, such as anticancer effects, DNA-protective effects, etc. However, EGCG will be mostly metabolized if it is directly orally ingested. Here, we report a drug delivery system (DDS) for loading EGCG to enhance its stability, promising target and anticancer effects in vitro and in vivo. The designed DDS is composed of three main moieties: anticancer drug, EGCG; drug vector, colloidal mesoporous silica (CMS); target ligand, breast tumor-homing cell-penetrating peptide (PEGA-pVEC peptide). Based on the results of CCK-8 assay, confocal imaging, cell cycle analysis, and Western blot, the anticancer effect of EGCG was increased by loading of EGCG into CMS and CMS@peptide. In vivo treatment displayed that CMS had a not obvious influence on breast tumor bearing mice, but CMS@peptide@EGCG showed the greatest tumor inhibition rate, with about 89.66%. H&E staining of organs showed no tissue injury in all experimental groups. All the above results prove that EGCG is an excellent anticancer drug without side effects and CMS@peptide could greatly promote the efficacy of EGCG on breast tumors by targeted accumulation and release, which provide much evidence for the CMS@peptide as a promising and targeting vector for DDS.

  6. Social security income and the utilization of home care: Evidence from the social security notch.

    Science.gov (United States)

    Tsai, Yuping

    2015-09-01

    This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals. Published by Elsevier B.V.

  7. Social security income and the utilization of home care: Evidence from the social security notch☆

    Science.gov (United States)

    Tsai, Yuping

    2018-01-01

    This paper exploits Social Security law changes to identify the effect of Social Security income on the use of formal and informal home care by the elderly. Results from an instrumental variables estimation strategy show that as retirement income increases, elderly individuals increase their use of formal home care and become less likely to rely on informal home care provided to them by their children. This negative effect on informal home care is most likely driven by male children withdrawing from their caregiving roles. The empirical results also suggest that higher Social Security benefits would encourage the use of formal home care by those who would not have otherwise used any type of home care and would also encourage the use of both types of home care services among elderly individuals. PMID:26184382

  8. Delayed intranasal delivery of hypoxic-preconditioned bone marrow mesenchymal stem cells enhanced cell homing and therapeutic benefits after ischemic stroke in mice.

    Science.gov (United States)

    Wei, Ning; Yu, Shan Ping; Gu, Xiaohuan; Taylor, Tammi M; Song, Denise; Liu, Xin-Feng; Wei, Ling

    2013-01-01

    Stem cell transplantation therapy has emerged as a potential treatment for ischemic stroke and other neurodegenerative diseases. Effective delivery of exogenous cells and homing of these cells to the lesion region, however, have been challenging issues that hinder the efficacy and efficiency of cell-based therapy. In the present investigation, we tested a delayed treatment of noninvasive and brain-targeted intranasal delivery of bone marrow mesenchymal stem cells (BMSCs) in a mouse focal cerebral ischemia model. The investigation tested the feasibility and effectiveness of intranasal delivery of BMSCs to the ischemic cortex. Hypoxia preconditioning (HP) of BMSCs was performed before transplantation in order to promote their survival, migration, and homing to the ischemic brain region after intranasal transplantation. Hoechst dye-labeled normoxic- or hypoxic-pretreated BMSCs (1 × 10(6) cells/animal) were delivered intranasally 24 h after stroke. Cells reached the ischemic cortex and deposited outside of vasculatures as early as 1.5 h after administration. HP-treated BMSCs (HP-BMSCs) showed a higher level of expression of proteins associated with migration, including CXC chemokine receptor type 4 (CXCR4), matrix metalloproteinase 2 (MMP-2), and MMP-9. HP-BMSCs exhibited enhanced migratory capacities in vitro and dramatically enhanced homing efficiency to the infarct cortex when compared with normoxic cultured BMSCs (N-BMSCs). Three days after transplantation and 4 days after stroke, both N-BMSCs and HP-BMSCs decreased cell death in the peri-infarct region; significant neuroprotection of reduced infarct volume was seen in mice that received HP-BMSCs. In adhesive removal test of sensorimotor functional assay performed 3 days after transplantation, HP-BMSC-treated mice performed significantly better than N-BMSC- and vehicle-treated animals. These data suggest that delayed intranasal administration of stem cells is feasible in the treatment of stroke and hypoxic

  9. Evidence for geomagnetic imprinting as a homing mechanism in Pacific salmon.

    Science.gov (United States)

    Putman, Nathan F; Lohmann, Kenneth J; Putman, Emily M; Quinn, Thomas P; Klimley, A Peter; Noakes, David L G

    2013-02-18

    In the final phase of their spawning migration, Pacific salmon use chemical cues to identify their home river, but how they navigate from the open ocean to the correct coastal area has remained enigmatic. To test the hypothesis that salmon imprint on the magnetic field that exists where they first enter the sea and later seek the same field upon return, we analyzed a 56-year fisheries data set on Fraser River sockeye salmon, which must detour around Vancouver Island to approach the river through either a northern or southern passageway. We found that the proportion of salmon using each route was predicted by geomagnetic field drift: the more the field at a passage entrance diverged from the field at the river mouth, the fewer fish used the passage. We also found that more fish used the northern passage in years with warmer sea surface temperature (presumably because fish were constrained to more northern latitudes). Field drift accounted for 16% of the variation in migratory route used, temperature 22%, and the interaction between these variables 28%. These results provide the first empirical evidence of geomagnetic imprinting in any species and imply that forecasting salmon movements is possible using geomagnetic models. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?

    Science.gov (United States)

    Leathers, Sonya J; Spielfogel, Jill E; Gleeson, James P; Rolock, Nancy

    2012-05-01

    Adoption is particularly important for foster children with special mental health needs who are unable to return home, as adoption increases parental support often critically needed by youth with mental health issues. Unfortunately, significant behavior problems frequently inhibit foster parents from adopting, and little is known about factors that predict adoption when a child has behavior problems. Previous research suggests that foster parent behavioral training could potentially increase rates of successful adoptions for pre-school-aged foster children with behavior problems (Fisher, Kim, & Pears, 2009), but this has not been previously tested in older samples. In older children, effective treatment of behavior problems might also increase adoption by reducing the interference of behavior problems and strengthening the child's foster home integration. This pilot study focused on this question by testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. This study used an intent-to-treat design to compare foster home integration and adoption likelihood for 31 foster children with histories of abuse and neglect whose foster parents received a foster behavioral parenting intervention (see Chamberlain, 2003) or usual services. Random effect regression analyses were used to estimate outcomes across four time points. As expected, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. However, the intervention did not have a direct effect on either foster home integration or adoption despite its positive effect on behavior problems. Results from this preliminary study provide further evidence of the negative effect of externalizing behavior problems on adoption. Its findings

  11. Evidence-Based Health Promotion in Nursing Homes: A Pilot Intervention to Improve Oral Health

    Science.gov (United States)

    Cadet, Tamara J.; Berrett-Abebe, Julie; Burke, Shanna L.; Bakk, Louanne; Kalenderian, Elsbeth; Maramaldi, Peter

    2016-01-01

    Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts' nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an…

  12. Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)

    Science.gov (United States)

    Farsalinos, Konstantinos E; Le Houezec, Jacques

    2015-01-01

    Tobacco smoking is the largest single preventable cause of many chronic diseases and death. Effective treatments exist; however, few smokers use them and most try to quit by themselves. Most of the tobacco cigarette’s toxicity is related to the combustion process. Models of harm reduction applied to tobacco suggest that switching from inhalation of combustible products to a noncombustible nicotine delivery product would likely result in a vast reduction in tobacco-related death and illness. Currently available evidence raises no doubt that electronic cigarettes (e-cigs) are by far less harmful than smoking (although probably not absolutely safe) and have the potential to be the most effective tobacco harm reduction products due to their unique property of resembling smoking and providing satisfaction to the user. A lot of controversy is surrounding e-cigs and their regulation, much of which is based on the precautionary principle. Although monitoring and further research is definitely needed, the arguments used to implement severe restrictions or bans are mostly hypothetical, weakly supported by evidence, and, in some cases, derived from mispresentation or misinterpretation of the study findings. Regulators should keep in mind that the target population is smokers who want to reduce or quit their deadly tobacco consumption. To achieve this goal, smokers should be honestly informed on the relative harmfulness of the different products. E-cigs are not tobacco products and are not used as medications. For this reason, a specific regulatory scheme is needed, separate from tobacco or medicinal products regulation. Regulation should implement specific quality criteria for products, rules for the exclusion of chemicals of reasonable concern, and appropriate testing for possible contaminants. Additionally, manufacturing standards derived from the food industry should be implemented and adjusted for specific conditions related to e-cigs. Finding the appropriate balance

  13. Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes).

    Science.gov (United States)

    Farsalinos, Konstantinos E; Le Houezec, Jacques

    2015-01-01

    Tobacco smoking is the largest single preventable cause of many chronic diseases and death. Effective treatments exist; however, few smokers use them and most try to quit by themselves. Most of the tobacco cigarette's toxicity is related to the combustion process. Models of harm reduction applied to tobacco suggest that switching from inhalation of combustible products to a noncombustible nicotine delivery product would likely result in a vast reduction in tobacco-related death and illness. Currently available evidence raises no doubt that electronic cigarettes (e-cigs) are by far less harmful than smoking (although probably not absolutely safe) and have the potential to be the most effective tobacco harm reduction products due to their unique property of resembling smoking and providing satisfaction to the user. A lot of controversy is surrounding e-cigs and their regulation, much of which is based on the precautionary principle. Although monitoring and further research is definitely needed, the arguments used to implement severe restrictions or bans are mostly hypothetical, weakly supported by evidence, and, in some cases, derived from mispresentation or misinterpretation of the study findings. Regulators should keep in mind that the target population is smokers who want to reduce or quit their deadly tobacco consumption. To achieve this goal, smokers should be honestly informed on the relative harmfulness of the different products. E-cigs are not tobacco products and are not used as medications. For this reason, a specific regulatory scheme is needed, separate from tobacco or medicinal products regulation. Regulation should implement specific quality criteria for products, rules for the exclusion of chemicals of reasonable concern, and appropriate testing for possible contaminants. Additionally, manufacturing standards derived from the food industry should be implemented and adjusted for specific conditions related to e-cigs. Finding the appropriate balance

  14. The Medical Home Model and Pediatric Asthma Symptom Severity: Evidence from a National Health Survey.

    Science.gov (United States)

    Rojanasarot, Sirikan; Carlson, Angeline M

    2017-08-14

    The objective was to investigate the association between receiving care under the medical home model and parental assessment of the severity of asthma symptoms. It was hypothesized that parents of children who received care under the medical home model reported less severe asthma symptoms compared with their counterparts, whose care did not meet the medical home criteria. Secondary analyses were conducted using cross-sectional data from the 2011-2012 National Survey of Children's Health. Children with asthma aged 0-17 years were included and classified as receiving care from the medical home if their care contained 5 components: a personal doctor, a usual source of sick care, family-centered care, no problems getting referrals, and effective care coordination. Ordinal logistic regression was used to examine the relationship between parent-rated severity of asthma symptoms (mild, moderate, and severe symptoms) and the medical home. Approximately 52% of 8229 children who reported having asthma received care from the medical home. Only 30.8% of children with severe asthma symptoms received care that met the medical home criteria, compared to 55.7% of children with mild symptoms. After accounting for confounding factors, obtaining care under the medical home model decreased the odds of parent-reported severe asthma symptoms by 31% (adjusted odds ratio 0.69; 95% CI, 0.56-0.85). Study results suggest that the medical home model can reduce parent-rated severity of asthma symptoms. The findings highlight the importance of providing medical home care to children with asthma to improve the outcomes that matter most to children and their families.

  15. Protocol for the OUTREACH trial: a randomised trial comparing delivery of cancer systemic therapy in three different settings - patient's home, GP surgery and hospital day unit

    Directory of Open Access Journals (Sweden)

    McCrone Paul

    2011-10-01

    Full Text Available Abstract Background The national Cancer Reform Strategy recommends delivering care closer to home whenever possible. Cancer drug treatment has traditionally been administered to patients in specialist hospital-based facilities. Technological developments mean that nowadays, most treatment can be delivered in the out-patient setting. Increasing demand, care quality improvements and patient choice have stimulated interest in delivering some treatment to patients in the community, however, formal evaluation of delivering cancer treatment in different community settings is lacking. This randomised trial compares delivery of cancer treatment in the hospital with delivery in two different community settings: the patient's home and general practice (GP surgeries. Methods/design Patients due to receive a minimum 12 week course of standard intravenous cancer treatment at two hospitals in the Anglia Cancer Network are randomised on a 1:1:1 basis to receive treatment in the hospital day unit (control arm, or their own home, or their choice of one of three neighbouring GP surgeries. Overall patient care, treatment prescribing and clinical review is undertaken according to standard local practice. All treatment is dispensed by the local hospital pharmacy and treatment is delivered by the hospital chemotherapy nurses. At four time points during the 12 week study period, information is collected from patients, nursing staff, primary and secondary care teams to address the primary end point, patient-perceived benefits (using the emotional function domain of the EORTC QLQC30 patient questionnaire, as well as secondary end points: patient satisfaction, safety and health economics. Discussion The Outreach trial is the first randomised controlled trial conducted which compares delivery of out-patient based intravenous cancer treatment in two different community settings with standard hospital based treatment. Results of this study may better inform all key

  16. Enriching preschool classrooms and home visits with evidence-based programming: sustained benefits for low-income children.

    Science.gov (United States)

    Bierman, Karen L; Heinrichs, Brenda S; Welsh, Janet A; Nix, Robert L; Gest, Scott D

    2017-02-01

    Growing up in poverty undermines healthy development, producing disparities in the cognitive and social-emotional skills that support early learning and mental health. Preschool and home-visiting interventions for low-income children have the potential to build early cognitive and social-emotional skills, reducing the disparities in school readiness that perpetuate the cycle of poverty. However, longitudinal research suggests that the gains low-income children make during preschool interventions often fade at school entry and disappear by early elementary school. In an effort to improve the benefits for low-income children, the REDI program enriched Head Start preschool classrooms (study one) and home visits (study two) with evidence-based programming, documenting positive intervention effects in two randomized trials. In this study, REDI participants were followed longitudinally, to evaluate the sustained impact of the classroom and home-visiting enrichments 3 years later, when children were in second grade. The combined sample included 556 children (55% European American, 25% African American, 19% Latino; 49% male): 288 children received the classroom intervention, 105 children received the classroom intervention plus the home-visiting intervention, and 173 children received usual practice Head Start. The classroom intervention led to sustained benefits in social-emotional skills, improving second grade classroom participation, student-teacher relationships, social competence, and peer relations. The coordinated home-visiting intervention produced additional benefits in child mental health (perceived social competence and peer relations) and cognitive skills (reading skills, academic performance). Significant effects ranged from 25% to 48% of a standard deviation, representing important effects of small to moderate magnitude relative to usual practice Head Start. Preschool classroom and home-visiting programs for low-income children can be improved with the use

  17. Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence.

    Science.gov (United States)

    Goodman, Claire; Norton, Christine; Buswell, Marina; Russell, Bridget; Harari, Danielle; Harwood, Rowan; Roe, Brenda; Rycroft-Malone, Jo; Drennan, Vari M; Fader, Mandy; Maden, Michelle; Cummings, Karen; Bunn, Frances

    2017-08-01

    Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. A realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders. The databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register. The scoping identified six programme theories with related context-mechanism-outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on

  18. Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

    Science.gov (United States)

    Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

    2017-07-14

    Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

  19. Economic Evidence for U.S. Asthma Self-Management Education and Home-Based Interventions

    OpenAIRE

    Hsu, Joy; Wilhelm, Natalie; Lewis, Lillianne; Herman, Elizabeth

    2016-01-01

    The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existin...

  20. Videoconferencing for Health Care Provision for Older Adults in Care Homes: A Review of the Research Evidence

    Directory of Open Access Journals (Sweden)

    Louise Newbould

    2017-01-01

    Full Text Available A scoping review was conducted to map the research evidence on the use of videoconferencing for remote health care provision for older adults in care homes. The review aimed to identify the nature and extent of the existing evidence base. Databases used were Embase, Medline, Web of Science, and Cochrane Library Reviews. The review identified 26 articles for inclusion, of which 14 were case studies, making the most used study design. Papers described videoconferencing as being used for assessment, management of health care, clinical support, and diagnosis, with eight of the papers reporting the use of videoconferencing for more than one clinical purpose. A further eight papers reported the use of videoconferencing for assessment alone. The literature reported the collection of various types of data, with 12 papers describing the use of both qualitative and quantitative data. The outcomes mainly addressed staff satisfaction (n=9 and resident satisfaction (n=8. Current evidence supports the feasibility of videoconferencing in care homes. However, research needs to be undertaken to establish the contexts and mechanisms that underpin the successful implementation of videoconferencing in care homes and to define useful measures for success.

  1. Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes

    Directory of Open Access Journals (Sweden)

    Farsalinos KE

    2015-09-01

    Full Text Available Konstantinos E Farsalinos,1,2 Jacques Le Houezec3,4 1Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, 2Department of Pharmacy, University of Patras, Patras, Greece; 3Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, England, UK; 4Addiction Research Unit, INSERM 1178 (Mental and Public Health, Paris, France Abstract: Tobacco smoking is the largest single preventable cause of many chronic diseases and death. Effective treatments exist; however, few smokers use them and most try to quit by themselves. Most of the tobacco cigarette's toxicity is related to the combustion process. Models of harm reduction applied to tobacco suggest that switching from inhalation of combustible products to a noncombustible nicotine delivery product would likely result in a vast reduction in tobacco-related death and illness. Currently available evidence raises no doubt that electronic cigarettes (e-cigs are by far less harmful than smoking (although probably not absolutely safe and have the potential to be the most effective tobacco harm reduction products due to their unique property of resembling smoking and providing satisfaction to the user. A lot of controversy is surrounding e-cigs and their regulation, much of which is based on the precautionary principle. Although monitoring and further research is definitely needed, the arguments used to implement severe restrictions or bans are mostly hypothetical, weakly supported by evidence, and, in some cases, derived from mispresentation or misinterpretation of the study findings. Regulators should keep in mind that the target population is smokers who want to reduce or quit their deadly tobacco consumption. To achieve this goal, smokers should be honestly informed on the relative harmfulness of the different products. E-cigs are not tobacco products and are not used as medications. For this reason, a specific regulatory

  2. Chinese Housing Reform and Social Sustainability: Evidence from Post-Reform Home Ownership

    Directory of Open Access Journals (Sweden)

    Lishan Xiao

    2016-10-01

    Full Text Available Since 1978, China has undergone an institutional reform, from a welfare-oriented housing allocation system to a market-oriented one. But with high housing prices, affordability is a major obstacle to home ownership for Chinese citizens. Now, the government has started to change the goal of housing policy from present economic benefits to sustainable housing, so future generations will have a decent place to live. Housing is an important indicator for social stratification, and home ownership, which is an important component of social sustainability in the Chinese context, is influenced by multiple factors that vary across countries. Although China has a long tradition of home ownership, there is a lack of comprehensive research on post-reform housing inequality. By undertaking a large-scale field study in the city of Xiamen, our research explored to what extent home ownership varies across socio-economic classes, and improves understanding of the reasons behind home ownership inequality. It was discovered that people have a variety of resources from which housing can be obtained, and that commercial housing served as the primary housing source, although, due to path dependence, public housing still comprises an important source of housing, as well as self-built houses. A structural equation model (SEM was used to further explore the driving forces of home ownership inequality. The model indicated that hukou (household registration status has the strongest effect on home ownership, followed by education, with family income and occupation as less important factors. Along with income and education, home ownership has a direct effect on people’s perception of their own socio-economic status (SES. A probability model of home ownership was developed, based on logistic regression. Local families with higher levels of income and education with at least one member working in a publicly owned organization had a higher probability of home ownership

  3. Evidence from SINPHONIE project: Impact of home environmental exposures on respiratory health among school-age children in Romania.

    Science.gov (United States)

    Lu, Yi; Lin, Shao; Lawrence, Wayne R; Lin, Ziqiang; Gurzau, Eugen; Csobod, Eva; Neamtiu, Iulia A

    2017-11-22

    Exposure to indoor air pollutants at home was found to be associated with respiratory diseases. As lifestyle changes with rapid economic growth in Romania, the aim of our study is to describe the characteristics of Romanian homes and their impact on children's respiratory health. Self-reported information on respiratory symptoms was collected from 280 Romanian elementary school students in 2011, and the symptoms were categorized into allergy, asthma-like, and flu-like symptoms. Home characteristics and demographic information were collected from questionnaires answered by parents. The association between home characteristics and respiratory health was assessed through multivariate logistic regression controlling for school indoor exposure. As compared to U.S. households, Romanian homes have a higher percentage of smokers, limited use of indoor climate control, and higher use of iron stoves. Exposure to environmental tobacco smoke was associated with both asthma and allergy symptoms. Additional risk factors identified for allergy symptoms include living in apartments, near pesticide sprayed areas, and the use of incense sticks. The significantly higher risk of flu-like symptoms was associated with mold and dampness issues, the use of air conditioner, gas heater/iron stove in children's bedroom. Our findings suggest that an increase in respiratory symptoms among Romanian school-age children can be partly related to their environmental exposure at home. Since most of the identified risk factors are preventable, our results provide critical information and evidence for policymakers, to develop target intervention and education strategies. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Evidence for the long term cost effectiveness of home care reablement programs

    Directory of Open Access Journals (Sweden)

    Lewin GF

    2013-10-01

    Full Text Available Gill F Lewin,1,2 Helman S Alfonso,3 Janine J Alan41Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain Group, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Faculty of Health Sciences, Curtin University, Perth, WA, AustraliaBackground: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years.Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time.Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years.Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.Keywords: restorative, older adults, community dwelling, service costs

  5. School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries.

    Science.gov (United States)

    Perman, Sarah; Turner, Simon; Ramsay, Angus I G; Baim-Lance, Abigail; Utley, Martin; Fulop, Naomi J

    2017-03-14

    Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes. We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1) focused on childhood or adolescent vaccination programmes delivered in schools; (2) considered organisational factors that influenced the preparation or delivery of programmes; (3) were conducted in a developed or high-income country; and (4) had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors. We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state) or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and students, including methods for obtaining consent

  6. School-based vaccination programmes: a systematic review of the evidence on organisation and delivery in high income countries

    Directory of Open Access Journals (Sweden)

    Sarah Perman

    2017-03-01

    Full Text Available Abstract Background Many countries have recently expanded their childhood immunisation programmes. Schools are an increasingly attractive setting for delivery of these new immunisations because of their ability to reach large numbers of children in a short period of time. However, there are organisational challenges to delivery of large-scale vaccination programmes in schools. Understanding the facilitators and barriers is important for improving the delivery of future school-based vaccination programmes. Methods We undertook a systematic review of evidence on school-based vaccination programmes in order to understand the influence of organisational factors on the delivery of programmes. Our eligibility criteria were studies that (1 focused on childhood or adolescent vaccination programmes delivered in schools; (2 considered organisational factors that influenced the preparation or delivery of programmes; (3 were conducted in a developed or high-income country; and (4 had been peer reviewed. We searched for articles published in English between 2000 and 2015 using MEDLINE and HMIC electronic databases. Additional studies were identified by searching the Cochrane Library and bibliographies. We extracted data from the studies, assessed quality and the risk of bias, and categorised findings using a thematic framework of eight organisational factors. Results We found that most of the recent published literature is from the United States and is concerned with the delivery of pandemic or seasonal flu vaccination programmes at a regional (state or local level. We found that the literature is largely descriptive and not informed by the use of theory. Despite this, we identified common factors that influence the implementation of programmes. These factors included programme leadership and governance, organisational models and institutional relationships, workforce capacity and roles particularly concerning the school nurse, communication with parents and

  7. Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: a systematic review.

    Science.gov (United States)

    Reeder, Blaine; Meyer, Ellen; Lazar, Amanda; Chaudhuri, Shomir; Thompson, Hilaire J; Demiris, George

    2013-07-01

    There is a critical need for public health interventions to support the independence of older adults as the world's population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions. We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology. One thousand, six hundred and thirty-nine candidate articles were identified. Thirty-one studies from the years 1998-2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier). The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of them used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults; social support; and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study.

    Science.gov (United States)

    Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

    2017-05-01

    Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  9. Public Reporting and Demand Rationing: Evidence from the Nursing Home Industry.

    Science.gov (United States)

    He, Daifeng; Konetzka, R Tamara

    2015-11-01

    This paper examines an under-explored unintended consequence of public reporting: the potential for demand rationing. Public reporting, although intended to increase consumer access to high-quality products, may have provided the perverse incentive for high-quality providers facing fixed capacity and administrative pricing to avoid less profitable types of residents. Using data from the nursing home industry before and after the implementation of the public reporting system in 2002, we find that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints. These effects, although small in magnitude, are consistent with provider rationing of demand on the basis of profitability and underscore the important role of institutional details in designing effective public reporting systems for regulated industries. Copyright © 2014 John Wiley & Sons, Ltd.

  10. Schedule Control and Nursing Home Quality: Exploratory Evidence of a Psychosocial Predictor of Resident Care.

    Science.gov (United States)

    Hurtado, David A; Berkman, Lisa F; Buxton, Orfeu M; Okechukwu, Cassandra A

    2016-02-01

    To examine whether nursing homes' quality of care was predicted by schedule control (workers' ability to decide work hours), independently of other staffing characteristics. Prospective ecological study of 30 nursing homes in New England. Schedule control was self-reported via survey in 2011-2012 (N = 1,045). Quality measures included the prevalence of decline in activities of daily living, residents' weight loss, and pressure ulcers, indicators systematically linked with staffing characteristics. Outcomes data for 2012 were retrieved from Medicare.gov. Robust Linear Regressions showed that higher schedule control predicted lower prevalence of pressure ulcers (β = -0.51, p quality of care. © The Author(s) 2014.

  11. Home Health Chains and Practice Patterns: Evidence of 2008 Medicare Reimbursement Revision.

    Science.gov (United States)

    Huang, Sean Shenghsiu; Kim, Hyunjee

    2017-10-01

    Home health agencies (HHAs) are known to exploit the Medicare reimbursement schedule by targeting a specific number of therapy visits. These targeting behaviors cause unnecessary medical spending. The Centers for Medicare & Medicaid Services estimates that during fiscal year 2015, Medicare made more than $10 billion in improper payments to HHAs. Better understanding of heterogeneous gaming behaviors among HHAs can inform policy makers to more effectively oversee the home health care industry. This article aims to study how home health chains adjust and adopt new targeting behaviors as compared to independent agencies under the new reimbursement schedule. The analytic data are constructed from: (1) 5% randomly sampled Medicare home health claim data, and (2) HHA chain information extracted from the Medicare Cost Report. The study period spans from 2007 to 2010, and the sample includes 7800 unique HHAs and 380,118 treatment episodes. A multivariate regression model is used to determine whether chain and independent agencies change their practice patterns and adopt different targeting strategies after the revision of the reimbursement schedule in 2008. This study finds that independent agencies are more likely to target 6 and 14 visits, while chain agencies are more likely to target 20 visits. Such a change of practice patterns is more significant among for-profit HHAs. The authors expect these findings to inform policy makers that organizational structures, especially the combination of for-profit status and chain affiliation, should be taken into the consideration when detecting medical fraud and designing the reimbursement schedule.

  12. Leaving home and leaving the state: evidence from the United States

    NARCIS (Netherlands)

    Mulder, C.H.; Clark, W.A.V.

    2000-01-01

    Leaving the parental home is an important first step in a long-term housing career. We extend the previous research on this topic by examining the impact of housing market factors on the risks of leaving with or without a partner in the United States. We also re-examine the role of the income of the

  13. Can Earlier Literacy Skills Have a Negative Impact on Future Home Literacy Activities? Evidence from Japanese

    Science.gov (United States)

    Inoue, Tomohiro; Georgiou, George K.; Muroya, Naoko; Maekawa, Hisao; Parrila, Rauno

    2018-01-01

    We examined the cross-lagged relations between the home literacy environment and literacy skills in Japanese, and whether child's gender, parents' education and child's level of literacy performance moderate the relations. One hundred forty-two Japanese children were followed from Grades 1 to 2 and assessed on character knowledge, reading fluency…

  14. Home deliveries in Chandigarh, the beautiful city of India: a tug of war between culture and science.

    Science.gov (United States)

    Jeyashree, Kathiresan; Gupta, Madhu; Kathirvel, Soundappan; Singh, Amarjeet

    2013-01-29

    There have been various commitments made in the international front to reduce maternal mortality ratio, and India has set its target at cultural appropriateness can be ensured in healthcare delivery. The study emphasises that there is need for improvement in cultural appropriateness of healthcare services delivered to the community.

  15. What is the evidence to support home environmental adaptation in Parkinson's disease? A call for multidisciplinary interventions.

    Science.gov (United States)

    Bhidayasiri, Roongroj; Jitkritsadakul, Onanong; Boonrod, Nonglak; Sringean, Jirada; Calne, Susan M; Hattori, Nobutaka; Hayashi, Akito

    2015-10-01

    "Home" is where one has a sense of belonging and feels secure, but it can also be a risky place for people with Parkinson's disease (PD). PD patients need assistance making adjustments to their physical environment to maintain appropriate care and provide a safe environment. This relationship is called the "person-environmental fit" (P-E fit). While most PD patients remain in their own homes, little is known about the specific challenges that PD patients and their caregivers encounter in the routine activities of daily living. The aim of our study was to identify the existing evidence on the issue of housing environmental adaptation in PD by performing a systematic review with a proposal of development strategies to integrate a multidisciplinary team into a home environmental research. MEDLINE, and life science journals were searched by querying appropriate key words, but revealed very few publications in this area. However, early evidence suggested that PD patients do not enjoy an adequate P-E fit in their own homes and face more functional limitations compared to matched controls. We concluded that we need to develop research-based evaluation strategies that can provide us with a theoretical and conceptual basis as well as tools for analysis of the P-E fit for PD patients and caregivers. We recommend that individual members of the multidisciplinary team including patients, caregivers, physicians, rehabilitation specialists, and social workers use a team approach to identify the key indicators and solutions for the development of PD-specific solutions for improving the P-E fit. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Modeling Day-to-Day Variability of Glucose-Insulin Regulation Over 12-Week Home Use of Closed-Loop Insulin Delivery.

    Science.gov (United States)

    Yue Ruan; Wilinska, Malgorzata E; Thabit, Hood; Hovorka, Roman

    2017-06-01

    Parameters of physiological models of glucose-insulin regulation in type 1 diabetes have previously been estimated using data collected over short periods of time and lack the quantification of day-to-day variability. We developed a new hierarchical model to relate subcutaneous insulin delivery and carbohydrate intake to continuous glucose monitoring over 12 weeks while describing day-to-day variability. Sensor glucose data sampled every 10-min, insulin aspart delivery and meal intake were analyzed from eight adults with type 1 diabetes (male/female 5/3, age 39.9 ± 9.5 years, BMI 25.4 ± 4.4kg/m2, HbA1c 8.4 ± 0.6% ) who underwent a 12-week home study of closed-loop insulin delivery. A compartment model comprised of five linear differential equations; model parameters were estimated using the Markov chain Monte Carlo approach within a hierarchical Bayesian model framework. Physiologically, plausible a posteriori distributions of model parameters including insulin sensitivity, time-to-peak insulin action, time-to-peak gut absorption, and carbohydrate bioavailability, and good model fit were observed. Day-to-day variability of model parameters was estimated in the range of 38-79% for insulin sensitivity and 27-48% for time-to-peak of insulin action. In conclusion, a linear Bayesian hierarchical approach is feasible to describe a 12-week glucose-insulin relationship using conventional clinical data. The model may facilitate in silico testing to aid the development of closed-loop insulin delivery systems.

  17. Exploring family home food environments: Household resources needed to utilise weekly deliveries of free fruits and vegetables.

    Science.gov (United States)

    Carty, Sophie A; Mainvil, Louise A; Coveney, John D

    2017-04-01

    An adapted ethnographic approach was used to explore household factors that influence family fruit and vegetable consumption when access and cost barriers are removed. 'Structural' barriers, such as food affordability and accessibility, are likely to influence fruit and vegetable consumption in disadvantaged households, but households may require additional resources (human and social) to increase consumption. Five low-income and five high-income households with children (N = 39 individuals) were observed in their home environment for three months. Including both advantaged and disadvantaged families allowed exploration of socioeconomic factors influencing these households. Each household received a free box of fresh fruit and vegetables each week for 10-12 weeks, delivered to their home, and were home-visited twice a week by a researcher (40+ hours per household). An inductive analysis of rich observational and discussion data revealed themes describing factors influencing household fruit and vegetable consumption. Household food cultures were dynamic and influenced by available resources. Even when free produce was delivered to homes, these households required human resource (personal drivers influenced by early life exposure and household dynamics) and external social networks to make use of them. When household finances and/or labour were limited, there was greater dependence on external organisations for tangible support. Even when structural barriers were removed, disadvantaged families needed a range of resources across the life course to improve eating behaviours, including sufficient, motivated and skilled labour and harmonious family relationships. Strategies targeting these households must consider structural, social, cultural and intra-familial influences on food choice. © 2016 Dietitians Association of Australia.

  18. Vitamin-Derived Nanolipoidal Carriers for Brain Delivery of Dimethyl Fumarate: A Novel Approach with Preclinical Evidence.

    Science.gov (United States)

    Kumar, Pramod; Sharma, Gajanand; Kumar, Rajendra; Malik, Ruchi; Singh, Bhupinder; Katare, O P; Raza, Kaisar

    2017-06-21

    Various oral treatment options have been reported for relapsing multiple sclerosis. Recently, dimethyl fumarate (DMF) has been approved for the management of the same. Though effective, DMF is associated with concerns like multiple dosing, patient incompliance, gastrointestinal flushing, lower brain permeation, and economic hurdles. Henceforth, the objective of the present study was to develop vitamin-based solid lipid nanoparticles (SLNs) for effective brain delivery of DMF with a promise of once-a-day dosing. The developed SLNs were characterized for micromeritics, morphology, entrapment efficiency, drug loading and in vitro drug release. Caco-2 and SH-SY5Y cell lines were used to assess the intestinal permeability and neuronal uptake. Pharmacokinetic and biodistribution studies were performed on rats. The developed nanometeric lipidparticles were able to control the drug release and substantially enhance the Caco-2 as well as SH-5YSY cell permeability. The developed systems not only enhanced the oral bioavailability of the drug, but also offered substantially elevated brain drug levels to that of plain drug. The drug was protected from liver and biological residence was increased, indicating promising potential of the carriers in effective brain delivery of DMF. Enhanced bioavailability and elevated bioresidence of DMF by vitamin-based SLNs provided the evidence for once-a-day delivery potential for DMF in the management of neurological disorders.

  19. Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys.

    Science.gov (United States)

    Mezmur, Markos; Navaneetham, Kannan; Letamo, Gobopamang; Bariagaber, Hadgu

    2017-01-01

    Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the

  20. Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys.

    Directory of Open Access Journals (Sweden)

    Markos Mezmur

    Full Text Available Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005 and 624 (in the year 2011 communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and

  1. Building Rural Surgical Networks: An Evidence-Based Approach to Service Delivery and Evaluation.

    Science.gov (United States)

    Kornelsen, Jude; Friesen, Randy

    2016-08-01

    Formalized rural health service delivery networks are emerging as an over-arching response to the attrition of rural surgical and maternity services in Canada. In effective networks, there is strong collaborative leadership, form follows function, core network elements are identified and site-specific variations are accommodated to meet the surgical needs of the population in each geographic catchment. The network catchment must reflect the natural alliances that already exist among health professionals, policy makers, health administrators, academic institutions and communities. Although each key stakeholder plays a key role in determining success, value is added through the synergistic interplay of all participants. Copyright © 2016 Longwoods Publishing.

  2. Home Use, Remotely Supervised, and Remotely Controlled Transcranial Direct Current Stimulation: A Systematic Review of the Available Evidence.

    Science.gov (United States)

    Palm, Ulrich; Kumpf, Ulrike; Behler, Nora; Wulf, Linda; Kirsch, Beatrice; Wörsching, Jana; Keeser, Daniel; Hasan, Alkomiet; Padberg, Frank

    2017-09-15

    Transcranial direct current stimulation (tDCS) is gaining growing importance in the treatment of neurological and psychiatric disorders and is currently investigated for home-based and remotely supervised applications. Here, we systematically review the available evidence from a database search (PubMed, ICTRP, clinicaltrials.gov) from January 2000 to May 2017. We detected 22 original research papers, trial protocols or trial registrations dealing with tDCS as an add-on intervention to cognitive or physiotherapeutic intervention. Overall, study samples are small; many studies are single-blinded and focus on feasibility and safety. There are two guideline papers setting basic requirements for clinical trials. Further research needs to focus on home-based treatment from different viewpoints, that is, safety, technical monitoring, reproducibility of repeated applications, feasibility of combined interventions and systematic assessment of efficacy, and safety in large randomized controlled clinical trials (RCTs). However, remotely controlled and supervised tDCS for home use represents a promising approach for widespread use of noninvasive brain stimulation (NIBS) in clinical care. © 2017 International Neuromodulation Society.

