A Swedish interview study: parents' assessment of risks in home births.

Science.gov (United States)

Lindgren, Helena; Hildingsson, Ingegerd; Rådestad, Ingela

2006-03-01

to describe home-birth risk assessment by parents. interviews using a semi-structured interview guide. Data were analysed using a phenomenological approach. independent midwifery practices in Sweden. five couples who had had planned home births. the parents had a fundamental trust that the birth would take place without complications, and they experienced meaningfulness in the event itself. Risks were considered to be part of a complex phenomenon that was not limited to births at home. This attitude seems to be part of a lifestyle that has a bearing on how risks experienced during the birth were handled. Five categories were identified as counterbalancing the risk of possible complications: (1) trust in the woman's ability to give birth; (2) trust in intuition; (3) confidence in the midwife; (4) confidence in the relationship; and (5) physical and intellectual preparation. although the parents were conscious of the risk of complications during childbirth, a fundamental trust in the woman's independent ability to give birth was central to the decision to choose a home birth. Importance was attached to the expected positive effects of having the birth at home. knowledge of parents' assessment can promote an increased understanding of how parents-to-be experience the risks associated with home birth.

Prevalence and risk factors of frailty among home care clients.

Science.gov (United States)

Miettinen, Minna; Tiihonen, Miia; Hartikainen, Sirpa; Nykänen, Irma

2017-11-17

Frailty is a common problem among older people and it is associated with an increased risk of death and long-term institutional care. Early identification of frailty is necessary to prevent a further decline in the health status of home care clients. The aims of the present study were to determine the prevalence of frailty and associated factors among 75-year-old or older home care clients. The study participants were 75-year-old or older home care clients living in three cities in Eastern and Central Finland. Home care clients who had completed the abbreviated Comprehensive Geriatric Assessment (aCGA) for frailty (n = 257) were included in the present study. Baseline data were obtained on functional status, cognitive status, depressive symptoms, self-rated health, ability to walk 400 m, nutritional status, drug use and comorbidities. Most of the home care clients (90%) were screened for frailty using the aCGA. Multivariate analysis showed that the risk of malnutrition or malnutrition (OR = 4.27, 95% CI = 1.56, 11.68) and a low level of education (OR = 1.14, 95% CI = 1.07, 1.23) were associated with frailty. Frailty is a prevalent problem among home care clients. The risk of malnutrition or malnourishment and a lower level of education increase the risk of frailty. Screening for frailty should be done to detect the most vulnerable older people for further intervention to prevent adverse health problems. ClinicalTrials.gov: NCT02214758 .

Risk factors for burnout among caregivers working in nursing homes.

Science.gov (United States)

Kandelman, Nadia; Mazars, Thierry; Levy, Antonin

2018-01-01

(i) To assess the level of burnout in nursing home caregivers within a unique healthcare network in France and (ii) to evaluate potential risk factors in this population. Burnout syndrome occurs frequently among nursing home caregivers and has strong detrimental effects on the quality of health care for residents. We used an observational survey to study burnout in nursing home caregivers. The survey was used to quantify burnout level (Maslach Burnout Inventory) and potential risk factors and was implemented from October 2013-April 2014. A logistic regression was used to explore the association between burnout and its risk factors. Three hundred and sixty questionnaires were delivered to caregivers in 14 nursing homes within a unique healthcare network. The response rate was 37% (132/360), and 124/132 (94%) surveys were analysed. Caregiver burnout rate was 40% (49/124). Median age was 41 years (range, 20-70) and most caregivers were female. The most common profession (n = 54; 44%) was nurse caregiver and 90% (n = 112) had an antecedent of bullying by a resident. Risk factors identified were as follows: the presence of institutional protocols (death announcement [OR: 3.7] and pain assessment [OR: 2.8]), working in a profit-making establishment (OR: 2.6) and the antecedent of bullying by a resident (OR: 6.2). Factors most negatively associated with burnout included: practising pastimes (OR: 0.4) and working as a nurse (OR: 0.3). The only significant risk factor in the multivariate analysis was the antecedent of bullying by a resident (OR: 5.3). Several specific risk factors for burnout in nursing home caregivers were identified. In high-risk populations of healthcare professionals, screening and management of risk factors is crucial for preventing burnout. © 2017 John Wiley & Sons Ltd.

Helping nursing homes "at risk" for quality problems: a statewide evaluation.

Science.gov (United States)

Rantz, Marilyn J; Cheshire, Debra; Flesner, Marcia; Petroski, Gregory F; Hicks, Lanis; Alexander, Greg; Aud, Myra A; Siem, Carol; Nguyen, Katy; Boland, Clara; Thomas, Sharon

2009-01-01

The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality indicators (QIs) derived from Minimum Data Set (MDS) data. Sixty of the 92 facilities accepted offered on-site clinical consultations by gerontological expert nurses with graduate nursing education. Content of consultations include quality improvement, MDS, care planning, evidence-based practice, and effective teamwork. The 60 "at-risk" facilities improved scores 4%-41% for 5 QIs: pressure ulcers (overall and high risk), weight loss, bedfast residents, and falls; other facilities in the state did not. Estimated cost savings (based on prior cost research) for 444 residents who avoided developing these clinical problems in participating "at-risk" facilities was more than $1.5 million for fiscal year 2006. These are similar to estimated savings of $1.6 million for fiscal year 2005 when 439 residents in "at-risk" facilities avoided clinical problems. Estimated savings exceed the total program cost by more than $1 million annually. QI improvements demonstrate the clinical effectiveness of on-site clinical consultation by gerontological expert nurses with graduate nursing education.

Risk Factors for Hip Fracture in Older Home Care Clients

Science.gov (United States)

Poss, Jeff; Cook, Richard J.; Byrne, Kerry; Hirdes, John P.

2009-01-01

Background Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients. Methods This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set–Home Care assessment instrument. Results In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65–74, relative risk [95% confidence interval]: 0.52 [0.43–0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51–0.70)]. Other risk factors include osteoporosis (1.19 [1.03–1.36]), falls (1.31 [1.15–1.49]), unsteady gait (1.18 [1.03–1.36]), use of ambulation aide (1.39 [1.21–1.59]), tobacco use (1.42, [1.13–1.80]), severe malnutrition (2.61 [1.67–4.08]), and cognitive impairment (1.30 [1.12–1.51]). Arthritis (0.86 [0.76–0.98]) and morbid obesity (0.34 [0.16–0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles. Conclusions Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies [22]. PMID:19196903

Muslims, Home Education and Risk in British Society

Science.gov (United States)

Myers, Martin; Bhopal, Kalwant

2018-01-01

The number of families who choose to home educate has significantly increased in the last decade. This article explores the experiences of British Muslims who home educate using data from a larger study exploring the views of a diverse range of families. Drawing on the work of Beck, we discuss how 'risk' is understood in relation to Muslim home…

Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.

Science.gov (United States)

Hiraizumi, Yoshie; Suzuki, Shunji

2013-11-01

It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

Science.gov (United States)

Ryvicker, Miriam; McDonald, Margaret V; Trachtenberg, Melissa; Peng, Timothy R; Sridharan, Sridevi; Feldman, Penny H

2013-01-01

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting. © 2013 National Association for Healthcare Quality.

Research on the model of home networking

Science.gov (United States)

Yun, Xiang; Feng, Xiancheng

2007-11-01

It is the research hotspot of current broadband network to combine voice service, data service and broadband audio-video service by IP protocol to transport various real time and mutual services to terminal users (home). Home Networking is a new kind of network and application technology which can provide various services. Home networking is called as Digital Home Network. It means that PC, home entertainment equipment, home appliances, Home wirings, security, illumination system were communicated with each other by some composing network technology, constitute a networking internal home, and connect with WAN by home gateway. It is a new network technology and application technology, and can provide many kinds of services inside home or between homes. Currently, home networking can be divided into three kinds: Information equipment, Home appliances, Communication equipment. Equipment inside home networking can exchange information with outer networking by home gateway, this information communication is bidirectional, user can get information and service which provided by public networking by using home networking internal equipment through home gateway connecting public network, meantime, also can get information and resource to control the internal equipment which provided by home networking internal equipment. Based on the general network model of home networking, there are four functional entities inside home networking: HA, HB, HC, and HD. (1) HA (Home Access) - home networking connects function entity; (2) HB (Home Bridge) Home networking bridge connects function entity; (3) HC (Home Client) - Home networking client function entity; (4) HD (Home Device) - decoder function entity. There are many physical ways to implement four function entities. Based on theses four functional entities, there are reference model of physical layer, reference model of link layer, reference model of IP layer and application reference model of high layer. In the future home network

Factors associated with home hazards: Findings from the Malaysian Elders Longitudinal Research study.

Science.gov (United States)

Romli, Muhammad H; Tan, Maw P; Mackenzie, Lynette; Lovarini, Meryl; Kamaruzzaman, Shahrul B; Clemson, Lindy

2018-03-01

Previous studies have investigated home hazards as a risk factor for falls without considering factors associated with the presence of home hazards. The present study aimed to determine patterns of home hazards among urban community-dwelling older Malaysians, and to identify factors contributing to home hazards. Cross-sectional data from the initial wave of the Malaysian Elders Longitudinal Research study were used. Basic demographics were obtained from the Global Questionnaire. Basic and instrumental activities of daily living were measured using the Katz and Lawton-Brody scales, and home hazards were identified using the Home Falls and Accidents Screening Tool. Participants were also asked if they had fallen in the previous 12 months. Data were analyzed from 1489 participants. Hazards were frequently identified (>30%) in the toilet and bathroom areas (no grab rail, no non-slip mat, distant toilet), slippery floors, no bedside light access and inappropriate footwear. Lower educational attainment, traditional housing, Chinese ethnicity, greater number of home occupants, lower monthly expenditure, poor vision and younger age were the factors independently associated with home hazards. This study provides evidence that home hazards are a product of the interaction of the individual's function within their home environment. Hazards are also influenced by local sociocultural and environmental factors. The relationship between home hazards and falls appears complex and deserves further evaluation. Geriatr Gerontol Int 2018; 18: 387-395. © 2017 Japan Geriatrics Society.

Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

Science.gov (United States)

Lohman, Matthew C; Cotton, Brandi P; Zagaria, Alexandra B; Bao, Yuhua; Greenberg, Rebecca L; Fortuna, Karen L; Bruce, Martha L

2017-12-01

Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes

Health Risks due to Exposure to Radon in Homes in Ireland

International Nuclear Information System (INIS)

2005-09-01

This document summarises the evidence that links exposure to radon in homes with an increase in lung cancer. Using the most recent risk estimates derived from epidemiological studies carried out abroad, the risk associated with radon exposure in homes in Ireland is derived. The relationship between exposure to radon and cigarette smoking is also discussed

Home Economics Archive: Research, Tradition and History (HEARTH)

Science.gov (United States)

Click here to go to the Mann Library Home Page Click here to return to the HEARTH Home Page Click , Tradition and History HEARTH is a core electronic collection of books and journals in Home Economics and Archive: Research, Tradition and History (HEARTH). Ithaca, NY: Albert R. Mann Library, Cornell University

Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care

Directory of Open Access Journals (Sweden)

Hirdes John P

2005-01-01

Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did

Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care

Science.gov (United States)

Dalby, Dawn M; Hirdes, John P; Fries, Brant E

2005-01-01

Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI). Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the

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

2018-04-01

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.

Facilitating home birth.

Science.gov (United States)

Finigan, Valerie; Chadderton, Diane

2015-06-01

The birth of a baby is a family experience. However, in the United Kingdom birth often occurs outside the family environment, in hospital. Both home and hospital births have risks and benefits, but research shows that, for most women, it is as safe to give birth at home as it is in hospital. Women report home-birth to be satisfying with lowered risks of intervention and less likelihood of being separated from their family. It is also more cost effective for the National Health Service. Yet, whilst midwives are working hard to promote home birth as an option, it remains controversial. The aim of this paper is to raise awareness of the safety of home birth and the needs of women and midwives when a home birth is chosen. It provides an overview of care required and the role of the midwife in the ensuring care is woman-centred and personalised.

Radon risk communication research: Practical lessons

International Nuclear Information System (INIS)

Fisher, A.; Johnson, F.R.

1990-01-01

Those responsible for state and local radon programs often express frustration about the small share of homes that have been tested for radon, and the small share of those with high readings that have been mitigated. There are now a number of completed studies that have examined how well alternative ways of communicating about radon risk have accomplished the goals of motivating appropriate testing and mitigation. This paper summarizes the research results that are most crucial for planning and implementing effective radon risk communication programs. We identify six reasons why people do not respond to radon as a serious threat and provide some remedies suggested by radon studies

Assessment of Home-Based Nigerian Engineers on Risk ...

African Journals Online (AJOL)

Assessment of Home-Based Nigerian Engineers on Risk Management Approach ... Journal of Applied Sciences and Environmental Management ... The Analysis of Variance (ANOVA) and Correlation methods were adopted for statistical ...

Perceptions of health and risk management among home care workers in Sweden.

Science.gov (United States)

Larsson, A; Karlqvist, L; Westerberg, M; Gard, G

2013-10-01

Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. This study aims to examine home care workers' perceptions of health, risks, working conditions, and risk management within their organization. The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides ( n  = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

An evaluation of venous thromboembolic risk in acutely ill medical patients immobilized at home: the AT-HOME Study.

Science.gov (United States)

Haas, Sylvia K; Hach-Wunderle, Viola; Mader, Frank H; Ruster, Katherine; Paar, Wilhelm D

2007-01-01

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.

Prevalence and risk indicators of depression in elderly nursing home patients : the AGED study

NARCIS (Netherlands)

Jongenelis, K; Eisses, AMH; Beekman, ATF; Kluiter, H; Ribbe, MW

2004-01-01

Background: Depression is a common and disabling psychiatric disorder in later life. Particular frail nursing home patients seem to be at increased risk. Nursing home-based studies on risk indicators of depression are scarce. Methods: Prevalence and risk indicators of depression were assessed in 333

Action research in nursing homes

DEFF Research Database (Denmark)

Andersen, John; Bilfeldt, Annette

2016-01-01

quality in a joint effort between care workers, residents at the nursing home, and researchers. It concludes that the project led to empowerment of the residents and staff and played an important role in the development of democratic knowledge building about better quality and ethics in elder care....

Effect of Maternal and Pregnancy Risk Factors on Early Neonatal Death in Planned Home Births Delivering at Home.

Science.gov (United States)

Bachilova, Sophia; Czuzoj-Shulman, Nicholas; Abenhaim, Haim Arie

2018-05-01

The prevalence of home birth in the United States is increasing, although its safety is undetermined. The objective of this study was to investigate the effects of obstetrical risk factors on early neonatal death in planned home births delivering at home. The authors conducted a retrospective 3-year cohort study consisting of planned home births that delivered at home in the United States between 2011 and 2013. The study excluded infants with congenital and chromosomal anomalies and infants born at ≤34 weeks' gestation. Multivariate logistic regression models were used to estimate the adjusted effects of individual obstetrical variables on early neonatal deaths within 7 days of delivery. During the study period, there were 71 704 planned and delivered home births. The overall early neonatal death rate was 1.5 deaths per 1000 planned home births. The risks of early neonatal death were significantly higher in nulliparous births (OR 2.71; 95% CI 1.71-4.31), women with a previous CS (OR 2.62, 95% CI 1.25-5.52), non-vertex presentations (OR 4.27; 95% CI 1.33-13.75), plural births (OR 9.79; 95% CI 4.25-22.57), preterm births (OR 4.68; 95% CI 2.30-9.51), and births at ≥41 weeks of gestation (OR 1.76; 95% CI 1.09-2.84). Early neonatal deaths occur more commonly in certain obstetrical contexts. Patient selection may reduce adverse neonatal outcomes among planned home births. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Away-from-home food intake and risk for obesity: Examining the influence of context

Science.gov (United States)

Ayala, Guadalupe X.; Rogers, Morgan; Arredondo, Elva M.; Campbell, Nadia R.; Baquero, Barbara; Duerksen, Susan C.; Elder, John P.

2013-01-01

Objective This study examined socio-demographic and cultural determinants of away-from-home food consumption in two contexts and the influence of frequency of away-from-home food consumption on children’s dietary intake and parent and child weight status. Research Methods and Procedures Parents of children (N=708) in grades K-2 were recruited from 13 elementary schools in Southern California. Parents were asked through a questionnaire the frequency with which they eat meals away from home and the restaurant they frequented most often. The height and weight of the parents and their children were measured to calculate body mass index (BMI). Results Consuming foods at least once a week from relatives/neighbors/friends [RNF] homes was associated with children’s dietary intake and children’s risk for obesity. For example, children of parents with weekly or greater RNF food consumption drank more sugar sweetened beverages. Parents of families who ate at restaurants at least weekly reported that their children consumed more sugar sweetened beverages, more sweet/savory snacks and less water compared with families who did not frequent restaurants this often. The type of restaurant visited did not impact diet intake or obesity. More acculturated families exhibited less healthy dietary behaviors than less acculturated families. Discussion Restaurants remain an important setting for preventing child and adult obesity, but other settings outside the home need to be considered in future intervention research. This may especially involve eating in the homes of relatives, neighbors and friends. PMID:18309297

The absolute power of relative risk in debates on repeat cesareans and home birth in the United States.

Science.gov (United States)

Declercq, Eugene

2013-01-01

Changes in policies and practices related to repeat cesareans and home birth in the U.S. have been influenced by different interpretations of the risk of poor outcomes. This article examines two cases-vaginal birth after cesarean (VBAC) and home birth to illustrate how an emphasis on relative over absolute risk has been used to characterize outcomes associated with these practices. The case studies will rely on reviews of the research literature and examination of data on birth trends and outcomes. Childbirth involves some unique challenges in assessing health risks, specifically the issues of: (1) timing of risks (lowering health risk in a current birth can increase it in subsequent births); (2) the potential weighing of risks to the mother's versus the infant's health; (3) the fact that birth is a condition of health and many of the feared outcomes (for example, symptomatic uterine rupture) involve very low absolute risk of occurrence; and (4) a malpractice environment that seizes upon those rare poor outcomes in highly publicized lawsuits that receive widespread attention in the clinical community. In the cases of VBAC and home birth, the result has been considerable emphasis on relative risks, typically an adjusted odds ratio, with little consideration of absolute risks. Assessments of the safety of interventions in childbirth should involve careful consideration and communication of the multiple dimensions of risk, particularly a balancing of relative and absolute risks of poor health outcomes.

Home economics in development through action research

DEFF Research Database (Denmark)

Benn, Jette

2010-01-01

This research study aimed at describing and developing home economics education through an action research approach in 2 schools and classes grade 6. The study went through 3 phases, an explorative phase with preliminary observations, interviews and discussions with teachers and pupils. Next...... in discursive phase changes have been implemented and conducted in accordance with findings. Third phase the explicative phase results were translated into text books for pupil's grade 4 to7 and to a teachers' guide. The subject is analysed theoretical through a model of the subject and research field. Findings...... and suggestions were discussed in relation to theories of learning, education and home economics. The overall perspectives were to involve pupils, to make them responsible by active and critical participation, and lastly to evaluate education in different ways....