  3. National integration of mental health providers in VA home-based primary care: an innovative model for mental health care delivery with older adults.

    Science.gov (United States)

    Karlin, Bradley E; Karel, Michele J

    2014-10-01

    To promote mental health (MH) service access and quality for veterans with complex and chronic medical, social, and behavioral conditions, the U.S. Department of Veterans Affairs (VA) has integrated a full-time MH provider into each VA home-based primary care (HBPC) team. The goal of the current evaluation is to examine the nature and extent to which MH care processes and practices have been integrated into HBPC nationally. Separate surveys assessing the integration of a wide range of MH care practices and HBPC team processes were sent to MH providers and program directors in each HBPC program in 2010. A total of 132 MH providers representing 119 HBPC programs, and 112 program directors completed the surveys. The most common clinical issues addressed by MH providers were depression, coping with illness and disability, anxiety, caregiver/family stress, and cognitive evaluation. Other team members typically conducted initial MH screenings, with MH providers' time focusing on cases with identified needs. Approximately 40% of MH providers' time was devoted to direct clinical care. Significant time was also spent on team activities, driving, and charting. Integration of MH services into HBPC is feasible and facilitates service access for a vulnerable population. Mental health care delivery in HPBC generally involves a high degree of interdisciplinary practice. Mental health integration into HBPC may serve as a model for other systems interested in promoting MH care delivery among homebound and other older individuals. Published by Oxford University Press on behalf of The Gerontological Society of America 2013.

  4. Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring

    Directory of Open Access Journals (Sweden)

    Moro M

    2016-08-01

    Full Text Available Marilyn Moro,1 Balaji Goparaju,1 Jelina Castillo,1 Yvonne Alameddine,1 Matt T Bianchi1,2 1Neurology Department, Massachusetts General Hospital, 2Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Introduction: Periodic limb movements of sleep (PLMS may increase cardiovascular and cerebrovascular morbidity. However, most people with PLMS are either asymptomatic or have nonspecific symptoms. Therefore, predicting elevated PLMS in the absence of restless legs syndrome remains an important clinical challenge.Methods: We undertook a retrospective analysis of demographic data, subjective symptoms, and objective polysomnography (PSG findings in a clinical cohort with or without obstructive sleep apnea (OSA from our laboratory (n=443 with OSA, n=209 without OSA. Correlation analysis and regression modeling were performed to determine predictors of periodic limb movement index (PLMI. Markov decision analysis with TreeAge software compared strategies to detect PLMS: in-laboratory PSG, at-home testing, and a clinical prediction tool based on the regression analysis.Results: Elevated PLMI values (>15 per hour were observed in >25% of patients. PLMI values in No-OSA patients correlated with age, sex, self-reported nocturnal leg jerks, restless legs syndrome symptoms, and hypertension. In OSA patients, PLMI correlated only with age and self-reported psychiatric medications. Regression models indicated only a modest predictive value of demographics, symptoms, and clinical history. Decision modeling suggests that at-home testing is favored as the pretest probability of PLMS increases, given plausible assumptions regarding PLMS morbidity, costs, and assumed benefits of pharmacological therapy.Conclusion: Although elevated PLMI values were commonly observed, routinely acquired clinical information had only weak predictive utility. As the clinical importance of elevated PLMI continues to evolve, it is likely that objective measures such as PSG or

  5. Demand for Non-Alcoholic Beverages: Evidence From The ACNielsen Home Scan Panel

    OpenAIRE

    Pofahl, Geoffrey M.; Capps, Oral, Jr.; Annette L. Clauson

    2005-01-01

    Using the ACNielsen HomeScan Panel over the period 1998 to 2001 as the source of data, we entertain various demand systems, namely, the LA/AIDS, the AIDS, and the QUAIDS to investigate the demand for eight non-alcoholic beverages. Own-price, cross-price, and expenditure elasticities are obtained by year and by demand system for milk, bottled water, carbonated soft drinks, powdered soft drinks, coffee, tea, fruit juices and drinks, and isotonics. Emphasis is placed on the magnitude of price se...

  6. Pilot study of home-based delivery of HIV testing and counseling and contraceptive services to couples in Malawi.

    Science.gov (United States)

    Becker, Stan; Taulo, Frank O; Hindin, Michelle J; Chipeta, Effie K; Loll, Dana; Tsui, Amy

    2014-12-20

    HIV counseling and testing for couples is an important component of HIV prevention strategies, particularly in Sub Saharan Africa. The purpose of this pilot study is to estimate the uptake of couple HIV counseling and testing (CHCT) and couple family planning (CFP) services in a single home visit in peri-urban Malawi and to assess related factors. This study involved offering CHCT and CFP services to couples in their homes; 180 couples were sampled from households in a peri-urban area of Blantyre. Baseline data were collected from both partners and follow-up data were collected one week later. A pair of male and female counselors approached each partner separately about HIV testing and counseling and contraceptive services and then, if both consented, CHCT and CFP services (pills, condoms and referrals for other methods) were given. Bivariate and multivariate logistic regression analyses were done to examine the relationship between individual partner characteristics and acceptance of the services. Selected behaviors reported pre- and post-intervention, particularly couple reports on contraceptive use and condom use at last sex, were also tested for differences. 89% of couples accepted at least one of the services (58% CHCT-only, 29% CHCT + CFP, 2% CFP-only). Among women, prior testing experience (p contraceptive services to prevent the undesired consequences of sexually transmitted infection and unintended pregnancy via unprotected sex.

  7. Public–Private Collaboration in Health and Human Service Delivery: Evidence from Community Partnerships

    Science.gov (United States)

    Bazzoli, Gloria J.; Stein, Rebecca; Alexander, Jeffrey A.; Conrad, Douglas A.; Sofaer, Shoshanna; Shortell, Stephen M.

    1997-01-01

    The collaboration among public–private partnerships that applied to the Community Care Network (CCN) demonstration program of the Hospital Research and Educational Trust is examined. These partnerships link broad-based community coalitions with health and human service providers in efforts to improve community health and local service delivery. Although they willingly collaborated in identifying community health needs, coordinating services, and reporting to the community, partnership participants showed less alacrity in joining forces to reduce redundancy and increase efficiency. Such patterns suggest that organizations might best profit from working together on activities that maintain existing power relations and that have the potential to add prestige and attract new clients. Collaboration in these areas may be essential to building a foundation of trust that leads to future cooperation in more sensitive areas. PMID:9415091

  8. Convergence of Home-based Enterprises with Domestic Spaces: Evidence from Dhaka Neighborhoods

    Directory of Open Access Journals (Sweden)

    Sadia Afrin

    2017-09-01

    Full Text Available This research inspects the utilization of domestic space management in marginalized slums of Bangladesh towards comprehending the contribution of urban poor women’s informal employment as a private initiative. The components that influence the physical association of “home-based enterprises” (HBEs spaces and its quality are assessed concerning the survival pattern of the low-income occupants. Further, the neighborhood and housing attributes, cultural and social, and the financial status of individuals living in slums are analyzed by in-depth interviews with questionnaires. A stratified random sampling method was used to choose 44 households in two notable neighborhoods in Dhaka City. Data was elicited through focus groups of inhabitants using qualitative research method. Thus, structured and open-ended interviews were conducted with household female members who are 18 years and above while participant observation at moderate level ensured the trustworthiness of the data. The differences observed quality and features of spaces in those settlements inhabited by the slum dwellers gave insight on the factors. The study discovered the prospect of women’s domestic spaces of home-based work in their dwelling spaces. Thereafter, the research recommends that future interferences should counter critically to the event of participation and strife contributing towards uplifting women’s situation inside a specific dwelling.

  9. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach.

    Science.gov (United States)

    Amador, Sarah; Goodman, Claire; Mathie, Elspeth; Nicholson, Caroline

    2016-06-03

    In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their

  10. Does involvement of local NGOs enhance public service delivery? Cautionary evidence from a malaria-prevention program in India.

    Science.gov (United States)

    Das, Ashis; Friedman, Jed; Kandpal, Eeshani

    2018-01-01

    Partnerships between government and non-state actors that aim to enhance the quality or efficiency of service delivery are increasingly common in today's development policy landscape. We investigate the impacts of such an approach using data from an experimental supportive intervention to India's malaria control program that leveraged local non-state capacity in order to promote mosquito net usage and recommended fever care-seeking patterns. The supportive activities were conducted simultaneously by 3 NGOs, contracted out by the Indian government, in 2 endemic districts in the state of Odisha. We find that program impact significantly varied by location. Examining 3 potential sources of this variation (differential population characteristics, differential health worker characteristics, and differential implementer characteristics), we provide evidence that both population and NGO characteristics significantly affected the success of the program. Specifically, the results suggest that the quality and effort of the local implementer played a key role in the differential effectiveness. We discuss these findings as they relate to the external validity of development policy evaluations and, specifically, for the ability of health and other service delivery systems to benefit from limited non-state capacity in underresourced areas. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Advances in the psychosocial treatment of addiction: the role of technology in the delivery of evidence-based psychosocial treatment.

    Science.gov (United States)

    Marsch, Lisa A; Dallery, Jesse

    2012-06-01

    The clinical community has a growing array of psychosocial interventions with a strong evidence base available for the treatment of SUDs. Considerable opportunity exists for leveraging technology in the delivery of evidence-based interventions to promote widespread reach and impact of evidence-based care. Data from this line of research to date are promising, and underscore the potential public health impact of technology-based therapeutic tools. To fully realize the potential of technology-delivered interventions, several areas of inquiry remain important. First, scientifically sound strategies should be explored to ensure technology-based interventions are optimally designed to produce maximal behavior change. Second, efficient and effective methods should be identified to integrate technology-based interventions into systems of care in a manner that is most responsive to the needs of individual users. Third, payment, privacy, and regulatory systems should be refined and extended to go beyond electronic medical records and telehealth/distance care models, and support the deployment of technology-based systems to enhance the quality, efficiency and cost-effectiveness of care. Fourth, the mechanisms underlying behavior change derived from technology-based treatments should be explicated, including new mechanisms that may be tapped via novel, technology-based tools. Such work will be critical in isolating mechanisms that are useful in predicting treatment response, and in ensuring that key ingredients are present in technology-based interventions as they are made widely available.

  12. Partos domiciliares acidentais na região sul do Município de São Paulo Accidental home deliveries in southern São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Márcia Furquim de Almeida

    2005-06-01

    of fetal and early neonatal mortality and the determinants of accidental home deliveries. METHODS: A population-based case control study of fetal and early neonatal deaths was carried out in the southern area of São Paulo, Brazil. Data were collected through home interviews and hospital record reviews. The reasons reported by the mothers were obtained from interviews and risk factors for home delivery were obtained comparing home to hospital deliveries. Data were analyzed separately for fetal and early neonatal deaths and survivors. Odds ratios, 95% confidence intervals and Fisher's exact test were used in estimating risk factors and mortality risk. RESULTS: The 0.2% frequency of home deliveries was underestimated in the live births information system. After adjustment, it reached 0.4%, comparable to other urban areas in Europe. All home deliveries identified were accidental and were associated to an increased fetal and early neonatal mortality. Mothers' social conditions and pregnancy characteristics were associated to accidental home deliveries and these factors are different outcomes studied (fetal losses, early neonatal deaths and survivors. In 30%, mothers reported lack of available transportation to the hospital as a reason for home delivery. Failure of health services in identifying labor women and non-availability of emergency care contributed to accidental home deliveries. CONCLUSIONS: Though rare events in urban areas, accidental home deliveries should be of special concern to health services because they seem to be avoidable and imply in increased risk of death.

  13. Gestational Diabetes and Postpartum Physical Activity: Evidence of Lifestyle Change One Year After Delivery

    Science.gov (United States)

    Retnakaran, Ravi; Qi, Ying; Sermer, Mathew; Connelly, Philip W; Zinman, Bernard; Hanley, Anthony J

    2010-01-01

    Although women with gestational diabetes mellitus (GDM) are advised to incorporate physical activity into their lifestyle in order to reduce their risk of developing type 2 diabetes, it is recognized that new mothers face barriers to postpartum exercise. Thus, we sought to determine whether, following the diagnosis of GDM, women indeed alter their postpartum physical activity patterns, as compared to their peers without GDM. In this prospective observational cohort study, we assessed the physical activity patterns of 238 Caucasian women (58 with GDM, 180 without GDM) in the year prior to pregnancy and in the year following delivery, using the Baecke questionnaire, which evaluates the following 3 domains of physical activity: work, sport activity, and non-sport leisure-time activity. Prior to diagnosis with GDM, women reported lower pre-gravid sport (p=0.010) and leisure-time activity (p=0.013), compared to their peers without GDM. By 1-year postpartum, however, there were no longer significant differences between the GDM and non-GDM groups in either sport or leisure-time activity (p=0.078 and p=0.957, respectively). In particular, women with GDM significantly increased their leisure-time activity over the first year postpartum (F=10.1,p=0.002), whereas the non-GDM group did not (F=0.00,p=0.984). Indeed, on multiple linear regression analysis, GDM independently predicted an increase in leisure-time activity between 1-year pre-gravid and 1-year postpartum (t=2.55,p=0.012). Furthermore, this significant relationship persisted even after adjustment for the finding of pre-diabetes/diabetes at 3-months postpartum (t=2.83,p=0.005). In conclusion, women with GDM successfully increased their leisure-time activity in the first year postpartum, reflecting an element of lifestyle change following this diagnosis. PMID:19834473

  14. Gestational diabetes and postpartum physical activity: evidence of lifestyle change 1 year after delivery.

    Science.gov (United States)

    Retnakaran, Ravi; Qi, Ying; Sermer, Mathew; Connelly, Philip W; Zinman, Bernard; Hanley, Anthony J

    2010-07-01

    Although women with gestational diabetes mellitus (GDM) are advised to incorporate physical activity into their lifestyle in order to reduce their risk of developing type 2 diabetes (T2DM), it is recognized that new mothers face barriers to postpartum exercise. Thus, we sought to determine whether, following the diagnosis of GDM, women indeed alter their postpartum physical activity patterns, as compared to their peers without GDM. In this prospective observational cohort study, we assessed the physical activity patterns of 238 white women (58 with GDM, 180 without GDM) in the year before pregnancy and in the year following delivery, using the Baecke questionnaire, which evaluates the following three domains of physical activity: work, sport activity, and nonsport leisure-time activity. Before diagnosis with GDM, women reported lower pregravid sport (P = 0.010) and leisure-time activity (P = 0.013), compared to their peers without GDM. By 1 year postpartum, however, there were no longer significant differences between the GDM and non-GDM groups in either sport or leisure-time activity (P = 0.078 and P = 0.957, respectively). In particular, women with GDM significantly increased their leisure-time activity over the first year postpartum (F = 10.1, P = 0.002), whereas the non-GDM group did not (F = 0.00, P = 0.984). Indeed, on multiple linear regression analysis, GDM independently predicted an increase in leisure-time activity between 1 year pregravid and 1 year postpartum (t = 2.55, P = 0.012). Furthermore, this significant relationship persisted even after adjustment for the finding of prediabetes/diabetes at 3 months postpartum (t = 2.83, P = 0.005). In conclusion, women with GDM successfully increased their leisure-time activity in the first year postpartum, reflecting an element of lifestyle change following this diagnosis.

  15. Effective in-service training design and delivery: evidence from an integrative literature review.

    Science.gov (United States)

    Bluestone, Julia; Johnson, Peter; Fullerton, Judith; Carr, Catherine; Alderman, Jessica; BonTempo, James

    2013-10-01

    In-service training represents a significant financial investment for supporting continued competence of the health care workforce. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE. A literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. The initial review of titles and abstracts produced 244 results. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The articles analysed included 37 systematic reviews and 32 RCTs. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education. The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Settings similar to the workplace improved skill acquisition and performance. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved

  16. Acceptance and willingness to pay for solar home system: Survey evidence from northern area of Pakistan

    Directory of Open Access Journals (Sweden)

    Abdullah

    2017-11-01

    Full Text Available The importance of solar energy has been accepted worldwide for the generation of electricity, but unfortunately, Pakistan has yet to exert efforts on the development of this source of energy. The purpose of this research is to explore the public acceptance and interest in solar home system (SHS. Moreover, the expectations of the public towards SHS development in Pakistan and the difficulties they face in SHS usage are identified. The result of the survey indicates that about 81% of the respondents show higher interest in SHS. However, many respondents claim that some hindrances obstruct them from using SHS which includes; high cost of solar panels, lack of information and trust on solar panel providers. Almost 60% of the respondents expect that government provision of incentives could be the best way to boost the usage of SHS countrywide. For the successful implementation of new SHS policy, the government of Pakistan needs to establish solar power plants, increase installation of solar panels, provides funding and full information for conducting independent research. In addition, almost 90% of the respondents believe that government should take the lead in developing the SHS sector. Therefore, this study provides some valuable references for SHS promotion in Pakistan.

  17. Home-Based Multidisciplinary Rehabilitation following Hip Fracture Surgery: What Is the Evidence?

    Directory of Open Access Journals (Sweden)

    Kathleen Donohue

    2013-01-01

    Full Text Available Objective. To determine the effects of multidisciplinary home rehabilitation (MHR on functional and quality of life (QOL outcomes following hip fracture surgery. Methods. Systematic review methodology suggested by Cochrane Collboration was adopted. Reviewers independently searched the literature, selected the studies, extracted data, and performed critical appraisal of studies. Summary of the results of included studies was provided. Results. Five studies were included. Over the short-term, functional status and lower extremity strength were better in the MHR group compared to the no treatment group (NT. Over the long-term, the MHR group showed greater improvements in balance confidence, functional status, and lower extremity muscle strength compared to NT group, whereas the effect on QOL and mobility was inconsistent across the studies. Several methodological issues related to study design were noted across the studies. Conclusion. The MHR was found to be more effective compared to the NT in improving functional status and lower extremity strength in patients with hip fracture surgery. Results of this review do not make a strong case for MHR due to high risk of bias in the included studies. Further research is required to accurately characterize the types of disciplines involved in MHR and frequency and dosage of intervention.

  18. Eating out of home and its association with dietary intake: a systematic review of the evidence.

    Science.gov (United States)

    Lachat, C; Nago, E; Verstraeten, R; Roberfroid, D; Van Camp, J; Kolsteren, P

    2012-04-01

    During the last decades, eating out of home (OH) has gained importance in the diets worldwide. We document the nutritional characteristics of eating OH and its associations with energy intake, dietary quality and socioeconomic status. We carried out a systematic review of peer-reviewed studies in eight databases up to 10 March 2011. Of the 7,319 studies retrieved, 29 met the inclusion criteria and were analysed in this review. The quality of the data was assessed and a sensitivity analysis was conducted by isolating nationally representative or large cohort data from 6 and 11 countries, respectively. OH foods were important sources of energy in all age groups and their energy contribution increased in adolescents and young adults. Eating OH was associated with a higher total energy intake, energy contribution from fat in the daily diet and higher socioeconomic status. Two large studies showed how eating OH was also associated with a lower intake of micronutrients, particularly vitamin C, Ca and Fe. Although the studies were cross-sectional and heterogeneous in the way they classified eating OH, we conclude that eating OH is a risk factor for higher energy and fat intake and lower micronutrient intake. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

  19. Treatment of peritoneal carcinomatosis by targeted delivery of the radio-labeled tumor homing peptide bi-DTPA-[F3]2 into the nucleus of tumor cells.

    Science.gov (United States)

    Drecoll, Enken; Gaertner, Florian C; Miederer, Matthias; Blechert, Birgit; Vallon, Mario; Müller, Jan M; Alke, Andrea; Seidl, Christof; Bruchertseifer, Frank; Morgenstern, Alfred; Senekowitsch-Schmidtke, Reingard; Essler, Markus

    2009-05-27

    Alpha-particle emitting isotopes are effective novel tools in cancer therapy, but targeted delivery into tumors is a prerequisite of their application to avoid toxic side effects. Peritoneal carcinomatosis is a widespread dissemination of tumors throughout the peritoneal cavity. As peritoneal carcinomatosis is fatal in most cases, novel therapies are needed. F3 is a tumor homing peptide which is internalized into the nucleus of tumor cells upon binding to nucleolin on the cell surface. Therefore, F3 may be an appropriate carrier for alpha-particle emitting isotopes facilitating selective tumor therapies. A dimer of the vascular tumor homing peptide F3 was chemically coupled to the alpha-emitter (213)Bi ((213)Bi-DTPA-[F3](2)). We found (213)Bi-DTPA-[F3](2) to accumulate in the nucleus of tumor cells in vitro and in intraperitoneally growing tumors in vivo. To study the anti-tumor activity of (213)Bi-DTPA-[F3](2) we treated mice bearing intraperitoneally growing xenograft tumors with (213)Bi-DTPA-[F3](2). In a tumor prevention study between the days 4-14 after inoculation of tumor cells 6x1.85 MBq (50 microCi) of (213)Bi-DTPA-[F3](2) were injected. In a tumor reduction study between the days 16-26 after inoculation of tumor cells 6x1.85 MBq of (213)Bi-DTPA-[F3](2) were injected. The survival time of the animals was increased from 51 to 93.5 days in the prevention study and from 57 days to 78 days in the tumor reduction study. No toxicity of the treatment was observed. In bio-distribution studies we found (213)Bi-DTPA-[F3](2) to accumulate in tumors but only low activities were found in control organs except for the kidneys, where (213)Bi-DTPA-[F3](2) is found due to renal excretion. In conclusion we report that (213)Bi-DTPA-[F3](2) is a novel tool for the targeted delivery of alpha-emitters into the nucleus of tumor cells that effectively controls peritoneal carcinomatosis in preclinical models and may also be useful in oncology.

  20. Relationship between home fruit and vegetable availability and infant and maternal dietary intake in African-American families: evidence from the exhaustive home food inventory.

    Science.gov (United States)

    Bryant, Maria; Stevens, June; Wang, Lily; Tabak, Rachel; Borja, Judith; Bentley, Margaret E

    2011-10-01

    The availability of foods in the home is likely to be related to consumption. We know of no studies that have reported this association in African-American participants, and few studies have examined home food availability using objective methods. This study aimed to assess the association between objective measures of fruits and vegetables in the home with reported infant and maternal diet in low-income African Americans. A cross-sectional study design was used to compare food availability and dietary intake. The Exhaustive Home Food Availability Inventory used barcode scanning to measure food availability in the home. Maternal and infant diet was assessed by 24-hour recall. Eighty African-American first-time mother/infant dyads were recruited from Wake and Durham counties in North Carolina. Adjusted mean dietary intake of infants and mothers was calculated within tertiles of food and nutrient availability using analysis of variance. The bootstrap method was used to estimate P values and 95% confidence intervals. Models were adjusted for mother's age, household size, shopping and eating-out behavior. Infants and mothers living in homes in the highest tertile of availability of energy, nutrients, and fruits and vegetables tended to have the highest consumption, respectively; however, statistically significant associations were more likely to occur with infant diet than maternal diet. The relationship was strongest for infant consumption of fruit, with an average of 103.3 g consumed by infants who lived in homes in the highest tertile of availability, compared to 42.5 g in those living in homes in the lowest tertile (Phome was associated with intake of those foods in a sample of African-American mothers and infants. Results support making changes in the home environment as a method of promoting changes in fruit and vegetable intake. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

  1. Becoming a parent to a child with birth asphyxia—From a traumatic delivery to living with the experience at home

    Directory of Open Access Journals (Sweden)

    Alina Heringhaus

    2013-04-01

    Full Text Available The aim of this study is to describe the experiences of becoming a parent to a child with birth asphyxia treated with hypothermia in the neonatal intensive care unit (NICU. In line with the medical advances, the survival of critically ill infants with increased risk of morbidity is increasing. Children who survive birth asphyxia are at a higher risk of functional impairments, cerebral palsy (CP, or impaired vision and hearing. Since 2006, hypothermia treatment following birth asphyxia is used in many of the Swedish neonatal units to reduce the risk of brain injury. To date, research on the experience of parenthood of the child with birth asphyxia is sparse. To improve today's neonatal care delivery, health-care providers need to better understand the experiences of becoming a parent to a child with birth asphyxia. A total of 26 parents of 16 children with birth asphyxia treated with hypothermia in a Swedish NICU were interviewed. The transcribed interview texts were analysed according to a qualitative latent content analysis. We found that the experience of becoming a parent to a child with birth asphyxia treated with hypothermia at the NICU was a strenuous journey of overriding an emotional rollercoaster, that is, from being thrown into a chaotic situation which started with a traumatic delivery to later processing the difficult situation of believing the child might not survive or was to be seriously affected by the asphyxia. The prolonged parent–infant separation due to the hypothermia treatment and parents’ fear of touching the infant because of the high-tech equipment seemed to hamper the parent–infant bonding. The adaption of the everyday life at home seemed to be facilitated by the follow-up information of the doctor after discharge. The results of this study underline the importance of family-centered support during and also after the NICU discharge.

  2. Local understandings of care during delivery and postnatal period to inform home based package of newborn care interventions in rural Ethiopia: a qualitative study.

    Science.gov (United States)

    Degefie, Tedbabe; Amare, Yared; Mulligan, Brian

    2014-05-19

    Despite a substantial decrease in child mortality in Ethiopia over the past decade, neonatal mortality remains unchanged (37/1000 live-births). This paper describes a qualitative study on beliefs and practices on immediate newborn and postnatal care in four rural communities of Ethiopia conducted to inform development of a package of community-based interventions targeting newborns. The study team conducted eight key informant interviews (KII) with grandmothers, 27 in-depth interviews (IDI) with mothers; seven IDI with traditional birth attendants (TBA) and 15IDI with fathers, from four purposively selected communities located in Sidama Zone of Southern Nationalities, Nations, and Peoples (SNNP) Region and in East Shewa and West Arsi Zones of Oromia Region. In the study communities deliveries occurred at home. After cutting the umbilical cord, the baby is put to the side of the mother, not uncommonly with no cloth covering. This is largely due to attendants focusing on delivery of the placenta which is reinforced by the belief that the placenta is the 'house' or 'blanket' of the baby and that any "harm" caused to the placenta will transfer to the newborn. Applying butter or ointment to the cord "to speed drying" is common practice. Initiation of breastfeeding is often delayed and women commonly report discarding colostrum before initiating breastfeeding. Sub-optimal breastfeeding practices continue, due to perceived inadequate maternal nutrition and breast milk often leading to the provision of herbal drinks. Poor thermal care is also demonstrated through lack of continued skin-to-skin contact, exposure of newborns to smoke, frequent bathing-often with cold water baths for low-birth weight or small babies; and, poor hygienic practices are reported, particularly hand washing prior to contact with the newborn. Cultural beliefs and newborn care practices do not conform to recommended standards. Local perspectives related to newborn care practices should inform

  3. Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory.

    Science.gov (United States)

    Nilsen, Per; Wallerstedt, Birgitta; Behm, Lina; Ahlström, Gerd

    2018-01-04

    Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes. Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care. Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff's beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff's competence and confidence, motivation, and attitudes to work in general, as well as the managers' plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care. There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff's change efficacy

  4. Homing of invasive Burmese pythons in South Florida: evidence for map and compass senses in snakes

    Science.gov (United States)

    Pittman, Shannon E.; Hart, Kristen M.; Cherkiss, Michael S.; Snow, Ray W.; Fujisaki, Ikuko; Smith, Brian J.; Mazzotti, Frank J.; Dorcas, Michael E.

    2014-01-01

    Navigational ability is a critical component of an animal's spatial ecology and may influence the invasive potential of species. Burmese pythons (Python molurus bivittatus) are apex predators invasive to South Florida. We tracked the movements of 12 adult Burmese pythons in Everglades National Park, six of which were translocated 21–36 km from their capture locations. Translocated snakes oriented movement homeward relative to the capture location, and five of six snakes returned to within 5 km of the original capture location. Translocated snakes moved straighter and faster than control snakes and displayed movement path structure indicative of oriented movement. This study provides evidence that Burmese pythons have navigational map and compass senses and has implications for predictions of spatial spread and impacts as well as our understanding of reptile cognitive abilities. PMID:24647727

  5. Neighborhood and home food environment and Children’s diet and obesity: Evidence from Military Personnel’s Installation Assignment

    Science.gov (United States)

    Nicosia, Nancy; Datar, Ashlesha

    2016-01-01

    Research and policy initiatives are increasingly focused on the role of neighborhood food environment in children’s diet and obesity. However, existing evidence relies on observational data that is limited by neighborhood selection bias. The Military Teenagers’ Environments, Exercise, and Nutrition Study (M-TEENS) leverages the quasi-random variation in neighborhood environment generated by military personnel’s assignment to installations to examine whether neighborhood food environments are associated with children’s dietary behaviors and BMI. Our results suggest that neither the actual nor the perceived availability of particular food outlets in the neighborhood is associated with children’s diet or BMI. The availability of supermarkets and convenience stores in the neighborhood was not associated with where families shop for food or children’s dietary behaviors. Further, the type of store that families shop at was not associated with the healthiness of food available at home. Similarly, availability of fast food and restaurants was unrelated to children’s dietary behaviors or how often children eat fast food or restaurant meals. However, the healthiness of food available at home was associated with healthy dietary behaviors while eating at fast food outlets and restaurants were associated with unhealthy dietary behaviors in children. Further, parental supervision, including limits on snack foods and meals eaten as a family, was associated with dietary behaviors. These findings suggest that focusing only on the neighborhood food environment may ignore important factors that influence children’s outcomes. Future research should also consider how families make decisions about what foods to purchase, where to shop for foods and eating out, how closely to monitor their children’s food intake, and, ultimately how these decisions collectively impact children’s outcomes. PMID:27135542

  6. Examining externalizing behavior trajectories of youth in group homes: is there evidence for peer contagion?

    Science.gov (United States)

    Lee, Bethany R; Thompson, Ron

    2009-01-01

    Although concerns about peer contagion are often cited in critiques of group treatments for troubled youths, few studies have examined the effects of exposure to deviant peers in residential group care settings. This study used administrative data of youth served at Boys Town, a nationally-known group care provider. Using latent class growth analysis, this study identified the externalizing behavior trajectories of youth in group care as well as the behavior trajectory of the peers with whom they lived, assessed the relationship between youth trajectory classes and individual and peer group characteristics as well as the relationship between an individual youth's behavior pattern and the behavior pattern of proximal peers. Several results suggested the presence of peer contagion in group care: a trajectory class of gradually increasing externalizing behavior problems, the strength of deviant peer density in predicting an individual youth's externalizing behavior trajectories and significant associations between behavior patterns of youth and proximal peers. While there is some evidence that suggests an increase in problem behavior during care, results from this study indicated that over 90% of the youth did not have an increase in problem behaviors and that positive peer influences may also be protective and inhibit problem behaviors.

  7. Evidence Molded by Contact with Staff Culture and Patient Milieu: An Analysis of the Social Process of Knowledge Utilization in Nursing Homes

    Science.gov (United States)

    Øye, Christine; Mekki, Tone Elin; Skaar, Randi; Dahl, Hellen; Forland, Oddvar; Jacobsen, Frode F.

    2015-01-01

    Knowledge utilization is politically "hot" because it informs decisions on improving the quality of care in nursing homes (NHs). The difficulties encountered in implementing evidence-based knowledge into practice may be explained by contextual factors. Contextual factors are crucial to understanding the process of knowledge utilization;…

  8. Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

    Science.gov (United States)

    McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

    2012-04-01

    In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering

  9. Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference?

    Directory of Open Access Journals (Sweden)

    Raîche Michel

    2011-10-01

    Full Text Available Abstract Background The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community. Methods Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF. We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study. Results On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08 of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r2 = 0.25; p Conclusions In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.

  10. Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone.

    Science.gov (United States)

    McKinnon, Britt; Harper, Sam; Kaufman, Jay S

    2015-06-01

    Coverage of skilled delivery care has been increasing across most low-income countries; however, it remains far from universal and is very unequally distributed according to socioeconomic position. In an effort to increase coverage of skilled delivery care and reduce socioeconomic inequalities, governments of several countries in sub-Saharan Africa have recently adopted policies that remove user fees for facility-based delivery services. There is little rigorous evidence of the impact of these policies and few studies have examined effects on socioeconomic inequalities. This study investigates the impact of recent delivery fee exemption policies in Ghana, Senegal, and Sierra Leone on socioeconomic differences in the use of facility-based delivery services. Using Demographic and Health Survey data from nine sub-Saharan African countries, we evaluated the user fee policy changes using a difference-in-differences approach that accounts for underlying common secular trends and time invariant differences among countries, and allows for differential effects of the policy by socioeconomic position. Removing user fees was consistent with meaningful increases in facility deliveries across all categories of household wealth and maternal education. We found little evidence of differential effects of removing user fees across quartiles of household wealth, with increases of 5.4 facility deliveries per hundred live births (95% CI: 2.1, 8.8) among women in the poorest quartile and 6.8 per hundred live births (95% CI: 4.0, 9.7) for women in the richest quartile. However, our results suggest that educated women benefited more from removing user fees compared to women with no education. For women with at least some secondary education, the estimated effect was 8.6 facility deliveries per hundred live births (95% CI: 5.4, 11.9), but only 4.6 per hundred live births (95% CI: 2.2, 7.0) for women with no education (heterogeneity p-value = 0.04). Thus, while removing fees at the point

  11. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach

    Directory of Open Access Journals (Sweden)

    Sarah Amador

    2016-06-01

    Full Text Available In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i identity mobilisation and (ii context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care

  12. Child Temperament and Home-Based Parent Involvement at Kindergarten Entry: Evidence from a Low-Income, Urban Sample

    Science.gov (United States)

    Han, Jinjoo; O'Connor, Erin E.; McCormick, Meghan P.; McClowry, Sandee G.

    2017-01-01

    Research Findings: Home-based involvement--defined as the actions parents take to promote children's learning outside of school--is often the most efficient way for low-income parents to be involved with their children's education. However, there is limited research examining the factors predicting home-based involvement at kindergarten entry for…

  13. What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence.

    Science.gov (United States)

    Buswell, Marina; Goodman, Claire; Roe, Brenda; Russell, Bridget; Norton, Christine; Harwood, Rowan; Fader, Mandy; Harari, Danielle; Drennan, Vari M; Malone, Jo Rycroft; Madden, Michelle; Bunn, Frances

    2017-09-01

    The prevalence of fecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. Using realist synthesis, 6 potential program theories of what should work were identified. These addressed clinician-led support, assessment, and review; the contribution of teaching and support for care home staff on how to reduce and manage FI; addressing the causes and prevention of constipation; how cognitive and physical capacity of the resident affects outcomes; how the potential for recovery, reduction, and management of FI is understood by those involved; and how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Dementia was a known risk factor for fecal incontinence (FI), but how it affected uptake of different interventions or the dementia specific continence and toileting skills staff require, were not addressed in the literature. There was a lack of dementia-specific evidence on continence aids. Most care home residents with FI will be doubly incontinent; there is, therefore, limited value in focusing solely on FI or single causes, such as constipation. Medical and nursing support for continence care is an important resource, but it is unhelpful to create a distinction between what is continence care and what is personal or intimate care. Prompted toileting is an approach that may be particularly beneficial for some residents. Valuing the intimate and personal care work unqualified and junior staff provide to people living with dementia and reinforcement of good practice in ways that are meaningful to this workforce are important clinician-led activities. Providing dementia-sensitive continence care within the daily work routines of care homes is key to helping to reduce and manage FI for this population. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by

  14. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

    National Research Council Canada - National Science Library

    Seims, La Rue K; Alegre, Juan Carlos; Murei, Lily; Bragar, Joan; Thatte, Nandita; Kibunga, Peter; Cheburet, Sammuel

    2012-01-01

    The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes...

  15. Predictors of children's secondhand smoke exposure at home: a systematic review and narrative synthesis of the evidence.

    Directory of Open Access Journals (Sweden)

    Sophie Orton

    Full Text Available Children's exposure to secondhand smoke (SHS has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children's SHS exposure in the home.To identify by systematic review, the factors which are associated with children's SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter.Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted.Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children's SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS.Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial.

  16. Do You Really Expect Me to Get MST Care in a VA Where Everyone Is Male Innovative Delivery of Evidence Based Psychotherapy to Women with Military Sexual Trauma

    Science.gov (United States)

    2017-08-01

    Based Psychotherapy to Women with Military Sexual Trauma PRINCIPAL INVESTIGATOR: Ronald Acierno, PhD CONTRACTING ORGANIZATION: Medical University of...Where Everyone Is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma 5a.  CONTRACT  NUMBER   5b.  GRANT...Veterans with Military Sexual Trauma (MST) related PTSD using videoconferencing technology, which allows a therapist and patient, who are at great

  17. The prevalence of disrespect and abuse during facility-based maternity care in Malawi: evidence from direct observations of labor and delivery.

    Science.gov (United States)

    Sethi, Reena; Gupta, Shivam; Oseni, Lolade; Mtimuni, Angella; Rashidi, Tambudzai; Kachale, Fannie

    2017-09-06

    There is increasing evidence throughout the world that the negative treatment of pregnant women during labor and delivery can be a barrier to seeking skilled maternity care. At this time, there has been little quantitative evidence published on disrespect and abuse (D&A) in Malawi. The objective of this research is to describe the prevalence of disrespect and abuse during labor and delivery through the secondary analysis of direct clinical observations and to describe the association between the observation of D&A items with the place of delivery and client background characteristics. As part of the evaluation of the Helping Babies Breathe intervention, direct observations of labor and delivery were conducted in August 2013 from 27 out of the 28 districts in Malawi. Frequencies of disrespect and abuse items organized around the Bowser and Hill categories of disrespect and abuse and presented in the White Ribbon Alliance's Universal Rights of Childbearing Women Framework were calculated. Bivariate analysis was done to assess the association between selected client background characteristics and the place of delivery with the disrespect and use during childbirth. A total of 2109 observations were made across 40 facilities (12 health centers and 28 hospitals) in Malawi. The results showed that while women were frequently greeted respectfully (13.9% were not), they were often not encouraged to ask the health provider questions (73.1%), were not given privacy (58.2%) and were not encouraged to have a support person present with them (83.2%). Results from the bivariate analysis did not show a consistent relationship between place of delivery and D&A items, where the odds of being shouted at was lower in a health center when compared to a hospital (OR: 0.19; CI: 0.59-0.62) while there was a higher odds of clients not being asked if they have any concerns if they were in a health center when compared to a hospital (OR: 2.40; CI: 1.06-5.44). Women who were HIV+ had

  18. Analysing the importance of older people's resources for the use of home care in a cash-for-care scheme: evidence from Vienna.

    Science.gov (United States)

    Schmidt, Andrea E

    2017-03-01

    Older people of lower socioeconomic status (SES) are disproportionately affected by chronic conditions, yet less able to compensate health limitations through use of formal long-term care (LTC) at home, a preferred type of care for most. Some, like older women and single people, are particularly vulnerable. Under the Austrian public cash-for-care scheme, which aims to incentivise care at home and empowerment of LTC users, this study analyses: (i) interdependencies between SES, gender and 'informal' or family care, and (ii) how these factors associate with the use of old age formal home care in Vienna. An adaptation of Arber and Ginn's theory is used to identify material resources (income), health resources (care needs) and informal caring resources (co-residence and/or availability of family care). Gender aspects are also considered as a persistent source of inequalities. Administrative and survey data, collected by public authorities between 2010 and 2012 in Vienna, serve to compare home care use in old age (60+) to other support forms (residential and informal care) using logistic regression analysis. Results show a pro-rich bias in home care use among single-living people, with high-income single people being less likely to move to a care home, while there are no significant income differences present for non-singles. Second, traditional gender roles are salient: female care recipients co-residing with a partner are more likely to use formal care than men, reflecting that men's traditional gender roles involve less unpaid care work than women's. In conclusion, in an urban setting, the Austrian cash-for-care scheme is likely to reinforce stratifications along gender and class, thus implementing the general policy objective of care at home, but more likely for those with higher income. A support mechanism promoting empowerment among all older people might contribute to unequal degrees of choice, especially for those with fewer resources to manage their way through

  19. Home-based malaria management in children by women: Evidence from a malaria endemic community in sub-Saharan Africa

    OpenAIRE

    Doreen Nkiru Eugene-Ezebilo; Eugene Ejike Ezebilo

    2015-01-01

    Objective: To examine the medicines and dosage that mothers who engage in home-based malaria management administer to children aged ≤ 5 years having signs and symptoms associated with malaria and to discuss the possibilities of designing an effective home-based malaria management strategy. Methods: The data were obtained from face-to-face semi-structured interviews conducted with mothers in the Ugbowo Community of Benin City, Nigeria who were selected using multi-stage systematic random s...

  20. PLGA-soya lecithin based micelles for enhanced delivery of methotrexate: Cellular uptake, cytotoxic and pharmacokinetic evidences.

    Science.gov (United States)

    Singh, Anupama; Thotakura, Nagarani; Kumar, Rajendra; Singh, Bhupinder; Sharma, Gajanand; Katare, Om Prakash; Raza, Kaisar

    2017-02-01

    Biocompatible and biodegradable polymers like PLGA have revolutionized the drug delivery approaches. However, poor drug loading and substantially high lipophilicity, pave a path for further tailing of this promising agent. In this regard, PLGA was feathered with biocompatible phospholipid and polymeric micelles were developed for delivery of Methotrexate (MTX) to cancer cells. The nanocarriers (114.6nm±5.5nm) enhanced the cytotoxicity of MTX by 2.13 folds on MDA-MB-231 cells. Confocal laser scanning microscopy confirmed the increased intracellular delivery. The carrier decreased the protein binding potential and enhanced the bioavailable fraction of MTX. Pharmacokinetic studies vouched substantial enhancement in AUC and bioresidence time, promising an ideal carrier to effectively deliver the drug to the site of action. The developed nanocarriers offer potential to deliver the drug in the interiors of cancer cells in an effective manner for improved therapeutic action. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Evidence on the validity and reliability of the German, French and Italian nursing home version of the Basel Extent of Rationing of Nursing Care instrument.

    Science.gov (United States)

    Zúñiga, Franziska; Schubert, Maria; Hamers, Jan P H; Simon, Michael; Schwendimann, René; Engberg, Sandra; Ausserhofer, Dietmar

    2016-08-01

    To develop and test psychometrically the Basel Extent of Rationing of Nursing Care for Nursing Homes instrument, providing initial evidence on the validity and reliability of the German, French and Italian-language versions. In the hospital setting, implicit rationing of nursing care is defined as the withholding of nursing activities due to lack of resources, such as staffing or time. No instrument existed to measure this concept in nursing homes. Cross-sectional study. We developed the instrument in three phases: (1) adaption and translation; (2) content validity testing; and (3) initial validity and reliability testing. For phase 3, we analysed survey data from 4748 care workers collected between May 2012-April 2013 from a randomly selected sample of 162 nursing homes in the German-, French- and Italian-speaking regions of Switzerland to provide evidence from response processes (e.g. missing), internal structure (exploratory factor analysis), inter-item inconsistencies (e.g. Cronbach's alpha) and interscorer differences (e.g. within-group agreement). Exploratory factor analysis revealed a four-factor structure with good fit statistics. Rationing of nursing care was structured in four domains: (1) activities of daily living; (2) caring, rehabilitation and monitoring; (3) documentation; and (4) social care. Items of the social care subscale showed lower content validity and more missing values than items of other subscales. First evidence indicates that the new instrument can be recommended for research and practice to measure implicit rationing of nursing care in nursing homes. Further refinements of single items are needed. © 2016 John Wiley & Sons Ltd.

  2. End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale.

    Science.gov (United States)

    Sánchez-García, María Remedios; Gutiérrez-Romero, Jose Antonio; Fernández-Alcántara, Manuel; Hueso-Montoro, César; Goodman, Claire; Montoya-Juárez, Rafael

    2017-10-01

    Quality end-of-life care is a central issue in nursing homes, requiring the assessment of individual and family needs by health professionals. Although previous instruments have been developed, they usually rely on family reports and have been adapted from other clinical contexts (hospital or primary care). It is important to consider how health care professionals working in nursing homes perceive what is necessary to achieve quality end-of-life care. In this study, the objective was to develop an instrument to assess quality of end-of-life care in the context of Spanish care homes. A 24 item scale Nursing Home End of Life Care Scale (NHEOLC) was developed through a systematic evaluation of existing tools combined with an iterative process of consultation with group experts in end of life care in long term care settings. A total of 307 health care professionals agreed to participate in the study and completed the scale. The scale was grouped in six dimensions: physical, psychological aspects and spiritual aspects of care, family care, bereavement, and patient/family preferences management. The results suggest an adequate factorial structure of the scale and good internal consistency for the total score and the subscales. In addition, the results showed significant differences depending on the size of the nursing home, the category of health professionals, and their own perceptions of his work regarding end-of-life care. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

    Directory of Open Access Journals (Sweden)

    Chi-Ling Joanna Sinn

    2017-11-01

    Full Text Available Abstract Background Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. Methods The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. Results The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. Conclusions The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

  4. Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

    Science.gov (United States)

    Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

    2017-11-25

    Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

  5. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries.

    Directory of Open Access Journals (Sweden)

    Angela Dawson

    Full Text Available Emergency contraception pills (ECP are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP.A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013 from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping.Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs.There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.

  6. Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries.

    Science.gov (United States)

    Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

    2014-01-01

    Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.

  7. Snails home

    Science.gov (United States)

    Dunstan, D. J.; Hodgson, D. J.

    2014-06-01

    Many gardeners and horticulturalists seek non-chemical methods to control populations of snails. It has frequently been reported that snails that are marked and removed from a garden are later found in the garden again. This phenomenon is often cited as evidence for a homing instinct. We report a systematic study of the snail population in a small suburban garden, in which large numbers of snails were marked and removed over a period of about 6 months. While many returned, inferring a homing instinct from this evidence requires statistical modelling. Monte Carlo techniques demonstrate that movements of snails are better explained by drift under the influence of a homing instinct than by random diffusion. Maximum likelihood techniques infer the existence of two groups of snails in the garden: members of a larger population that show little affinity to the garden itself, and core members of a local garden population that regularly return to their home if removed. The data are strongly suggestive of a homing instinct, but also reveal that snail-throwing can work as a pest management strategy.

  8. Home-based malaria management in children by women: Evidence from a malaria endemic community in sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Doreen Nkiru Eugene-Ezebilo

    2015-07-01

    Full Text Available Objective: To examine the medicines and dosage that mothers who engage in home-based malaria management administer to children aged ≤ 5 years having signs and symptoms associated with malaria and to discuss the possibilities of designing an effective home-based malaria management strategy. Methods: The data were obtained from face-to-face semi-structured interviews conducted with mothers in the Ugbowo Community of Benin City, Nigeria who were selected using multistage systematic random sampling technique. The data were analyzed by qualitative content analysis, arithmetic mean, simple percentages and bar chart. Results: Approximately 90% of the interviewees engaged in home-based malaria management and 10% patronized the hospital. Most of the interviewees who engaged in home-based malaria management administered medicines that stimulates the production of red blood cells and supplies vitamins to children having signs and symptoms of malaria, followed by painkillers and anti-malaria and cough medicine was the least. Of the anti-malaria medicines administered to children, almost 80% of the interviewees administered chloroquine to children, 15% quinine and 3% halfan. Approximately 60% of the interviewees had the correct knowledge of the dosage regime for chloroquine, 38% for quinine and 9% for halfan. Conclusions: Although home-based malaria management is important, it cannot serve as a substitute to the hospital. Some diseases have signs and symptoms that are similar to that of malaria which implies that administering anti-malaria medicines to a child without confirmatory tests might lead to irredeemable complications in that child. If the strategy is to make home-based malaria management effective and sustainable mothers, community health officials should be involved in designing the strategy. Simple rapid diagnostic test kits for malaria should be made available to community health officials and pharmacists so that confirmatory tests could be

  9. Determinants of institutional delivery among young married women in Nepal: Evidence from the Nepal Demographic and Health Survey, 2011.

    Science.gov (United States)

    Shahabuddin, Asm; De Brouwere, Vincent; Adhikari, Ramesh; Delamou, Alexandre; Bardaj, Azucena; Delvaux, Therese

    2017-04-13

    To identify the determinants of institutional delivery among young married women in Nepal. Nepal Demographic and Health Survey (NDHS) data sets 2011 were analysed. Bivariate and multivariate logistic regression analyses were performed using a subset of 1662 ever-married young women (aged 15-24 years). Place of delivery. The rate of institutional delivery among young married women was 46%, which is higher than the national average (35%) among all women of reproductive age. Young women who had more than four antenatal care (ANC) visits were three times more likely to deliver in a health institution compared with women who had no antenatal care visit (OR: 3.05; 95% CI: 2.40 to 3.87). The probability of delivering in an institution was 69% higher among young urban women than among young women who lived in rural areas. Young women who had secondary or above secondary level education were 1.63 times more likely to choose institutional delivery than young women who had no formal education (OR: 1.626; 95% CI: 1.171 to 2.258). Lower use of a health institution for delivery was also observed among poor young women. Results showed that wealthy young women were 2.12 times more likely to deliver their child in an institution compared with poor young women (OR: 2.107; 95% CI: 1.53 to 2.898). Other factors such as the age of the young woman, religion, ethnicity, and ecological zone were also associated with institutional delivery. Maternal health programs should be designed to encourage young women to receive adequate ANC (at least four visits). Moreover, health programs should target poor, less educated, rural, young women who live in mountain regions, are of Janajati ethnicity and have at least one child as such women are less likely to choose institutional delivery in Nepal. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Enriching Preschool Classrooms and Home Visits with Evidence-Based Programming: Sustained Benefits for Low-Income Children

    Science.gov (United States)

    Bierman, Karen L.; Heinrichs, Brenda S.; Welsh, Janet A.; Nix, Robert L.; Gest, Scott D.

    2017-01-01

    Background: Growing up in poverty undermines healthy development, producing disparities in the cognitive and social-emotional skills that support early learning and mental health. Preschool and home-visiting interventions for low-income children have the potential to build early cognitive and social-emotional skills, reducing the disparities in…

  11. Location Planning Problem of Service Centers for Sustainable Home Healthcare: Evidence from the Empirical Analysis of Shanghai

    Directory of Open Access Journals (Sweden)

    Gang Du

    2015-11-01

    Full Text Available It is of theoretical and practical significance to understand what factors influence the sustainable development of home healthcare services in China. Based on a face-to-face survey, we find that the location planning, which is decisive for the improvement of patient satisfaction, can effectively reduce the risks, as well as the costs of redundant construction and re-construction of service centers for home healthcare and, thus, helps ensure the sustainability of health and the environment. The purposes of this paper are to investigate the existing problem of home healthcare in Shanghai and to find the optimum location planning scheme under several realistic constraints. By considering differentiated services provided by the medical staff at different levels and the degrees of patient satisfaction, a mixed integer programming model is built to minimize the total medical cost. The IBM ILOGCPLEX is used to solve the above model. Finally, a case study of Putuo district in Shanghai is conducted to validate the proposed model and methodology. Results indicate that the model used in this paper can effectively reduce the total medical cost and enhance the medical sustainability, and therefore, the results of the model can be used as a reference for decision makers on the location planning problem of home healthcare services in China.

  12. Characteristics of Quality Improvement Champions in Nursing Homes: A Systematic Review With Implications for Evidence-Based Practice.

    Science.gov (United States)

    Woo, Kyungmi; Milworm, Gvira; Dowding, Dawn

    2017-10-13

    Improving care quality while reducing cost has always been a focus of nursing homes. Certified nursing assistants comprise the largest proportion of the workforce in nursing homes and have the potential to contribute to the quality of care provided. Quality improvement (QI) initiatives using certified nursing assistants as champions have the potential to improve job satisfaction, which has been associated with care quality. To identify the role, use and preparation of champions in a nursing home setting as a way of informing future QI strategies in nursing homes. A systematic literature review. Medical Subject Headings and text words for "quality improvement" were combined with those for "champion*" to search Medline, CINAHL, Joanna Briggs Institute, MedLine In-Process, and other Nonindexed Citations. After duplicates were removed, a total of 337 potential articles were identified for further review. After full text review, seven articles from five original studies met inclusion criteria and were included in the synthesis. Various types of QI initiatives and implementation strategies were used together with champions. Champions were identified by study authors as one of the single most effective strategies employed in all studies. The majority of studies described the champion role as that of a leader, who fosters and reinforces changes for improvement. Although all the included studies suggested that implementing nurse or aid champions in their QI initiatives were important facilitators of success, how the champions were selected and trained in their role is either missing or not described in any detail in the studies included in the review. Utilizing certified nursing assistants as QI champions can increase participation in QI projects and has the potential to improve job satisfaction and contribute to improve quality of care and improved patient outcomes in nursing homes. © 2017 Sigma Theta Tau International.

  13. The practice of physicians and nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model

    Directory of Open Access Journals (Sweden)

    Andrade Ana M

    2006-11-01

    Full Text Available Abstract The article analyzes the practice of physicians and nurses working on the Family Health Programme (Programa de Saúde da Família or PSF, in Portuguese. A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams' work agenda to their routine labour activities.

  14. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

    Directory of Open Access Journals (Sweden)

    Seims La Rue K

    2012-08-01

    Full Text Available Abstract Background The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. Methods The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. Results Results showed significant increases in health-service coverage at the district level (p = P  Conclusions Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.

  15. Expansion in the private sector provision of institutional delivery services and horizontal equity: evidence from Nepal and Bangladesh.

    Science.gov (United States)

    Hotchkiss, David R; Godha, Deepali; Do, Mai

    2014-07-01

    Wealth-related inequity in the use of maternal healthcare services continues to be a substantial problem in most low- and middle-income countries. One strategic approach to increase the use of appropriate maternal healthcare services is to encourage the expansion of the role of the private sector. However, critics of such an approach argue that increasing the role of the private sector will lead to increased inequity in the use of maternal healthcare services. This article explores this issue in two South Asian countries that have traditionally had high rates of maternal mortality-Nepal and Bangladesh. The study is based on multiple rounds of nationally representative household survey data collected in Nepal and Bangladesh from 1996 to 2011. The methodology involves estimating a concentration index for each survey to assess changes in wealth-related inequity in the use of institutional delivery assistance over time. The results of the study suggest that the expansion of private sector supply of institutional-based delivery services in Nepal and Bangladesh has not led to increased horizontal inequity. In fact, in both countries, inequity was shown to have decreased over the study period. The study findings also suggest that the provision of government delivery services to the poor protects against increased wealth-related inequity in service use. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  16. A Process Evaluation of the WV Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Dissemination Initiative: Assessing the Fidelity and Impact of Delivery for State-Wide, Home-Based Healthy Start Services.

    Science.gov (United States)

    Windsor, Richard; Clark, Jeannie; Davis, Amanda; Wedeles, John; Abroms, Lorien

    2017-01-01

    Objectives Process evaluation data are essential to document the fidelity of program implementation by clinical staff and confirm patient behavior change. This report presents a process evaluation model applied to the Smoking Cessation and Reduction in Pregnancy Treatment Dissemination Initiative for the statewide, home-based West Virginia Right From The Start Project. Methods Trained RFTS Designated Care Coordinators, nurses and social workers, of 50+ primary care agencies in all 55 counties, delivered SCRIPT to Medicaid patients who smoked. Results The process evaluation defined the level of DCC delivery of seven core SCRIPT procedures to produce a Program Implementation Index: a summary performance metric. A SCRIPT PII > 0.80 was established as the RFTS adoption standard. The PII increased from 0.53 in 2004 to 0.65 in 2006-2007 to 0.77 in 2009-2010. Although the PII > 0.80 was not achieved, exposure rates were increased for all seven SCRIPT procedures. Agency and DCC turnover, a transient patient population, and recession of 2008-2010 were barriers to achieving the adoption metric and implementation of an experimental design. A quasi-experimental Stratified, Matched Comparison (C) Group Design was selected to evaluate behavioral impact differences between a RFTS-Comparison (C) Group from 2006 to 2007 and the RFTS-SCRIPT E Group from 2009 to 2010. Impact analyses of the DCC delivery of the SCRIPT Program with higher fidelity documented a statistically significant increase in the cessation rate from 4.6 % and significant reduction rate from 6.9 % for the (C) Group in 2006-2007 to 13.9 % and 11.22 % respectively for the E Group in 2009-2010. Conclusion The PEM can assist statewide, home-based prenatal care programs to improve the quality of delivery and evaluate counseling programs.

  17. The reliability of in-home measures of height and weight in large cohort studies: Evidence from Add Health

    Directory of Open Access Journals (Sweden)

    Jon Hussey

    2015-05-01

    Full Text Available Background: With the emergence of obesity as a global health issue, an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. Objective: We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health, compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES and, using both sources, provide a detailed anthropometric description of young adults in the United States. Methods: The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. Results: Short-term reliabilities of in-home measures of height, weight, waist and arm circumference - as well as derived body mass index (BMI, kg/m2 - were excellent. Prevalence of obesity (37Š vs. 29Š and central obesity (47Š vs. 38Š was higher in Add Health than in NHANES, while socio-demographic patterns of obesity and central obesity were comparable in the two studies. Conclusions: Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality.

  18. The reliability of in-home measures of height and weight in large cohort studies: Evidence from Add Health

    Science.gov (United States)

    Hussey, Jon M.; Nguyen, Quynh C.; Whitsel, Eric A.; Richardson, Liana J.; Halpern, Carolyn Tucker; Gordon-Larsen, Penny; Tabor, Joyce W.; Entzel, Pamela P.; Harris, Kathleen Mullan

    2015-01-01

    Background With the emergence of obesity as a global health issue an increasing number of major demographic surveys are collecting measured anthropometric data. Yet little is known about the characteristics and reliability of these data. Objectives We evaluate the accuracy and reliability of anthropometric data collected in the home during Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), compare our estimates to national standard, clinic-based estimates from the National Health and Nutrition Examination Survey (NHANES) and, using both sources, provide a detailed anthropometric description of young adults in the United States. Methods The reliability of Add Health in-home anthropometric measures was estimated from repeat examinations of a random subsample of study participants. A digit preference analysis evaluated the quality of anthropometric data recorded by field interviewers. The adjusted odds of obesity and central obesity in Add Health vs. NHANES were estimated with logistic regression. Results Short-term reliabilities of in-home measures of height, weight, waist and arm circumference—as well as derived body mass index (BMI, kg/m2)—were excellent. Prevalence of obesity (37% vs. 29%) and central obesity (47% vs. 38%) was higher in Add Health than in NHANES while socio-demographic patterns of obesity and central obesity were comparable in the two studies. Conclusions Properly trained non-medical field interviewers can collect reliable anthropometric data in a nationwide, home visit study. This national cohort of young adults in the United States faces a high risk of early-onset chronic disease and premature mortality. PMID:26146486

  19. The relationship between apathy and participation in therapeutic activities in nursing home residents with dementia: Evidence for an association and directions for further research.

    Science.gov (United States)

    Ellis, Julie M; Doyle, Colleen J; Selvarajah, Suganya

    2016-07-01

    Apathy is one of the most frequent and early symptoms of dementia. Because apathy is characterised by lack of initiative and motivation, it leads to considerable burden being placed on carers to ensure that the person living with dementia has a reasonable quality of life. The aim of this study was to investigate the relationship between apathy and participation in therapeutic activities for older people with dementia living in nursing homes. Ninety residents were recruited into the study, and apathy was measured by nursing home staff using the Apathy Evaluation Scale Clinician version. Staff also compiled data on each resident's involvement in therapeutic activities. Among this sample, the mean age was 84.8 years, and mean length of stay in the nursing home was 1.8 years. The mean apathy score was 50.4, indicating that on average the residents had a moderate level of apathy. Overall, residents participated in six activities per week and those residents who were involved in the most activities had the lowest levels of apathy. This paper provides evidence that residents involved in therapeutic activities have lower levels of apathy. Further research should be conducted on the direction of causality, whether apathy levels can be changed through participation in therapeutic activities, the relationship between dementia severity and modifiability of apathy, and the intensity of therapeutic activities required to maintain functioning. © The Author(s) 2014.

  20. Evaluation of an evidence-based guidance on the reduction of physical restraints in nursing homes: a cluster-randomised controlled trial [ISRCTN34974819

    Directory of Open Access Journals (Sweden)

    Haastert Burkhard

    2009-09-01

    Full Text Available Abstract Background Physical restraints are regularly applied in German nursing homes. Their frequency varies substantially between centres. Beneficial effects of physical restraints have not been proven, however, observational studies and case reports suggest various adverse effects. We developed an evidence-based guidance on this topic. The present study evaluates the clinical efficacy and safety of an intervention programme based on this guidance aimed to reduce physical restraints and minimise centre variations. Methods/Design Cluster-randomised controlled trial with nursing homes randomised either to the intervention group or to the control group with standard information. The intervention comprises a structured information programme for nursing staff, information materials for legal guardians and residents' relatives and a one-day training workshop for nominated nurses. A total of 36 nursing home clusters including approximately 3000 residents will be recruited. Each cluster has to fulfil the inclusion criteria of at least 20% prevalence of physical restraints at baseline. The primary endpoint is the number of residents with at least one physical restraint at six months. Secondary outcome measures are the number of falls and fall-related fractures. Discussion If successful, the intervention should be implemented throughout Germany. In case the intervention does not succeed, a three-month pre-post-study with an optimised intervention programme within the control group will follow the randomised trial. Trial registration ISRCTN34974819

  1. The effect of a home delivery meal service of energy- and protein-rich meals on quality of life in malnourished outpatients suffering from lung cancer

    DEFF Research Database (Denmark)

    Leedo, Eva; Gade, Josephine; Granov, Sabrina

    2017-01-01

    . Intervention exerted a significant positive effect on performance score after 12 wk (P = 0.047). Increased energy and protein intakes were strongly associated with improved QoL, functional score, hand grip strength, symptom and performance scores. Food delivery service with energy- and protein-rich main meals...

  2. Investigations into pulsed high-intensity focused ultrasound-enhanced delivery: preliminary evidence for a novel mechanism.

    Science.gov (United States)

    Hancock, Hilary A; Smith, Lauren H; Cuesta, Julian; Durrani, Amir K; Angstadt, Mary; Palmeri, Mark L; Kimmel, Eitan; Frenkel, Victor

    2009-10-01

    Pulsed high-intensity focused ultrasound (HIFU) exposures without ultrasound contrast agents have been used for noninvasively enhancing the delivery of various agents to improve their therapeutic efficacy in a variety of tissue models in a nondestructive manner. Despite the versatility of these exposures, little is known about the mechanisms by which their effects are produced. In this study, pulsed-HIFU exposures were given in the calf muscle of mice, followed by the administration of a variety of fluorophores, both soluble and particulate, by local or systemic injection. In vivo imaging (whole animal and microscopic) was used to quantify observations of increased extravasation and interstitial transport of the fluorophores as a result of the exposures. Histological analysis indicated that the exposures caused some structural alterations such as enlarged gaps between muscle fiber bundles. These effects were consistent with increasing the permeability of the tissues; however, they were found to be transient and reversed themselves gradually within 72 h. Simulations of radiation force-induced displacements and the resulting local shear strain they produced were carried out to potentially explain the manner by which these effects occurred. A better understanding of the mechanisms involved with pulsed HIFU exposures for noninvasively enhancing delivery will facilitate the process for optimizing their use.

  3. Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh.

    Science.gov (United States)

    Begum, Tahmina; Rahman, Aminur; Nababan, Herfina; Hoque, Dewan Md Emdadul; Khan, Al Fazal; Ali, Taslim; Anwar, Iqbal

    2017-01-01

    Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. C-section rate in this area was much higher than national average as well as global

  4. Inflammatory response following neutrophil recovery postchemotherapy in acute myeloid leukemia cases without evidence of infection: role of homing of neutrophils

    Directory of Open Access Journals (Sweden)

    Pawar RD

    2014-03-01

    Full Text Available Rahul D Pawar,1 Travis Williams,2 Rahul Khera,2 Albert Eid,3 Omar S Aljitawi,1,4 Reginald W Dusing5 1Internal Medicine, 2Hematology/Oncology, 3Infectious Diseases, 4Pathology and Laboratory Medicine, 5Radiology, University of Kansas Medical Center, Kansas City, KS, USA Abstract: Neutropenic sepsis is a common clinical entity occurring in postchemotherapy patients. Infection may not be the cause of fever in such patients after neutrophil-count recovery. Herein, we present two patients who developed fever during the neutropenic phase of induction chemotherapy and were treated with broad-spectrum antibiotics until they were no longer febrile and had recovered their neutrophil count. Being off antibiotics, they redeveloped fever within 48–72 hours. These fevers seemed to be secondary to postinfectious inflammatory response and not infection, supported by the fact that adequate antibiotic treatment was given and the collected fluid contained neutrophils but the cultures were negative. We hypothesize an explanation for this phenomenon based on the “homing of neutrophils” to bone marrow, which involves chemoattraction of CXC chemokine receptor (CXCR-4 expressed on neutrophils towards the chemokine stromal cell-derived factor (SDF-1 (CXCL12 expressed constitutively by bone marrow. Literature has shown that elevation of SDF-1 levels at injured/inflamed sites might create a similar gradient. This gradient results in the migration of neutrophils to the sites of previous injury/inflammation, leading to the formation of sterile abscesses. Based on our cases, we also conclude that antibiotics do not prevent the formation or treat such sterile “abscesses”; however, the drainage of these “abscesses” and treatment with anti-inflammatory agents are useful in such cases. Keywords: SDF-1, CXCR4, postinfectious inflammatory response, homing of neutrophils

  5. Working practices and incomes of health workers: evidence from an evaluation of a delivery fee exemption scheme in Ghana

    Directory of Open Access Journals (Sweden)

    Kusi Anthony

    2007-01-01

    Full Text Available Abstract Background This article describes a survey of health workers and traditional birth attendants (TBAs which was carried out in 2005 in two regions of Ghana. The objective of the survey was to ascertain the impact of the introduction of a delivery fee exemption scheme on both health workers and those providers who were excluded from the scheme (TBAs. This formed part of an overall evaluation of the delivery fee exemption scheme. The results shed light not only on the scheme itself but also on the general productivity of a range of health workers in Ghana. Methods A structured questionnaire was developed, covering individual and household characteristics, working hours and practices, sources of income, and views of the exemptions scheme and general motivation. After field testing, this was administered to 374 respondents in 12 districts of Central and Volta regions. The respondents included doctors, medical assistants (MAs, public and private midwives, nurses, community health nurses (CHNs, and traditional birth attendants, both trained and untrained. Results Health workers were well informed about the delivery fee exemptions scheme and their responses on its impact suggest a realistic view that it was a good scheme, but one that faces serious challenges regarding financial sustainability. Concerning its impact on their morale and working conditions, the responses were broadly neutral. Most public sector workers have seen an increased workload, but counterbalanced by increased pay. TBAs have suffered, in terms of client numbers and income, while the picture for private midwives is mixed. The survey also sheds light on pay and productivity. The respondents report long working hours, with a mean of 54 hours per week for community nurses and up to 129 hours per week for MAs. Weekly reported client loads in the public sector range from a mean of 86 for nurses to 269 for doctors. Over the past two years, reported working hours have been

  6. The best evidence for minimizing resistance-to-care during assisted personal care for older adults with dementia in nursing homes: a systematic review.

    Science.gov (United States)

    Konno, Rie; Kang, Hee Sun; Makimoto, Kiyoko

    2012-01-01

    behavior toward caregivers, therapeutic effects of music and singing, the use of preferred music intervention at mealtimes, feeding-related nursing care, and a review on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty. A recently published review has reported on the relevant factors that trigger resistance-to-care behaviors.By examining previously published systematic reviews, it was evident that their focus tended to be broad and not solely concerned with resistance-to-care behaviors in the context of daily personal care. Alternatively, they addressed a specific care situation such as oral care or mealtime, raising questions whether interventions should differ for each care activity or if any interventions can be effective in daily personal care in general. Thus, the present review will aim to examine what interventions are effective for managing or reducing resistance-to-care behaviors of nursing home residents who have dementia. The review will focus on effective interventions for each care activity in daily personal care and overall daily personal care. Thus the review's results will provide practical recommendations concerning the effective nursing care for each daily care activity and overall daily care activities for managing resistance-to-care behaviors of older adults with dementia in nursing homes.Resistance-to-care behaviors are, in reality, often very difficult to differentiate from other dementia-related behaviors. For instance the term "noncompliance" was used in one study referring to "resistiveness to care", which preceded physically aggressive behavior occurring in response to the invasion of the resident's personal space. This clearly encapsulates the resistive nature of the behavior demonstrated by nursing home residents. Other terms possibly overlapping with the meaning of "resistance-to-care" behaviors include "uncooperative behaviours", "disruptive behaviours", "aggression/aggressive behaviours

  7. The Effect of a Home Delivery Meal Service of Energy- and Protein-Rich Meals on Quality of Life in Malnourished Outpatients Suffering from Lung Cancer: A Randomized Controlled Trial.

    Science.gov (United States)

    Leedo, Eva; Gade, Josephine; Granov, Sabrina; Mellemgaard, Anders; Klausen, Tobias Wirenfeldt; Rask, Katrine; Astrup, Arne

    2017-04-01

    Undernutrition is prevalent in cancer patients and associated with increased incidence of complications and mortality. We investigated the effects of a home delivery meal service, providing a selection of energy-dense, protein-rich meals, on quality of life (QoL) in malnourished lung cancer patients. Forty lung cancer patients with nutritional risk score ≥3 (NRS-2002) were randomized to control or intervention. The intervention group was offered energy- and protein-rich main meals and snacks, delivered 3 times per week. The control group continued their habitual diet. Primary endpoint, QoL, and secondary endpoints were assessed at baseline, and after 6 and 12 wk. Data on unplanned readmissions, length of hospital stay, and mortality were collected 3 and 6 mo post-intervention. Intervention group improved standard Chair Stand Test (30-s CST) after 6 and 12 wk (P Food delivery service with energy- and protein-rich main meals and snacks can improve lower body strength and performance status in malnourished lung cancer patients.

  8. Smoke-Free Workplaces Are Associated with Protection from Second-Hand Smoke at Homes in Nigeria: Evidence for Population-Level Decisions

    Directory of Open Access Journals (Sweden)

    Dorota Kaleta

    2015-01-01

    Full Text Available The evidence suggests that smoke-free workplace policies may change social norms towards exposing others to second-hand smoke at home. The aim of the study was to assess whether being employed in a smoke-free workplace (SFWP is associated with living in a smoke-free home (SFH. We used the data from the Global Adult Tobacco Survey conducted in Nigeria in 2012, in which 9,765 individuals were interviewed including 1,856 persons who worked indoors. The percentage of Nigerians employed in SFWP that reported living in a SFH was higher compared to those employed in a workplace where smoking occurred (95% versus 73%. Working in a SFWP was associated with a significantly higher likelihood of living in a SFH (OR = 5.3; p<0.001. Urban inhabitants indicated more frequently that they lived in SFH compared to rural residents (OR = 2.0; p=0.006. The odds of living in a SFH were significantly higher among nonsmokers and nonsmokeless tobacco users compared to smokers and smokeless tobacco users (OR = 28.8; p<0.001; OR = 7.0; p<0.001. These findings support the need for implementation of comprehensive smoke-free policies in Nigeria that result in substantial health benefits.

  9. Inflammatory response following neutrophil recovery postchemotherapy in acute myeloid leukemia cases without evidence of infection: role of homing of neutrophils.

    Science.gov (United States)

    Pawar, Rahul D; Williams, Travis; Khera, Rahul; Eid, Albert; Aljitawi, Omar S; Dusing, Reginald W

    2014-01-01

    Neutropenic sepsis is a common clinical entity occurring in postchemotherapy patients. Infection may not be the cause of fever in such patients after neutrophil-count recovery. Herein, we present two patients who developed fever during the neutropenic phase of induction chemotherapy and were treated with broad-spectrum antibiotics until they were no longer febrile and had recovered their neutrophil count. Being off antibiotics, they redeveloped fever within 48-72 hours. These fevers seemed to be secondary to postinfectious inflammatory response and not infection, supported by the fact that adequate antibiotic treatment was given and the collected fluid contained neutrophils but the cultures were negative. We hypothesize an explanation for this phenomenon based on the "homing of neutrophils" to bone marrow, which involves chemoattraction of CXC chemokine receptor (CXCR)-4 expressed on neutrophils towards the chemokine stromal cell-derived factor (SDF)-1 (CXCL12) expressed constitutively by bone marrow. Literature has shown that elevation of SDF-1 levels at injured/inflamed sites might create a similar gradient. This gradient results in the migration of neutrophils to the sites of previous injury/inflammation, leading to the formation of sterile abscesses. Based on our cases, we also conclude that antibiotics do not prevent the formation or treat such sterile "abscesses"; however, the drainage of these "abscesses" and treatment with anti-inflammatory agents are useful in such cases.