Consent, including advanced consent, of older adults to research in care homes: a qualitative study of stakeholders' views in South Wales.

Science.gov (United States)

Wood, Fiona; Prout, Hayley; Bayer, Antony; Duncan, Donna; Nuttall, Jacqueline; Hood, Kerenza; Butler, Christopher C

2013-08-09

Care home residents, especially those lacking capacity to provide consent for themselves, are frequently excluded from research, thus limiting generalisability of study findings. We set out to explore stakeholders' views about the ethical and practical challenges associated with recruiting care home residents into research studies. Qualitative individual interviews with care home residents (n = 14), their relatives (n = 14), and general practitioners (GPs) (n = 10), and focus groups (n = 2) with care home staff. Interviews focused on the issues of older adults consenting to research in care homes, including advanced consent, in general and through reference to a particular study on the use of probiotics to prevent Antibiotic Associated Diarrhoea. Data were analysed using a thematic approach incorporating themes that had been identified in advance, and themes derived from the data. Researchers discussed evidence for themes, and reached consensus on the final themes. Respondents were generally accepting of low risk observational studies and slightly less accepting of low risk randomised trials of medicinal products. Although respondents identified some practical barriers to informed consent, consenting arrangements were considered workable. Residents and relatives varied in the amount of detail they wanted included in information sheets and consent discussions, but were generally satisfied that an advanced consent model was acceptable and appropriate. Opinions differed about what should happen should residents lose capacity during a research study. Research staff should be mindful of research guidance and ensure that they have obtained an appropriate level of informed consent without overwhelming the participant with unnecessary detail. For research involving medicinal products, research staff should also be more explicit when recruiting that consent is still valid should an older person lose capacity during a trial provided the individual did not previously state a

[Work-related stress risk assessment in a home care agency].

Science.gov (United States)

Latocca, R; Riva, M A; D'Orso, M; Ploia, P; Rocca, S; De Vito, G; Cesana, G

2012-01-01

The workload, the quality of professional relationships and emotional involvement have a significant impact on distress and burnout in health care-workers; this impact has an hight variability among the different environments and different care facilities (hospital, erderly nursing homes, home care). The risk assessment of work-related stress performed in 2010 in a homecare agency highlighted organizational problems related to the content/context of work and risk factors for health and safety. High turn-over is evidenced as critical among the "sentinel events". The level of job-strain was moderate, even if some critical issues were evidenced especially in the group of physiotherapists; nurses were configured as a homogeneous group with a low level of job-strain. In informative meetings the workers identified the discomfort related to the time for transferring patients from their homes in a high-traffic metropolitan area was identified as the most critical aspect.

Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes.

Science.gov (United States)

Kosar, Cyrus M; Thomas, Kali S; Inouye, Sharon K; Mor, Vincent

2017-07-01

To identify the rate of delirium present during admission to postacute care (PAC) in the nursing home setting and to determine whether patients with delirium had higher risk for adverse outcomes. Retrospective cohort study. US Medicare- and Medicaid-certified nursing homes, 2011 to 2014. Individuals admitted to all US nursing homes for PAC, aged ≥65 years, and without prior history of nursing home residence (n = 5,588,702). Minimum Data Set (MDS) 3.0 admission assessments identified delirium based upon Confusion Assessment Method (CAM) items. Robust Poisson regression was used to calculate adjusted relative risks (aRRs) with 95% confidence intervals (CIs) for death following PAC admission, and for 30-day discharge outcomes including re-hospitalization from PAC, discharge home, and functional improvement. Delirium was identified in 4.3% of new postacute nursing home admissions. Mortality within 30 days of PAC admission was observed in 16.3% of patients with delirium and 5.8% of patients without delirium (aRR = 2.27, CI = 2.24-2.30). The rate of 30-day readmission from PAC was 21.3% for patients with delirium compared with 15.1% among patients without delirium (aRR = 1.42, 95% CI = 1.40, 1.43). 26.9% of patients with delirium were discharged home within 30 days of admission compared to 52.5% of patients without delirium (aRR = 0.57, 95% CI = 0.57, 0.58). 48.9% of patients with delirium showed functional improvement at discharge compared to 59.9% of patients without delirium (aRR = 0.83, 95% CI = 0.82, 0.83). Patients with delirium present upon PAC admission were at high risk for mortality and 30-day re-hospitalization and were less likely to have timely discharge to home or to improve in physical function at discharge. Early identification and care planning for individuals with delirium at PAC admission may be essential to improve outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

Science.gov (United States)

Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

2016-01-01

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

Sleep Disruption at Home As an Independent Risk Factor for Postoperative Delirium.

Science.gov (United States)

Todd, Oliver M; Gelrich, Lisa; MacLullich, Alasdair M; Driessen, Martin; Thomas, Christine; Kreisel, Stefan H

2017-05-01

To determine whether sleep disruption at home or in hospital is an independent risk factor for postoperative delirium in older adults undergoing elective surgery. Prospective cohort study. German teaching hospital. Individuals aged 65 and older undergoing elective arthroplasty (N = 101). Preoperative questionnaires were used to assess sleep disruption at home (Pittsburgh Sleep Quality Index). Actigraphy was used to objectively measure sleep disruption in the hospital before and after surgery. Delirium was assessed daily after surgery using the Confusion Assessment Method and, if there was uncertainty, validated according to International Classification of Diseases, Tenth Revision (ICD-10), criteria. Twenty-seven participants developed postoperative delirium. Those with sleep disruption at home were 3.26 times as likely to develop postoperative delirium as those without (95% confidence interval (CI) = 1.34-7.92, P = .009). Participants with sleep disruption in hospital were 1.21 times as likely to develop postoperative delirium as those without (95% CI = 1.03-1.41, P = .02). When adjusting for other variables, risk remained significant for sleep disruption at home (risk ratio (RR) = 3.90, 95% CI = 2.14-7.11, P delirium than those without. Sleep disruption in the hospital may further heighten this risk. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Prevalence of risk factors for falls among elderly people living in long-term care homes

OpenAIRE

Pradnya Dhargave, PhD; Ragupathy Sendhilkumar, MSc, MPT

2016-01-01

Background: Falls are common among the geriatric population, causing frequent morbidity and mortality. There is an increased risk of fall among older people living in long-term care homes. Identifying risk factors for falls among older people living in old-age homes can help in the care and prevention of falls in this population. Aim: To evaluate the prevalence of various risk factors for falls among older people living in long-term care homes. Methods: A total of 163 elderly men and wo...

Under pressure, out of control, or home alone? Reviewing research and policy debates on the occupational health and safety effects of outsourcing and home-based work.

Science.gov (United States)

Quinlan, Michael; Bohle, Philip

2008-01-01

The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.

Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services.

Science.gov (United States)

Solis, Guillermina R; Champion, Jane Dimmitt

2017-03-01

Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person's quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

Review of Researches on Agricultural Industry Chain at Home and Abroad

Institute of Scientific and Technical Information of China (English)

Ge; SONG; Taiyan; YANG; Jianhui; LIU

2014-01-01

Management of agricultural industry chain is the main form of modern agricultural industrialization. Integration and optimization of agricultural chain have great significance in deepening the reform in the countryside,quickening the development of agricultural modernization and establishing new system of agricultural management. Based on the theory sources and contents of agricultural chain as well as the current researches at home and abroad,this paper hackles and concludes information technology,logistics management and food safety and quality in foreign agricultural chain as well as the organization model,operation mechanism,integration and optimization,promotion and extension,financing and risk prevention,influencing factors as well as performance evaluation in domestic agricultural chain and offers relevant review in order to provide further reference for future researches.

Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.

Science.gov (United States)

Mezuk, Briana; Lohman, Matthew; Leslie, Marc; Powell, Virginia

2015-07-01

We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. LTC may be an important point of engagement in suicide prevention.

Home Environmental and Behavioral Risk Indices for Reading Achievement.

Science.gov (United States)

Taylor, Jeanette; Ennis, Chelsea R; Hart, Sara A; Mikolajewski, Amy J; Schatschneider, Christopher

2017-07-01

The goal of this study was to identify home environmental and temperament/behavior variables that best predict standardized reading comprehension scores among school-aged children. Data from 269 children aged 9-16 ( M = 12.08; SD = 1.62) were used in discriminant function analyses to create the Home and Behavior indices. Family income was controlled in each index. The final Home and Behavior models each classified around 75% of cases correctly (reading comprehension at grade level vs. not). Each index was then used to predict other outcomes related to reading. Results showed that Home and/or Behavior accounted for 4-7% of the variance in reading fluency and spelling and 20-35% of the variance in parent-rated problems in math, social anxiety, and other dimensions. These metrics show promise as environmental and temperament/behavior risk scores that could be used to predict and potentially screen for further assessment of reading related problems.

Home Remodeling and Food Allergy Interact Synergistically to Increase the Risk of Atopic Dermatitis

Directory of Open Access Journals (Sweden)

Won Seok Lee

2017-01-01

Full Text Available Purpose. The purpose of this study was to investigate the effects of home remodeling and food allergy (FA on the development of atopic dermatitis (AD in children. Methods. The Modified International Study of Asthma and Allergies in Childhood questionnaire was used to survey 4,111 children recruited from 3 kindergartens and 6 elementary schools from Seongnam, Korea. Participants’ parents agreed for them to participate in physical examinations, skin prick tests, and blood tests. Results. Home remodeling in the past 12 months (adjusted odds ratio [aOR] 3.40, P=0.006, lifetime diagnosis of FA (aOR 3.95, P<0.001, parental history of AD (aOR 2.67, P=0.001, and FA (aOR 2.35, P=0.004 were independent risk factors for lifetime diagnosis of AD ever. When history of home remodeling and FA were combined, the risk for moderate-to-severe AD by scoring atopic dermatitis (SCORAD score increased (aOR, 7.19, P=0.011, P for interaction = 0.034. Conclusion. Home remodeling, lifetime diagnosis of FA, parental history of AD, and parental history of FA were independent risk factors for AD. In addition, we observed a synergistic interaction between home remodeling and FA in the risk of moderate-to-severe AD.