  10. Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the 'wobbly hub and double spokes' project

    Directory of Open Access Journals (Sweden)

    Veitch Craig

    2012-03-01

    Full Text Available Abstract Background Policy that supports rural allied health service delivery is important given the shortage of services outside of Australian metropolitan centres. The shortage of allied health professionals means that rural clinicians work long hours and have little peer or service support. Service delivery to rural and remote communities is further complicated because relatively small numbers of clients are dispersed over large geographic areas. The aim of this five-year multi-stage project is to generate evidence to confirm and develop evidence-based policies and to evaluate their implementation in procedures that allow a regional allied health workforce to more expeditiously respond to disability service need in regional New South Wales, Australia. Methods/Design The project consists of four inter-related stages that together constitute a full policy cycle. It uses mixed quantitative and qualitative methods, guided by key policy concerns such as: access, complexity, cost, distribution of benefits, timeliness, effectiveness, equity, policy consistency, and community and political acceptability. Stage 1 adopts a policy analysis approach in which existing relevant policies and related documentation will be collected and reviewed. Policy-makers and senior managers within the region and in central offices will be interviewed about issues that influence policy development and implementation. Stage 2 uses a mixed methods approach to collecting information from allied health professionals, clients, and carers. Focus groups and interviews will explore issues related to providing and receiving allied health services. Discrete Choice Experiments will elicit staff and client/carer preferences. Stage 3 synthesises Stage 1 and 2 findings with reference to the key policy issues to develop and implement policies and procedures to establish several innovative regional workforce and service provision projects. Stage 4 uses mixed methods to monitor and

  11. Impact of Online Education on Nurses' Delivery of Smoking Cessation Interventions With Implications for Evidence-Based Practice.

    Science.gov (United States)

    Bialous, Stella A; Sarna, Linda; Wells, Marjorie J; Brook, Jenny K; Kralikova, Eva; Pankova, Alexandra; Zatoński, Witold; Przewozniak, Krzysztof

    2017-10-01

    Tobacco use is the leading cause of preventable disease and death in Europe and worldwide. Nurses, if properly educated, can contribute to decreasing the burden of tobacco use in the region by helping smokers quit smoking. To assess: (a) the feasibility of an online program to educate nurses in Czech Republic and Poland on evidence-based smoking cessation interventions for patients and (b) self-reported changes in practices related to consistently (usually or always) providing smoking cessation interventions to smokers, before and 3 months after participation in the program. A prospective single-group pre-post design. A total of 280 nurses from Czech Republic and 156 from Poland completed baseline and follow-up surveys. At 3 months, nurses were significantly more likely to provide smoking cessation interventions to patients who smoke and refer patients for cessation services (p Nurses significantly improved their views about the importance of nursing involvement in tobacco control. Education about tobacco control can make a difference in clinical practice, but ongoing support is needed to maintain these changes. Health system changes can also facilitate the expectation that delivering evidence-based smoking cessation interventions should be routine nursing care. Educating nurses on cessation interventions and tobacco control is pivotal to decrease tobacco-related disparities, disease, and death. Online methods provide an accessible way to reach a large number of nurses. © 2017 Sigma Theta Tau International.

  12. Leaving home in Denmark

    DEFF Research Database (Denmark)

    Nielsen, Rikke Skovgaard

    2015-01-01

    The paper focuses on ethnic differences in the timing and patterns of leaving the parental home. Leaving home is a key transition in the life course of the individual, and extensive research has been conducted on the timing and patterns of leaving it. However, ethnic differences in these patterns...... of leaving home. Results showed that while some differences disappeared when controlling for covariates, others persisted, thus indicating ethnic differences in home-leaving patterns. A strong link between leaving home and marriage was substantiated for Turks, but not for Somalis. The home-leaving patterns...... of Somalis were much more similar to those of Danes. Overall, Turkish descendants were similar to Turkish immigrants but with some differentiation. The analyses identified the existence of ethnic differences in home-leaving patterns but also found evidence of a shift towards less traditional patterns, i...

  13. In vivo kinematics of the thumb during flexion and adduction motion: Evidence for a screw-home mechanism.

    Science.gov (United States)

    D'Agostino, Priscilla; Dourthe, Benjamin; Kerkhof, Faes; Stockmans, Filip; Vereecke, Evie E

    2017-07-01

    The thumb plays a crucial role in basic hand function. However, the kinematics of its entire articular chain have not yet been quantified. Such investigation is essential to improve our understanding of thumb function and to develop better strategies to treat thumb joint pathologies. The primary objective of this study is to quantify the in vivo kinematics of the trapeziometacarpal (TMC) and scaphotrapezial (ST) joints during flexion and adduction of the thumb. In addition, we want to evaluate the potential coupling between the TMC and ST joints during these tasks. The hand of 16 asymptomatic women without signs of thumb osteoarthritis were CT scanned in positions of maximal thumb extension, flexion, abduction, and adduction. The CT images were segmented and three-dimensional surface models of the radius, scaphoid, trapezium, and the first metacarpal were created for each thumb motion. The corresponding rotations angles, translations, and helical axes were calculated for each sequence. The analysis shows that flexion and adduction of the thumb result in a three-dimensional rotation and translation of the entire articular chain, including the trapezium and scaphoid. A wider range of motion is observed for the first metacarpal, which displays a clear axial rotation. The coupling of axial rotation of the first metacarpal with flexion and abduction during thumb flexion supports the existence of a screw-home mechanism in the TMC joint. In addition, our results point to a potential motion coupling between the TMC and ST joints and underline the complexity of thumb kinematics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1556-1564, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  14. Taking care of your back at home

    Science.gov (United States)

    Back strain treatment; Back pain - home care; Low back pain - home care; Lumbar pain - home care; LBP - home care; Sciatic - home care ... R, Loeser JD, Owens DK, et al. Interventional therapies, surgery, ... pain: an evidence-based clinical practice guideline from the ...

  15. Home Care

    Science.gov (United States)

    ... and respiratory ), social workers, personal care aides, home medical equipment suppliers, and most importantly, informal caregivers (e.g., ... also available to help with home assessment. Assistive Technology to improve home safety can also be an ...

  16. Health-economic evaluation of home telemonitoring for COPD in Germany: evidence from a large population-based cohort.

    Science.gov (United States)

    Achelrod, Dmitrij; Schreyögg, Jonas; Stargardt, Tom

    2017-09-01

    Telemonitoring for COPD has gained much attention thanks to its potential of reducing morbidity and mortality, healthcare utilisation and costs. However, its benefit with regard to clinical and economic outcomes remains to be clearly demonstrated. To analyse the effect of Europe's largest COPD telemonitoring pilot project on direct medical costs, health resource utilisation and mortality at 12 months. We evaluated a population-based cohort using administrative data. Difference-in-difference estimators were calculated to account for time-invariant unobservable heterogeneity after removing dissimilarities in observable characteristics between the telemonitoring and control group with a reweighting algorithm. The analysis comprised 651 telemonitoring participants and 7047 individuals in the standard care group. The mortality hazards ratio was lower in the intervention arm (HR 0.51, 95 % CI 0.30-0.86). Telemonitoring cut total costs by 895 € (p patients (-1056 €, p Telemonitoring enrolees used healthcare (all-cause and COPD-related) less intensely with shorter hospital stays, fewer inpatient stays and smaller proportions of people with emergency department visits and hospitalisations (all p telemonitoring for COPD is a viable strategy to reduce mortality, healthcare costs and utilisation at 12 months. Contrary to widespread fear, reducing the intensity of care does not seem to impact unfavourably on health outcomes. The evidence offers strong support for introducing telemonitoring as a component of case management.

  17. Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

    Science.gov (United States)

    Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

    2016-01-01

    The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

  18. Assessing the quality of evidence from randomized, controlled drug and nutritional supplement trials conducted among nursing home residents between 1968 and 2004: what can we learn?

    Science.gov (United States)

    Cheng, Huai Yong

    2009-01-01

    An estimated 1.5 million residents of nursing homes (NH) in the United States were prescribed an average of 7 to 8 medications each month. However, it is unknown which of these prescribed drugs and nutritional supplements have been tested for use among NH residents who often have distinct and complex needs compared with other geriatric patients. This pilot study addresses the quantity and quality of randomized, controlled drug and nutritional supplement trials that have been conducted among NH residents. Using multiple search strategies and review protocol, I assessed the quality of evidence from randomized, controlled drug and nutritional supplement trials that had a parallel-group design, were conducted among NH residents, and were published in English between 1968 and October 2004. Internal validity of the trials was examined by assessing adequately reporting power calculation, drop-outs (completion fraction), randomization and allocation concealment, blind status, and intention-to-treat analysis. External validity of the trials was examined by assessing adequately reporting the sample description, the inclusion and exclusion criteria, the recruitment process, and comorbidities and harm. Relatively few drug and nutritional supplements have been tested among NH residents by well-designed and executed randomized controlled trials (N = 42). The total number of participants (N = 7941) is small. The quality of many trials is poor. Given the limited number and poor quality of existing trials conducted among NH residents in this pilot study, I conclude that there is a limited body of evidence that could be used to establish quality of care standards or pay for performance criteria for drug therapy and nutritional supplements in NH. Long-term care providers face a great challenge in practicing evidence-based medicine in prescribing drugs and nutritional supplements.

  19. A Delivery Model for Home Fortification of Complementary Foods with Micronutrient Powders: Innovation in the Context of Vietnamese Health System Strengthening

    Directory of Open Access Journals (Sweden)

    Marie Nguyen

    2016-04-01

    Full Text Available Adding micronutrient powders (MNP to complementary foods at the point of preparation (home fortification can improve micronutrient status of young children. Ensuring sustained access to MNPs at scale, however, remains challenging in many countries. The Global Alliance for Improved Nutrition (GAIN partnered with the National Institute of Nutrition (NIN in Vietnam to pioneer the distribution of a locally-produced MNP, provided for sale through the public health system with counseling on optimal infant and young child feeding practices by trained health workers. Different packaging options were available to adapt to caregivers’ disposable income. During the six-month pilot, 1.5 million sachets were sold through 337 health centers across four provinces, targeting children 6–59 months of age. Sales were routinely monitored, and a cross-sectional survey in 32 communes for caregivers (n = 962 and health staff (n = 120 assessed MNP coverage and compliance, five months after the start of distribution. A total of 404 caregivers among the 962 caregivers surveyed (i.e., 42% had visited the health center in the past year. Among them, 290 caregivers had heard about the product and a total of 217caregivers had given the MNP to their child at least once, representing a conversion rate from product awareness to product trial of 74.8%. The effective coverage (i.e., consumption of ≥3 sachets/child/week was 11.5% among the total surveyed caregivers and reached 27.3% amongst caregivers who visited health centers in the previous month. The MNP purchase trends showed that the number of sachets bought by caregivers was positively correlated with the wealth index. The pilot showed that providing MNPs for sale in packs of various quantities, combined with infant and young child feeding (IYCF counseling at the health center, is effective for groups accessing the health system.

  20. Calculating evidence-based renal replacement therapy - Introducing an excel-based calculator to improve prescribing and delivery in renal replacement therapy - A before and after study.

    Science.gov (United States)

    Cottle, Daniel; Mousdale, Stephen; Waqar-Uddin, Haroon; Tully, Redmond; Taylor, Benjamin

    2016-02-01

    Transferring the theoretical aspect of continuous renal replacement therapy to the bedside and delivering a given "dose" can be difficult. In research, the "dose" of renal replacement therapy is given as effluent flow rate in ml kg -1  h -1 . Unfortunately, most machines require other information when they are initiating therapy, including blood flow rate, pre-blood pump flow rate, dialysate flow rate, etc. This can lead to confusion, resulting in patients receiving inappropriate doses of renal replacement therapy. Our aim was to design an excel calculator which would personalise patient's treatment, deliver an effective, evidence-based dose of renal replacement therapy without large variations in practice and prolong filter life. Our calculator prescribes a haemodialfiltration dose of 25 ml kg -1  h -1 whilst limiting the filtration fraction to 15%. We compared the episodes of renal replacement therapy received by a historical group of patients, by retrieving their data stored on the haemofiltration machines, to a group where the calculator was used. In the second group, the data were gathered prospectively. The median delivered dose reduced from 41.0 ml kg -1  h -1 to 26.8 ml kg -1  h -1 with reduced variability that was significantly closer to the aim of 25 ml kg -1 .h -1 ( p  < 0.0001). The median treatment time increased from 8.5 h to 22.2 h ( p  = 0.00001). Our calculator significantly reduces variation in prescriptions of continuous veno-venous haemodiafiltration and provides an evidence-based dose. It is easy to use and provides personal care for patients whilst optimizing continuous veno-venous haemodiafiltration delivery and treatment times.

  1. The impact of flavour, device type and warning messages on youth preferences for electronic nicotine delivery systems: evidence from an online discrete choice experiment.

    Science.gov (United States)

    Shang, Ce; Huang, Jidong; Chaloupka, Frank J; Emery, Sherry L

    2017-11-02

    To examine the impact of flavour, device type and health warning messages on youth preference for electronic nicotine delivery systems (ENDS), and to provide evidence and data to inform the Food and Drug Administration's potential regulatory actions on ENDS. An online discrete choice experiment was conducted in September 2015. Each participant was given nine choice sets and asked to choose one out of two alternative ENDS products, with varying characteristics in three attributes (flavour, device type and warning message). The impact of the attributes on the probability of choosing ENDS was analysed using conditional and nested logit regressions, controlling for individual sociodemographic characteristics and current smoking status. A general population sample of 515 participants (50 ever-users and 465 never-users of ENDS) aged 14-17 years were recruited to complete the experiment using an online panel. Fruit/sweets/beverage flavours significantly increase the probability of choosing ENDS among youth (pe-cigarettes, increase (p<0.05) the probability of choosing ENDS among adolescent never-users. Warning messages reduce (p<0.01) the probability of choosing ENDS among never-users. Restricting fruit/sweets/beverage flavours in ENDS, regulating modifiable vaping devices and adopting strong health warning messages may reduce the uptake of ENDS among youth. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study

    Science.gov (United States)

    Craig Rushing, Stephanie; Jessen, Cornelia; Gorman, Gwenda; Torres, Jennifer; Lambert, William E; Prokhorov, Alexander V; Miller, Leslie; Allums-Featherston, Kelly; Addy, Robert C; Peskin, Melissa F; Shegog, Ross

    2016-01-01

    Background American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. Objective We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet’s potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. Methods This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths’ perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using

  3. Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study.

    Science.gov (United States)

    Markham, Christine M; Craig Rushing, Stephanie; Jessen, Cornelia; Gorman, Gwenda; Torres, Jennifer; Lambert, William E; Prokhorov, Alexander V; Miller, Leslie; Allums-Featherston, Kelly; Addy, Robert C; Peskin, Melissa F; Shegog, Ross

    2016-11-21

    American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet's potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths' perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Sites

  4. Home range and travels

    Science.gov (United States)

    Stickel, L.F.; King, John A.

    1968-01-01

    . Peromyscus generally used and maintained several or many different home sites and refuges in various parts of their home ranges, and frequently shifted about so that their principal activities centered on different sets of holes at different times. Once established, many Peromyscus remained in the same general area for a long time, perhaps for the duration of their lives. Extent of their travels in different directions and intensity of use of different portions of their home ranges varied within a general area in response to habitat changes, loss of neighbors, or other factors. Various authors have obtained both direct and indirect evidence of territoriality, in some degree, among certain species of Peromyscus. Young mice dispersed from their birth sites to establish home ranges of their own. Adults also sometimes left their home areas; some re-established elsewhere; others returned after exploratory travels. Most populations contained a certain proportion of transients; these may have been wanderers or individuals exploring out from established home ranges or seeking new ones. When areas were depopulated by removal trapping, other Peromyscus invaded. Invasion rates generally followed seasonal trends of reproduction and population density. Peromyscus removed from their home areas and released elsewhere returned home from various distances, but fewer returned from greater distances than from nearby; speed of return increased with successive trials. The consensus from present evidence is that ho-ming is made possible by a combination of random wandering and familiarity with a larger area than the day-to-day range. Records of juvenile wanderings during the dispersal phase and of adult explorations very nearly encompassed the distances over which any substantial amount of successful homing occurred. Methods of measuring sizes of home ranges and the limitations of these measurements were discussed in brief synopsis. It was co

  5. Bringing antiretroviral therapy (ART) closer to the end-user through mobile clinics and home-based ART: systematic review shows more evidence on the effectiveness and cost effectiveness is needed.

    Science.gov (United States)

    Mdege, Noreen Dadirai; Chindove, Stanley

    2014-01-01

    Home-based antiretroviral therapy (ART) and ART through mobile clinics can potentially increase access to ART for large numbers of people, including hard-to-reach populations. We reviewed literature on the effectiveness and cost implications of the home-based ART and mobile clinic ART models. We searched Medline, Embase, PsycInfo, CINAHL, Cochrane Library, Web of Knowledge and Current Controlled Trials Register for articles published up to March 2012. We included non-randomised and randomised controlled clinical trials that recruited HIV/AIDS positive adults with or without prior exposure to ART. Six studies were included in the review, with only four effectiveness studies (all evaluating home-based ART and none for mobile clinic ART) and four studies reporting on the cost implications. The evidence suggests home-based ART is as effective as health facility-based ART, including on clinical outcomes, viral load and CD4+ count. However, three of these studies were very small. Studies suggest health facility-based ART is the most cost-effective, followed by mobile-clinic ART, with home-based ART being the least cost-effective. Evidence on the effectiveness and cost implications of mobile clinic and home-based ART is currently limited. Although the few available studies suggest home-based ART can potentially be as effective as health facility-based ART, there is need for more research before robust conclusions can be made. Results from the few available studies also suggest that health facility-based ART is the most cost-effective. Copyright © 2013 John Wiley & Sons, Ltd.

  6. Home, Smart Home

    DEFF Research Database (Denmark)

    Hansen, Ellen Kathrine; Olesen, Gitte Gylling Hammershøj; Mullins, Michael

    2013-01-01

    The article places focus on how smart technologies integrated in a one family- home and particular the window offer unique challenges and opportunities for designing buildings with the best possible environments for people and nature. Toward an interdisciplinary approach, we address the interaction...... between daylight defined in technical terms and daylight defined in aesthetic, architectural terms. Through field-tests of a Danish carbon-neutral home and an analysis of five key design parameters, we explore the contradictions and potentials in smart buildings, using the smart window as example of how...... to the energy design is central. The study illuminates an approach of the design of smart houses as living organisms by connecting technology with the needs of the occupants with the power and beauty of daylight....

  7. Home hemodialysis: a comprehensive review of patient-centered and economic considerations

    Science.gov (United States)

    Walker, Rachael C; Howard, Kirsten; Morton, Rachael L

    2017-01-01

    Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD) continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD) has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL) advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients’ lifestyle. This is a comprehensive literature review of patient-centered and economic impacts of home HD with the studies published between January 2000 and July 2016. Data from the primary studies representing both efficiency and equity of home HD were presented as a narrative synthesis under the following topics: advantages to patients, barriers to patients, economic factors influencing patients, cost-effectiveness of home HD, and inequities in home HD delivery. There were a number of advantages for patients on home HD including improved survival and QoL and flexibility and potential for employment, compared to hospital HD. Similarly, there were several barriers to patients preferring or maintaining home HD, and the strategies to overcome these barriers were frequently reported. Good evidence reported that indigenous, low-income, and other socially disadvantaged individuals had reduced access to home HD compared to other forms of dialysis and that this situation compounds already-poor health outcomes on renal replacement therapy. Government policies that minimize barriers to home HD include reimbursement for dialysis-related out-of-pocket costs and employment-retention interventions for home HD patients and their family members. This review argues that home HD is a cost-effective treatment, and increasing the proportion of patients on this

  8. Patient satisfaction with home-birth care in The Netherlands.

    NARCIS (Netherlands)

    Kerssens, J.J.

    1994-01-01

    One of the necessary elements in an obstetric system of home confinements is well-organized postnatal home care. In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry

  9. Kinship Foster Care and School Adjustment: Evidence from a Nationally Representative Sample of Children in Out-of-Home Care in South Korea

    Science.gov (United States)

    Lee, RaeHyuck; Chun, JongSerl; Chung, Ick-Joong; Kang, Hyunah; Nho, Choong Rai; Woo, Seokjin

    2017-01-01

    Background: There are many appealing reasons to support kinship foster care as an alternative to other types of out-of-home care. In South Korea, however, less is known about whether or not kinship foster care is beneficial for children's development, and nothing is known about how kinship foster care compares with other types of out-of-home care…

  10. Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions.

    Science.gov (United States)

    Williams, Virginia; Oades, Lindsay G; Deane, Frank P; Crowe, Trevor P; Ciarrochi, Joseph; Andresen, Retta

    2013-07-02

    There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a 'life worth living'). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. 'Autonomy' is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples

  11. A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.

    Science.gov (United States)

    Maloney, Stephen; Nicklen, Peter; Rivers, George; Foo, Jonathan; Ooi, Ying Ying; Reeves, Scott; Walsh, Kieran; Ilic, Dragan

    2015-07-21

    Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear. This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program. The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost. The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its

  12. Home Safety

    Science.gov (United States)

    ... Furniture Tip-Overs filter Water and Drowning Apply Water and Drowning filter Space and Place: (-) Remove Home filter Home Car and Road Apply Car and Road filter Sports and Play Apply Sports and Play filter Type: Activities for ...

  13. Home hemodialysis

    DEFF Research Database (Denmark)

    Agar, John W; Perkins, Anthony; Heaf, James G

    2015-01-01

    We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use.......We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use....

  14. Home childbirth: progress or retrocession?

    OpenAIRE

    SANFELICE, Clara Fróes de Oliveira; SHIMO, Antonieta Keiko Kakuda

    2014-01-01

    Giving birth at home represents a rising modality of delivery care in the Brazilian society, although in unrepresentative proportion when compared to the number of hospital childbirths. In Brazil, the topic has been broadly discussed by different professional categories, highlighting the safety issue involved in the process. The aim of this theoretical and reflective study was to present a brief overview of the overall care related to home childbirth, also questioning the reality of the conte...

  15. Home Rx: The Health Benefits of Home Performance

    Energy Technology Data Exchange (ETDEWEB)

    J. Wilson, D. Jacobs, A. Reddy, E. Tohn, J. Cohen, E. Jacobsohn

    2016-12-01

    Evidence in a new, groundbreaking U.S. Department of Energy report, Home Rx: The Health Benefits of Home Performance, shows that home performance upgrades can improve the quality of a home’s indoor environment by reducing the prevalence of harmful indoor air pollutants and contaminants. Until recently, no systematic review of this evidence had been conducted, limiting full understanding of the link between home performance and health. This new report summarizes current knowledge and identifies research gaps. The design characteristics and results of each of the 40 studies considered in the report are summarized in a searchable matrix.

  16. Do You Really Expect Me to Get MST Care in a VA Where Everyone is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma

    Science.gov (United States)

    2015-08-01

    Based Psychotherapy to Women with Military Sexual Trauma PRINCIPAL INVESTIGATOR: Ronald Acierno, PhD CONTRACTING ORGANIZATION: Medical University of...a VA Where Everyone is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma 5a. CONTRACT NUMBER 5b...Military Sexual Trauma (MST) related PTSD using videoconferencing technology, which allows a therapist and patient, who are at great distance from

  17. Dipankar Home

    Indian Academy of Sciences (India)

    Home; Journals; Pramana – Journal of Physics. Dipankar Home. Articles written in Pramana – Journal of Physics. Volume 56 Issue 2-3 February-March 2001 pp 179-187. Facets of tripartite entanglement · Dipankar Home · More Details Abstract Fulltext PDF. Tripartite entangled states of systems 1, 2 and 3 involving ...

  18. Homing oneself

    DEFF Research Database (Denmark)

    Winther, Ida Wentzel

    2009-01-01

    What is home? A building, a physical and mental phenomenon, or a concept?  There are many homes and ways `to home oneself´. Many of us quite often dwell in other places than at home (as professional commuters between two places, as travellers staying in hotels, as children of divorced parents...... expands on the notion that home indicates more than a house, but also responds to the overuse of the concept home. The aim of this article is to examine how home is done, stretched between everyday life, practices, dreams, loss and cultural ideas of home. My intention is not to remove home......, but to revitalize it to prevent it from turning into a pell-mell or a zombie (Beck 1999). This is important because we are moving away from the hegemonic idea of one home to the tactics of feeling at home, even in more mobile ways. The study is cross-disciplinary, drawing on cultural phenomenology, the history...

  19. Maternal Hypertension after a Low-Birth-Weight Delivery Differs by Race/Ethnicity: Evidence from the National Health and Nutrition Examination Survey (NHANES) 1999–2006

    Science.gov (United States)

    Xu, Jia; Barinas-Mitchell, Emma; Kuller, Lewis H.; Youk, Ada O.; Catov, Janet M.

    2014-01-01

    Studies have suggested an increase in maternal morbidity and mortality due to cardiovascular diseases in women with a prior low-birth-weight (LBW, <2,500 grams) delivery. This study evaluated blood pressure and hypertension in women who reported a prior preterm or small-for-gestational-age (SGA) LBW delivery in the National Health and Nutrition Examination Survey 1999–2006 (n = 6,307). This study also aimed to explore if race/ethnicity, menopause status, and years since last pregnancy modified the above associations. A total of 3,239 white, 1,350 black, and 1,718 Hispanics were assessed. Linear regression models were used to evaluate blood pressure by birth characteristics (preterm-LBW, SGA-LBW, and birthweight ≥2,500). Logistic regression models estimated the odds ratios (OR) of hypertension among women who reported a preterm-LBW or SGA-LBW delivery compared with women who reported an infant with birthweight ≥2,500 at delivery. Overall, there was a positive association between a preterm-LBW delivery and hypertension (adjusted OR = 1.39, 95% confidence interval (CI) 1.02–1.90). Prior SGA-LBW also increased the odds of hypertension, but the estimate did not reach statistical significance (adjusted OR = 1.21, 95% CI 0.76–1.92). Race/ethnicity modified the above associations. Only black women had increased risk of hypertension following SGA-LBW delivery (adjusted OR = 2.09, 95% CI 1.12–3.90). Black women were at marginally increased risk of hypertension after delivery of a preterm-LBW (adjusted OR = 1.49, 95% CI 0.93–2.38). Whites and Hispanics had increased, but not statistically significant, risk of hypertension after a preterm-LBW (whites: adjusted OR = 1.39, 95% CI 0.92–2.10; Hispanics: adjusted OR = 1.22, 95% CI 0.62–2.38). Stratified analysis indicated that the associations were stronger among women who were premenopausal and whose last pregnancy were more recent. The current study suggests that in a representative

  20. Maternal hypertension after a low-birth-weight delivery differs by race/ethnicity: evidence from the National Health and Nutrition Examination Survey (NHANES 1999-2006.

    Directory of Open Access Journals (Sweden)

    Jia Xu

    Full Text Available Studies have suggested an increase in maternal morbidity and mortality due to cardiovascular diseases in women with a prior low-birth-weight (LBW, <2,500 grams delivery. This study evaluated blood pressure and hypertension in women who reported a prior preterm or small-for-gestational-age (SGA LBW delivery in the National Health and Nutrition Examination Survey 1999-2006 (n = 6,307. This study also aimed to explore if race/ethnicity, menopause status, and years since last pregnancy modified the above associations. A total of 3,239 white, 1,350 black, and 1,718 Hispanics were assessed. Linear regression models were used to evaluate blood pressure by birth characteristics (preterm-LBW, SGA-LBW, and birthweight ≥2,500. Logistic regression models estimated the odds ratios (OR of hypertension among women who reported a preterm-LBW or SGA-LBW delivery compared with women who reported an infant with birthweight ≥2,500 at delivery. Overall, there was a positive association between a preterm-LBW delivery and hypertension (adjusted OR = 1.39, 95% confidence interval (CI 1.02-1.90. Prior SGA-LBW also increased the odds of hypertension, but the estimate did not reach statistical significance (adjusted OR = 1.21, 95% CI 0.76-1.92. Race/ethnicity modified the above associations. Only black women had increased risk of hypertension following SGA-LBW delivery (adjusted OR = 2.09, 95% CI 1.12-3.90. Black women were at marginally increased risk of hypertension after delivery of a preterm-LBW (adjusted OR = 1.49, 95% CI 0.93-2.38. Whites and Hispanics had increased, but not statistically significant, risk of hypertension after a preterm-LBW (whites: adjusted OR = 1.39, 95% CI 0.92-2.10; Hispanics: adjusted OR = 1.22, 95% CI 0.62-2.38. Stratified analysis indicated that the associations were stronger among women who were premenopausal and whose last pregnancy were more recent. The current study suggests that in a representative United

  1. Maternal hypertension after a low-birth-weight delivery differs by race/ethnicity: evidence from the National Health and Nutrition Examination Survey (NHANES) 1999-2006.

    Science.gov (United States)

    Xu, Jia; Barinas-Mitchell, Emma; Kuller, Lewis H; Youk, Ada O; Catov, Janet M

    2014-01-01

    Studies have suggested an increase in maternal morbidity and mortality due to cardiovascular diseases in women with a prior low-birth-weight (LBW, <2,500 grams) delivery. This study evaluated blood pressure and hypertension in women who reported a prior preterm or small-for-gestational-age (SGA) LBW delivery in the National Health and Nutrition Examination Survey 1999-2006 (n = 6,307). This study also aimed to explore if race/ethnicity, menopause status, and years since last pregnancy modified the above associations. A total of 3,239 white, 1,350 black, and 1,718 Hispanics were assessed. Linear regression models were used to evaluate blood pressure by birth characteristics (preterm-LBW, SGA-LBW, and birthweight ≥2,500). Logistic regression models estimated the odds ratios (OR) of hypertension among women who reported a preterm-LBW or SGA-LBW delivery compared with women who reported an infant with birthweight ≥2,500 at delivery. Overall, there was a positive association between a preterm-LBW delivery and hypertension (adjusted OR = 1.39, 95% confidence interval (CI) 1.02-1.90). Prior SGA-LBW also increased the odds of hypertension, but the estimate did not reach statistical significance (adjusted OR = 1.21, 95% CI 0.76-1.92). Race/ethnicity modified the above associations. Only black women had increased risk of hypertension following SGA-LBW delivery (adjusted OR = 2.09, 95% CI 1.12-3.90). Black women were at marginally increased risk of hypertension after delivery of a preterm-LBW (adjusted OR = 1.49, 95% CI 0.93-2.38). Whites and Hispanics had increased, but not statistically significant, risk of hypertension after a preterm-LBW (whites: adjusted OR = 1.39, 95% CI 0.92-2.10; Hispanics: adjusted OR = 1.22, 95% CI 0.62-2.38). Stratified analysis indicated that the associations were stronger among women who were premenopausal and whose last pregnancy were more recent. The current study suggests that in a representative United States

  2. Neither philopatric nor panmictic: microsatellite and mtDNA evidence suggests lack of natal homing but limits to dispersal in Pacific lamprey.

    Science.gov (United States)

    Spice, Erin K; Goodman, Damon H; Reid, Stewart B; Docker, Margaret F

    2012-06-01

    Most species with lengthy migrations display some degree of natal homing; some (e.g. migratory birds and anadromous salmonids) show spectacular feats of homing. However, studies of the sea lamprey (Petromyzon marinus) indicate that this anadromous species locates spawning habitat based on pheromonal cues from larvae rather than through philopatry. Previous genetic studies in the anadromous Pacific lamprey (Entosphenus tridentatus) have both supported and rejected the hypothesis of natal homing. To resolve this, we used nine microsatellite loci to examine the population structure in 965 Pacific lamprey from 20 locations from central British Columbia to southern California and supplemented this analysis with mitochondrial DNA restriction fragment length polymorphism analysis on a subset of 530 lamprey. Microsatellite analysis revealed (i) relatively low but often statistically significant genetic differentiation among locations (97% pairwise F(ST) values were lampreys are unusual among species with long migrations, but suggest that limited dispersal at sea precludes panmixia in this species. © 2012 Blackwell Publishing Ltd.

  3. What can local authorities do to improve the social care-related quality of life of older adults living at home? Evidence from the Adult Social Care Survey.

    Science.gov (United States)

    van Leeuwen, K M; Malley, J; Bosmans, J E; Jansen, A P D; Ostelo, R W; van der Horst, H E; Netten, A

    2014-09-01

    Local authorities spend considerable resources on social care at home for older adults. Given the expected growth in the population of older adults and budget cuts on local government, it is important to find efficient ways of maintaining and improving the quality of life of older adults. The ageing in place literature suggests that policies in other functions of local authorities may have a significant role to play. This study aims to examine the associations between social care-related quality of life (SCRQoL) in older adults and three potential policy targets for local authorities: (i) accessibility of information and advice, (ii) design of the home and (iii) accessibility of the local area. We used cross-sectional data from the English national Adult Social Care Survey (ASCS) 2010/2011 on service users aged 65 years and older and living at home (N=29,935). To examine the association between SCRQoL, as measured by the ASCOT, and three single-item questions about accessibility of information, design of the home and accessibility of the local area, we estimate linear and quantile regression models. After adjusting for physical and mental health factors and other confounders our findings indicate that SCRQoL is significantly lower for older adults who find it more difficult to find information and advice, for those who report that their home design is inappropriate for their needs and for those who find it more difficult to get around their local area. In addition, these three variables are as strongly associated with SCRQoL as physical and mental health factors. We conclude that in seeking to find ways to maintain and improve the quality of life of social care users living at home, local authorities could look more broadly across their responsibilities. Further research is required to explore the cost-effectiveness of these options compared to standard social care services. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Integrating Advanced Practice Nurses in Home Care. Recommendations for a Teaching Home Care Program.

    Science.gov (United States)

    Mitty, Ethel; Mezey, Mathy

    1998-01-01

    A telephone survey of home care agencies and providers revealed a need for the following: evidence of the effectiveness of nurse practitioners in home care, regulatory and financial support for nurse practitioner home care, and development of home care agencies as clinical sites for training. (SK)

  5. Impact of ICT on Agricultural Extension Services Delivery: Evidence from the Catholic Relief Services SMART Skills and Farmbook Project in Kenya

    Science.gov (United States)

    Tata, Joyous S.; McNamara, Paul E.

    2018-01-01

    Purpose: The study was carried out to assess the impact of the Catholic Relief Services (CRS) Skills for Marketing and Rural Transformation (SMART) skills and Farmbook information communication technology (ICT) on agricultural extension service delivery by front-line extension officers in two counties in Kenya. The second objective was to assess…

  6. Clear goals, solid evidence, integrated systems, realistic roles.

    Science.gov (United States)

    Thompson, L G

    2000-01-01

    To maximize the effectiveness of home care in improving or maintaining the health of Canadians, home-care programs must have clear goals, be founded firmly on evidence of effectiveness, form part of an integrated healthcare system and be grounded in constitutional and political reality. Goals should be client-centred and distinguish between curative, supportive and preventive care. Curative and supportive home care can be cost-effective if substitution for more costly institutional services can be achieved, but the cost-effectiveness of preventive home care and comprehensive care for the elderly has not been clearly demonstrated. Integrated delivery systems are a prerequisite for effective substitution of care at home for institutional care. Federal financing dedicated to a home-care program is unnecessary and is a political and constitutional non-starter. Federal leadership for a national home-care approach would be welcome. Canada Health Act protection for access to medically necessary home care is attractive, but such protection for pharmaceuticals is a higher need. Federal support for research and demonstration of new models of care is valuable.

  7. A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice

    NARCIS (Netherlands)

    Zuidema, Sytse U.; Johansson, Alice; Selbaek, Geir; Murray, Matt; Burns, Alistair; Ballard, Clive; Koopmans, Raymond T. C. M.