Relations among Neighborhood Social Networks, Home Literacy Environments, and Children's Expressive Vocabulary in Suburban At-Risk Families

Science.gov (United States)

Froiland, John Mark; Powell, Douglas R.; Diamond, Karen E.

2014-01-01

In response to increasing research and policy interest in the neighborhood context of early school success, this study examined relations among neighborhood social networks, home literacy practices/resources, and children's expressive vocabulary in a suburban at-risk sample in the USA at the beginning of the school year. In a Structural Equation…

Rehabilitation Risk Management: Enabling Data Analytics with Quantified Self and Smart Home Data.

Science.gov (United States)

Hamper, Andreas; Eigner, Isabella; Wickramasinghe, Nilmini; Bodendorf, Freimut

2017-01-01

A variety of acute and chronic diseases require rehabilitation at home after treatment. Outpatient rehabilitation is crucial for the quality of the medical outcome but is mainly performed without medical supervision. Non-Compliance can lead to severe health risks and readmission to the hospital. While the patient is closely monitored in the hospital, methods and technologies to identify risks at home have to be developed. We analyze state-of-the-art monitoring systems and technologies and show possibilities to transfer these technologies into rehabilitation monitoring. For this purpose, we analyze sensor technology from the field of Quantified Self and Smart Homes. The available sensor data from this consumer grade technology is summarized to give an overview of the possibilities for medical data analytics. Subsequently, we show a conceptual roadmap to transfer data analytics methods to sensor based rehabilitation risk management.

Pilot study to investigate the feasibility of the Home Falls and Accidents Screening Tool (HOME FAST) to identify older Malaysian people at risk of falls.

Science.gov (United States)

Romli, Muhammad Hibatullah; Mackenzie, Lynette; Lovarini, Meryl; Tan, Maw Pin

2016-08-16

The relationship between home hazards and falls in older Malaysian people is not yet fully understood. No tools to evaluate the Malaysian home environment currently exist. Therefore, this study aimed to pilot the Home Falls and Accidents Screening Tool (HOME FAST) to identify hazards in Malaysian homes, to evaluate the feasibility of using the HOME FAST in the Malaysian Elders Longitudinal Research (MELoR) study and to gather preliminary data about the experience of falls among a small sample of Malaysian older people. A cross-sectional pilot study was conducted. An urban setting in Kuala Lumpur. 26 older people aged 60 and over were recruited from the control group of a related research project in Malaysia, in addition to older people known to the researchers. The HOME FAST was applied with the baseline survey for the MELoR study via a face-to-face interview and observation of the home by research staff. The majority of the participants were female, of Malay or Chinese ethnicity and living with others in a double-storeyed house. Falls were reported in the previous year by 19% and 80% of falls occurred at home. Gender and fear of falling had the strongest associations with home hazards. Most hazards were detected in the bathroom area. A small number of errors were detected in the HOME FAST ratings by researchers. The HOME FAST is feasible as a research and clinical tool for the Malaysian context and is appropriate for use in the MELoR study. Home hazards were prevalent in the homes of older people and further research with the larger MELoR sample is needed to confirm the validity of using the HOME FAST in Malaysia. Training in the use of the HOME FAST is needed to ensure accurate use by researchers. 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/

Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'.

Science.gov (United States)

McCann, Mark; Grundy, Emily; O'Reilly, Dermot

2012-02-01

Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors. To analyse the probability of admission to residential and nursing home care according to housing tenure and house value. Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of ≈28% of the population of Northern Ireland. Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters. The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.

Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial

DEFF Research Database (Denmark)

Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe

2014-01-01

BACKGROUND: Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss......-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. METHODS: An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home...... older adults in home-care and nursing home and contribute to important research. TRIAL REGISTRATION: ClinicalTrials.gov 2013 NCT01873456....

Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety.

Science.gov (United States)

Horowitz, Beverly P; Almonte, Tiffany; Vasil, Andrea

2016-10-01

This exploratory research examined the benefits of a health education program utilizing the Home Safety Self-Assessment Tool (HSSAT) to increase perceived knowledge of home safety, recognition of unsafe activities, ability to safely perform activities, and develop home safety plans of 47 older adults. Focus groups in two senior centers explored social workers' perspectives on use of the HSSAT in community practice. Results for the health education program found significant differences between reported knowledge of home safety (p = .02), ability to recognize unsafe activities (p = .01), safely perform activities (p = .04), and develop a safety plan (p = .002). Social workers identified home safety as a major concern and the HSSAT a promising assessment tool. Research has implications for reducing environmental fall risks.

More Than Four Walls: The Meaning of Home in Home Birth Experiences

Directory of Open Access Journals (Sweden)

Emily Burns

2015-04-01

Full Text Available The “home versus hospital” as places of birth debate has had a long and at times vicious history. From academic literature to media coverage, the two have often been pitted against each other not only as opposing physical spaces, but also as opposing ideologies of birth. The hospital has been heavily critiqued as a site of childbirth since the 1960s, with particular focus on childbirth and medicalisation. The focus of much of the hospital and home birthing research exists on a continuum of medicalisation, safety, risk, agency, and maternal and neonatal health and wellbeing. While the hospital birthing space has been interrogated, a critique of home birthing space has remained largely absent from the social sciences. The research presented in this article unpacks the complex relationship between home birthing women and the spaces in which they birth. Using qualitative data collected with 59 home birthing women in Australia in 2010, between childbearing and the home should not be considered as merely an alternative to hospital births, but rather as an experience that completely renegotiates the home space. Home, for the participants in this study, is a dynamic, changing, and even spiritual element in the childbirth experience, and not simply the building in which it occurs.

A Study to Assess the Knowledge on Risk for Fall among Geriatric People Above 60 Years at Selected Oldage Home at Karaikal

OpenAIRE

R.G. Padmapriya; E. Kalaivani

2017-01-01

A study to assess the risk for fall among geriatric people above 60 years of age in selected old age home at karaikal. The research approach was adopted for this study was quantitative approach. The research design used for this study is descriptive design. A simple random sampling technique adopted to select the desired sample. Sample size is 50. Donna conley fall risk assessment scale was used to assess the risk for fall among geriatric people above 60 years of age . The collected data was...

Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

Science.gov (United States)

Goldberg, Elizabeth M.; Trivedi, Amal N.; Mor, Vincent; Jung, Hye-Young; Rahman, Momotazur

2016-01-01

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates. PMID:27516452

Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

Science.gov (United States)

Lohman, Matthew; Leslie, Marc; Powell, Virginia

2015-01-01

Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions. LTC may be an important point of engagement in suicide prevention. PMID:25973805

Home birth or short-stay hospital birth in a low risk population in The Netherlands.

NARCIS (Netherlands)

Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

1998-01-01

In the Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have

Indoor tanning in businesses and homes and risk of melanoma and nonmelanoma skin cancer in 2 US case-control studies.

Science.gov (United States)

Ferrucci, Leah M; Vogel, Rachel Isaksson; Cartmel, Brenda; Lazovich, DeAnn; Mayne, Susan T

2014-11-01

Indoor tanning increases skin cancer risk. Beyond early research describing melanoma and sun lamps, few recent reports describe where individuals indoor tan and whether skin cancer risk varies by location (business, home-based). We sought to assess where individuals tanned indoors and skin cancer risk by tanning device location. Multivariate logistic regression was conducted in 2 US case-control studies of melanoma (1161 cases, 1083 controls, ages 25-59 years) and early-onset basal cell carcinoma (375 cases, 382 controls, agetanned exclusively in businesses. Persons who used indoor tanning exclusively in businesses were at increased risk of melanoma (odds ratio 1.82, 95% confidence interval 1.47-2.26) and basal cell carcinoma (odds ratio 1.69, 95% confidence interval 1.15-2.48) compared with non-users. Melanoma risk was also increased in the small number who reported tanning indoors only at home relative to non-users (odds ratio 4.14, 95% confidence interval 1.75-9.78); 67.6% used sun lamps. Self-reported tanning and potential recall bias are limitations. Business-only tanning, despite claims of "safe" tanning, was positively associated with a significant risk of melanoma and basal cell carcinoma. Home tanning was uncommon and mostly from sun lamps, which were rarely used by younger participants. Regardless of location, indoor tanning was associated with increased risk of skin cancer. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Weight loss, Mortality and associated potentially modifiable nutritional risk factors among nursing home residents

DEFF Research Database (Denmark)

Beck, Anne Marie

2015-01-01

Objectives The objective of this follow-up study is to assess the association between different potentially modifiable nutritional risk factors; weight loss after six and 12 months and mortality. Design and setting A one year follow-up project among Danish nursing home residents. Participants...... A total of 441 nursing home resident living in 11 nursing homes. Measurements Odds ratio was calculated and used to assess the strength of association between different potentially modifiable nutritional risk factors and nutritional status of the participants. The difference in mortality between those who...... at most meals, chewing and swallowing problems. The prevalence of eating dependency; leaves 25% or more of food uneaten at most meals; swallowing problems and enteral nutrition were higher among those who died than among survivors. Conclusion A high percentage of old nursing home residents suffer from...

Influence of cognitive impairment on fall risk among elderly nursing home residents.