    2015-01-01

    Background: To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes. Methods: We used a modified Delphi consensus procedure with three rounds, where we actively specified

  8. Home sweet home? Community care for older people in Australia.

    Science.gov (United States)

    Henderson, Emily J; Caplan, Gideon A

    2008-02-01

    Community care provision for older Australians is growing in places and options, based on older people's preference to stay in their own homes, coupled with its cost efficiency compared to long-term residential care. Australia's aging population, cultural diversity, and dispersed population in rural and remote areas presents significant challenges in meeting these care needs. The objective of this review is to provide a critical overview of community care services in Australia, from its origin in the 1940s through to the current array of programs that deliver care. Barriers to access for these programs, growth in funding and expenditure, evidence of client satisfaction and the problems of workforce provision are presented. It is not clear how the growing future demands for care programs, resulting from greater client expectation, increasingly complex care needs and a diminishing workforce of paid and unpaid carers, will be met. However, the economic burden is anticipated to be manageable. Despite seemingly well-structured programs, the current multiplicity and rigidity of services means care provided is sometimes unsatisfactory at the point of delivery. It remains to be seen therefore if services can be expanded, modified and developed to address current deficiencies and meet future demands. The reality of timely and equitable care for all older Australians living in the community is elusive at present. The ongoing rationing of residential care beds coupled with people's desires to stay in their own homes means community care is here to stay. The future inevitably presents huge challenges to those planning, implementing and providing care in this setting.

  9. Halfway Home.

    Science.gov (United States)

    Sandham, Jessica L.

    1998-01-01

    Describes the pros and cons of Alaska's unique Family Partnership Charter School, which oversees distribution of public funding to home-schooling families, offers support to help home-schooling parents meet district standards on their own terms, and monitors required purchase of teacher time and expenditures. A sidebar describes an Alaskan…

  10. Nursing Homes

    Science.gov (United States)

    ... homes have nursing aides and skilled nurses on hand 24 hours a day. Some nursing homes are set up like a hospital. The staff provides medical care, as well as physical, speech and occupational therapy. There might be a nurses' station on each ...

  11. Nursing Homes

    Science.gov (United States)

    ... to time. At least one-third of nursing home residents have problematic behaviors. These behaviors may include verbal and physical abuse, ... accessible are they? How close is the nursing home to family members? How close is it to the ... is the food like? How much do basic services cost? What ...

  12. Unimaginable homes

    DEFF Research Database (Denmark)

    Møller, Kristian; Klausen, Maja

    2018-01-01

    The chapter draw from critical mediatization theory, critical intimacy theory, and cultural gerontology and asks: How do elderly people practice their mediatized homes? Which roles do media play in constituting and disturbing the flows of bodies into the home? Moreover: how do dominant categoriza...

  13. High performance homes

    DEFF Research Database (Denmark)

    Beim, Anne; Vibæk, Kasper Sánchez

    2014-01-01

    . Consideration of all these factors is a precondition for a truly integrated practice and as this chapter demonstrates, innovative project delivery methods founded on the manufacturing of prefabricated buildings contribute to the production of high performance homes that are cost effective to construct, energy......Can prefabrication contribute to the development of high performance homes? To answer this question, this chapter defines high performance in more broadly inclusive terms, acknowledging the technical, architectural, social and economic conditions under which energy consumption and production occur...... efficient to operate and valuable for building communities. Herein discussed are two successful examples of low energy prefabricated housing projects built in Copenhagen Denmark, which embraced both the constraints and possibilities offered by prefabrication....

  14. Assessing Home Visit Quality: Dosage, Content, and Relationships

    Science.gov (United States)

    Paulsell, Diane; Boller, Kimberly; Hallgren, Kristin; Mraz Esposito, Andrea

    2010-01-01

    Home visiting is a service delivery strategy, but the content and focus of home visiting, as well as the characteristics of home visitors and the targeted outcomes, vary across program models. Understanding what is common, what is unique, and what the targets of change are for a range of models can support identification of key factors that make…

  15. Home births and postnatal practices in madagali, North.Eastern ...

    African Journals Online (AJOL)

    Background: Home births are common in resource poor countries and postnatal practices vary from one community to the other. Objective: To determine the proportion of home births, reasons for home delivery, and evaluate postnatal practices in Madagali, north.eastern Nigeria. Materials and Methods: This was a ...

  16. Training and in-service training of home economics extension ...

    African Journals Online (AJOL)

    Home economics is traditionally a femaledominated profession. Home economists employed in the KwaZulu-Natal agricultural and rural development extension delivery system are mainly responsible for serving a predominantly female clientele, namely rural women. These home economists focus on women's domestic ...

  17. After Delivery

    Science.gov (United States)

    ... for Association Events Messaging Tools Recruiting Advocates Local Market Planning Training Webinars News & Events Advocacy News Call ... A Listen En Español After Delivery After your baby arrives, your body begins to recover from the ...

  18. Forceps Delivery

    Science.gov (United States)

    ... 2015. Related Signs of labor Forceps delivery About Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  19. Home Hemodialysis

    Science.gov (United States)

    ... weeks of home hemodialysis training. Diet and Liquids Strict limits on liquids, phosphorus, sodium, and potassium Fewer ... Health Information Diabetes Digestive Diseases Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition ...

  20. The Role of Preference on Outcomes of People Receiving Evidence-Informed Community Wound Care in Their Home or in a Nurse-Clinic Setting: A Cohort Study (n = 230

    Directory of Open Access Journals (Sweden)

    Margaret B. Harrison

    2014-09-01

    Full Text Available This study followed a cohort of community-dwelling individuals receiving wound-care in a large urban-rural region. During a randomized control trial (RCT evaluating outcomes of receiving care in a nurse-clinic or at home, many approached were willing to participate if they could choose their location of care. This provided a unique opportunity to enroll them as a “choice” cohort, following them in the same manner as the trial participants but allowing them to select their setting of care. The objective was to investigate the role of preference and location of care on care outcomes, including satisfaction with care, healing, health-related quality of life (HRQL, pain, and resource use. This is a secondary analysis of a prospective cohort of 126 individuals enrolled in an RCT to receive care at home or in a nurse-clinic (Allocated group, and an additional 104 who received care at home or in a nurse-clinic based on their preference (Choice group. Mobile individuals with a leg ulcer of venous or mixed venous etiology, referred for community leg ulcer care, were eligible. Specially-trained nurses provided care to both groups using an evidence-informed protocol. Baseline data included socio-demographic, circumstance-of-living and a detailed wound assessment. Mean age of the cohort was 68 years. Satisfaction, healing, recurrence, pain, HRQL, and resource utilization did not differ between groups. If available, individuals should have an option of care venue given almost half of those approached indicated a clear preference for clinic or home. With outcomes being similar, health care planners and decision-makers, as well as individuals and their families, can feel confident that the setting of care will not impact the outcomes. However, larger studies in other contexts are needed to explore the interaction between choice and setting.

  1. Nursing Home

    OpenAIRE

    Allocca Hernandez, Giacomo Antonio

    2016-01-01

    Getting old involves a lot of changes in life. Family and social relations change and mobility can decrease. These variations require new settings, and of course special care. A nursing home is a place dedicated to help with this situation. Sometimes nursing homes can be perceived as mere institutions by society, and even by future residents. Inside, senior citizens are suppose to spend the rest of their lives doing the same activities day after day. How can we improve these days? Archite...

  2. Competition and quality in home health care markets.

    Science.gov (United States)

    Jung, Kyoungrae; Polsky, Daniel

    2014-03-01

    Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. Copyright © 2013 John Wiley & Sons, Ltd.

  3. Value and the medical home: effects of transformed primary care.

    Science.gov (United States)

    Gilfillan, Richard J; Tomcavage, Janet; Rosenthal, Meredith B; Davis, Duane E; Graham, Jove; Roy, Jason A; Pierdon, Steven B; Bloom, Frederick J; Graf, Thomas R; Goldman, Roy; Weikel, Karena M; Hamory, Bruce H; Paulus, Ronald A; Steele, Glen D

    2010-08-01

    The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 different primary care practices. The goals were to improve the quality, efficiency, and patient experience of care. To evaluate the ability of a medical home model to improve the efficiency of care for Medicare beneficiaries. Observational study using regression modeling based on preintervention and postintervention data and a propensity-selected control cohort. Four years of claims data for Medicare patients at 11 intervention sites and 75 control groups were analyzed to compute hospital admission and readmission rates, and the total cost of care. Regression modeling was used to establish predicted rates and costs in the absence of the intervention. Actual results were compared with predicted results to compute changes attributable to the PHN model. ProvenHealth Navigator was associated with an 18% (P Investing in the capabilities of primary care practices to serve as medical homes may increase healthcare value by improving the efficiency of care. This study demonstrates that the PHN model is capable of significantly reducing admissions and readmissions for Medicare Advantage members.

  4. How labour intensive is a doctor-based delivery model for antiretroviral treatment (ART? Evidence from an observational study in Siem Reap, Cambodia

    Directory of Open Access Journals (Sweden)

    Janssens Bart

    2007-05-01

    Full Text Available Abstract Background Funding for scaling-up antiretroviral treatment (ART in low-income countries has increased substantially, but the lack of human resources for health (HRH is increasingly being identified as an important constraint for scaling-up ART. Methods In a clinic run by Médecins Sans Frontières in Siem Reap, Cambodia, we documented the use of doctor-time for ART in September 2004 and in August 2005, for different phases in ART (pre-ART, ART initiation, ART follow-up Year 1, & ART follow-up Year 2. Based on these observations and using a variety of assumptions for survival of patients on ART (between 90 and 95% annually and for further reductions in doctor-time per patient (between 0 and 10% annually, we estimated the need for doctors for the period 2004 till 2013 in the Siem Reap clinic, and in a hypothetical district in sub-Saharan Africa. Results In the Siem Reap clinic, we found that from 2004 to 2005 the doctor-time needed per patient was reduced by between 14% and 33%, thanks to a reduction in number of visits per patient and shorter consultation times. In 2004, 2.06 full-time equivalent (FTE doctors were needed for 522 patients on ART, and in 2005 this was slightly reduced to 1.97 FTE doctors for 911 patients on ART. By 2013, Siem Reap clinic will need between 2 and 5 FTE doctors for ART. In a district in sub-Saharan Africa with 200,000 inhabitants and 20% adult HIV prevalence, using a similar doctor-based ART delivery model, between 4 and 11 FTE doctors would be needed to cover 50% of ART needs. Conclusion ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints.

  5. Replacing the Transfusion of 1–2 Units of Blood with Plasma Expanders that Increase Oxygen Delivery Capacity: Evidence from Experimental Studies

    Directory of Open Access Journals (Sweden)

    Amy G. Tsai

    2014-10-01

    Full Text Available At least a third of the blood supply in the world is used to transfuse 1–2 units of packed red blood cells for each intervention and most clinical trials of blood substitutes have been carried out at this level of oxygen carrying capacity (OCC restoration. However, the increase of oxygenation achieved is marginal or none at all for molecular hemoglobin (Hb products, due to their lingering vasoactivity. This has provided the impetus for the development of “oxygen therapeutics” using Hb-based molecules that have high oxygen affinity and target delivery of oxygen to anoxic areas. However it is still unclear how these oxygen carriers counteract or mitigate the functional effects of anemia due to obstruction, vasoconstriction and under-perfusion. Indeed, they are administered as a low dosage/low volume therapeutic Hb (subsequently further diluted in the circulatory pool and hence induce extremely small OCC changes. Hyperviscous plasma expanders provide an alternative to oxygen therapeutics by increasing the oxygen delivery capacity (ODC; in anemia they induce supra-perfusion and increase tissue perfusion (flow by as much as 50%. Polyethylene glycol conjugate albumin (PEG-Alb accomplishes this by enhancing the shear thinning behavior of diluted blood, which increases microvascular endothelial shear stress, causes vasodilation and lowering peripheral vascular resistance thus facilitating cardiac function. Induction of supra-perfusion takes advantage of the fact that ODC is the product of OCC and blood flow and hence can be maintained by increasing either or both. Animal studies suggest that this approach may save a considerable fraction of the blood supply. It has an additional benefit of enhancing tissue clearance of toxic metabolites.

  6. The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Tura Gurmesa

    2013-01-01

    Full Text Available Abstract Background Though promising progress has been made towards achieving the Millennium Development Goal four through substantial reduction in under-five mortality, the decline in neonatal mortality remains stagnant, mainly in the middle and low-income countries. As an option, health facility delivery is assumed to reduce this problem significantly. However, the existing evidences show contradicting conclusions about this fact, particularly in areas where enabling environments are constraint. Thus, this review was conducted with the aim of determining the pooled effect of health facility delivery on neonatal mortality. Methods The reviewed studies were accessed through electronic web-based search strategy from PUBMED, Cochrane Library and Advanced Google Scholar by using combination key terms. The analysis was done by using STATA-11. I2 test statistic was used to assess heterogeneity. Funnel plot, Begg’s test and Egger’s test were used to check for publication bias. Pooled effect size was determined in the form of relative risk in the random-effects model using DerSimonian and Laird's estimator. Results A total of 2,216 studies conducted on the review topic were identified. During screening, 37 studies found to be relevant for data abstraction. From these, only 19 studies fulfilled the preset criteria and included in the analysis. In 10 of the 19 studies included in the analysis, facility delivery had significant association with neonatal mortality; while in 9 studies the association was not significant. Based on the random effects model, the final pooled effect size in the form of relative risk was 0.71 (95% CI: 0.54, 0.87 for health facility delivery as compared to home delivery. Conclusion Health facility delivery is found to reduce the risk of neonatal mortality by 29% in low and middle income countries. Expansion of health facilities, fulfilling the enabling environments and promoting their utilization during childbirth are

  7. Home hemodialysis: a comprehensive review of patient-centered and economic considerations

    Directory of Open Access Journals (Sweden)

    Walker RC

    2017-02-01

    Full Text Available Rachael C Walker,1,2 Kirsten Howard,1 Rachael L Morton3 1School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia; 2Hawke’s Bay District Health Board, Hastings, New Zealand; 3NHMRC Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, Australia Abstract: Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients’ lifestyle. This is a comprehensive literature review of patient-centered and economic impacts of home HD with the studies published between January 2000 and July 2016. Data from the primary studies representing both efficiency and equity of home HD were presented as a narrative synthesis under the following topics: advantages to patients, barriers to patients, economic factors influencing patients, cost-effectiveness of home HD, and inequities in home HD delivery. There were a number of advantages for patients on home HD including improved survival and QoL and flexibility and potential for employment, compared to hospital HD. Similarly, there were several barriers to patients preferring or maintaining home HD, and the strategies to overcome these barriers were frequently reported. Good evidence reported that indigenous, low-income, and other socially disadvantaged individuals had reduced access to home HD compared to other forms of dialysis and that this situation compounds already-poor health outcomes on renal

  8. Innovative Interdisciplinary Training in and Delivery of Evidence-Based Geriatric Services: Creating a Bridge with Social Work and Physical Therapy

    Science.gov (United States)

    Rowan, Noell L.; Gillette, Patricia D.; Faul, Anna C.; Yankeelov, Pamela A.; Borders, Kevin W.; Deck, Stacy; Nicholas, Lori D.; Wiegand, Mark

    2009-01-01

    With focus on interdisciplinary education models, social work and physical therapy faculty from two proximate universities partnered to create an evidence-based geriatric assessment and brief intervention research, training, and service project for community-dwelling older adults. Assessment tools and interventions were selected from the…

  9. Home Dissolution

    DEFF Research Database (Denmark)

    Gram-Hanssen, Kirsten; Bech-Danielsen, Claus

    2008-01-01

    Building a home and creating a family are highly inter­connec­ted processes. So what happens with the home when people separate or divorce? In this paper we address this question both from a quantitative and a qualitative approach. Based on an extensive database with socio-economic background data...... of 42,000 separated Danish couples in 2002, we follow the housing careers of both partners, to see how the housing situation of different types of people was affected by the separation. In the qualitative approach, nine interviews with couples who have parted shed light on the emotions and practical...

  10. Home Visitation Programs for At-risk Young Families: A Systematic Literature Review

    National Research Council Canada - National Science Library

    J.E. Drummond; A.E. Weir; G.M. Kysela

    2002-01-01

    ... home visitation for at-risk young families as the major delivery method. Objectives: To describe the program components, practices, outcomes, and reliability of the evaluation approaches. Methods...

  11. The Science of Home Automation

    Science.gov (United States)

    Thomas, Brian Louis

    Smart home technologies and the concept of home automation have become more popular in recent years. This popularity has been accompanied by social acceptance of passive sensors installed throughout the home. The subsequent increase in smart homes facilitates the creation of home automation strategies. We believe that home automation strategies can be generated intelligently by utilizing smart home sensors and activity learning. In this dissertation, we hypothesize that home automation can benefit from activity awareness. To test this, we develop our activity-aware smart automation system, CARL (CASAS Activity-aware Resource Learning). CARL learns the associations between activities and device usage from historical data and utilizes the activity-aware capabilities to control the devices. To help validate CARL we deploy and test three different versions of the automation system in a real-world smart environment. To provide a foundation of activity learning, we integrate existing activity recognition and activity forecasting into CARL home automation. We also explore two alternatives to using human-labeled data to train the activity learning models. The first unsupervised method is Activity Detection, and the second is a modified DBSCAN algorithm that utilizes Dynamic Time Warping (DTW) as a distance metric. We compare the performance of activity learning with human-defined labels and with automatically-discovered activity categories. To provide evidence in support of our hypothesis, we evaluate CARL automation in a smart home testbed. Our results indicate that home automation can be boosted through activity awareness. We also find that the resulting automation has a high degree of usability and comfort for the smart home resident.

  12. Home Enteral Nutrition therapy: Difficulties, satisfactions and support needs of caregivers assisting older patients.

    Science.gov (United States)

    Jukic P, Nikolina; Gagliardi, Cristina; Fagnani, Donata; Venturini, Claudia; Orlandoni, Paolo

    2017-08-01

    The purpose of this study was to comprehend and describe the views, experiences and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition. The objective was to gather empirical evidence to improve the delivery of Home Enteral Nutrition for old patients taking into account the caregivers' support needs. A qualitative methodology with focus groups as data collection method was used to collect the testimonies of 30 informal and formal caregivers of older patients treated with Home Enteral Nutrition by the Clinical Nutrition Service of INRCA (Ancona) during 2014. Quantitative methodology was used to collect socio-demographic data. Partially modified Silver's "Home Enteral Nutrition Caregiver Task Checklist" was used to identify training needs. The constant comparison method was used to code and categorize data and to develop themes of focus groups. Simple descriptive statistics were used to summarize questionnaires. Five main themes were identified from focus groups: acceptance of the therapy, skill acquisition process, need for psychological and practical support at home from healthcare professionals, lifestyle adaptation, affirmation of life and family. All caregivers testified the initial fear and refusal to manage the nutrition pump and the therapy. They expressed the need to be trained gradually, starting during a patient's hospitalization, and continuing in the community. With reference to their overall QoL, it emerged that informal caregivers suffered mostly from the reduction of their free time while formal caregivers suffered social isolation and psychological burden. For both groups the monthly home visit was the most important element of the HEN service. Informal caregivers highlighted the importance of having their loved ones at home. Unsatisfied training needs were identified by the modified Silver's "Home Enteral Nutrition Caregiver Task Checklist". This qualitative study underlined the challenges and adaptations of

  13. The public/private debate in the funding, administration and delivery of healthcare in Canada.

    Science.gov (United States)

    Marchildon, Gregory P

    2004-01-01

    To help clarify the confusing debate concerning the public-private divide in Canada and the respective positions of the Romanow and Kirby reports, a new approach is proposed. The funding, administration and delivery of the healthcare "system" is split into distinct analytical categories and then applied to three major coverage groupings: universal public (Canada Health Act) coverage for medically necessary/required services; mixed coverage for drug care, home and long-term care; and private health goods and services. While there were no fundamental differences between Romanow and Kirby concerning the funding of public healthcare in Canada, there were some important differences on issues of administration. In particular, the Romanow report recommended that home mental healthcare services become universally covered under the Canada Health Act as well as fundamental changes to the regulation and administration of prescription drug care. The reports also differed in terms of framing the private delivery question, with the Romanow report questioning whether the evidence justified private-for-profit delivery replacing current private not-for-profit or public arm's length delivery modes.

  14. Failure to perform assisted deliveries is resulting in an increased ...

    African Journals Online (AJOL)

    The need to perform assisted vaginal delivery has been regarded as self-evident. Textbooks state: 'Assisted vaginal ... in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is .... delivery[20] states that blood-borne viral infections of the mother are no contraindication to operative ...

  15. RESPONDING PROFESSIONALLY TO REQUESTS FOR CESAREAN DELIVERY.

    Science.gov (United States)

    Chervenak, F; McCullough, L

    2017-01-01

    Patients' requests for non-indicated cesarean delivery challenge the professionalism of obstetricians. This is because physicians should not provide clinical management in the absence of an evidence-based indication for it. The ethics of responding professionally to requests for non-indicated cesarean delivery would appear to be simple: just say "No." This paper presents an ethically and clinically more nuanced approach, on the basis of the professional responsibility model of obstetric ethics, emphasizinga preventive ethics approach. Preventive ethics deploys the informed consent process to minimize ethical conflict in clinical practice. This process should focus on when to recommend against cesarean delivery - rather than simply saying no. There is no evidence of net clinical benefit for pregnant, fetal, and neonatal patients from non-indicated cesarean delivery. Obstetricians should therefore respond to such requests by recommending against cesarean delivery, recommending vaginal delivery, and explaining the evidence base for these recommendations.

  16. Protective effects of equol and their polyphenolic isomers against dermal aging: microarray/protein evidence with clinical implications and unique delivery into human skin.

    Science.gov (United States)

    Lephart, Edwin D

    2013-11-01

    Equol is a polyphenolic/isoflavonoid molecule that can be expressed as isomers. However, the characteristics of the equol isomers on dermal gene/protein expression and human skin percutaneous absorption remain unknown. Perform a comprehensive investigation on equol as: R-equol, racemic equol or S-equol to determine their differential expression of skin-related genes, quantify collagen expression and determine percutaneous absorption in human skin. Quantified: (i) gene expression/mRNA levels via gene array technology using human skin equivalents with equol exposure at 1.2% in qPCR experiments, (ii) in vitro collagen expression in human fibroblasts, and (iii) percutaneous absorption by Franz cell techniques. In the qPCR studies, only three genes displayed the greatest significant expression by S-equol, whereas 16 genes displayed the greatest significant levels (either stimulation or inhibition) by R-equol and/or racemic equol, such as extracellular matrix proteins (i.e., collagen and elastin), nerve growth factor, aging genes [FOS, 100 A8 and A9 calcium-binding proteins, 5α-reductase type 1, and matrix metalloproteinases (1, 3, and 9)], and inflammatory genes (e.g., interleukin-1 alpha, interleukin-6, and cyclooxygenase-1). Collagen type I expression in fibroblasts was greater with racemic versus S-equol treatment at 1 and 10 nM. Percutaneous absorption demonstrated high sequestering in keratinocytes with subsequent accumulation/release over time. Overall, these results illustrate the significant differences in mirror-image molecules or isomers of equol where R-equol and/or racemic equol are better molecules for skin gene expression compared to S-equol and the percutaneous absorption of equol represents a unique epidermal reservoir delivery mechanism.

  17. A joint protocol for home skeletal traction.

    Science.gov (United States)

    Walsh, C R; McBryde, A M

    1997-01-01

    Cost-effective delivery of quality patient care is a major focus of the orthopaedic advanced practice nurse's practice. Long-term skeletal traction therapy for select fractures of the pelvis remains a treatment option for certain patients. The purposes of this article are to describe the development of a joint proposal for home skeletal traction therapy and to analyze the cost savings involved by reviewing a case study of a home traction patient.

  18. Mobile healthcare in the home environment.

    Science.gov (United States)

    Price, Sheila; Summers, Ron

    2006-01-01

    Mobile healthcare provision in the home environment presents many challenges. Patients are becoming more informed about the management of chronic conditions and the use of technology to support the process is rising. Issues such as system interoperability, cost, security and training all have to be addressed to ensure effective use of mobile devices within the home healthcare arena. An aging population will impact upon traditional healthcare delivery methods.

  19. Bringing politics and evidence together: policy entrepreneurship and the conception of the At Home/Chez Soi Housing First Initiative for addressing homelessness and mental illness in Canada.

    Science.gov (United States)

    Macnaughton, Eric; Nelson, Geoffrey; Goering, Paula

    2013-04-01

    An interesting question concerns how large-scale (mental) health services policy initiatives come into being, and the role of evidence within the decision-making process behind their origins. This paper illustrates the process by which motivation to address homelessness, in the context of the upcoming 2010 Vancouver Olympics, was leveraged into a pan-Canadian project including sites in Vancouver, Winnipeg, Toronto, Montreal and Moncton, New Brunswick. The aim of the initiative was to implement and evaluate an intervention, Housing First, to provide housing and support to previously homeless people with mental illness. This qualitative case study was conducted between December 2009 and December 2010, employing grounded theory, and drawing on archival documents and interviews with 19 key informants involved in the conception of the project. Overall, the findings affirm that policy-making does not follow a rational, linear process of knowledge translation/exchange (KTE) and implementation, whereby evidence-based "products" are brought forward to address objectively determined needs and then "placed into decision-making events" (Lomas, 2007, p. 130). Instead, evidence-based policy making should be understood within the much more complex context of "policy entrepreneurship" (Kingdon, 2003; Mintrom & Norman, 2009) which entails taking advantage of windows of opportunity, and helping to bring together the "streams" of problems, politics, and policy ideas (Kingdon, 2003). Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Home Seismometer

    Science.gov (United States)

    Horiuchi, S.; Yamamoto, S.; Nakmaura, H.; Wu, C.; Rydelek, P.; Kachi, M.

    2007-12-01

    We have developed an automated system for analyzing Hi-net seismograms for earthquake early warning (EEW) in Japan. Because of limitations imposed by station spacing, our system generally cannot issue an EEW to areas within about 30 km distance of the earthquake's hypocenter. We estimate that about 10 times the number of stations would be needed to issue an EEW in these areas, but the overhead would be cost prohibitive for governmental agencies. The practical deployment of EEW in Japan has started in October, 2007 and millions of people are expected to purchase and install the receiving/alarm unit of EEW. Since most of these units are connected to internet and equipped with a CPU and memory, we realized that the addition of an inexpensive seismometer and digitizer would transform the receiver into a real-time seismic observatory, which we are calling a home seismometer; these modifications only cost about $20. The home seismometer can help to generate alerts at the time of the occurrence of a large local earthquake by using locally observed data. Also, home seismograms can be used to estimate the amplification factor in sedimentary layers, which will be used to determine the site correction for shaking intensity by comparing the waveform data from the home seismometer against those from nearby Hi-net or K-NET stations. This amplification factor, which is essentially the basis of a shake-map with very-high spatial resolution, will help to establish a safety index of houses/buildings for large earthquakes, since a structure located at a site with large seismic amplification can be damaged more seriously than those with small amplification factors. The installation of home seismometers will create an extremely dense seismic network that is without precedence. We are developing an automatic system that collects waveform data from all home seismometer installations, calculates earthquake parameters in real-time, and then sends back alarms signals based on computed

  1. Use of statistical process control charts in stroke medicine to determine if clinical evidence and changes in service delivery were associated with improvements in the quality of care.

    Science.gov (United States)

    Henderson, G R; Mead, G E; van Dijke, M L; Ramsay, S; McDowall, M A; Dennis, M

    2008-08-01

    Monitoring the effect of service changes on quality of care is essential. By using statistical process control (SPC) charts, this study aimed to explore the relationship between changes in the structure of stroke services and the process of care. Prospectively acquired data on the process of acute stroke care from three hospitals admitting 2962 patients (July 2001 to June 2004) were charted retrospectively on SPC charts for individual values (I charts) to determine whether or not "special cause variation" followed known changes in stroke service structure and publication of the Medical Research Council (MRC) Heart Protection Study. Unexpected signals of special cause variation were identified and reasons for observed patterns were sought by discussion with clinical teams. Improved brain imaging provision was followed by a reduction in time to imaging and earlier prescription of aspirin for ischaemic stroke. The MRC Heart Protection Study was followed by increased statin prescription. However, increasing beds allocated to stroke had no influence on the proportion of patients receiving stroke unit care. Some unexpected signals of special cause variation could be plausibly explained (eg, breakdown of brain scanner), but others could not. Anecdotal evidence from healthcare professionals suggests that charts may be acceptable in clinical practice. SPC charts have the potential to provide valuable insights into the impact of changes in structure of services and of clinical evidence on the process of stroke care. In the present study, the charts were generally well received by healthcare professionals.

  2. Depression in nursing homes.

    Science.gov (United States)

    Snowdon, John

    2010-11-01

    Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended. This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008-2009 were collected from three Sydney nursing homes. CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged. Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.

  3. Seasonality of CO2 in coastal oceans altered by increasing anthropogenic nutrient delivery from large rivers: evidence from the Changjiang–East China Sea system

    Directory of Open Access Journals (Sweden)

    W.-C. Chou

    2013-06-01

    Full Text Available Model studies suggested that human-induced increase in nutrient load may have stimulated primary production and thus enhanced the CO2 uptake capacity in the coastal ocean. In this study, we investigated the seasonal variations of the surface water's partial pressure of CO2 (pCO2sw in the highly human-impacted Changjiang–East China Sea system between 2008 and 2011. The seasonality of pCO2sw has large spatial variations, with the largest extreme of 170 ± 75 μatm on the inner shelf near the Changjiang Estuary (from 271 ± 55 μatm in summer to 441 ± 51 μatm in autumn and the weakest extreme of 53 ± 20 μatm on the outer shelf (from 328 ± 9 μatm in winter to 381 ± 18 μatm in summer. During the summer period, stronger stratification and biological production driven by the eutrophic Changjiang plume results in a very low dissolved inorganic carbon (DIC in surface waters and a very high DIC in bottom waters of the inner shelf, with the latter returning high DIC to the surface water during the mixed period. Interestingly, a comparison with historical data shows that the average pCO2sw on the inner shelf near the Changjiang Estuary has decreased notably during summer, but has increased during autumn and winter from the 1990s to the 2000s. We suggest that this decadal change is associated with recently increased eutrophication. This would increase both the photosynthetic removal of DIC in surface waters and the respiratory release of DIC in bottom waters during summertime, thereby returning more DIC to the surface during the subsequent mixing seasons and/or episodic extreme weather events (e.g., typhoons. Our finding demonstrates that increasing anthropogenic nutrient delivery from a large river may enhance the sequestration capacity of CO2 in summer but may reduce it in autumn and winter. Consequently, the coastal ocean may not necessarily take up more atmospheric CO2 in response to increasing eutrophication, and the net effect largely depends

  4. Evidências sobre o suporte durante o trabalho de parto/parto: uma revisão da literatura Evidence on support during labor and delivery: a literature review

    Directory of Open Access Journals (Sweden)

    Odaléa Maria Brüggemann

    2005-10-01

    Full Text Available Os efeitos do suporte à mulher durante o trabalho de parto/parto por profissionais de saúde, mulheres leigas e doulas, sobre os resultados maternos e neonatais têm sido avaliados em vários ensaios clínicos randomizados, metanálises e revisões sistemáticas. Este artigo apresenta a revisão desses estudos, enfocando as principais características, o provedor de suporte, a simultaneidade na presença ou não do companheiro/familiares da parturiente durante o trabalho de parto e parto, e os resultados obtidos. Foram incluídos os estudos publicados entre os anos de 1980 e 2004, que contemplam explicitamente os aspectos avaliados. De maneira geral, os resultados do suporte são favoráveis, destacando-se redução da taxa de cesarianas, da analgesia/medicamentos para alívio da dor, da duração do trabalho de parto, da utilização de ocitocina e produzindo aumento na satisfação materna com a experiência vivida. Quando o provedor de suporte não é um profissional de saúde, os benefícios têm sido mais acentuados. Os estudos disponíveis não avaliam o acompanhante escolhido pela parturiente como um provedor de suporte, o que constitui lacuna de conhecimento a ser preenchida.The effects of support for women during labor and delivery provided by health professionals, lay women, and doulas on the maternal and neonatal outcomes have been evaluated through randomized clinical trials, meta-analyses, and systematic reviews. This article presents a review of these studies, focusing on the principal characteristics, support provider, simultaneous presence of the woman's spouse and/or family members during labor and delivery and the outcomes. The analysis included studies published from 1980 to 2004 which explicitly approached these aspects. In general, the results of such support were favorable, highlighting a reduction in the cesarean rate, analgesia/ medication for pain relief, duration of labor, and utilization of oxytocin and an increase in

  5. Returning home

    DEFF Research Database (Denmark)

    Agergaard, Jytte; Brøgger, Ditte

    2016-01-01

    Migration to domestic and international destinations has become an emblematic feature of Nepal’s societal changes. Part of this development is education migration from rural to urban areas within the borders of Nepal, an often overlooked but increasingly important aspect of contemporary migration...... flows. By focusing on these educational migrants, this paper explores how they connect to their rural homes. Guided by a critical reading of the migration-development scholarship, the paper examines how migrants and their relatives make sense of educational migrants’ remitting and returning practices......, and by comparing three groups of educational migrants, the migrants’ reasons for staying connected and sending remittances are scrutinized. The paper finds that although educational migrants do not generate extensive economic remittances for local development in Nepal, they stay connected to their rural homes...

  6. New Whole-House Solutions Case Study: Quadrant Homes

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-02-01

    Quadrant moved ducts and high efficiency furnace inside conditioned space on nearly all 300 customizable house plans. The builder uses dry, true factory-assembled walls, extensive air sealing, and just in time delivery for pre-sold homes.

  7. Home Bias

    OpenAIRE

    田端, 克至; タバタ, カツシ; Katsushi, TABATA

    2002-01-01

    This article discussed on, what we call, the home bias puzzle and international equity investment transactions, in which international security has less been invested in foreign countries After 1989, US and German foreign capital outflow have drastically increased, however. It is the background why this article focuses on these maters. Some changes might be happen in the international financial market. These developments in the world have important implications for us.

  8. The Medical Home

    Science.gov (United States)

    ... the Flu Vaccine? Eating Disorders Arrhythmias The Medical Home KidsHealth > For Parents > The Medical Home Print A ... for your child. What Does the Term "Medical Home" Mean? A medical home isn't a place ...

  9. Factors associated with institutional delivery service utilization in Ethiopia

    Directory of Open Access Journals (Sweden)

    Kebede A

    2016-09-01

    Full Text Available Alemi Kebede,1 Kalkidan Hassen,2 Aderajew Nigussie Teklehaymanot1 1Department of Population and Family Health, 2College of Health Sciences, Jimma University, Ethiopia Background: Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home.Objective: The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia.Methods: The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs and their 95% confidence intervals (CIs were calculated. Heterogeneity of the study was assessed using I2 test.Results: People living in urban areas (OR =13.16, CI =1.24, 3.68, with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively, who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39, and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57 showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization.Conclusion and recommendation: Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available

  10. No Clinical or Biochemical Evidence for Essential Fatty Acid Deficiency in Home Patients Who Depend on Long-Term Mixed Olive Oil- and Soybean Oil-Based Parenteral Nutrition.

    Science.gov (United States)

    Olthof, Evelyn D; Roelofs, Hennie M J; Fisk, Helena L; Calder, Philip C; Wanten, Geert J A

    2016-09-01

    Home parenteral nutrition (HPN) patients depend on lipid emulsions as part of their parenteral nutrition regimen to provide essential fatty acids (EFAs). Mixed-oil sources are used in modern lipid emulsions to decrease the amount of proinflammatory EFAs, mainly linoleic acid, which is present in large amounts in soybean oil. It is unknown whether patients who fully depend on such mixed lipids have adequate EFA supply. We therefore evaluated whether HPN patients who depend on mixed olive oil- and soybean oil-based HPN show clinical or biochemical evidence of EFA deficiency. Fatty acid status was assessed in plasma phosphatidylcholine (PC) and peripheral blood mononuclear cells from 30 patients receiving mixed olive oil- and soybean oil-based HPN (>3 months, ≥5 times per week) and 30 healthy controls. Innate immune cell functions were evaluated by assessing expression of surface membrane molecules, and reactive oxygen species, and cytokine production. None of the patients or controls showed clinical evidence (skin rash) or biochemical evidence (increased Holman index [>0.2]) for EFA deficiency. The Holman index in plasma PC (median [25th-75th percentile]) was significantly higher in patients (0.019 [0.015-0.028]) compared with controls (0.015 [0.011-0.017]). No differences were found in innate immune cell functions between groups, except for a 3.6-fold higher tumor necrosis factor-α production in patients. We found no clinical or biochemical evidence that HPN patients who fully and long-term depend on mixed olive oil- and soybean oil-based lipids have an increased risk for EFA deficiency. © 2015 American Society for Parenteral and Enteral Nutrition.

  11. Enhanced Brain Delivery of Dimethyl Fumarate Employing Tocopherol-Acetate-Based Nanolipidic Carriers: Evidence from Pharmacokinetic, Biodistribution, and Cellular Uptake Studies.

    Science.gov (United States)

    Kumar, Pramod; Sharma, Gajanand; Kumar, Rajendra; Malik, Ruchi; Singh, Bhupinder; Katare, O P; Raza, Kaisar

    2017-04-19

    Dimethyl fumarate (DMF) is an approved drug for the management of relapsing multiple sclerosis. Despite efficacy, DMF is also reported to be a challenging drug owing to concerns like gastrointestinal tract flushing, multiple dosing, lower brain permeability, less patient compliance, and economic hurdles. The present study aims to develop DMF-tocopherol acetate nanolipidic carrier (NLCs) to enhance brain permeability and improve the gastric tolerance. The developed DMF-tocopherol acetate NLCs offered an average size of 69.70 nm, PDI of 0.317, and a zeta potential of -9.71 mV. Higher drug entrapment (90.12%) and drug loading (20.13%) assured controlled drug release behavior both in gastric and intestinal pH. Cellular uptake studies on Caco-2 and SH-SY5Y monolayers confirmed better intestinal absorption and neuronal uptake of the developed system, which was further corroborated by the pharmacokinetic and biodistribution studies. The oral bioavailability was enhanced by 4.09 times and brain availability was substantially improved vis-à-vis plain drug. The findings are promising and offer preclinical evidence for better brain availability of DMF, which can be exploited in the better management of diseases like multiple sclerosis.

  12. Evidence for contribution of CD4+ CD25+ regulatory T cells in maintaining immune tolerance to human factor IX following perinatal adenovirus vector delivery.

    Science.gov (United States)

    Nivsarkar, Megha S; Buckley, Suzanne M K; Parker, Alan L; Perocheau, Dany; McKay, Tristan R; Rahim, Ahad A; Howe, Steven J; Waddington, Simon N

    2015-01-01

    Following fetal or neonatal gene transfer in mice and other species immune tolerance of the transgenic protein is frequently observed; however the underlying mechanisms remain largely undefined. In this study fetal and neonatal BALB/c mice received adenovirus vector to deliver human factor IX (hFIX) cDNA. The long-term tolerance of hFIX was robust in the face of immune challenge with hFIX protein and adjuvant but was eliminated by simultaneous administration of anti-CD25+ antibody. Naive irradiated BALB/c mice which had received lymphocytes from donors immunised with hFIX developed anti-hFIX antibodies upon immune challenge. Cotransplantation with CD4+CD25+ cells isolated from neonatally tolerized donors decreased the antibody response. In contrast, cotransplantation with CD4+CD25- cells isolated from the same donors increased the antibody response. These data provide evidence that immune tolerance following perinatal gene transfer is maintained by a CD4+CD25+ regulatory population.

  13. Evidence for Contribution of CD4+CD25+ Regulatory T Cells in Maintaining Immune Tolerance to Human Factor IX following Perinatal Adenovirus Vector Delivery

    Directory of Open Access Journals (Sweden)

    Megha S. Nivsarkar

    2015-01-01

    Full Text Available Following fetal or neonatal gene transfer in mice and other species immune tolerance of the transgenic protein is frequently observed; however the underlying mechanisms remain largely undefined. In this study fetal and neonatal BALB/c mice received adenovirus vector to deliver human factor IX (hFIX cDNA. The long-term tolerance of hFIX was robust in the face of immune challenge with hFIX protein and adjuvant but was eliminated by simultaneous administration of anti-CD25+ antibody. Naive irradiated BALB/c mice which had received lymphocytes from donors immunised with hFIX developed anti-hFIX antibodies upon immune challenge. Cotransplantation with CD4+CD25+ cells isolated from neonatally tolerized donors decreased the antibody response. In contrast, cotransplantation with CD4+CD25− cells isolated from the same donors increased the antibody response. These data provide evidence that immune tolerance following perinatal gene transfer is maintained by a CD4+CD25+ regulatory population.

  14. Modes of delivery assistance in Bangladesh | Rahman | Tanzania ...

    African Journals Online (AJOL)

    Tanzania Journal of Health Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Modes of delivery assistance in Bangladesh.

  15. EDITORIAL Reinvigorating maternal health service delivery in Ethiopia

    African Journals Online (AJOL)

    kim

    onset of labor, failure of prior preparation for labor and delivery, health professional's maltreatment of women looking for healthcare services and on the other hand, the friendly home setting and close assistance by neighbors and relatives as factors encouraging women to deliver at home. In connection to this, there are ...

  16. Smart homes and home health monitoring technologies for older adults: A systematic review.

    Science.gov (United States)

    Liu, Lili; Stroulia, Eleni; Nikolaidis, Ioanis; Miguel-Cruz, Antonio; Rios Rincon, Adriana

    2016-07-01

    Around the world, populations are aging and there is a growing concern about ways that older adults can maintain their health and well-being while living in their homes. The aim of this paper was to conduct a systematic literature review to determine: (1) the levels of technology readiness among older adults and, (2) evidence for smart homes and home-based health-monitoring technologies that support aging in place for older adults who have complex needs. We identified and analyzed 48 of 1863 relevant papers. Our analyses found that: (1) technology-readiness level for smart homes and home health monitoring technologies is low; (2) the highest level of evidence is 1b (i.e., one randomized controlled trial with a PEDro score ≥6); smart homes and home health monitoring technologies are used to monitor activities of daily living, cognitive decline and mental health, and heart conditions in older adults with complex needs; (3) there is no evidence that smart homes and home health monitoring technologies help address disability prediction and health-related quality of life, or fall prevention; and (4) there is conflicting evidence that smart homes and home health monitoring technologies help address chronic obstructive pulmonary disease. The level of technology readiness for smart homes and home health monitoring technologies is still low. The highest level of evidence found was in a study that supported home health technologies for use in monitoring activities of daily living, cognitive decline, mental health, and heart conditions in older adults with complex needs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. How much does it cost to get a dose of vaccine to the service delivery location? Empirical evidence from Vietnam's Expanded Program on Immunization.

    Science.gov (United States)

    Mvundura, Mercy; Kien, Vu Duy; Nga, Nguyen Tuyet; Robertson, Joanie; Cuong, Nguyen Van; Tung, Ho Thanh; Hong, Duong Thi; Levin, Carol

    2014-02-07

    Few studies document the costs of operating vaccine supply chains, but decision-makers need this information to inform cost projections for investments to accommodate new vaccine introduction. This paper presents empirical estimates of vaccine supply chain costs for Vietnam's Expanded Program on Immunization (EPI) for routine vaccines at each level of the supply chain, before and after the introduction of the pentavalent vaccine. We used micro-costing methods to collect resource-use data associated with storage and transportation of vaccines and immunization supplies at the national store, the four regional stores, and a sample of provinces, districts, and commune health centers. We collected stock ledger data on the total number of doses of vaccines handled by each facility during the assessment year. Total supply chain costs were estimated at approximately US$65,000 at the national store and an average of US$39,000 per region, US$5800 per province, US$2200 per district, and US$300 per commune health center. Across all levels, cold chain equipment capital costs and labor were the largest drivers of costs. The cost per dose delivered was estimated at US$0.19 before the introduction of pentavalent and US$0.24 cents after introduction. At commune health centers, supply chain costs were 104% of the value of vaccines before introduction of pentavalent vaccine and 24% after introduction, mainly due to the higher price per dose of the pentavalent vaccine. The aggregated costs at the last tier of the health system can be substantial because of the large number of facilities. Even in countries with high-functioning systems, empirical evidence on current costs from all levels of the system can help estimate resource requirements for expanding and strengthening resources to meet future immunization program needs. Other low- and middle-income countries can benefit from similar studies, in view of new vaccine introductions that will put strains on existing systems. Copyright

  18. Skilled Health Personnel Attended Delivery as a Proxy Indicator for ...

    African Journals Online (AJOL)

    BACKGROUND: Several demographic and health surveys in Africa have shown the high prevalence of home delivery, but little is known how strongly skilled person unattended deliveries are associated with maternal and perinatal mortality. The aim of this review was to assess the gross correlation of maternal mortality ...

  19. Delivery of enteral nutrition.

    Science.gov (United States)

    Grant, M J; Martin, S

    2000-11-01

    There is increasing evidence that enteral feeding is superior to parenteral nutrition with regard to maintaining gut structure and function. Selection of the enteral access route depends on the type and anticipated duration of nutrient delivery. At present, enteral feeding devices can be divided into two major categories: those entering the gastrointestinal tract through the oral or nasal cavity (oroenteric or nasoenteric tubes) and those entering through the abdominal wall including gastrostomy, duodenostomy, or jejunostomy tubes. This article provides a review of methods to insert and confirm gastric and intestinal feeding tube placement. Care of the patient with an enteric tube will be described.

  20. Rhetoric and reality of daily life in English care homes: the role of organised activities

    OpenAIRE

    Eyers, Ingrid; Arber, Sara; Luff, Rebekah; Young, Emma; Ellmers, Theresa

    2012-01-01

    In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict betwe...

  1. Merging Systems: Integrating Home Visitation and the Family-Centered Medical Home

    OpenAIRE

    Tschudy, Megan M.; Toomey, Sara L.; Cheng, Tina L.

    2013-01-01

    To improve the health of children and bend the health care cost curve we must integrate the individual and population approaches to health and health care delivery. The 2012 Institute of Medicine (IOM) report Primary Care and Public Health: Exploring Integration to Improve Population Health laid out the continuum for integration of primary care and public health stretching from isolation to merging systems. Integration of the family-centered medical home (FCMH) and home visitation (HV) would ...

  2. A systematic review of integrated working between care homes and health care services

    Directory of Open Access Journals (Sweden)

    Davies Sue L

    2011-11-01

    Full Text Available Abstract Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed, CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for

  3. A systematic review of integrated working between care homes and health care services.

    Science.gov (United States)

    Davies, Sue L; Goodman, Claire; Bunn, Frances; Victor, Christina; Dickinson, Angela; Iliffe, Steve; Gage, Heather; Martin, Wendy; Froggatt, Katherine

    2011-11-24

    In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration. Despite evidence

  4. Evaluation of Retrofit Delivery Packages

    Energy Technology Data Exchange (ETDEWEB)

    Berman, M.; Smith, P.; Porse, E.

    2013-07-01

    Residential energy retrofit activities are a critical component of efforts to increase energy efficiency in the U.S. building stock; however, retrofits account for a small percentage of aggregate energy savings at relatively high per unit costs. This report by Building America research team, Alliance for Residential Building Innovation (ARBI), describes barriers to widespread retrofits and evaluates opportunities to improve delivery of home retrofit measures by identifying economies of scale in marketing, energy assessments, and bulk purchasing through pilot programs in portions of Sonoma, Los Angeles, and San Joaquin Counties, CA. These targeted communities show potential and have revealed key strategies for program design, as outlined in the report.

  5. The use of public policy analysis to enhance the Nursing Home Reform Act of 1987.

    Science.gov (United States)

    Breen, Gerald-Mark; Matusitz, Jonathan; Wan, Thomas T H

    2009-01-01

    Given the prevalence of abuse and neglect in nursing home care delivery vis-à-vis elderly and frail residents, and despite the advent and implementation of the Nursing Home Reform Act of 1987 (a policy that sought to diminish such conduct in such institutional settings), deficiency citations in nursing home care and services remain both problematic and common. By employing public policy analysis, and by analyzing various social science theories applicable to the improvement of care delivery and quality, this article seeks to develop methods to enhance compliance with the Nursing Home Reform Act and reduce care deficiencies in nursing homes.

  6. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  7. Dementia - home care

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Dementia - home care URL of this page: //medlineplus.gov/ency/article/007428.htm Dementia - home care To use the ...

  8. Exercise at Home

    Science.gov (United States)

    ... Home Health Insights Exercise & Weight Exercise at Home Exercise at Home Make an Appointment Ask a Question ... with the movement and contact your provider. Posture Exercises Better posture means better breathing and movement. Axial ...

  9. HOME Grantee Areas

    Data.gov (United States)

    Department of Housing and Urban Development — The HOME Investment Partnership Program (HOME) is authorized under Title II of the Cranston-Gonzalez National Affordable Housing Act. HOME provides formula grants to...

  10. Music therapy-assisted labor and delivery.

    Science.gov (United States)

    Clark, M E; McCorkle, R R; Williams, S B

    1981-01-01

    This article describes a new clinical music therapy program for application in the labor and delivery setting, and presents results of a preliminary study to evaluate effectiveness of the treatment. Over 50 women participated in the project; however, inclusion of patients in the data collection portion of the project was limited by criteria designed to minimize the effects of spurious variables. An experimental group of 13 patients participated in six individual predelivery music therapy training sessions during the third trimester of pregnancy. Experimental patients listened to preselected musical works throughout labor and delivery, with the music therapist in attendance. A control group of seven subjects participated in labor and delivery according to regular hospital routines. Data consisted of patients' responses to questionnaire items reflecting subjective perceptions and recollections of the labor/delivery experience and reports of frequency and duration of home practice. Experimental subjects achieved significantly higher "success" scores than did control subjects on five of seven indices (p less than .05). A moderate correlation between music home practice and successful childbirth outcome was demonstrated, with frequency/length of music home practice revealed as a significant predictor of success in the childbirth experience.

  11. Selfish DNA: Homing Endonucleases Find a Home

    National Research Council Canada - National Science Library

    Edgell, David R

    2009-01-01

    ...] . Intriguingly, many self-splicing introns (and inteins) are also mobile genetic elements at the DNA level because they encode mobility-promoting proteins termed homing endonucleases that have the interesting property of being site-specific but sequence-tolerant DNA endonucleases [4–7] . Intron-encoded homing endonucleases recognize a site, the homing ...

  12. Home Schooling in the United States: Trends and Characteristics.

    Science.gov (United States)

    Bauman, Kurt J.

    2002-01-01

    Assembles evidence from several sources to show that home schooling is growing. Finds that home-schooled students are more likely to be middle-income, white, from larger families, and from two-parent families with one parent at home. The analysis finds support for a divide based on attitudes towards regular schools. (SLD)

  13. Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of "Dads matter".

    Science.gov (United States)

    Guterman, Neil B; Bellamy, Jennifer L; Banman, Aaron

    2018-02-01

    Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being. Copyright © 2017. Published by Elsevier Ltd.

  14. 'Physical activity at home (PAAH', evaluation of a group versus home based physical activity program in community dwelling middle aged adults: rationale and study design

    Directory of Open Access Journals (Sweden)

    Freene Nicole

    2011-11-01

    Full Text Available Abstract Background It is well recognised that the adoption and longer term adherence to physical activity by adults to reduce the risk of chronic disease is a challenge. Interventions, such as group and home based physical activity programs, have been widely reported upon. However few studies have directly compared these interventions over the longer term to determine their adherence and effectiveness. Participant preference for home based or group interventions is important. Some evidence suggests that home based physical activity programs are preferred by middle aged adults and provide better long term physical activity adherence. Physiotherapists may also be useful in increasing physical activity adherence, with limited research on their impact. Methods 'Physical Activity at Home' is a 2 year pragmatic randomised control trial, with a non-randomised comparison to group exercise. Middle-aged adults not interested in, or unable to attend, a group exercise program will be targeted. Sedentary community dwelling 50-65 year olds with no serious medical conditions or functional impairments will be recruited via two mail outs using the Australian federal electoral roll. The first mail out will invite participants to a 6 month community group exercise program. The second mail out will be sent to those not interested in the group exercise program inviting them to take part in a home based intervention. Eligible home based participants will be randomised into a 6 month physiotherapy-led home based physical activity program or usual care. Outcome measures will be taken at baseline, 6, 12, 18 and 24 months. The primary outcome is physical activity adherence via exercise diaries. Secondary outcomes include the Active Australia Survey, accelerometry, aerobic capacity (step test, quality of life (SF-12v2, blood pressure, waist circumference, waist-to-hip ratio and body mass index. Costs will be recorded prospectively and qualitative data will be collected

  15. Quality assessment of home births in Denmark.

    Science.gov (United States)

    Jensen, Sabrina; Colmorn, Lotte B; Schroll, Anne-Mette; Krebs, Lone

    2017-05-01

    The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births compared with hospital births and to discuss which data are needed to evaluate the safety of home births. This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women with uncomplicated pregnancies and no medical interventions during delivery. A total of 6,395 home births and 266,604 hospital births were eligible for analysis. Comparative analyses were performed separately in nulliparous and multiparous women. The outcome measures were neonatal mortality and morbidity. Frequencies of admission to a neonatal intensive care unit and treatment with continuous positive airway pressure were significantly lower in infants born at home than in infants born at a hospital. A slightly, but significantly increased rate of early neonatal death was found among infants delivered by nulliparous at home. This study indicates that home births in Denmark are characterized by a high level of safety owing to low rates of perinatal mortality and morbidity. Missing registration on intrapartum transfers and planned versus unplanned home births in the DMBR are, however, major limitations to the validity and utility of the reported results. Registration of these items of information is necessary to make reasonable assessments of home births in the future. none. not relevant. Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

  16. Hospital at home: home-based end of life care

    Science.gov (United States)

    Shepperd, Sasha; Wee, Bee; Straus, Sharon E

    2014-01-01

    included inpatient care). Admission to hospital while receiving home-based end of life care varied between trials and this was reflected by high levels of statistically significant heterogeneity in this analysis. There was some evidence of increased patient satisfaction with home-based end of life care, and little evidence of the impact this form of care has on care givers. Authors’ conclusions The evidence included in this review supports the use of end of life home-care programmes for increasing the number of patients who will die at home, although the numbers of patients being admitted to hospital while receiving end of life care should be monitored. Future research should also systematically assess the impact of end of life home care on care givers. PMID:21735440

  17. Clinician attendance and delivery practices at hospital-based vaginal deliveries in Western Kenya.

    Science.gov (United States)

    Patel, Suha J; Bogaert, Kelly; Gachuno, Onesmus W; Kibore, Minnie W; Unger, Jennifer; Walker, Dilys M

    2016-05-01

    To characterize delivery practices and factors associated with respectful, evidence-based care at a referral hospital in Western Kenya. An exploratory observational study used a standardized birth-observation form to record information on patient characteristics and healthcare practitioner behaviors during uncomplicated vaginal deliveries between June 30, 2014 and July 17, 2014. All deliveries were monitored for whether healthcare staff performed six specific evidence-based practices (three maternal and three neonatal practices). In total, 75 vaginal deliveries were observed. In 48 (64%) deliveries, nursing students were the only practitioners present. The mean number of evidence-based practices performed at each delivery was 3.58. The number of evidence-based practices performed by junior practitioners was higher when a nurse educator was assessing their performance (4.47 vs 3.36, Prespectful-care scores were recorded when delivery teams comprised three or more practitioners (1.38; 95% confidence interval 0.93-1.84 vs 2.74; 95% confidence interval 2.16-3.31, P=0.002). The present study found low rates of evidence-based practice and respectful maternity care; this could serve as a deterrent for women seeking care at the study facility. These findings emphasize the need for a comprehensive approach in increasing the quality of patient care to improve maternal and newborn health outcomes. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Integrating Social Services and Home-Based Primary Care for High-Risk Patients.

    Science.gov (United States)

    Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas

    2017-06-13

    There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

  19. Meals in nursing homes

    DEFF Research Database (Denmark)

    Kofod, Jens Erik; Birkemose, A.

    2004-01-01

    Undernutrition is present among 33% of nursing home residents in Denmark. Hence, it is relevant to examine the meal situation at nursing homes to single out factors that may increase or reduce the residents' food intake. in the ongoing Danish nursing home debate it is claimed that a new type...... of nursing home improves the residents' meal situation with a positive effect on nutrition. The aim of this work is to test the general hypothesis that (i) residents appreciate the meal situation in these nursing homes and (ii) nutritional status of the residents is improved in this type of nursing home....... This study was carried out in four Danish nursing homes at various locations in Denmark. The methods used are qualitative interviews and observations at four nursing homes in combination with measurement of body mass index (BMI) at two of the four nursing homes. Undernutrition is defined as a BMI below 20...

  20. A soluble granulocyte colony stimulating factor decoy receptor as a novel tool to increase hematopoietic cell homing and reconstitution in mice.

    Science.gov (United States)

    Fortin, Audrey; Benabdallah, Basma; Palacio, Lina; Carbonneau, Cynthia L; Le, Oanh N; Haddad, Elie; Beauséjour, Christian M

    2013-03-15

    The relative ineffectiveness of hematopoietic stem cells in reaching the bone marrow upon transplantation combined with the limited number of these cells available is a major reason for graft failure and delayed hematopoietic recovery. Hence, the development of strategies that could enhance homing is of high interest. Here, we provide evidence that homing is severely impaired postexposure to ionizing radiation (IR) in mice, an effect we found was time dependent and could be partially rescued using mesenchymal stromal cell (MSC) therapy. In an attempt to further increase homing, we took advantage of our observation that the granulocyte colony stimulating factor (G-CSF), a cytokine known to induce cell mobilization, is increased in the marrow of mice shortly after their exposure to IR. As such, we developed a truncated, yet functional, soluble G-CSF receptor (solG-CSFR), which we hypothesized could act as a decoy and foster homing. Using MSCs or conditioned media as delivery vehicles, we show that an engineered solG-CSFR has the potential to increase homing and hematopoietic reconstitution in mice. Altogether, our results provide novel findings at the interplay of IR and stromal cell therapy and present the regulation of endogenous G-CSF as an innovative proof-of-concept strategy to manipulate hematopoietic cell homing.

  1. Lunar Cycle Influences Spontaneous Delivery in Cows.

    Science.gov (United States)

    Yonezawa, Tomohiro; Uchida, Mona; Tomioka, Michiko; Matsuki, Naoaki

    2016-01-01

    There is a popular belief that the lunar cycle influences spontaneous delivery in both humans and cattle. To assess this relationship, we investigated the synodic distribution of spontaneous deliveries in domestic Holstein cows. We used retrospective data from 428 spontaneous, full-term deliveries within a three-year period derived from the calving records of a private farm in Hokkaido, Japan. Spontaneous birth frequency increased uniformly from the new moon to the full moon phase and decreased until the waning crescent phase. There was a statistically significant peak between the waxing gibbous and full moon phases compared with those between the last quarter and the waning crescent. These changes were clearly observed in deliveries among multiparous cows, whereas they were not evident in deliveries among nulliparous cows. These data suggest the utility of dairy cows as models for bio-meteorological studies, and indicate that monitoring lunar phases may facilitate comprehensive understanding of parturition.

  2. Assisted Vaginal Delivery

    Science.gov (United States)

    ... prescription. If sitting is uncomfortable, sit on a pillow. There also are special cushions that may be ... vagina. Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus. ...

  3. Delayed interval delivery in a triplet gestation.

    Science.gov (United States)

    Wooldridge, Rachel J; Oliver, Emily A; Singh, Tulika

    2012-11-27

    A 27-year-old Ghanaian primigravida with a known triamniotic trichorionic triplet pregnancy presented at 17 weeks gestation following a miscarriage of one triplet at home. Examination and investigation revealed no signs of imminent delivery or infection. After careful counselling with regard to prognosis and options available for management, the couple opted for intervention including rescue cerclage. The patient received antibiotic prophylaxis for five days and daily progesterone suppositories until delivery. An ultrasound scan was performed every three weeks to monitor fetal growth and cervical length. At 24 weeks corticosteroids for fetal lung maturity were given. At 31 weeks gestation she experienced spontaneous rupture of membranes followed by active labour and forceps delivery. There were no maternal complications. Both babies were born in a good condition, but required ventilatory support for 72 h.

  4. Delayed interval delivery in a triplet gestation

    Science.gov (United States)

    Wooldridge, Rachel J; Oliver, Emily A; Singh, Tulika

    2012-01-01

    A 27-year-old Ghanaian primigravida with a known triamniotic trichorionic triplet pregnancy presented at 17 weeks gestation following a miscarriage of one triplet at home. Examination and investigation revealed no signs of imminent delivery or infection. After careful counselling with regard to prognosis and options available for management, the couple opted for intervention including rescue cerclage. The patient received antibiotic prophylaxis for five days and daily progesterone suppositories until delivery. An ultrasound scan was performed every three weeks to monitor fetal growth and cervical length. At 24 weeks corticosteroids for fetal lung maturity were given. At 31 weeks gestation she experienced spontaneous rupture of membranes followed by active labour and forceps delivery. There were no maternal complications. Both babies were born in a good condition, but required ventilatory support for 72 h. PMID:23188854

  5. Seniors managing multiple medications: using mixed methods to view the home care safety lens.

    Science.gov (United States)

    Lang, Ariella; Macdonald, Marilyn; Marck, Patricia; Toon, Lynn; Griffin, Melissa; Easty, Tony; Fraser, Kimberly; MacKinnon, Neil; Mitchell, Jonathan; Lang, Eddy; Goodwin, Sharon

    2015-12-12

    Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home

  6. Home-based chronic care. An expanded integrative model for home health professionals.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Harrison, Gregory; Fagan, Martha; Norman, Barbara; Suter, W Newton

    2008-04-01

    The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.

  7. The debate on continuous home oxygen therapy.

    Science.gov (United States)

    Díaz Lobato, Salvador; García González, José Luis; Mayoralas Alises, Sagrario

    2015-01-01

    Two studies published in the early 80s, namely the Nocturnal Oxygen Therapy Trial (NOTT) and the Medical Research Council Trial (MRC), laid the foundations for modern home oxygen therapy. Since then, little progress has been made in terms of therapeutic indications, and several prescription-associated problems have come to light. Advances in technology have gone hand in hand with growing disregard for the recommendations in clinical guidelines on oxygen therapy. The introduction of liquid oxygen brought with it a number of technical problems, clinical problems related to selecting candidate patients for portable delivery devices, and economic problems associated with the rising cost of the therapy. Continuous home oxygen therapy has been further complicated by the recent introduction of portable oxygen concentrators and the development in quick succession of a range of delivery devices with different levels of efficiency and performance. Modern oxygen therapy demands that clinicians evaluate the level of mobility of their patients and the mobility permitted by available oxygen sources, correctly match patients with the most appropriate oxygen source and adjust the therapy accordingly. The future of continuous home oxygen therapy lies in developing the ideal delivery device, improving the regulations systems and information channels, raise patient awareness and drive research. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  8. Home care in Europe: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Fagerström Cecilia

    2011-08-01

    Full Text Available Abstract Background Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Results Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more

  9. Home care in Europe: a systematic literature review.

    Science.gov (United States)

    Genet, Nadine; Boerma, Wienke Gw; Kringos, Dionne S; Bouman, Ans; Francke, Anneke L; Fagerström, Cecilia; Melchiorre, Maria Gabriella; Greco, Cosetta; Devillé, Walter

    2011-08-30

    Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires the

  10. Home care in Europe: a systematic literature review

    Science.gov (United States)

    2011-01-01

    Background Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Results Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the

  11. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Ciapponi, Agustín; Lewin, Simon; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Glenton, Claire; Okwundu, Charles I; Peñaloza, Blanca; Suleman, Fatima; Oxman, Andrew D

    2017-09-13

    findings to low-income countries. We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile

  12. Architectural factors influencing the sense of home in nursing homes: An operationalization for practice

    Directory of Open Access Journals (Sweden)

    A. Eijkelenboom

    2017-06-01

    Full Text Available Various studies have shown that the architecture and design of a nursing home can have a profound impact on the sense of home of old people residing in the nursing home, next to psychological and social factors. However, adequate guidance on how these factors can be operationalized in practice is not provided for architects and interior designers. This study investigated which architectural factors contribute to a sense of home and how these can be implemented in the design guidelines. Two existing data sets were used, combining the most recent evidence from the literature and experiences of residents, family caregivers, and professional staff of Dutch nursing homes. These analyses resulted in theoretical implications for the private space, quasi-public space, the look and feel of the nursing home, and the outdoors. Furthermore, these analyses were used for the design of a demonstration apartment that integrates the factors of the sense of home. This description was concluded by a checklist for practice, in which design guidelines were formulated. A holistic understanding of which factors influence the sense of home could lead to improvements of the sense of home of nursing home residents.

  13. The slowdown in existing home sales

    OpenAIRE

    Krainer, John

    2014-01-01

    Sales of existing homes slowed noticeably over the second half of 2013, reflecting a more drawn-out recovery than expected for housing markets. A main reason for the slowdown is higher mortgage rates that have made financing more costly nationwide. Sales appear to be slowing even more in distressed markets, where real estate investors had bought up single-family homes to convert into rental properties following the housing bust. Evidence suggests that investors may be retreating from these ma...

  14. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

    Science.gov (United States)

    Ciapponi, Agustín; Lewin, Simon; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Glenton, Claire; Okwundu, Charles I; Peñaloza, Blanca; Suleman, Fatima; Oxman, Andrew D

    2017-01-01

    assessments of the relevance of findings to low-income countries. Main results We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care

  15. Adverse Selection in China's Home Mortgage Policy

    DEFF Research Database (Denmark)

    Gao, Cixiu

    2016-01-01

    The Chinese home buyers are liquidity constrained with limited access to refinance, dissatisfactory social insurance and high home prices. The government requires all borrowers to make a substantial down payment, normally 20% to 50% of the home price, depending on non-risk-related qualifications....... vulnerable to negative shocks. The model is estimated using individual mortgage data provided by a major commercial bank of southeast China. We then provide forecasts on long-run default probabilities, as well as quantitative evidence for future adverse selection....

  16. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...

  17. National Nursing Home Survey

    Science.gov (United States)

    The National Nursing Home Survey provides includes characteristics such as size of nursing home facilities, ownership, Medicare/Medicaid certification, occupancy rate, number of days of care provided, and expenses.

  18. Home Health Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Home Health Compare has information about the quality of care provided by Medicare-certified home health agencies throughout the nation. Medicare-certified means the...

  19. Home Health Aides

    Science.gov (United States)

    ... State & Area Data Explore resources for employment and wages by state and area for home health aides and personal care aides. Similar Occupations Compare the job duties, education, job growth, and pay of home health aides ...

  20. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... UOAA). The skills kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...

  1. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Bundled Payment Models Surgeons as Institutional Employees Our Changing Health Care System ACS Surgery News Statements About ... the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A ...

  2. Home Canning and Botulism

    Science.gov (United States)

    ... this? Submit What's this? Submit Button Past Emails Home Canning and Botulism Language: English (US) Español (Spanish) ... myself and others safe when it comes to home-canned foods? Many cases of foodborne botulism have ...

  3. Eye Injuries at Home

    Science.gov (United States)

    ... Steps to Safer Champagne Celebrations Eye Injuries at Home Leer en Español: Lesiones de los Ojos en ... chore is being done. Preventing Eye Injuries at Home Wearing protective eyewear will prevent 90 percent of ...

  4. Community Nursing Home (CNH)

    Data.gov (United States)

    Department of Veterans Affairs — The Community Nursing Home (CNH) database contains a list of all Community Nursing Home facilities under local contract to Veterans Health Administration (VHA). CNH...

  5. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Shop ( 0 ) Cart Donate American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo ...

  6. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  7. Home blood sugar testing

    Science.gov (United States)

    Diabetes - home glucose testing; Diabetes - home blood sugar testing ... day Your blood sugar level The amount of carbohydrates you ate The type and dose of your diabetes medicine The type of any exercise you do ...

  8. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... ACS Careers at ACS About ACS Career Types Working at ACS ... Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy ...

  9. HOME Rent Limits

    Data.gov (United States)

    Department of Housing and Urban Development — In accordance with 24 CFR Part 92.252, HUD provides maximum HOME rent limits. The maximum HOME rents are the lesser of: The fair market rent for existing housing for...

  10. TRAVEL AND HOME LEAVE

    CERN Multimedia

    Human Resources Division

    2002-01-01

    Administrative procedures for : Travel to the home station and home leave (hl) Additional travel to the home station (at) Travel to the home station and home leave for family reasons (hlf) As part of the process of simplifying administrative procedures, HR and AS Divisions have devised a new, virtually automatic procedure for payment of travel expenses to the home station. The changes are aimed at rationalising administrative procedures and not at reducing benefits. The conditions of eligibility are unchanged. The new procedure, which will be operational with effect from 1st June 2002, will greatly simplify the administrative processing of claims for travel expenses and the recording of home leaves. Currently, requests for payment are introduced manually into the Advances and Claims system (AVCL) by divisional secretariats. All travel to the home station starting prior to 1st June 2002 will be processed according to the existing system whereas that starting on 1st June and after will be processed accordi...

  11. Meals served in Danish nursing homes and to meals-on-wheels clients may not offer nutritionally adequate choices

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Hansen, Kirsten S.

    2010-01-01

    Underweight is a significant problem among older Danish nursing home residents and home-care clients. The aim of this study was to evaluate the nutritional composition of the meals prepared for older adults in nursing homes and receiving Meals-on-Wheels deliveries, focusing on the menus most...... offer adequate nutritional intakes....

  12. Situated Adult Learning: The Home Education Neighbourhood Group

    Directory of Open Access Journals (Sweden)

    Dr. Leslie SAFRAN

    2009-12-01

    Full Text Available Many families who home educate turn to a neighbourhood home education group for support, resources and guidance. The purpose of this paper is to first outline briefly the context of home education in the UK and US, to analyse three different types of home education neighbourhood group as communities of practice and then to theorise how these parents learn some of what it is to be home educators through participation in such groups as members. The analysis is based on evidence from long-term home educating parents collected through thirty-four in-depth interviews and the Community of Practice framework (Wenger, 1998. It will be argued that although communities of practice have variable features depending on the type of neighbourhood home education group a parent joins, they all engage in a form of collective situated life learning which helps transform parents to the point where they become home educators.

  13. Situated Adult Learning: The Home Education Neighbourhood Group

    Directory of Open Access Journals (Sweden)

    Dr. Leslie Safran

    2009-04-01

    Full Text Available Many families who home educate turn to a neighbourhood home education group for support, resources and guidance. The purpose of this paper is to first outline briefly the context of home education in the UK and US, to analyse three different types of home education neighbourhood group as communities of practice and then to theorise how these parents learn some of what it is to be home educators through participation in such groups as members. The analysis is based on evidence from long-term home educating parents collected through thirty-four in-depth interviews and the Community of Practice framework (Wenger, 1998.It will be argued that although communities of practice have variable features depending on the type of neighbourhood home education group a parent joins, they all engage in a form of collective situated life learning which helps transform parents to the point where they become ‘home educators’.

  14. WLAN Technologies for Audio Delivery

    Directory of Open Access Journals (Sweden)

    Nicolas-Alexander Tatlas

    2007-01-01

    Full Text Available Audio delivery and reproduction for home or professional applications may greatly benefit from the adoption of digital wireless local area network (WLAN technologies. The most challenging aspect of such integration relates the synchronized and robust real-time streaming of multiple audio channels to multipoint receivers, for example, wireless active speakers. Here, it is shown that current WLAN solutions are susceptible to transmission errors. A detailed study of the IEEE802.11e protocol (currently under ratification is also presented and all relevant distortions are assessed via an analytical and experimental methodology. A novel synchronization scheme is also introduced, allowing optimized playback for multiple receivers. The perceptual audio performance is assessed for both stereo and 5-channel applications based on either PCM or compressed audio signals.

  15. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo ...

  16. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit ...

  17. Asthma Home Environment Checklist

    Science.gov (United States)

    This checklist guides home care visitors in identifying environmental asthma triggers most commonly found in homes. It includes sections on the building, home interior and room interior and provides low-cost action steps for remediation. EPA 402-F-03-030.

  18. Home Schooling Goes Mainstream

    Science.gov (United States)

    Gaither, Milton

    2009-01-01

    This article reports that while home schooling may have particular appeal to celebrities, over the last decade families of all kinds have embraced the practice for widely varying reasons: no longer is home schooling exclusive to Christian fundamentalism and the countercultural Left. Along with growing acceptance of home schooling nationally has…

  19. Schooling at Home.

    Science.gov (United States)

    Long, Joyce Fleck

    2001-01-01

    Presents one family's experience with home schooling, explaining that no two home schools are alike, which is both a strength and a weakness of the movement. The paper discusses the parent's educational philosophy and the family's personal curriculum and pedagogical choices. It concludes by examining the growing trend in home schooling. (SM)

  20. School@Home.

    Science.gov (United States)

    Hammons, Christopher W.

    2001-01-01

    Describes home schooling movement and argues home schooling is viable alternative to public education system. Discusses increase in home-schooled students applying to college, taking and performing well on college entrance exams (ACT and SAT), engaging in extracurricular activities, and succeeding in college. Addresses and refutes criticisms of…

  1. Home in the Making

    DEFF Research Database (Denmark)

    Kreuzer, Maria; von Wallpach, Sylvia; Muehlbacher, Hans

    2016-01-01

    In a context of unprecedented migration home reaches high relevance. This study aims at understanding the (re-)construction of home by first generation consumer migrants. The findings provide insights into consumers’ (re-)construction of various dimensions of home and identify “inner home” as a new...