Science.gov (United States)

Seijo-Martinez, M; Cancela, J M; Ayán, C; Varela, S; Vila, H

2016-12-01

Information relating the severity of cognitive decline to the fall risk in institutionalized older adults is still scarce. This study aims to identify potential fall risk factors (medications, behavior, motor function, and neuropsychological disturbances) depending on the severity of cognitive impairment in nursing home residents. A total of 1,167 nursing home residents (mean age 81.44 ± 8.26 years; 66.4% women) participated in the study. According to the MEC, (the Spanish version of the Mini-Mental State Examination) three levels of cognitive impairment were established: mild (20-24) "MCI", moderate (14-19) "MOCI", and severe (≤14) "SCI". Scores above 24 points indicated the absence cognitive impairment (NCI). Information regarding fall history and fall risk during the previous year was collected using standardized questionnaires and tests. Sixty falls (34%) were registered among NCI participants and 417 (43%) among people with cognitive impairment (MCI: 35%; MOCI: 40%; SCI: 50%). A different fall risk model was observed for MCI, MOCI, SCI, and NCI patients. The results imply that the higher the level of cognitive impairment, the greater the number of falls (F1,481 = 113.852; Sig = 0.015), although the level of significance was not maintained when MOCI and SCI participants were compared. Depression, neuropsychiatric disturbances, autonomy constraints in daily life activity performance, and low functional mobility were factors closely associated with fall risk. This study provides evidence indicating that fall risk factors do not hold a direct correlation with the level of cognitive impairment among elderly nursing home care residents.

Fall Risk and Its Associated Factors among Older Adults without Home-Help Services in a Swedish Municipality.

Science.gov (United States)

Hammarlund, Catharina Sjödahl; Hagell, Peter; Westergren, Albert

2016-01-01

During preventive home visits, the purpose of this study was to identify the prevalence of fall risk and any associated factors. Participants (n = 1471) were cognitively sound community-dwelling older adults (≥ 70 years) without home-help service, living in a Swedish municipality. The Downton Fall Risk Index and nine single items were used. Tiredness/fatigue, age ≥ 80, inability to walk 1 hr, inability to climb stairs and worrying were significantly associated with fall risk. Preventive home visits incorporating fall-risk screening proved valuable, providing information for interventions aimed at preventing falls, maintaining independence, and facilitating health among community dwelling participants.

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

Science.gov (United States)

Henriksen, Eva; Burkow, Tatjana M; Johnsen, Elin; Vognild, Lars K

2013-08-09

Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient's TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO's standard for information security risk management. A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality

Living alone, receiving help, helplessness, and inactivity are strongly related to risk of undernutrition among older home-dwelling people

Directory of Open Access Journals (Sweden)

Tomstad ST

2012-03-01

Full Text Available Solveig T Tomstad1, Ulrika Söderhamn2, Geir Arild Espnes3, Olle Söderhamn21Department of Social Work and Health Science, Faculty of Sciences and Technology Management, NTNU, Trondheim, Norway and Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 2Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 3Research Centre for Health Promotion and Resources HiST-NTNU, Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, NorwayBackground: Being at risk of undernutrition is a global problem among older people. Undernutrition can be considered inadequate nutritional status, characterized by insufficient food intake and weight loss. There is a lack of Norwegian studies focusing on being at risk of undernutrition and self-care ability, sense of coherence, and health-related issues among older home-dwelling people.Aim: To describe the prevalence of being at risk of undernutrition among a group of older home-dwelling individuals in Norway, and to relate the results to reported self-care ability, sense of coherence, perceived health and other health-related issues.Methods: A cross-sectional design was applied. A questionnaire with instruments for nutritional screening, self-care ability, and sense of coherence, and health-related questions was sent to a randomized sample of 450 persons (aged 65+ years in southern Norway. The study group included 158 (35.1% participants. Data were analysed using statistical methods.Results: The results showed that 19% of the participants were at medium risk of undernutrition and 1.3% at high risk. Due to the low response rate it can be expected that the nonparticipants can be at risk of undernutrition. The nutritional at-risk group had lower self-care ability and weaker sense of coherence. Living alone, receiving help

Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi Method.

NARCIS (Netherlands)

Hollaar, V.; Maarel-Wierink, C. van der; Putten, G.J. van der; Sanden, W. van der; Swart, B.J. de; Baat, C. de

2016-01-01

BACKGROUND: In nursing home residents, it is not possible to distinguish pneumonia and aspiration pneumonia clinically. International literature reveals no consensus on which and how many characteristics and risk indicators must be present to diagnose (nursing home-acquired) pneumonia and aspiration

Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial

DEFF Research Database (Denmark)

Cook, Robert L; Østergaard, Lars; Hillier, Sharon L

2007-01-01

OBJECTIVE: Home screening tests could eliminate several barriers to testing sexually transmitted diseases (STDs). AIM: To determine whether offering repeated home screening tests would increase the rate of testing for chlamydia and gonorrhoea in a high-risk sample of young women. METHODS: In this...

Indoor tanning in businesses and homes and risk of melanoma and non-melanoma skin cancer in two US case-control studies

Science.gov (United States)

Ferrucci, Leah M.; Vogel, Rachel Isaksson; Cartmel, Brenda; Lazovich, DeAnn; Mayne, Susan T.

2014-01-01

Background Indoor tanning increases skin cancer risk. Beyond early research describing melanoma and sun lamps, few recent reports describe where individuals indoor tan and whether skin cancer risk varies by location (business, home-based). Objective Assess where individuals tanned indoors and skin cancer risk by tanning device location. Methods Multivariate logistic regression in two US case-control studies of melanoma (1,161 cases, 1,083 controls, ages 25–59) and early-onset basal cell carcinoma (BCC) (375 cases, 382 controls, under age 40) conducted between 2004 and 2010. Results Most indoor tanners (86.4–95.1%), especially younger individuals, tanned exclusively in businesses. Persons who used indoor tanning exclusively in businesses were at increased risk of melanoma (OR=1.82, 95% CI=1.47–2.26) and BCC (OR=1.69, 95% CI=1.15–2.48) compared to non-users. Melanoma risk was also increased in the small number who reported tanning indoors only at home relative to non-users (OR=4.14, 95% CI=1.75–9.78); 67.6% used sun lamps. Limitations Self-reported tanning, potential recall bias. Conclusion Business only tanning, despite claims of “safe" tanning, was positively associated with a significant risk of melanoma and BCC. Home tanning was uncommon and mostly from sun lamps which were rarely used by younger participants. Regardless of location, indoor tanning was associated with increased risk of skin cancer. PMID:25062934

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study.

Science.gov (United States)

Kwong, Enid Wy; Hung, Maria Sy; Woo, Kevin

2016-11-25

A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate

Radon risks: Attitudes, perceptions and actions. Risk communication series. Final report

Energy Technology Data Exchange (ETDEWEB)

Sjoeberg, L.

1989-08-01

As many as 8 million homes in the United States may have elevated radon levels, with accompanying lung cancer risks several orders of magnitude higher than for most other environmental risks. The U.S. Environmental Protection Program (EPA) does not have clear regulatory authority over radon, so has relied on an information program. Less than 5% of homes have been tested, which is disappointing from a public health stance. The report summarizes the available research on communicating about the risk from radon from the perspective of a psychologist. The research results are critiqued to draw practical conclusions for radon policy and suggest the most important topics for further risk communication research.

Research Toward Zero Energy Homes

Energy Technology Data Exchange (ETDEWEB)

Robert Hammon

2010-12-31

This final report was compiled from the detailed annual reports that were submitted for efforts in 2008 and 2009, and from individual task reports from 2010. Reports, case studies, and presentations derived from this work are available through the Building America website. The BIRA team is led by ConSol, a leading provider of energy solutions for builders since 1983. In partnership with over fifty builders, developers, architects, manufactures, researchers, utilities, and agencies, research work was performed in California, Colorado, Utah, New Mexico, Washington, Oregon, and Hawaii and five (5) climate regions (Hot-Dry, Marine, Hot-Humid, Cold, and Hot/Mixed Dry). In addition to research work, the team provided technical assistance to our partners whose interests span the entire building process. During the three year budget period, the BIRA team performed analyses of several emerging technologies, prototype homes, and high performance communities through detailed computer simulations and extensive field monitoring to meet the required climate joule milestone targets.

A multivariate fall risk assessment model for VHA nursing homes using the minimum data set.

Science.gov (United States)

French, Dustin D; Werner, Dennis C; Campbell, Robert R; Powell-Cope, Gail M; Nelson, Audrey L; Rubenstein, Laurence Z; Bulat, Tatjana; Spehar, Andrea M

2007-02-01

The purpose of this study was to develop a multivariate fall risk assessment model beyond the current fall Resident Assessment Protocol (RAP) triggers for nursing home residents using the Minimum Data Set (MDS). Retrospective, clustered secondary data analysis. National Veterans Health Administration (VHA) long-term care nursing homes (N = 136). The study population consisted of 6577 national VHA nursing home residents who had an annual assessment during FY 2005, identified from the MDS, as well as an earlier annual or admission assessment within a 1-year look-back period. A dichotomous multivariate model of nursing home residents coded with a fall on selected fall risk characteristics from the MDS, estimated with general estimation equations (GEE). There were 17 170 assessments corresponding to 6577 long-term care nursing home residents. The increased odds ratio (OR) of being classified as a faller relative to the omitted "dependent" category of activities of daily living (ADL) ranged from OR = 1.35 for "limited" ADL category up to OR = 1.57 for "extensive-2" ADL (P canes, walkers, or crutches, or the use of wheelchairs increases the odds of being a faller (OR = 1.17, P falls in long-term care settings. The model incorporated an ADL index and adjusted for case mix by including only long-term care nursing home residents. The study offers clinicians practical estimates by combining multiple univariate MDS elements in an empirically based, multivariate fall risk assessment model.