  2. Healthy Homes Tools

    Science.gov (United States)

    Peek, Gina; Lyon, Melinda; Russ, Randall

    2012-01-01

    Extension is focusing on healthy homes programming. Extension educators are not qualified to diagnose consumers' medical problems as they relate to housing. We cannot give medical advice. Instead, we can help educate consumers about home conditions that may affect their well-being. Extension educators need appropriate healthy homes tools to…

  3. About Home gateway mashups

    OpenAIRE

    Schneps-schneppe, Manfred; Namiot, Dmitry

    2013-01-01

    This paper discusses Home Gateway Initiative software and telecom mashups. Can we use IMS for mashups and how to do that? What is impact of Home Gateway Initiative decisions to application developers and what can we expect to see on the application market for home devices.

  4. Home Within Me

    DEFF Research Database (Denmark)

    Kreuzer, Maria; Mühlbacher, Hans; von Wallpach, Sylvia

    2017-01-01

    ). Home, however, is a multi-dimensional concept and reaching a universal definition is nearly impossible (Moore, 2000). Therefore, this research project aims to answer the following research questions: 1) What is the meaning of home? 2) How do consumers experience home? And 3) What is the role...

  5. UAV Delivery Monitoring System

    Directory of Open Access Journals (Sweden)

    San Khin Thida

    2018-01-01

    Full Text Available UAV-based delivery systems are increasingly being used in the logistics field, particularly to achieve faster last-mile delivery. This study develops a UAV delivery system that manages delivery order assignments, autonomous flight operation, real time control for UAV flights, and delivery status tracking. To manage the delivery item assignments, we apply the concurrent scheduler approach with a genetic algorithm. The present paper describes real time flight data based on a micro air vehicle communication protocol (MAVLink. It also presents the detailed hardware components used for the field tests. Finally, we provide UAV component analysis to choose the suitable components for delivery in terms of battery capacity, flight time, payload weight and motor thrust ratio.

  6. Effect of maternal education on choice of location for delivery among Indian women.

    Science.gov (United States)

    Aggarwal, Rakesh; Thind, Amardeep

    2011-01-01

    Delivery in a healthcare facility is associated with better outcomes for both mother and child. However, in India, a large proportion of deliveries take place outside health facilities. We studied the effect of maternal education on the choice of location for delivery in the Indian population. Data from the National Family Health Survey 3 (NFHS-3) were used. The survey included women who were selected using a multi-stage (2-stage for urban areas and 3- stage for rural areas), stratified (based on demographic or social factors) sampling technique; the primary sampling units selected were proportional to population size, and the subsequent steps used simple random sampling. Effect of maternal education on the choice of place for delivery (home, public or private facility) was investigated through a multinomial logistic regression model. The model adjusted for several factors at individual, household and community level, the survey design effect and included sampling weights. Of the 124 385 women aged 15-49 years included in the NFHS-3 dataset, 36 850 (29.6%) had had one or more childbirth during the past 5 years. A little more than half of all the deliveries were at home, and approximately a quarter each of the remaining deliveries were at public and private facilities, respectively. Maternal education was strongly and independently associated with the choice of location of delivery. For the choice sets of public facility versus home delivery and private facility versus home delivery, a clear dose-response relationship was apparent-higher maternal education was associated with a higher probability of delivery at a public or private health facility compared to home. Level of maternal education was a significant independent predictor of choice of location for childbirth among Indian women. Compared to cash incentives to increase facility-based delivery, improving maternal education may be a better way to achieve long term and sustained increase in facility deliveries

  7. Rationale and design: telepsychology service delivery for depressed elderly veterans

    Directory of Open Access Journals (Sweden)

    Richardson Lisa K

    2009-04-01

    Full Text Available Abstract Background Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health" represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1 utility to address existing problematic access to care for rural residents; (2 capacity to reduce stigma associated with traditional mental health care; and (3 utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas. Methods We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology" or traditional face-to-face services ("Same-Room". Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room. Two-hundred twenty-four (224 male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1 clinical outcomes (symptom severity, social functioning; (2 process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout; and (3 economic outcomes (cost and resource use. Discussion Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective

  8. Persistent Mission Home Delivery in Ibadan: Attractive Role of ...

    African Journals Online (AJOL)

    Background and objective: One of the major factors responsible for high maternal and neonatal deaths in Nigeria and other developing countries is the use of Traditional Birth Attendants (TBAs). The current study was carried out to evaluate the attractive roles of the TBAs that make pregnant mothers persistently use them.

  9. Digital Living at Home

    DEFF Research Database (Denmark)

    Andersen, Pernille Viktoria Kathja; Christiansen, Ellen Tove

    2013-01-01

    Does living with digital technology inevitably lead to digital living? Users talking about a digital home control system, they have had in their homes for eight years, indicate that there is more to living with digital technology than a functional-operational grip on regulation. Our analysis...... of these user voices has directed us towards a ‘home-keeping’ design discourse, which opens new horizons for design of digital home control systems by allowing users to perform as self-determined controllers and groomers of their habitat. The paper concludes by outlining the implications of a ‘home...

  10. Strategy Guideline: Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Savage, C.; Hunt, A.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  11. Strategy Guideline. Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, A.; Savage, C.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  12. Health service delivery models for the provision of antiretroviral therapy in sub-Saharan Africa: a systematic review.

    Science.gov (United States)

    Lazarus, Jeffrey V; Safreed-Harmon, Kelly; Nicholson, Joey; Jaffar, Shabbar

    2014-10-01

    In response to the lack of evidence-based guidance for how to continue scaling up antiretroviral therapy (ART) in ways that make optimal use of limited resources, to assess comparative studies of ART service delivery models implemented in sub-Saharan Africa. A systematic literature search and analysis of studies that compared two or more methods of ART service delivery using either CD4 count or viral load as a primary outcome. Most studies identified in this review were small and non-randomised, with low statistical power. Four of the 30 articles identified by this review conclude that nurse management of ART compares favourably to physician management. Seven provide evidence of the viability of managing ART at lower levels within the health system, and one indicates that vertical and integrated ART programmes can achieve similar outcomes. Five articles show that community/home-based ART management can be as effective as facility-based ART management. Five of seven articles investigating community support link it to better clinical outcomes. The results of four studies suggest that directly observed therapy may not be an important component of ART programmes. Given that the scale-up of antiretroviral therapy represents the most sweeping change in healthcare delivery in sub-Saharan Africa in recent years, it is surprising to not find more evidence from comparative studies to inform implementation strategies. The studies reported on a wide range of service delivery models, making it difficult to draw conclusions about some models. The strongest evidence was related to the feasibility of decentralisation and task-shifting, both of which appear to be effective strategies. © 2014 John Wiley & Sons Ltd.

  13. No Clinical or Biochemical Evidence for Essential Fatty Acid Deficiency in Home Patients Who Depend on Long-Term Mixed Olive Oil- and Soybean Oil-Based Parenteral Nutrition

    NARCIS (Netherlands)

    Olthof, E.D.; Roelofs, H.M.J.; Fisk, H.L.; Calder, P.C.; Wanten, G.J.A.

    2016-01-01

    BACKGROUND: Home parenteral nutrition (HPN) patients depend on lipid emulsions as part of their parenteral nutrition regimen to provide essential fatty acids (EFAs). Mixed-oil sources are used in modern lipid emulsions to decrease the amount of proinflammatory EFAs, mainly linoleic acid, which is

  14. Vaginal delivery of breech presentation.

    Science.gov (United States)

    Kotaska, Andrew; Menticoglou, Savas; Gagnon, Robert

    2009-06-01

    To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth. Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term. Reduced perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short- and long-term maternal morbidity and mortality. Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008. The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. This guideline was compared with the 2006 American College of Obstetrician's Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Vaginal breech birth can be associated with a higher risk of perinatal mortality and short-term neonatal morbidity than

  15. Creating a new home

    DEFF Research Database (Denmark)

    Gram-Hanssen, Kirsten; Bech-Danielsen, Claus

    2012-01-01

    Housing research is increasingly focusing on how different groups of residents use their dwelling and transform it into a home. In this article, we look at the homes of immigrants in Danish social housing. The article is based on qualitative interviews with Somali, Iraqi and Turkish immigrants......, and it includes a review of the literature regarding the home in general, as well as a discussion on the home for immigrants. Literature argues that the home and the meaning of the dwelling are socially constructed rather than depending on universal human needs. This means that immigrants from other cultures...... might find another meaning in the concept of 'home' than their Danish neighbours. Thus the main issue for our research is to ascertain the extent to which immigrants are able to identify with their dwelling and to establish 'home' in Danish social housing. Does the meaning of the dwelling amongst...

  16. Eldercare at Home: Choosing a Nursing Home

    Science.gov (United States)

    ... a regular basis? Residents can give you valuable insights. Talk with nursing assistants and observe them with ... a pleasant manner? Can residents bring furniture and personal items from home? Are there pet animals in ...

  17. LHC@home gets new home

    CERN Multimedia

    Oates, John

    2007-01-01

    "The distributed computing project LHC@home is moving to London from Cern in Switzerland. Researchers at Qeen Mary University have been trialling the system since June, but are now ready for the offical launch" (1 page)

  18. [Interventions during labor for reducing instrumental deliveries].

    Science.gov (United States)

    Schmitz, T; Meunier, E

    2008-12-01

    Several interventions have been demonstrated, with high evidence levels (EL), to be associated with reduced instrumental deliveries and should therefore be undertaken during labor for increasing spontaneous vaginal deliveries. Using a partogram (EL1) and continuous support during labor and childbirth (EL1) lead to fewer operative vaginal deliveries. Systematic early amniotomy increases the frequency of fetal heart rate abnormalities (EL2) without decreasing the incidence of instrumental deliveries (EL1) and should thus be avoided. Early oxytocin in dysfunctional labor (EL2) and manual rotation of posterior and transverse presentations (EL3) may reduce operative vaginal deliveries. Even without epidural analgesia, any upright or lateral positions compared to supine or lithotomy positions do not reduce instrumental deliveries (EL2). Epidural analgesia alters significantly instrumental delivery rates and therefore patient management in the labor ward. Indeed, when used with high concentration of local anesthetic, epidural analgesia is associated with increased operative vaginal deliveries (EL1), at least in part because of increased posterior presentations (EL2). However, the effect of epidural analgesia on instrumental delivery rates closely depends from the type of anesthetic and concentrations used. This effect is reduced when low concentrations of local anesthetic are used in combination with fat-soluble morphinated agent (EL1). Finally, for nulliparous women with continuous epidural analgesia, unless irresistible urge to push or medical indication to shorten second stage of labor, delayed pushing is associated with reduced difficult instrumental deliveries (EL1). Fundal pressure maneuvers should be prohibited because of their inefficiency (EL2) and dangerousness (EL4).

  19. Outcomes from the work of registered nurses working with older people in UK care homes.

    Science.gov (United States)

    Heath, Hazel

    2010-06-01

    This research sought to illuminate the distinct contributions made by Registered Nurses (RNs) and Care Assistants (CAs) to outcomes for older people in UK (nursing) care homes and to identify the outcomes of their work. This paper reports on aspects relevant to RNs. Older people living in long-term residential care settings around the world are among the most vulnerable individuals within their communities and those with the most complex needs. Nursing has historically been fundamental in the delivery of these services but, in some countries, the role of Registered Nurses in residential care is coming under increasing scrutiny, particularly in the context of escalating costs and funding restrictions, a questioning of the need for a 24-hour 'health' professional presence in a 'social care' service and a lack of evidence on the distinct contribution that RNs make to outcomes in these settings. A multi-method qualitative interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer (2003). For Phase 1 of the study, RNs and CAs from care homes around the UK contributed examples of their work, which they identified as having made a 'significant' difference to older individuals. Phase 2 comprised researcher fieldwork (observations, interviews and documentary analysis) in three care homes around UK. Research participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. RN roles in care homes are broad and multifaceted. Distinct outcomes of RN work are consequent to their caring and their knowledge and skills developed through broad experience in a range of healthcare settings. Outcomes for residents from RN work include enhanced personhood and wellbeing, improved health and function, the prevention of problems/adverse outcomes and enhanced quality of life. RN outcomes have positive impact on relatives, staff and the homes in general. There is

  20. Bioadhesive delivery systems for mucosal vaccine delivery.

    Science.gov (United States)

    Baudner, Barbara C; O'Hagan, Derek T

    2010-12-01

    Mucosal vaccine delivery potentially induces mucosal as well as systemic immune responses and may have advantages particularly for optimal protection against pathogens that infect the host through mucosal surfaces. However, the delivery of antigens through mucosal membranes remains a major challenge due to unfavorable physiological conditions (pH and enzymes) and significant biological barriers, which restrict the uptake of antigens. To improve mucosal vaccine delivery, the use of bioadhesive delivery systems offers numerous advantages, including protection from degradation, increasing concentration of antigen in the vicinity of mucosal tissue for better absorption, extending their residence time, and/or targeting them to sites of antigen uptake. Although some bioadhesives have direct immune stimulating properties, it appears most likely that successful mucosal vaccination will require the addition of vaccine adjuvants for optimal immune responses, particularly if they are to be used in an unprimed population. Thus, complex vaccine formulations and delivery strategies have to be carefully designed to appropriately stimulate immune response for the target pathogen. In addition, careful consideration is needed to define the "best" route for mucosal immunization for each individual pathogen.

  1. Comparison of domiciliary and institutional delivery-care practices in rural Rajasthan, India.

    Science.gov (United States)

    Iyengar, Sharad D; Iyengar, Kirti; Suhalka, Virendra; Agarwal, Kumaril

    2009-04-01

    A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home- and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population--279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1947 (96%) of 2031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home- and institutional delivery respectively. While 34% of the women delivered in health facilities, modem care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1336 (US$ 30), Rs 2419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts.

  2. Project delivery system (PDS)

    CERN Document Server

    2001-01-01

    As business environments become increasingly competitive, companies seek more comprehensive solutions to the delivery of their projects. "Project Delivery System: Fourth Edition" describes the process-driven project delivery systems which incorporates the best practices from Total Quality and is aligned with the Project Management Institute and ISO Quality Standards is the means by which projects are consistently and efficiently planned, executed and completed to the satisfaction of clients and customers.

  3. Utilization of Antenatal Care and Delivery Services in Sagamu ...

    African Journals Online (AJOL)

    Utilization of Antenatal Care and Delivery Services in Sagamu, SouthWestern Nigeria. ... Log in or Register to get access to full text downloads. ... Results: Majority of the women received antenatal care (84.6%) during their last pregnancy while 11.2% used other sources such as traditional herbal and spiritual healing homes ...

  4. The use of residential gateways in content delivery networking

    NARCIS (Netherlands)

    Hartog, F.T.H. den; Bastiaans, B.L.G.; Blom, M.A.; Pluijmaekers, M.G.M.; Mei, R.D. van der

    2004-01-01

    We have investigated and compared various aspects of the storage of multimedia content at residential gateways (RG) in the home or at caches in the public network. From qualitative analyses of Personal Video Recording and Content Delivery Networking techniques, we conclude that service architectures

  5. The prevalence of domiciliary deliveries in Khayelitsha, Cape Town

    African Journals Online (AJOL)

    Objective. To determine whether the 17% decrease in the number of patients cared for at the Khayelitsha Midwrt'e. Obstetric Unit (MOUl between 1991 and 1994 could be ascribed to an increase in home deliveries. Method. Survey of KhayeJitsha labour ward records, vaccination cards and family planning statistics at ...

  6. Family planning, antenatal and delivery care: cross-sectional survey evidence on levels of coverage and inequalities by public and private sector in 57 low- and middle-income countries.

    Science.gov (United States)

    Campbell, Oona M R; Benova, Lenka; MacLeod, David; Baggaley, Rebecca F; Rodrigues, Laura C; Hanson, Kara; Powell-Jackson, Timothy; Penn-Kekana, Loveday; Polonsky, Reen; Footman, Katharine; Vahanian, Alice; Pereira, Shreya K; Santos, Andreia Costa; Filippi, Veronique G A; Lynch, Caroline A; Goodman, Catherine

    2016-04-01

    The objective of this study was to assess the role of the private sector in low- and middle-income countries (LMICs). We used Demographic and Health Surveys for 57 countries (2000-2013) to evaluate the private sector's share in providing three reproductive and maternal/newborn health services (family planning, antenatal and delivery care), in total and by socio-economic position. We used data from 865 547 women aged 15-49, representing a total of 3 billion people. We defined 'met and unmet need for services' and 'use of appropriate service types' clearly and developed explicit classifications of source and sector of provision. Across the four regions (sub-Saharan Africa, Middle East/Europe, Asia and Latin America), unmet need ranged from 28% to 61% for family planning, 8% to 22% for ANC and 21% to 51% for delivery care. The private-sector share among users of family planning services was 37-39% across regions (overall mean: 37%; median across countries: 41%). The private-sector market share among users of ANC was 13-61% across regions (overall mean: 44%; median across countries: 15%). The private-sector share among appropriate deliveries was 9-56% across regions (overall mean: 40%; median across countries: 14%). For all three healthcare services, women in the richest wealth quintile used private services more than the poorest. Wealth gaps in met need for services were smallest for family planning and largest for delivery care. The private sector serves substantial numbers of women in LMICs, particularly the richest. To achieve universal health coverage, including adequate quality care, it is imperative to understand this sector, starting with improved data collection on healthcare provision. © 2016 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

  7. A home care visit with Congressman Jim Gerlach: fighting to help chronically ill seniors.

    Science.gov (United States)

    2011-07-01

    Taking your legislator on a home care visit is one of the best ways to make a lasting connection. The more first-hand knowledge they have, the more informed they will be when they address legislation that affects the industry. They need to understand what home care does and how important home care is to the patients it serves. They also need to realize that home care can cut costs and improve the delivery of health care in the United States. This is what Congressman Jim Gerlach (R-PA) concluded after he made a home care visit last month.

  8. Improving the Quality of Home Health Care for Children With Medical Complexity.

    Science.gov (United States)

    Nageswaran, Savithri; Golden, Shannon L

    2017-08-01

    The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  9. The Homing Frog: High Homing Performance in a Territorial Dendrobatid Frog Allobates femoralis (Dendrobatidae)

    Science.gov (United States)

    Pašukonis, Andrius; Ringler, Max; Brandl, Hanja B; Mangione, Rosanna; Ringler, Eva; Hödl, Walter; Tregenza, T

    2013-01-01

    Dendrobatidae (dart-poison frogs) exhibit some of the most complex spatial behaviors among amphibians, such as territoriality and tadpole transport from terrestrial clutches to widely distributed deposition sites. In species that exhibit long-term territoriality, high homing performance after tadpole transport can be assumed, but experimental evidence is lacking, and the underlying orientation mechanisms are unknown. We conducted a field translocation experiment to test whether male Allobates femoralis, a dendrobatid frog with paternal extra-territorial tadpole transport, are capable of homing after experimental removal, as well as to quantify homing success and speed. Translocated individuals showed a very high homing success for distances up to 200 m and successfully returned from up to 400 m. We discuss the potential orientation mechanisms involved and selective forces that could have shaped this strong homing ability. PMID:25104869

  10. Green House Adoption and Nursing Home Quality.

    Science.gov (United States)

    Afendulis, Christopher C; Caudry, Daryl J; O'Malley, A James; Kemper, Peter; Grabowski, David C

    2016-02-01

    To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures. Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010. Using a difference-in-differences framework, we compared changes in care quality and outcomes in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nursing homes that had not adopted the GH model. For individuals residing in GH homes, adoption of the model lowered readmissions and several MDS measures of poor quality, including bedfast residents, catheter use, and pressure ulcers, but these results were not present across the entire GH organization, suggesting possible offsetting effects for residents of non-GH "legacy" units within the GH organization. GH adoption led to improvement in rehospitalizations and certain nursing home quality measures for individuals residing in a GH home. The absence of evidence of a decline in other clinical quality measures in GH nursing homes should reassure anyone concerned that GH might have sacrificed clinical quality for improved quality of life. © Health Research and Educational Trust.

  11. Female labour supply and nursing home prices.

    Science.gov (United States)

    Bauer, Thomas K; Stroka, Magdalena A

    2013-09-01

    Long term care in Germany is provided in nursing homes, by professional ambulatory services and by the patient's relatives at home, with the latter being predominantly provided by women. Given an increasing labour market participation of women, long term care at home by female relatives might become less frequent in the future which in turn may result in rising demand for and hence rising prices for long term care services. This paper builds upon the existing literature on the determinants of nursing home prices and investigates whether the labour market participation and the education level of women are correlated with the prices of nursing homes. To the best of our knowledge, this is the first study using panel data approaches in this field of research. Based on a full sample of nursing homes in Germany for the years 2001, 2003, 2005 and 2007, our empirical results suggest that a high share of full-time employed women aged 50-65 at the district level is not associated with higher prices of nursing homes. Furthermore, we find only weak evidence for a positive correlation of prices with the local average of women's educational level and a negative correlation with part-time employment indicating that price levels are lower in regions with higher shares of part-time employed women.

  12. Aggression and violence against home care workers.

    Science.gov (United States)

    Büssing, André; Höge, Thomas

    2004-07-01

    This article describes the development of the Violence and Aggression in Health Care Questionnaire (VAQ) and the application of the measure in the field of home care. In a 1st sample of 361 German home care workers, the scales of the VAQ reached internal consistencies from .72 to .93. A confirmatory factor analysis gave evidence to the hypothesized factor structure. Significant correlation with indicators of psychophysical strain and health resulted in a 2nd sample of 180 home care workers. In multiple regression analysis based on a 3rd sample of 180 home care workers, verbal aggression by patients was a significant predictor of negative psychological outcomes. The relationship is completely mediated by negative emotional reactions after aggressive incidents.

  13. Home births in the Mosvold health ward of KwaZulu | Buchman ...

    African Journals Online (AJOL)

    A community survey was carried out to determine the frequency and the methods of home deliveries in the Mosvold health ward in northern KwaZulu. Of a sample of 210 mothers interviewed 46% had given birth at home, and of these 48% were delivered by traditional birth attendants; 84% gave birth in a kneeling or sitting ...

  14. HomePort

    DEFF Research Database (Denmark)

    Madsen, Per Printz

    2009-01-01

    In the last couple of year's computer based home control systems are getting more and more common in modern homes. For instance these systems take care of light control, heat control and security systems.  The latest trend is to use wireless communication like Z-Wave and ZigBee to interconnect...... different components in these systems. One of the characteristics is that each system, like for instance heat and light, has their own specific way of using the communication system.   This paper describes a way to connect different home control systems through an intelligent gateway, called a Home......Port. The HomePort consists of a number of Subsystem communication drivers, a virtual communication layer, an interpreter and a PC- based compiler for a high level control language, called GIL (Gateway intelligence language). The focus in this paper will be on the upper two layers in the Home...

  15. Carer preferences for home support services in later stage dementia.

    Science.gov (United States)

    Kampanellou, Eleni; Chester, Helen; Davies, Linda; Davies, Sue; Giebel, Clarissa; Hughes, Jane; Challis, David; Clarkson, Paul

    2017-11-01

    To examine the relative importance of different home support attributes from the perspective of carers of people with later-stage dementia. Preferences from 100 carers, recruited through carers' organisations, were assessed with a Discrete Choice Experiment (DCE) survey, administered online and by paper questionnaire. Attributes were informed by an evidence synthesis and lay consultations. A conditional logit model was used to estimate preference weights for the attributes within a home support 'package'. The most preferred attributes were 'respite care, available regularly to fit your needs' (coefficient 1.29, p = home care provided regularly for as long as needed' (coefficient 0.93, p = home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers' preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support.

  16. Relationship between home hazards and falling among community-dwelling seniors using home-care services.

    Science.gov (United States)

    Leclerc, B-S; Bégin, C; Cadieux, E; Goulet, L; Allaire, J-F; Meloche, J; Leduc, N; Kergoat, M-J

    2010-02-01

    Evidence linking home hazards to falls has not been well established. The evidence-based approach to fall-risk assessment in longitudinal studies becomes difficult because of exposures that change during follow-up. We conducted a cohort study to determine the prevalence of hazards and to resolve whether they are linked to the risk of falls among 959 seniors receiving home-care services. A home hazards assessment was completed at entry and every six months thereafter using a standardized form. The adjusted (for a number of confounding factors) relationship between home hazards and falls was estimated using a survival model taking into account updated time-varying exposures and multiple events. Falls leading to a medical consultation were examined as a secondary outcome, hypothesized as a measure of severity. Home environmental hazards were found in 91% of homes, with a mean of 3.3 risks per individual. The bathroom was the most common place for hazards. The presence of hazards was significantly associated with all falls and fall-related medical consultations, and showed relatively constant effects from one fall to another. The current study is innovative in its approach and useful in its contribution to the understanding of the interaction between home environmental hazards and falls. Our results indicate that inattention to changes in exposure masks the statistical association between home hazards and falls. Each environmental hazard identified in the home increases the risk of falling by about 19%. These findings support the positive findings of trials that demonstrate the effectiveness of this home hazard reduction program, particularly for at-risk people.

  17. Logistics impacts of student online shopping – Evaluating delivery consolidation to halls of residence

    OpenAIRE

    Cherrett, T.; Dickinson, Janet E.; McLeod, F.; Sit, K (Jason); Bailey, G; Whittle, G.

    2017-01-01

    Growth in online shopping has led to increased numbers of small delivery vehicles in urban areas leading to a range of negative externalities. Young people are significant generators of home deliveries and, when clustered in university halls of residence, can generate considerable freight traffic to one location. This paper explores the potential to consolidate these deliveries using an urban consolidation centre. Based on the case of Southampton, UK, data were compiled from three linked sour...

  18. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Donate American College of Surgeons Education Patients and Family Skills Programs ... The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn ...

  19. Dying at home

    Science.gov (United States)

    Kiyanda, Brigitte Gagnon; Dechêne, Geneviève; Marchand, Robert

    2015-01-01

    Abstract Objective To demonstrate that it is possible for a team of palliative care nurses in an urban centre to care for more than 50% of their terminally ill patients at home until they die, and that medical care delivered in the home is a determining factor in death at home versus death in a hospital. Design Analysis of place of death of terminally ill patients who died in 2012 and 2013 (N = 212) and who had been cared for by palliative care nurses, by type of medical care. Setting The centre local de services communautaires (CLSC) in Verdun, Que, an urban neighbourhood in southwest Montreal. Participants A total of 212 terminally ill patients. Main outcome measures Rate of deaths at home. Results Of the 212 patients cared for at home by palliative care nurses, 56.6% died at home; 62.6% received medical home care from CLSC physicians, compared with 5.0% who did not receive medical home care from any physician. Conclusion Combined with a straightforward restructuring of the nursing care delivered by CLSCs, development of medical services delivered in the home would enable the more than 50% of terminally ill patients in Quebec who are cared for by CLSCs to die at home—something that most of them wish for. PMID:25873716

  20. Prediction of preterm delivery

    NARCIS (Netherlands)

    Wilms, F.F.

    2014-01-01

    Preterm delivery is in quantity and in severity an important issue in the obstetric care in the Western world. There is considerable knowledge on maternal and obstetric risk factors of preterm delivery. Of the women presenting with preterm labor, the majority is pregnant with a male fetus and in

  1. [The moon and delivery].

    Science.gov (United States)

    Romero Martínez, Jorge; Guerrero Guijo, Inmaculada; Artura Serrano, Antonio

    2004-11-01

    In different cultures and mythologies, the moon is related with fertility, pregnancy and delivery. Professional obstetricians also notice an increase in care demands on the days when the moon is full. Many studies have been made which try to correlate delivery processes to the phases of the moon with contradictory results. The authors plan to try to find any basis in fact which support these popular beliefs and to discover if lunar phases bear an influence on the distribution of deliveries. They carried out a descriptive transversal study on a total of 1715 unassisted deliveries over the course of ten complete lunar cycles. The authors have carried out a descriptive and inferential analysis, a one way ANOVA and a Kruskal Wallis test on their three data bases which are general, primipara and multipara in which they contemplated the total number of deliveries per phase, the mean of each phase, as well as the central day in each phase of the lunar cycle. The differences found in the distribution of deliveries over the four lunar phases, along with the comparison of the means and the comparison of the number of deliveries on the central day in each phase are not statistically significant. The different phases in the lunar cycle and especially the full moon do not appear to have any influence over the distribution of deliveries in this study.

  2. Global Delivery Models

    DEFF Research Database (Denmark)

    Manning, Stephan; Larsen, Marcus M.; Bharati, Pratyush

    2013-01-01

    This article examines antecedents and performance implications of global delivery models (GDMs) in global business services. GDMs require geographically distributed operations to exploit both proximity to clients and time-zone spread for efficient service delivery. We propose and empirically show...

  3. Teaching about home visits to university students

    Directory of Open Access Journals (Sweden)

    Fernanda Ribeiro Borges

    2017-01-01

    Full Text Available To identify the scientific evidence available in the literature on the teaching strategies used in the home visit. Methods: it is an integrative literature review in the Nursing Database, Scientific Electronic Library Online, Latin American and Caribbean Literature in Health Sciences, and Cumulative Index to Nursing & Allied Health Literature. Results: six articles with evidence strength level VI were included. Different strategies and teaching methods related to the home visit activity were found, such as socio-drama, active methodologies and curricular practices in the health services network. Experiencing social reality was a potentiality, and there was lack of planning of the visit as weaknesses found by the students. Conclusion: the main teaching strategy for university students in the health area is the early insertion for the direct monitoring of families through home visits.

  4. Accessing Safe Deliveries in Tanzania (IMCHA) | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The project team will publish evidence on the effectiveness of the comprehensive emergency obstetrical and newborn care training program as it relates to health service delivery and health outcomes. Researchers will submit policy briefs to government officials and use a Web-based reporting tool to share lessons learned.

  5. Quantitative Indicators for Behaviour Drift Detection from Home Automation Data.

    Science.gov (United States)

    Veronese, Fabio; Masciadri, Andrea; Comai, Sara; Matteucci, Matteo; Salice, Fabio

    2017-01-01

    Smart Homes diffusion provides an opportunity to implement elderly monitoring, extending seniors' independence and avoiding unnecessary assistance costs. Information concerning the inhabitant behaviour is contained in home automation data, and can be extracted by means of quantitative indicators. The application of such approach proves it can evidence behaviour changes.

  6. The "H" Word: Home Schooling.

    Science.gov (United States)

    Butler, Shery

    2000-01-01

    This article discusses home schooling gifted children, including reasons families choose to home school their children, laws regulating home schooling, the educational background of parents who home school, and curriculum options. Advantages and disadvantages of home schooling are explored, along with data indicating the higher achievement of home…

  7. Cells as delivery vehicles for cancer therapeutics.

    Science.gov (United States)

    Basel, Matthew T; Shrestha, Tej B; Bossmann, Stefan H; Troyer, Deryl L

    2014-05-01

    Cell-based therapeutics have advanced significantly over the past decade and are poised to become a major pillar of modern medicine. Three cell types in particular have been studied in detail for their ability to home to tumors and to deliver a variety of different payloads. Neural stem cells, mesenchymal stem cells and monocytes have each been shown to have great potential as future delivery systems for cancer therapy. A variety of other cell types have also been studied. These results demonstrate that the field of cell-based therapeutics will only continue to grow.

  8. Sex Away from Home

    Science.gov (United States)

    Greenwald, Harold

    1971-01-01

    The reasons why people who are normally truthful to their spouses engage in sex away from home are discussed. These reasons can include loneliness, ego building or the opportunity to have homosexual relations. Sex away from home is likely to increase since the number of people traveling is increasing. (Author/CG)

  9. Home Education in Russia

    Science.gov (United States)

    Staroverova, T. I.

    2011-01-01

    From the eighteenth through the early twentieth centuries, home education (home schooling) by tutors and governesses in Russia was a customary form of schooling for an overwhelming majority of members of the nobility. Social and political transformations of the twentieth century led to substantial changes as the state got actively involved with…

  10. Home Teaching and Herbart.

    Science.gov (United States)

    Rust, Val D.; Reed, Frances

    1979-01-01

    Viewing the growing disenchantment with state-controlled schooling, the authors predict that home teaching will become an established educational alternative within a short time, and they reflect on the teachings and writings of Johann Friedrich Herbart, an eighteenth-century advocate of educating children at home. (Editor/SJL)

  11. European Home Energy

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.

    2009-01-01

    An important aim of the european energy performance of buildings directive is to improve the overall energy efficiency of new homes......An important aim of the european energy performance of buildings directive is to improve the overall energy efficiency of new homes...

  12. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn and ...

  13. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Stay Up to Date with ACS Association Management Jobs Events Find a Surgeon Patients and Family Contact My Profile Shop ( 0 ) Cart Donate American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills ...

  14. Technologies for Home Networking

    DEFF Research Database (Denmark)

    A broad overview of the home networking field, ranging from wireless technologies to practical applications. In the future, it is expected that private networks (e.g. home networks) will become part of the global network ecosystem, participating in sharing their own content, running IP...

  15. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit supports patients with educational and simulation ...

  16. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit ...

  17. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... checklist Evaluation (Complete the Ostomy Patient Survey . We need your opinion!) Program outcomes The ACS Ostomy Home Skills Kit program covers: Adult Ostomy Pediatric Ostomy Ostomía Adulto Order Today Ostomy Home Skills Kit (login or create account ...

  18. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Ostomy Programa de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit supports patients with ...

  19. No Place Like Home.

    Science.gov (United States)

    Austin, Elizabeth

    2000-01-01

    To fight rampant consumerism (Martha Stewart Inc.), reduce the divorce rate, prevent cancer and heart disease, and ensure domestic tranquility, educators should bring back home economics. Workers must put more energy into the home front, and we must begin teaching our children how to live well on less. (MLH)

  20. Asbestos in the Home.

    Science.gov (United States)

    Environmental Protection Agency, Washington, DC.

    The United States Government is concerned about asbestos-containing products in the home because sometimes asbestos fibers can be released from these produces. If asbestos fibers are inhaled, certain types of cancer may later develop. Asbestos in homes poses several problems. Household members have little or no protection from exposure to asbestos…

  1. Health Begins at Home

    Centers for Disease Control (CDC) Podcasts

    2009-03-30

    Clean and well-maintained homes can prevent many illnesses and injuries. This podcast discusses how good health begins at home.  Created: 3/30/2009 by Coordinating Center for Environmental Health and Injury Prevention (CCEHIP).   Date Released: 3/30/2009.

  2. Classroom at Home.

    Science.gov (United States)

    Simmons, Betty Jo

    1994-01-01

    Parents applying for home schooling should be informed about such matters as curriculum options, testing procedures, teaching qualifications, and opportunities for socialization. Home-schooled children should be allowed to participate in as many of the regular school offerings as schools can legitimately accommodate. Provides statistics about home…

  3. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn ... skills needed for optimal postoperative recovery. The kit supports the entire surgical ... on the operation, home skills such as emptying and changing a pouch, ...

  4. FIRST-GENERATION LATINA MOTHERS' EXPERIENCES OF SUPPLEMENTING HOME-BASED EARLY HEAD START WITH THE ATTACHMENT AND BIOBEHAVIORAL CATCH-UP PROGRAM.

    Science.gov (United States)

    Aparicio, Elizabeth M; Denmark, Nicole; Berlin, Lisa J; Jones Harden, Brenda

    2016-09-01

    This qualitative pilot study examined first-generation Latina mothers' experiences of supplementing home-based Early Head Start (EHS) services with the evidence-based Attachment and Biobehavioral Catch-up (ABC; M. Dozier, O. Lindheim, & J. Ackerman, 2005) program. Ten low-income, first-generation Latina mothers with infants and toddlers enrolled in home-based EHS were provided 10 ABC home visits by a supplemental parent coach. Following delivery of ABC, mothers participated in in-depth, semistructured, qualitative interviews about their experiences. Interview themes included positive experiences of both EHS and the ABC, a high value placed on receiving both programs, and cultural relevance of the ABC program for Latino families. Participants offered several suggestions for improved program delivery. Study findings suggest that a model of EHS supplemented by ABC delivered to the Latino community is feasible, valuable to participants, and culturally relevant. Considerations for sustainability of this supplemental model are discussed. © 2016 Michigan Association for Infant Mental Health.

  5. Still too far to walk: literature review of the determinants of delivery service use.

    Science.gov (United States)

    Gabrysch, Sabine; Campbell, Oona M R

    2009-08-11

    Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of

  6. Still too far to walk: Literature review of the determinants of delivery service use

    Directory of Open Access Journals (Sweden)

    Campbell Oona MR

    2009-08-01

    Full Text Available Abstract Background Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. Methods We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1 sociocultural factors, (2 perceived benefit/need of skilled attendance, (3 economic accessibility and (4 physical accessibility. Results There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. Conclusion Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider

  7. Aligning health information technologies with effective service delivery models to improve chronic disease care.

    Science.gov (United States)

    Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-09-01

    Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study.