Home and away: Area socioeconomic disadvantage and obesity risk.

Science.gov (United States)

Kimbro, Rachel Tolbert; Sharp, Gregory; Denney, Justin T

2017-03-01

Although residential context is linked to obesity risk, less is known about how the additional places where we work, shop, play, and worship may influence that risk. We employ longitudinal data from the Los Angeles Family and Neighborhood Survey (LAFANS) to derive time-weighted measures of exposure to home and activity space contexts to ascertain the impacts of each on obesity risk for adults. Results show that increased exposure to socioeconomic disadvantage in the residential neighborhood significantly increases obesity risk, and although activity space disadvantage does not directly influence obesity, it reduces the association between residential disadvantage and obesity. We further explore the ways in which residential and activity space disadvantages may interact to influence obesity and discuss the value of integrating personal exposure and activity space contexts to better understand how places contribute to individual health risks. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ideas of home in palliative care research: A concept analysis.

Science.gov (United States)

Tryselius, Kristina; Benzein, Eva; Persson, Carina

2018-04-23

To explore the concept of home and its' expressed spatialities in current palliative care research. Home is a central environment for living, caring, and dying. However, pure investigations of the sets of ideas linked to the concept seemed missing. Although identified as an important location, spatial perspectives expressed through the concept of home appeared unexplored. Rodgers' evolutionary concept analysis. Scientific articles published between January 2009 and September 2015. Rodgers' evolutionary concept analysis. Resulting attributes were explored from two geographically informed spatial perspectives. As main results, six attributes were identified and explored: Home as actor-capable of acting; emotional environment-something people have feelings for; place-a part of personal identity and a location; space-complex and relational spatial connections and a site for care; setting-passive background and absolute space; becoming-a fluid spatiality constantly folded. Examples of attributes and suggestions for further concept development were identified. The concept reflects various sets of ideas as well as expressing both relational and absolute perspectives of space. The most challenging for nursing research and practice seems to be investigation, operationalization, and testing the implementation of sets of ideas reflecting a relational thinking of space. © 2018 Wiley Periodicals, Inc.

Challenges to conducting research with older people living in nursing homes

OpenAIRE

Hall, Sue; Longhurst, Susan; Higginson, Irene J

2009-01-01

Abstract Background Although older people are increasingly cared for in nursing homes towards the end of life, there is a dearth of research exploring the views of residents. There are however, a number of challenges and methodological issues involved in doing this. The aim of this paper is to discuss some of these, along with residents' views on taking part in a study of the perceptions of dignity of older people in care homes and make recommendations for future research in these settings. M...

Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies.

Science.gov (United States)

van der Kooy, Jacoba; Poeran, Jashvant; de Graaf, Johanna P; Birnie, Erwin; Denktasş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

2011-11-01

The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment. The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000-2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat-like analysis) and perfect guideline approach (per-protocol-like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth. Intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71-0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91-1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase). Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

[The Incidence and Risk Factors of the Home Accidents in the Househoulds with Low Socioeconomic Level in Kocaeli

Directory of Open Access Journals (Sweden)

Pervin Sahiner

2011-06-01

Full Text Available SUMMARY: AIM: This study aimed to determine the incidence of home accidents in the households with low socioeconomic level who preferred in single flat or duplex and the risk factor related to house and sociodemographic characteristics. METHOD: The prospective cohort study. The universe of the survey composed of 419 households (N=1539 persons both with single flat and duplex house located at the “42 Evler” region of Izmit district of the Kocaeli province. The questionaries included “The Sociodemographic Characteristics of the Households” and “The Characteristics and Reasons of the Home Accidents.” The data were collected with face to face tecniques by home visits of households between November 28, 2008 and April 2, 2009. After the first form were filled, each household was followed up three months for home accidents. RESULTS: Twenty-seven of the households and 13.6% of the participants had home accident. The incidence of the home accident also was 4.2 person per/year. Most of the accidents (89% occurred inside of the houses. The mostly observed home accidents were 39.1% burn, 28.6% incision and 12.8% falling respectively. It was important risk factors heater for burns, knife for incisions and slippery-floor for fallings. The incidence of the home accident was higher among women (22.0% (p0.05, and in those with not house ownership itself (for rent 34.5%, for relatives house 34.8% (p<0.05. CONCLUSIONS: This study has showed that the incidence of home accidents are high, and the characteristics of house and some sociodemographic characteristics are important risk factors in term of the home accidents. The qualified primary health services which are financed by the government have great importance for the preventing of the household accidents, determination of the risk factors and recording the home accidents. [TAF Prev Med Bull 2011; 10(3.000: 257-268

Exploring workplace violence among home care workers in a consumer-driven home health care program.

Science.gov (United States)

Nakaishi, Lindsay; Moss, Helen; Weinstein, Marc; Perrin, Nancy; Rose, Linda; Anger, W Kent; Hanson, Ginger C; Christian, Mervyn; Glass, Nancy

2013-10-01

Nominal research has examined sexual harassment and workplace violence against home care workers within consumer-driven home care models such as those offered in Oregon. This study examined home care workers' experiences of violence while providing care to consumer employers, the patients who hire and manage home care workers. Focus groups and interviews were conducted in Oregon with 83 home care workers, 99 Oregon Department of Human Services (DHS) employees, and 11 consumer employers. Home care workers reported incidents of workplace physical violence (44%), psychological abuse (65%), sexual harassment (41%), and sexual violence (14%). Further, three themes were identified that may increase the risk of workplace violence: (1) real and perceived barriers to reporting violence; (2) tolerance of violence; and (3) limited training to prevent violence. To ensure worker safety while maintaining quality care, safety policies and training for consumer employers, state DHS employees, and home care workers must be developed. Copyright 2013, SLACK Incorporated.

Research supporting the congruence between rehabilitation principles and home health nursing practice.

Science.gov (United States)

Neal, L J

1999-01-01

A grounded-theory study of 30 home health nurses conducted in the Washington, DC, metropolitan area used unstructured audiotaped interviews to elicit data as to how home health nurses define their practice. The purpose of the study was to develop a beginning substantive research-based theory of home health nursing practice. The model that emerged consists of three stages by which nurses attain autonomy in their practice. Adaptation was found to be the core category, in that nurses cannot function effectively or successfully in the home health arena unless they are or learn to be adaptable. Data also revealed that home health nurses either knowingly or unknowingly use rehabilitation nursing principles in their practice, thereby lending credence to the supposition that home health nursing practice is congruent with rehabilitation nursing principles.

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study

Directory of Open Access Journals (Sweden)

Enid WY Kwong

2016-11-01

Full Text Available Abstract Background A need exits to develop a protocol for preventing pressure ulcers (PUs in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning, changing (action, and refreezing (results were carried out. During each cycle, focus group interviews, field observations of the care staff’s practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the

Home Visiting Processes: Relations with Family Characteristics and Outcomes

Science.gov (United States)

Peterson, Carla A.; Roggman, Lori A.; Green, Beth; Chazan-Cohen, Rachel; Korfmacher, Jon; McKelvey, Lorraine; Zhang, Dong; Atwater, Jane B.

2013-01-01

Variations in dosage, content, and family engagement with Early Head Start (EHS) home visiting services were examined for families participating in the EHS Research and Evaluation Project. Families were grouped by characteristics of maternal age, maternal ethnicity, and level of family risk. All home visiting variables were related differentially…

Bank Risk-Taking Abroad : Does Home-Country Regulation and Supervision Matter

NARCIS (Netherlands)

Ongena, S.; Popov, A.; Udell, G.F.

2011-01-01

This paper provides the first empirical evidence on how home-country regulation and supervision affects bank risk-tailing in host-country markets. We analyze lending by 136 banks to 8,253 firms in 1,513 different localities across 13 countries. We find strong evidence that laxer regulatory

Bank Risk-Taking Abroad : Does Home-Country Regulation and Supervision Matter

NARCIS (Netherlands)

Ongena, S.; Popov, A.; Udell, G.F.

2011-01-01

This paper provides the first empirical evidence on how home-country regulation and supervision affects bank risk-tailing in hostr-country markets. We analyze lending by 136 banks to 8,253 firms in 1,513 different localities across 13 countries. We find strong evidence that laxer regulatory

Fall Risk Assessment and Early-Warning for Toddler Behaviors at Home

Directory of Open Access Journals (Sweden)

Mau-Tsuen Yang

2013-12-01

Full Text Available Accidental falls are the major cause of serious injuries in toddlers, with most of these falls happening at home. Instead of providing immediate fall detection based on short-term observations, this paper proposes an early-warning childcare system to monitor fall-prone behaviors of toddlers at home. Using 3D human skeleton tracking and floor plane detection based on depth images captured by a Kinect system, eight fall-prone behavioral modules of toddlers are developed and organized according to four essential criteria: posture, motion, balance, and altitude. The final fall risk assessment is generated by a multi-modal fusion using either a weighted mean thresholding or a support vector machine (SVM classification. Optimizations are performed to determine local parameter in each module and global parameters of the multi-modal fusion. Experimental results show that the proposed system can assess fall risks and trigger alarms with an accuracy rate of 92% at a speed of 20 frames per second.