    Science.gov (United States)

    Sun, Winnie; Doran, Diane M; Wodchis, Walter P; Peter, Elizabeth

    2017-03-14

    care service delivery required to improve clients' health and functioning. Such knowledge is vital for informing health care leaders about effective strategies that promote therapeutic self-care, as well as providing evidence for policy formulation in relation to risk mitigation in home care.

  9. Task Oriented Training and Evaluation at Home.

    Science.gov (United States)

    Rowe, Veronica T; Neville, Marsha

    2018-01-01

    Principles of experience-dependent plasticity, motor learning theory, and the theory of Occupational Adaptation coalesce into a translational model for practice in neurorehabilitation. The objective of this study was to explore the effectiveness of a Task Oriented Training and Evaluation at Home (TOTE Home) program completed by people with subacute stroke, and whether effects persisted 1 month after this training. A single-subject design included a maximum of 30, 1hour sessions of training conducted in participants' homes. Repeated target measures of accelerometry and level of confidence were used to assess movement and confidence in weaker arm use through baseline, intervention, and follow-up phases of TOTE Home. Four participants completed TOTE Home and each demonstrated improvement in movement and confidence in function. The degree of improvement varied between participants, but a detectable change was evident in outcome measures. TOTE Home, using client-centered, salient tasks not only improved motor function but also facilitated an adaptive response demonstrated in continued improvement beyond the intervention.

  10. Leadership philosophy of care home managers.

    Science.gov (United States)

    Rippon, Daniel; James, Ian Andrew

    Care home managers have a significant influence on staff morale and care delivery. Training methods underpinned by transformational leadership theory (TLT) have been used successfully to develop leaders in healthcare services. The aim of this preliminary study was to establish which aspects of TLT were apparent in care home managers' philosophies of leadership. A qualitative research design was used and 25 care home managers in the north-east of England took part. Participants were asked to provide their philosophies of leadership by completing a questionnaire; a thematic analysis of the responses was then conducted. Development of philosophy, enablement and interpersonal impact emerged as key themes. The findings suggested that elements of TLT were apparent in the participants' philosophies of leadership. However, the importance of gaining the support of senior management when attempting to apply a philosophy of eadership in practice was lacking. Aspects of TLT, such as supporting frontline employees to engage in education and establishing trust, were embedded in care home managers' philosophies. To develop leadership skills, managers may benefit from training programmes that involve both structured teaching and guided learning through experience.

  11. Palliative Care Development in European Care Homes and Nursing Homes: Application of a Typology of Implementation.

    Science.gov (United States)

    Froggatt, Katherine; Payne, Sheila; Morbey, Hazel; Edwards, Michaela; Finne-Soveri, Harriet; Gambassi, Giovanni; Pasman, H Roeline; Szczerbińska, Katarzyna; Van den Block, Lieve

    2017-06-01

    The provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. To identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe. We undertook a mapping exercise in 29 European countries, using 2 methods of data collection: (1) a survey of country informants, and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data, we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From these data, a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed. We identified 3 levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities, such as education, tools/frameworks, service models, and research), and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development, and means of provision. We found that macro and meso factors at 2 levels shape palliative care implementation and provision in care homes at the micro organizational level. Implementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high

  12. Biometrics for home networks security

    KAUST Repository

    Ansari, Imran Shafique

    2009-01-01

    Hacking crimes committed to the home networks are increasing. Advanced network protection is not always possible for the home networks. In this paper we will study the ability of using biometric systems for authentication in home networks. ©2009 IEEE.

  13. Telecommunication technology used in home healthcare.

    Science.gov (United States)

    Mishra, Sumant; Nayak, C G; Shet, K C; George, V I

    2011-01-01

    Current telemedicine applications are usually developed for doctors to do consultation and case study between several hospitals. Patients see doctor at home via Internet becomes possible and it might be a part of lifestyle in the future. Telemedicine has been an active area of research for over 30 years. In the past, several telemedicine applications using wired EPABX telecommunications equipment were provided whereas now-a-days the evolution of wireless communication means enabling telemedicine systems to operate everywhere in the world, thus expanding telemedicine benefits, services and applications. How these applications are used in healthcare delivery and what are the technologies used in this system are explained in this paper.

  14. Monitoring pressure ulcers in nursing homes.

    Science.gov (United States)

    Madsen, W; Leonard, M

    1997-12-01

    Clinical indicators may be used to monitor the quality of care delivery. Unfortunately, they are often viewed by nursing staff as unnecessary paper work. This study used Waterlow's Pressure Sore Risk Assessment Tool as the basis of a clinical indicator to monitor pressure ulcers within a nursing home. It was found that by closely monitoring the skin status of residents, preventative actions could be implemented, thereby minimizing the risk of pressure ulcer development. The advantage of utilizing such a tool is that it is seen to be clinically relevant for nursing staff while providing a bank of data for quality management.

  15. Silica-Coated Liposomes for Insulin Delivery

    Directory of Open Access Journals (Sweden)

    Neelam Dwivedi

    2010-01-01

    Full Text Available Liposomes coated with silica were explored as protein delivery vehicles for their enhanced stability and improved encapsulation efficiency. Insulin was encapsulated within the fluidic phosphatidylcholine lipid vesicles by thin film hydration at pH 2.5, and layer of silica was formed above lipid bilayer by acid catalysis. The presence of silica coating and encapsulated insulin was identified using confocal and electron microscopy. The native state of insulin present in the formulation was evident from Confocal Micro-Raman spectroscopy. Silica coat enhances the stability of insulin-loaded delivery vehicles. In vivo study shows that these silica coated formulations were biologically active in reducing glucose levels.

  16. Preliminary Results From a Newly Established Behavioral Health Home

    Directory of Open Access Journals (Sweden)

    Alexandros Maragakis

    2015-05-01

    Full Text Available Objective: Individuals with serious mental illness (SMI have higher rates of preventable diseases such as diabetes in comparison to the general population. While multifaceted, these high rates of preventable diseases in the population with SMI may be partially attributed to limited access to primary care. A new program, the Behavioral Health Home (BHH, which allows for the delivery of somatic care coordination and population-based care, may provide this population with the much needed somatic coordination and education it requires. Methods: The impact of the population-based health management program of the BHH identification and severity rating of glucose metabolism disorders was assessed during the initial 10 months of the BHH. Results: Multiple patients were identified who either were not having hemoglobin A1c (HbA1c levels drawn per recommended guidelines for individuals prescribed antipsychotic medications or were within diabetic range but did not have a diagnosis of diabetes. Mixed results occurred in regard to patients’ HbA1c levels while engaging in the BHH. Conclusion: This case study provides some initial evidence for the utility of the BHH in regard to identifying patients who need preventive care.

  17. Breastfeeding After Cesarean Delivery

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Breastfeeding After Cesarean Delivery Page Content Article Body A ... delivered vaginally. It is especially important to begin breastfeeding as soon as you are able and to ...

  18. Prospective study of determinants and costs of home births in Mumbai slums

    Directory of Open Access Journals (Sweden)

    Das Sushmita

    2010-07-01

    Full Text Available Abstract Background Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. Methods As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. Results We described 1708 (16% home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai, and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. Conclusions We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be

  19. Prospective study of determinants and costs of home births in Mumbai slums

    Science.gov (United States)

    2010-01-01

    Background Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth. Methods As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models. Results We described 1708 (16%) home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location. Conclusions We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on

  20. Condensation in insulated homes

    Energy Technology Data Exchange (ETDEWEB)

    Wiley, R A

    1978-05-28

    A research proposal on condensation in insulated homes is presented. Information is provided on: justification for condensation control; previous work and present outlook (good vapor barrier, condensation and retrofit insulation, vapor barrier decreases condensation, brick-veneer walls, condensation in stress-skin panels, air-conditioned buildings, retrofitting for conservation, study on mobile homes, high indoor relative humidity, report on various homes); and procedure (after funding has been secured). Measures are briefly described on opening walls, testing measures, and retrofitting procedures. An extensive bibliography and additional informative citations are included. (MCW)

  1. Out-of-pocket expenditure on institutional delivery in India.

    Science.gov (United States)

    Mohanty, Sanjay K; Srivastava, Akanksha

    2013-05-01

    Though promotion of institutional delivery is used as a strategy to reduce maternal and neonatal mortality, about half of the deliveries in India are conducted at home without any medical care. Among women who deliver at home, one in four cites cost as barrier to facility-based care. The relative share of deliveries in private health centres has increased over time and the associated costs are often catastrophic for poor households. Though research has identified socio-economic, demographic and geographic barriers to the utilization of maternal care, little is known on the cost differentials in delivery care in India. The objective of this paper is to understand the regional pattern and socio-economic differentials in out-of-pocket (OOP) expenditure on institutional delivery by source of provider in India. The study utilizes unit data from the District Level Household and Facility Survey (DLHS-3), conducted in India during 2007-08. Descriptive statistics, principal component analyses and a two-part model are used in the analyses. During 2004-08, the mean OOP expenditure for a delivery in a public health centre in India was US$39 compared with US$139 in a private health centre. The predicted expenditure for a caesarean delivery was six times higher than for a normal delivery. With an increase in the economic status and educational attainment of mothers, the propensity and rate of OOP expenditure increases, linking higher OOP expenditure to quality of care. The OOP expenditure in public health centres, adjusting for inflation, has declined over time, possibly due to increased spending under the National Rural Health Mission. Based on these findings, we recommend that facilities in public health centres of poorly performing states are improved and that public-private partnership models are developed to reduce the economic burden for households of maternal care in India.

  2. Designing Intuitive Web Solutions for Monitoring Patients’ Rehabilitation at Home

    Directory of Open Access Journals (Sweden)

    Raihana Ferdous

    2015-12-01

    Full Text Available This paper describes the design of web-based remote monitoring interfaces aimed at supporting therapists and caregivers in supervising motor-cognitive rehabilitation plans of care to be performed by patients at home. This work was part of a three years’ research project where game-based environments for upper body motor rehabilitation of post-stroke patients were developed in collaboration with two main rehabilitation centers in Italy and Austria, for a subsequent deployment at patients’ homes. The paper will specifically focus on describing the iterative design of the home rehabilitation features for clinicians over the first two years of the project to enable the delivery and monitoring of more personalized, engaging plans of care for home therapy by rehabilitation centers and services.

  3. An open trial of in-home CBT for depressed mothers in home visitation.

    Science.gov (United States)

    Ammerman, Robert T; Putnam, Frank W; Stevens, Jack; Bosse, Nicole R; Short, Jodie A; Bodley, Amy L; Van Ginkel, Judith B

    2011-11-01

    Research has demonstrated that low income mothers participating in home visitation programs have high rates of depression. This study used an open trial design to evaluate In-Home Cognitive Behavioral Therapy (IH-CBT), an evidence-based treatment for depression that is delivered in the home setting and has been adapted to address the needs of low income mothers participating in home visitation. 64 depressed mothers recruited from a home visitation program and who had completed IH-CBT were compared to 241 mothers from the same setting who met identical screening criteria at enrollment but did not receive the treatment. In addition, pre- and post-treatment measures of depression and related clinical features were contrasted in the 64 mothers receiving IH-CBT. There was a significantly greater reduction in depressive symptoms in the IH-CBT group relative to their counterparts who did not receive the treatment. Results from pre-post comparisons showed that treated mothers had decreased diagnosis of major depression, lower reported stress, increased coping and social support, and increased positive views of motherhood at post-treatment. Findings suggest that IH-CBT is a promising approach to addressing maternal depression in the context of home visitation and warrants further study. Public health implications for home visiting programs are discussed.

  4. Home diuretic protocol for heart failure: partnering with home health to improve outcomes and reduce readmissions.

    Science.gov (United States)

    Veilleux, Richard P; Wight, Joseph N; Cannon, Ann; Whalen, Moira; Bachman, David

    2014-01-01

    The management of heart failure (HF) is challenging, with high rates of readmission and no single solution. MaineHealth, a health care system serving southern Maine, has shown initial success with home health nurses partnering with physicians in the management of complex patients with HF using the MaineHealth Home Diuretic Protocol (HDP). To demonstrate that augmented diuretic therapy, both oral and intravenous, an evidence-based treatment for care of patients with HF experiencing fluid retention, can be delivered safely in the home setting using the HDP and can improve outcomes for recently hospitalized patients with HF. In late 2011, the MaineHealth HDP was implemented in two hospitals and in the home health agency serving those hospitals. The patient population included recently hospitalized patients with a diagnosis of advanced HF, eligible for home health services and telemonitoring. Home health nurses reported data on the patients managed using the protocol, including interventions made, physical findings, lab values, and patient disposition after each episode of care. Questionnaires were used to determine patient and clinician satisfaction. Sixty patients meeting the criteria above were enrolled between November 2011 and January 2014. The protocol was initiated 84 times for 30 of these patients. Sixteen patients had multiple activations. The readmission rate was 10% and no adverse outcomes were observed. Clinician and patient satisfaction was 97% or greater. The MaineHealth HDP can be delivered effectively and safely to improve outcomes, reducing readmissions and allowing patients to remain at home.

  5. Education and training to enhance end-of-life care for nursing home staff: a systematic literature review.

    Science.gov (United States)

    Anstey, Sally; Powell, Tom; Coles, Bernadette; Hale, Rachel; Gould, Dinah

    2016-09-01

    The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles. To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care. Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically. Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported. There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... entire surgical team with quality, comprehensive education. The standardized interactive program has been developed by the American ... Ostomy Home Skills Hospital Quality Improvement Package The standardized interactive program has been developed by the American ...

  7. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Complete the Ostomy Patient Survey . We need your opinion!) Program outcomes The ACS Ostomy Home Skills Kit ... ACS Links About ACS ACS Foundation Have a Question? Press Releases Shop My Profile American College of ...

  8. Home Health PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Under prospective payment, Medicare pays home health agencies (HHAs) a predetermined base payment. The payment is adjusted for the health condition and care needs of...

  9. Home Health Compare Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — These are the official datasets used on the Medicare.gov Home Health Compare Website provided by the Centers for Medicare and Medicaid Services. These data allow you...

  10. Nursing Home Data Compendium

    Data.gov (United States)

    U.S. Department of Health & Human Services — The compendium contains figures and tables presenting data on all Medicare- and Medicaid-certified nursing homes in the United States as well as the residents in...

  11. Nursing Home Compare Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — These are the official datasets used on the Medicare.gov Nursing Home Compare Website provided by the Centers for Medicare and Medicaid Services. These data allow...

  12. Home Improvements Prevent Falls

    Science.gov (United States)

    ... Adults / How Can Older Adults Prevent Falls? / Home Improvements Prevent Falls Winter 2014 Issue: Volume 8 Number 4 Page 16-17 MedlinePlus | Subscribe | Magazine Information | Contact Us | Viewers & Players Friends of the National Library of Medicine (FNLM)

  13. Genetics Home Reference: aceruloplasminemia

    Science.gov (United States)

    ... an inherited neurodegenerative disease with impairment of iron homeostasis. Ann N Y Acad Sci. 2004 Mar;1012:299-305. Review. Citation on PubMed More from Genetics Home Reference Bulletins Crick, Watson, and Wilkins Awarded ...

  14. Managing migraines at home

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000420.htm Managing migraines at home To use the sharing features ... you drink every day. Learn and practice stress management . Some people find relaxation exercises and meditation helpful. ...

  15. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Program Commission on Cancer National Accreditation Program for Breast Centers National Cancer Database National Accreditation Program for Rectal Cancer Oncology Medical Home Accreditation Program Stereotactic Breast Biopsy Accreditation Program Cancer Programs Staff Information Children's ...

  16. Staying safe at home

    Science.gov (United States)

    ... both smoke and CO. Make sure that your home heating system and all your appliances are all working correctly. DO NOT leave a ... Never reach into water to get a fallen appliance unless it is unplugged.

  17. Genetics Home Reference: hemophilia

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Hemophilia Hemophilia Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Hemophilia is a bleeding disorder that slows the blood ...

  18. Heart failure - home monitoring

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000113.htm Heart failure - home monitoring To use the sharing features on this page, please enable JavaScript. Heart failure is a condition in which the heart is ...

  19. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative ... The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn and practice the ...

  20. Genetics Home Reference: desmosterolosis

    Science.gov (United States)

    ... Neurological Disorders KidsHealth from Nemours: Cholesterol and Your Child KidsHealth from Nemours: Delayed Speech or Language Development MalaCards: desmosterolosis Merck Manual Home Edition for Patients ...

  1. Genetics Home Reference: sialidosis

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Sialidosis Sialidosis Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Sialidosis is a severe inherited disorder that affects many ...

  2. Genetics Home Reference: osteoarthritis

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Osteoarthritis Osteoarthritis Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Osteoarthritis is a common disease of the joints that ...

  3. Genetics Home Reference: schizophrenia

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Schizophrenia Schizophrenia Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Schizophrenia is a brain disorder classified as a psychosis, ...

  4. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... System (PQRS) Value-Based Payment Modifier Accountable Care Organizations Regulatory Burden Reduction Stark Law and Anti-Kickback ... Order Today Ostomy Home Skills Kit (login or create account first) Skills Kits Broadcast Rights for Hospitals ...

  5. Home Oxygen Therapy

    Science.gov (United States)

    ... dewar ) that acts like a large thermos. When released, the liquid oxygen immediately converts to a gas ... must be periodically refilled by the home care company but not as frequently as with the older ...

  6. Genetics Home Reference: aniridia

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions aniridia aniridia Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Aniridia is an eye disorder characterized by a complete ...

  7. Home Health PPS - Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Abt Associates July 21, 2010 Analysis of 2000-2008 Home Health Case-mix Change Report estimates the extent to which the observed increases in average case-mix were...

  8. Nursing Home Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data that is used by the Nursing Home Compare tool can be downloaded for public use. This functionality is primarily used by health policy researchers and the...

  9. Genetics Home Reference: vitiligo

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Vitiligo Vitiligo Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Vitiligo is a condition that causes patchy loss of ...

  10. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Kits Broadcast Rights for Hospitals Ostomy Home Skills Hospital Quality Improvement Package The standardized interactive program has been developed by the ... and Associates Medical Students International Surgeons ...

  11. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... login or create account first) Skills Kits Broadcast Rights for Hospitals Ostomy Home Skills Hospital Quality Improvement ... American College of Surgeons, Chicago, IL 60611-3211 | Privacy Policy | Terms of Use

  12. Genetics Home Reference: porphyria

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Porphyria Porphyria Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Porphyria is a group of disorders caused by abnormalities ...

  13. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... at ACS Careers at ACS About ACS Career Types Working at ACS ... Family Contact My Profile Shop ( 0 ) Cart Donate American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills ...

  14. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Subscribe ACS Case Reviews Login CME Test Login Author Instructions Sample Article Chapter Competition Contact Resources in ... login or create account first) Skills Kits Broadcast Rights for Hospitals Ostomy Home Skills Hospital Quality Improvement ...

  15. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma Practice Model Stoma supplies (measurement guide, marking pen, scissors, sample ...

  16. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Medical Student Core Curriculum ACS/ASE Medical Student Simulation-Based Surgical Skills Curriculum Cancer Education Cancer Education ... Home Skills Kit supports patients with educational and simulation materials to learn and practice the skills needed ...

  17. Genetics Home Reference: achondroplasia

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Achondroplasia Achondroplasia Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Achondroplasia is a form of short-limbed dwarfism. The ...

  18. Home Health Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — The instrument-data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS)....

  19. Home Health Care Agencies

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.

  20. Genetics Home Reference: preeclampsia

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions Preeclampsia Preeclampsia Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Preeclampsia is a complication of pregnancy in which affected ...

  1. Pervasive Home Environments

    Science.gov (United States)

    Bull, P.; Limb, R.; Payne, R.

    An increasing number of computers and other equipment, such as games consoles and multimedia appliances for the home, have networking capability. The rapid growth of broadband in the home is also fuelling the demand for people to network their homes. In the near future we will see a number of market sectors trying to 'own' the home by providing gateways either from the traditional ISP or from games and other service providers. The consumer is bombarded with attractive advertising to acquire the latest technological advances, but is left with a plethora of different appliances, which have a bewildering range of requirements and features in terms of networking, user interface, and higher-level communications protocols. In many cases, these are proprietary, preventing interworking. Such technical and usability anarchy confuses the consumer and could ultimately suppress market adoption.

  2. HOME Income Limits

    Data.gov (United States)

    Department of Housing and Urban Development — HOME Income Limits are calculated using the same methodology that HUD uses for calculating the income limits for the Section 8 program. These limits are based on HUD...

  3. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Specific Registry Surgeon Specific Registry News and Updates Account Setup Resources and FAQs Features of the SSR ... Today Ostomy Home Skills Kit (login or create account first) Skills Kits Broadcast Rights for Hospitals Ostomy ...

  4. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative ... create account first) Skills Kits Broadcast Rights for Hospitals Ostomy Home Skills Hospital Quality Improvement Package The ...

  5. Optimizing Cancer Care Delivery through Implementation Science

    Directory of Open Access Journals (Sweden)

    Heather B Neuman

    2016-01-01

    Full Text Available The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer.

  6. α-Melanocyte stimulating hormone (MSH) and prostaglandin E2 (PGE2) drive melanosome transfer by promoting filopodia delivery and shedding spheroid granules: Evidences from atomic force microscopy observation.

    Science.gov (United States)

    Ma, Hui-Jun; Ma, Hui-Yong; Yang, Yang; Li, Peng-Cheng; Zi, Shao-Xia; Jia, Chi-Yu; Chen, Rong

    2014-12-01

    Skin pigmentation is accomplished by production of melanin in melanosome and by transfer of these organelles from melanocytes (MCs) to surrounding keratinocytes (KCs). However, the detailed mechanism is still unknown. We aimed to investigate the morphological structure changes on human epidermal MCs and KCs, which were either mono-cultured or co-cultured, with or without the treatment of both α-Melanocyte-stimulating hormone (α-MSH) and prostaglandin E2 (PGE2), by atomic force microscopy (AFM) and to provide more direct proofs for process of melanosome transfer. Human epidermal MCs and KCs were isolated and co-cultured with 1:10 ratio in a defined Keratinocyte-serum free medium (K-SFM). After exposure with 100 nM α-MSH or 20 μM PGE2 for 3 days, cells were fixed with 0.5% glutaraldehyde and AFM images of scanning observation were captured by contacting and tapping model under normal atmospheric pressure and temperature. It showed that human epidermal MCs in culture had secondary or tertiary branches. Except for globular granules structure on the surface of dendrites, some filopodia were protruded on the tips and lateral sides of the dendrites. The administration of α-MSH and PGE2 made not only the dendrites thinner and longer, but also the globular granules more intensive and denser. Many spheroid granules were shed from branches of dendrite and most of them adhered with dense filopodia. Compared with untreated group, the number of filopodia per cell, diameter of filopodia, and shedding spheroid granules per field all increased following α-MSH and PGE2 exposure (Pspheroid granules per field all increased after the administration of α-MSH and PGE2 (Pspheroid granules, filopodia delivery and KC phagocytosis are major mode of melanosome transfer between MCs and KCs. PGE2, as well as α-MSH, drives melanosome transfer by promoting filopodia delivery and numbers of shedding spheroid granules in MCs, but no direct morphological effects on KCs. These findings open a

  7. Transdermal Spray in Hormone Delivery

    African Journals Online (AJOL)

    market for the delivery system and ongoing development of transdermal sprays for hormone delivery. Keywords: Transdermal, Delivery systems, ... delivery compared with gels, emulsions, patches, and subcutaneous implants. Among .... In a safety announcement, the US Food and. Drug Administration (FDA) warned that ...

  8. Home management of haemophilia.

    Science.gov (United States)

    Teitel, J M; Barnard, D; Israels, S; Lillicrap, D; Poon, M-C; Sek, J

    2004-03-01

    The demonstrated benefits of home care for haemophilia include improved quality of life, less pain and disability, fewer hospitalizations, and less time lost from work or school. Although reduced mortality has not been demonstrated, the substantial increase in longevity since the early 1980s correlates with the introduction of home treatment and prophylaxis programmes. These programmes must be designed and monitored by haemophilia treatment centres (HTC), which are staffed with professionals with broad and complementary expertise in the disease and its complications. In return, patients and their families must be willing to accept the reciprocal responsibilities that come from administering blood products or their recombinant equivalents at home. Patients with inhibitors to factors VIII or IX pose special challenges, but these complications do not obviate participation in home care programmes. Home care was an essential prerequisite to the introduction of effective prophylactic factor replacement therapy. Prophylaxis offers significant improvements in quality of life, but requires a substantial commitment. The use of implantable venous access devices can eliminate some of the difficulty and discomfort of peripheral venous access in small children, but brings additional risks. The future holds the promise of factor concentrates for home use that have longer half-lives, or can be administered by alternate routes. Knowledge of patient genotypes may allow treatments tailored to avoid complications such as inhibitor development. Gene therapy trials, which are currently ongoing, will ultimately lead to gene-based treatments as a complement to traditional protein-based therapy.

  9. Business Metrics for High-Performance Homes: A Colorado Springs Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Beach, R. [IBACOS, Inc, Pittsburgh, PA (United States); Jones, A. [IBACOS, Inc, Pittsburgh, PA (United States)

    2016-04-26

    This report explores the correlation between energy efficiency and the business success of home builders by examining a data set of builders and homes in the Colorado Springs, Colorado, market between 2006 and 2014. During this time, the Great Recession of 2007 to 2009 occurred, and new-home sales plummeted both nationally and in Colorado Springs. What is evident from an analysis of builders and homes in Colorado Springs is that builders who had Home Energy Rating System (HERS) ratings performed on some or all of their homes during the Recession remained in business during this challenging economic period. Many builders who did not have HERS ratings performed on their homes at that time went out of business or left the area. From the analysis presented in this report, it is evident that a correlation exists between energy efficiency and the business success of home builders, although the reasons for this correlation remain largely anecdotal and not yet clearly understood.

  10. Birth delivery assisted by nurse-midwife: perspectives and controversies

    Directory of Open Access Journals (Sweden)

    Selma Aparecida Lagrosa Garcia

    2010-12-01

    Full Text Available Objectives: To present the conflicts in birth deliveries assisted by nurse midwife and propose ways to minimize them. Methods: We researched the historical evolution of childbirth and the actions that were necessary for the training of professionals. Codes of Ethics of Nursing and Medicine, the current law, basic books of obstetrics and gynecology, articles from medical and nursing journals, with Lilacs and Medline as data sources; laic texts and others from non-governmental organizations (NGO were surveyed. Conflicts were identified in birth deliveries by nurse midwife, for which we propose ways of acting. Results: The analysis of research material shows that the time of delivery, initially at home and afterwards in institutions, brought interventionism in this activity; that social and human aspects of birth and delivery were minimized and birth delivery changed into medical act. We found a strong link between the focus in humanization at child delivery and its assistance by nurses. Conclusions: We conclude that even with legal and ethical support the delivery care by nurse midwife is a source of conflict between the health team, particularly with regard to the limits of performance of the nurse and doctor. Such conflicts must be identified and discussed in the institutions and they should invest in teamwork and have clear protocols defining boundaries of responsibility.

  11. Racial Segregation and Quality of Care Disparity in US Nursing Homes

    Science.gov (United States)

    Rahman, Momotazur; Foster, Andrew D.

    2014-01-01

    In this paper we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. PMID:25461895

  12. Racial segregation and quality of care disparity in US nursing homes.

    Science.gov (United States)

    Rahman, Momotazur; Foster, Andrew D

    2015-01-01

    In this paper, we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Residential Photovoltaic Energy Systems in California: The Effect on Home Sales Prices

    Energy Technology Data Exchange (ETDEWEB)

    Hoen, Ben; Wiser, Ryan; Thayer, Mark; Cappers, Peter

    2012-04-15

    Relatively little research exists estimating the marginal impacts of photovoltaic (PV) energy systems on home sale prices. Using a large dataset of California homes that sold from 2000 through mid-2009, we find strong evidence, despite a variety of robustness checks, that existing homes with PV systems sold for a premium over comparable homes without PV systems, implying a near full return on investment. Premiums for new homes are found to be considerably lower than those for existing homes, implying, potentially, a tradeoff between price and sales velocity. The results have significant implications for homeowners, builders, appraisers, lenders, and policymakers.

  14. Tissue-penetrating delivery of compounds and nanoparticles into tumors

    OpenAIRE

    Sugahara, Kazuki N.; Teesalu, Tambet; Karmali, Priya Prakash; Kotamraju, Venkata Ramana; Agemy, Lilach; Girard, Olivier M.; Hanahan, Douglas; Mattrey, Robert F.; Ruoslahti, Erkki

    2009-01-01

    Poor penetration of drugs into tumors is a major obstacle in tumor treatment. We describe a strategy for peptide-mediated delivery of compounds deep into the tumor parenchyma that employs a tumor homing peptide, iRGD (CRGDK/RGPD/EC). Intravenously injected compounds coupled to iRGD bound to tumor vessels and spread into the extravascular tumor parenchyma, whereas conventional RGD peptides only delivered the cargo to the blood vessels. iRGD homes to tumors through a 3-step process: The RGD mot...

  15. Embedding a Palliative Approach in Nursing Care Delivery

    Science.gov (United States)

    Porterfield, Pat; Roberts, Della; Lee, Joyce; Liang, Leah; Reimer-Kirkham, Sheryl; Pesut, Barb; Schalkwyk, Tilly; Stajduhar, Kelli; Tayler, Carolyn; Baumbusch, Jennifer; Thorne, Sally

    2017-01-01

    A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration. PMID:27930401

  16. Ambiguities: residents' experience of 'nursing home as my home'.

    Science.gov (United States)

    Nakrem, Sigrid; Vinsnes, Anne G; Harkless, Gene E; Paulsen, Bård; Seim, Arnfinn

    2013-09-01

    Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live at home. Uncovering what nursing home residents' view as quality of care in nursing homes will help further understanding of how best to provide high quality, person-centred care. To describe residents' experiences of living in a nursing home related to quality of care. The study utilises a descriptive exploratory design. In-depth interviews were undertaken with 15 residents who were not cognitively impaired, aged 65 and over and living in one of four nursing homes. The interviews were transcribed verbatim and analysed by categorising of meaning. Residents perceived the nursing home as their home, but at the same time not 'a home'. This essential ambiguity created the tension from which the categories of perceptions of quality emerged. Four main categories of quality of care experience were identified: 'Being at home in a nursing home', 'Paying the price for 24-hour care', 'Personal habits and institutional routines', and 'Meaningful activities for a meaningful day'. Ambiguities concerning the nursing home as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. High-quality care was when ambiguities were managed well and a home could be created within the institution. Implication for practice. Achieving quality care in nursing homes requires reconciling the ambiguities of the nursing home as a home. This implies helping residents to create a private home distinct from the professional home, allowing residents' personal habits to guide institutional routines and supporting meaningful activities. Using these resident developed quality indicators is an important step in improving nursing home services. © 2012 Blackwell Publishing Ltd.

  17. Exploring Local and Community Capacity to Reduce Fuel Poverty: The Case of Home Energy Advice Visits in the UK

    Directory of Open Access Journals (Sweden)

    Andrew Reeves

    2016-04-01

    Full Text Available Local delivery of support to householders to reduce the exposure to, and impacts of, fuel poverty is attracting increasing policymaker interest, but there is a dearth of empirical research that describes and evaluates local support schemes. Community organisations are viewed as having great potential to aid this delivery, but research on how this could be achieved is scarce. The research presented in this paper responds to these needs through an exploratory study of the delivery of home energy advice visits in the UK. Data were collected through interviews and supporting documents from twelve projects and analysis examined the inter-relationships between the process, delivered outputs and impacts of each project. The research findings suggest that long-term local professional initiatives appear to be most effective at reaching and providing support to fuel poor households across a local area. Community organisations appear to have some potential to fill gaps in local provision and can assist professional initiatives, particularly through signposting, but a lack of volunteer capacity ultimately constrains their impact. Issues identified for further study include: how local support services can be resourced and delivered nationwide; trade-offs between pursuing climate change and fuel poverty agendas; a need for more robust evidence of impacts.

  18. Organizational home care models across Europe: A cross sectional study.

    Science.gov (United States)

    Van Eenoo, Liza; van der Roest, Henriëtte; Onder, Graziano; Finne-Soveri, Harriet; Garms-Homolova, Vjenka; Jonsson, Palmi V; Draisma, Stasja; van Hout, Hein; Declercq, Anja

    2018-01-01

    Decision makers are searching for models to redesign home care and to organize health care in a more sustainable way. The aim of this study is to identify and characterize home care models within and across European countries by means of structural characteristics and care processes at the policy and the organization level. At the policy level, variables that reflected variation in health care policy were included based on a literature review on the home care policy for older persons in six European countries: Belgium, Finland, Germany, Iceland, Italy, and the Netherlands. At the organizational level, data on the structural characteristics and the care processes were collected from 36 home care organizations by means of a survey. Data were collected between 2013 and 2015 during the IBenC project. An observational, cross sectional, quantitative design was used. The analyses consisted of a principal component analysis followed by a hierarchical cluster analysis. Fifteen variables at the organizational level, spread across three components, explained 75.4% of the total variance. The three components made it possible to distribute home care organizations into six care models that differ on the level of patient-centered care delivery, the availability of specialized care professionals, and the level of monitoring care performance. Policy level variables did not contribute to distinguishing between home care models. Six home care models were identified and characterized. These models can be used to describe best practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Perceived effects of home renovation on independence of physically disabled Koreans living at home.

    Science.gov (United States)

    Lee, Yeunsook; Park, Jiyoung; Jang, Miseon

    2017-06-06

    This study aims to identify the potential effects of home renovation on independence promotion of physically disabled Koreans living at home. The method of the study is a survey with a questionnaire; subjects are physically disabled people living at home in rural and urban areas in Korea. The Functional Independence Measure was used to measure changes in subjects' levels of independence. It was expected that if homes were renovated according to individual needs, disabled people's independence level would be increased by one or more level compared to their current daily independence level in their existing homes. In particular, independence levels concerning bathing and locomotion, which are low in existing conditions, were expected to increase significantly with renovation. Such effects on independence level were conspicuous for disabled people in rural area. The results prove the positive effects of home renovations of disabled people's independence, thus providing meaningful academic evidence on home renovations for disabled people. Implication for rehabilitation Korea had a culture where support measures to aid the life independence of disabled persons relied heavily on human services, leading to a lack of diversity in support measures. By closing the gap between the resident's disability and the inadequacy in their prevailing environment, house remodeling can be a crucial intervention for improving the independence of disabled persons in their daily lives. Depending on the nature of their disabilities and their residential arrangements, disabled persons have diverse needs regarding home remodeling. Implementing home remodeling in such a manner that suits the resident's needs is crucial to boosting their independence. Because of this, remodeling personnel must interact with residents prior to the renovation while also strengthening their expertise.

  20. Antioxidant Nanoplatforms for Dermal Delivery: Melatonin.

    Science.gov (United States)

    Milan, Aroha Sanchez; Campmany, Ana Cristina Calpena; Naveros, Beatriz Clares

    2017-01-01

    Melatonin is emerging as a promising therapeutic agent, mainly due to its role as antioxidant. Substantial evidences show that melatonin is potentially effective in a variety of diseases as cancer, inflammation and neurodegenerative diseases. The excellent antioxidant capacity with pharmacokinetics characteristics and the emerging search for new pharmaceutical nanotechnology based systems, make it particularly attractive to elaborate nanoplatforms based on melatonin for biomedical or cosmetic dermal applications. Different nanosystems for dermal delivery have been investigated. This review focuses on nanocarrier production strategies, dermal melatonin application and delivery advances in vivo and in vitro. Equally, future perspectives of this assisted melatonin delivery have also been discussed. In the current review, we have revised relevant articles of the available literature using the major scientific databases. One hundred and thirteen papers were included in the review, the majority of which represent latest researches in nanosized platforms for the dermal delivery of melatonin including liposomes, ethosomes, niosomes, polymeric nanoparticles, solid lipid nanoparticles and cyclodextrins. Furthermore, relevant papers reporting in vitro and in vivo application studies of these nano-based melatonin platforms were also discussed. The use of nanoplatforms for the dermal melatonin delivery as antioxidant agent could improve the efficacy of conventional melatonin administration due to the preservation of the drug from premature oxidation and the enhancement of drug permeation through the skin providing greater exposure times. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.