Fall Risk Assessment and Early-Warning for Toddler Behaviors at Home

Science.gov (United States)

Yang, Mau-Tsuen; Chuang, Min-Wen

2013-01-01

Accidental falls are the major cause of serious injuries in toddlers, with most of these falls happening at home. Instead of providing immediate fall detection based on short-term observations, this paper proposes an early-warning childcare system to monitor fall-prone behaviors of toddlers at home. Using 3D human skeleton tracking and floor plane detection based on depth images captured by a Kinect system, eight fall-prone behavioral modules of toddlers are developed and organized according to four essential criteria: posture, motion, balance, and altitude. The final fall risk assessment is generated by a multi-modal fusion using either a weighted mean thresholding or a support vector machine (SVM) classification. Optimizations are performed to determine local parameter in each module and global parameters of the multi-modal fusion. Experimental results show that the proposed system can assess fall risks and trigger alarms with an accuracy rate of 92% at a speed of 20 frames per second. PMID:24335727

Fall risk assessment and early-warning for toddler behaviors at home.

Science.gov (United States)

Yang, Mau-Tsuen; Chuang, Min-Wen

2013-12-10

Accidental falls are the major cause of serious injuries in toddlers, with most of these falls happening at home. Instead of providing immediate fall detection based on short-term observations, this paper proposes an early-warning childcare system to monitor fall-prone behaviors of toddlers at home. Using 3D human skeleton tracking and floor plane detection based on depth images captured by a Kinect system, eight fall-prone behavioral modules of toddlers are developed and organized according to four essential criteria: posture, motion, balance, and altitude. The final fall risk assessment is generated by a multi-modal fusion using either a weighted mean thresholding or a support vector machine (SVM) classification. Optimizations are performed to determine local parameter in each module and global parameters of the multi-modal fusion. Experimental results show that the proposed system can assess fall risks and trigger alarms with an accuracy rate of 92% at a speed of 20 frames per second.

Dutch home-based pre-reading intervention with children at familial risk of dyslexia

NARCIS (Netherlands)

van Otterloo, S.G.; van der Leij, A.

2009-01-01

Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected

Early home-based intervention in the Netherlands for children at familial risk of dyslexia

NARCIS (Netherlands)

van Otterloo, S.G.; van der Leij, A.; Henrichs, L.F.

2009-01-01

Dutch children at higher familial risk of reading disability received a home-based intervention programme before formal reading instruction started to investigate whether this would reduce the risk of dyslexia. The experimental group (n=23) received a specific training in phoneme awareness and

Board statement on radon in homes

International Nuclear Information System (INIS)

1990-01-01

A new Action Level of 200 becquerels per cubic metre of air in existing homes is proposed because recent research has shown that the risk of contracting lung cancer from the inhalation of the radioactive decay products of radon is greater than earlier studies had indicated. NRPB also recommends that affected areas be identified in which widespread radon measurements should be made in present homes and precautions be considered for future homes. This focuses attention on radon where it is most required. Affected areas would be those parts of the UK with 1% probability or more of present of future homes being above the new action level. A programme to define these areas is underway. (author)

Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa.

Science.gov (United States)

Lygizos, Melissa; Shenoi, Sheela V; Brooks, Ralph P; Bhushan, Ambika; Brust, James C M; Zelterman, Daniel; Deng, Yanhong; Northrup, Veronika; Moll, Anthony P; Friedland, Gerald H

2013-07-01

Transmission of drug susceptible and drug resistant TB occurs in health care facilities, and community and households settings, particularly in highly prevalent TB and HIV areas. There is a paucity of data regarding factors that may affect TB transmission risk in household settings. We evaluated air exchange and the impact of natural ventilation on estimated TB transmission risk in traditional Zulu homes in rural South Africa. We utilized a carbon dioxide decay technique to measure ventilation in air changes per hour (ACH). We evaluated predominant home types to determine factors affecting ACH and used the Wells-Riley equation to estimate TB transmission risk. Two hundred eighteen ventilation measurements were taken in 24 traditional homes. All had low ventilation at baseline when windows were closed (mean ACH = 3, SD = 3.0), with estimated TB transmission risk of 55.4% over a ten hour period of exposure to an infectious TB patient. There was significant improvement with opening windows and door, reaching a mean ACH of 20 (SD = 13.1, p ventilation conditions (windows/doors open) and window to volume ratio. Expanding ventilation increased the odds of achieving ≥12 ACH by 60-fold. There is high estimated risk of TB transmission in traditional homes of infectious TB patients in rural South Africa. Improving natural ventilation may decrease household TB transmission risk and, combined with other strategies, may enhance TB control efforts.

Public involvement in research within care homes: benefits and challenges in the APPROACH study.

Science.gov (United States)

Froggatt, Katherine; Goodman, Claire; Morbey, Hazel; Davies, Sue L; Masey, Helen; Dickinson, Angela; Martin, Wendy; Victor, Christina

2016-12-01

Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health-care services achieve integrated working to promote older people's health, PIR was integrated throughout the research processes. This paper aims to present one way in which PIR has been integrated into the design and delivery of a multisite research study based in care homes. A prospective case study design, with an embedded qualitative evaluation of PIR activity. Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. Qualitative data collection involved discussion groups, and site-specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. PIR members supported recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimized distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. Clearly defined roles with identified training and support facilitated involvement in different aspects of the data collection process. This can also ensure that vulnerable older people who participate in research have a positive experience that reinforces the value of their views. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Higher energy efficient homes are associated with increased risk of doctor diagnosed asthma in a UK subpopulation.

Science.gov (United States)

Sharpe, Richard A; Thornton, Christopher R; Nikolaou, Vasilis; Osborne, Nicholas J

2015-02-01

The United Kingdom (UK) has one of the highest prevalence of asthma in the world, which represents a significant economic and societal burden. Reduced ventilation resulting from increased energy efficiency measures acts as a modifier for mould contamination and risk of allergic diseases. To our knowledge no previous study has combined detailed asset management property and health data together to assess the impact of household energy efficiency (using the UK Government's Standard Assessment Procedure) on asthma outcomes in an adult population residing in social housing. Postal questionnaires were sent to 3867 social housing properties to collect demographic, health and environmental information on all occupants. Detailed property data, residency periods, indices of multiple deprivation (IMD) and household energy efficiency ratings were also investigated. Logistic regression was used to calculate odds ratios and confidence intervals while allowing for clustering of individuals coming from the same location. Eighteen percent of our target social housing population were recruited into our study. Adults had a mean age of 59 (SD±17.3) years and there was a higher percentage of female (59%) and single occupancy (58%) respondents. Housing demographic characteristics were representative of the target homes. A unit increase in household Standard Assessment Procedure (SAP) rating was associated with a 2% increased risk of current asthma, with the greatest risk in homes with SAP >71. We assessed exposure to mould and found that the presence of a mouldy/musty odour was associated with a two-fold increased risk of asthma (OR 2.2 95%; CI 1.3-3.8). A unit increase in SAP led to a 4-5% reduction in the risk of visible mould growth and a mouldy/musty odour. In contrast to previous research, we report that residing in energy efficient homes may increase the risk of adult asthma. We report that mould contamination increased the risk of asthma, which is in agreement with existing

Risk factors for out-of-home custody child care among families with alcohol and substance abuse problems.

Science.gov (United States)

Sarkola, Taisto; Kahila, Hanna; Gissler, Mika; Halmesmäki, Erja

2007-11-01

To study the risk of children to mothers with alcohol and/or substance abuse related problems for early childhood out-of-home care in Finland. A population-based cross-sectional retrospective analysis of 526 pregnant women attending special outpatient clinics during 1992-2001 and their 626 offspring, with out-of-home care data until 2003 provided by the National Child Welfare Register. Fifty percent (95% confidence interval 46-54%) were at some point and 38% (34-42%) by the age of two years, in out-of-home care. Out-of-home care was associated with maternal care for substance abuse after delivery, nonemployment, housing, daily smoking during pregnancy, increasing number of previous births, mother in custody in her childhood, maternal education, previous child in custody, drug in urine during pregnancy, unplanned pregnancy, partner with significant abuse, regular health-care contact for abuse, daily alcohol consumption before and/or during pregnancy, newborn not discharged with mother, neonatal abstinence symptoms (NAS), intensified perinatal surveillance or NICU, and delayed discharge from hospital. There is a substantial risk of children born to mothers with significant alcohol and/or substance abuse related problems for out-of-home care during early childhood. Factors identified during the pre- and perinatal period are associated with this risk.

The care unit in nursing home research: evidence in support of a definition.

Science.gov (United States)

Estabrooks, Carole A; Morgan, Debra G; Squires, Janet E; Boström, Anne-Marie; Slaughter, Susan E; Cummings, Greta G; Norton, Peter G

2011-04-14

Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A

Challenges to conducting research with older people living in nursing homes

Directory of Open Access Journals (Sweden)

Higginson Irene J

2009-08-01

Full Text Available Abstract Background Although older people are increasingly cared for in nursing homes towards the end of life, there is a dearth of research exploring the views of residents. There are however, a number of challenges and methodological issues involved in doing this. The aim of this paper is to discuss some of these, along with residents' views on taking part in a study of the perceptions of dignity of older people in care homes and make recommendations for future research in these settings. Methods Qualitative interviews were used to obtain the views on maintaining dignity of 18 people aged 75 years and over, living in two private nursing homes in South East London. Detailed field notes on experiences of recruiting and interviewing participants were kept. Results Challenges included taking informed consent (completing reply slips and having a 'reasonable' understanding of their participation; finding opportunities to conduct interviews; involvement of care home staff and residents' families and trying to maintain privacy during the interviews. Most residents were positive about their participation in the study, however, five had concerns either before or during their interviews. Although 15 residents seemed to feel free to air their views, three seemed reluctant to express their opinions on their care in the home. Conclusion Although we experienced many challenges to conducting this study, they were not insurmountable, and once overcome, allowed this often unheard vulnerable group to express their views, with potential long-term benefits for future delivery of care.

Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention

Science.gov (United States)

Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

2018-01-01

Introduction Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. Methods and analysis The aim of the ‘Improving Quality and Safety in Primary Care—Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers’ and staffs’ knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. Ethics and dissemination The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. PMID:29599394

Gender and ethical consumption of energy in smart homes

DEFF Research Database (Denmark)

Gram-Hanssen, Kirsten; Mechlenborg, Mette; Madsen, Line Valdorff

2017-01-01

An adaption to smart technologies in homes will inevitably produce new conditions for everyday life and thus also for relations between gender and ethical consumption. The home can be seen as a feminine domain and research shows that men tend to be more technically interested, whereas women gener...... gender inequalities in everyday practices.......An adaption to smart technologies in homes will inevitably produce new conditions for everyday life and thus also for relations between gender and ethical consumption. The home can be seen as a feminine domain and research shows that men tend to be more technically interested, whereas women...... in everyday life. Acknowledging how everyday life and home are gendered and that gender roles are produced and reproduced through everyday practices, is therefore vital to ensure a successful transition into a smart home future. Otherwise, the risk is that the development will contribute to producing further...

Dutch Home-Based Pre-Reading Intervention with Children at Familial Risk of Dyslexia

Science.gov (United States)

van Otterloo, Sandra G.; van der Leij, Aryan

2009-01-01

Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected a year earlier. After training, we found a small…

Utility of home sleep apnea testing in high-risk veterans.

Science.gov (United States)

Cairns, Alyssa; Sarmiento, Kathleen; Bogan, Richard

2017-09-01

Many Veterans Affairs Medical Centers (VAMCs) have implemented home sleep apnea testing (HSAT) in lieu of traditional in-lab testing to establish a timely and cost-sensitive diagnosis of obstructive sleep apnea (OSA). However, concern remains for the sensitivity and specificity of said technology in this population as many veterans are at increased risk for many of the comorbid conditions that can limit the accuracy of HSAT results. Hence, the purpose of this study is to evaluate rate of incongruent outcomes (e.g., negative HSAT results despite high clinical symptomology) as well as differences in study quality metrics and predictors of OSA between veteran sleep patients and general sleep patients being evaluated by a home sleep test. A random sample of HSAT outcomes from 1500 veterans and 1500 general sleep clinic patients was retrieved from a repository of anonymized HSAT outcomes from 2009 to 2013. General sleep clinic data were from patients referred for home sleep testing from a variety of clinical practices across North America, whereas VAMC patients were tested using a central dissemination process. All patients were tested for OSA using the Apnea Risk and Evaluation System (ARES), an HSAT that simultaneously records airflow, pulse oximetry, snoring, accelerometry, and EEG. Sample differences and rates of comorbidities, HSAT outcomes, predictors of OSA, and pretest OSA risk information were evaluated between groups. The presence of OSA was defined as an apnea-hypopnea index (AHI; using 4% desaturation criterion) of ≥5 and ≥15 events per hour. Sample differences in predictors of OSA were evaluated using logistic multiple regression. Veterans (91.3% male) were more likely to report comorbidities, especially depression, insomnia, hypertension, diabetes, restless legs syndrome (RLS), and use of sleep and pain medications compared to general sleep clinic patients (57.1% male). Despite differences in the rate of medical comorbidities, no differences were

Early Home-Based Intervention in the Netherlands for Children at Familial Risk of Dyslexia

Science.gov (United States)

van Otterloo, Sandra G.; van der Leij, Aryan; Henrichs, Lotte F.

2009-01-01

Dutch children at higher familial risk of reading disability received a home-based intervention programme before formal reading instruction started to investigate whether this would reduce the risk of dyslexia. The experimental group (n = 23) received a specific training in phoneme awareness and letter knowledge. A control group (n = 25) received…

The Impact of a Home-Delivered Meal Program on Nutritional Risk, Dietary Intake, Food Security, Loneliness, and Social Well-Being.

Science.gov (United States)

Wright, Lauri; Vance, Lauren; Sudduth, Christina; Epps, James B

2015-01-01

Maintaining independence and continuing to live at home is one solution to manage the rising health care costs of aging populations in the United States; furthermore, seniors are at risk of malnutrition and food insecurity. Home-delivered meal programs are a tool to address food, nutrition, and well-being concerns of this population. Few studies have identified outcomes from these programs; this pilot study reviews the nutritional status, dietary intake, well-being, loneliness, and food security levels of seniors participating in a Meals on Wheels delivery service. Clients, new to the meal program, participated in pre- and postphone interviews, and 51 seniors completed the study. The survey was composed of five scales or questionnaires, and statistical analyses were conducted using SPSS. Improvements across all five measures were statistically significant after participating two months in the home-delivered meal program. Implications for further research, practice, and the Older Americans Act are discussed.

Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention.

Science.gov (United States)

Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

2018-03-28

Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. The aim of the 'Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers' and staffs' knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

Science.gov (United States)

Rolland, Yves; Resnick, Barbara; Katz, Paul R; Little, Milta O; Ouslander, Joseph G; Bonner, Alice; Geary, Carol R; Schumacher, Karen L; Thompson, Sarah; Martin, Finbarr C; Wilbers, Joachim; Zúñiga, Franziska; Ausserhofer, D; Schwendimann, R; Schüssler, S; Dassen, Theo; Lohrmann, Christa; Levy, Cari; Whitfield, Emily; de Souto Barreto, Philipe; Etherton-Beer, Christopher; Dilles, Tinne; Azermai, Majda; Bourgeois, Jolyce; Orrell, Martin; Grossberg, George T; Kergoat, Hélène; Thomas, David R; Visschedijk, Jan; Taylor, Stephanie J C; Handajani, Yvonne S; Widjaja, Nelly T; Turana, Yuda; Rantz, Marilyn J; Skubic, Marjorie; Morley, John E

2014-05-01

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Is compromised oral health associated with a greater risk of mortality among nursing home residents? A controlled clinical study.

Science.gov (United States)

Klotz, Anna-Luisa; Hassel, Alexander Jochen; Schröder, Johannes; Rammelsberg, Peter; Zenthöfer, Andreas

2017-08-30

The objective of this controlled clinical study was to evaluate the association between oral health and 1-year mortality among nursing home residents with or without oral health intervention. This research was part of a multidisciplinary intervention study (EVI-P) performed in 14 nursing homes in Germany. Two-hundred and nineteen nursing home residents were included in the study and assigned to an intervention group, for which dental health education was offered and ultrasonic baths were used for denture cleaning (n = 144), or to a control group (n = 75). Before the intervention, each participant was examined, and dental status, plaque control record (PCR), Denture Hygiene Index, and results from the Revised Oral Assessment Guide were recorded. Amount of care needed and dementia were also assessed, by use of the Barthel Index and the Mini Mental State Examination, respectively. Participant mortality was determined after 12 months, and bivariate analysis and logistic regression models were used to evaluate possible factors affecting mortality. Bivariate analysis detected a direct association between greater mortality and being in the control group (p = .038). Participants with higher PCR were also more likely to die during the study period (p = .049). For dentate participants, the protective effect of being in the intervention group was confirmed by multivariate analysis in which covariates such as age and gender were considered. Oral hygiene and oral health seem to affect the risk of mortality of nursing home residents. Dental intervention programs seem to reduce the risk of 1-year mortality among nursing home residents having remaining natural teeth. Further studies, with larger sample sizes and evaluation of the causes of death, are necessary to investigate the reasons for these associations.

Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge.

Science.gov (United States)

Noureldin, Marwa; Hass, Zachary; Abrahamson, Kathleen; Arling, Greg

2017-09-04

Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge. Participants in the Minnesota Return to Community Initiative who were assisted in achieving a community discharge (N = 1459) comprised the study sample. The main outcome was fall occurrence within 30 days of discharge. Factor analyses were used to estimate latent models from variables of interest. A structural equation model (SEM) was estimated to determine the relationship between the emerging latent variables and falls. Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p risk of falling post NH discharge. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

Science.gov (United States)

Baranzini, Federico; Diurni, Marcello; Ceccon, Francesca; Poloni, Nicola; Cazzamalli, Sara; Costantini, Chiara; Colli, Cristiano; Greco, Laura; Callegari, Camilla

2009-12-11

Polypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls. A retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents. 221 residents (75.4%) were female and 72 (24.6%) male, and 133 (45.4%) were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4%) and major in 46 (32.6%). Only fall dynamics (p = 0.013) and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (> or =7 medications) seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36). This work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.

A diaper bank and home visiting partnership: Initial exploration of research and policy questions.

Science.gov (United States)

Sadler, Lois S; Condon, Eileen M; Deng, Shirley Z; Ordway, Monica Roosa; Marchesseault, Crista; Miller, Andrea; Alfano, Janet Stolfi; Weir, Alison M

2018-03-01

The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby ® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed. © 2017 Wiley Periodicals, Inc.

The psychology of home environments: a call for research on residential space.

Science.gov (United States)

Graham, Lindsay T; Gosling, Samuel D; Travis, Christopher K

2015-05-01

Homes are important: People devote much of their thought, time, and resources to selecting, modifying, and decorating their living spaces, and they may be devastated when their homes must be sold or are destroyed. Yet the empirical psychological literature says virtually nothing about the roles that homes might play in people's lives. We argue that homes provide an informative context for a wide variety of studies examining how social, developmental, cognitive, and other psychological processes play out in a consequential real-world setting. The topic of homes is also well suited to collaborations with a diverse array of disciplines ranging from architecture and engineering to sociology and law. We illustrate the potential insights to be gained from studying homes with an exploratory study that maps the psychological ambiances (e.g., romance, comfort, togetherness) that people desire in their homes; we identify six broad ambiance dimensions (restoration, kinship, storage, stimulation, intimacy, productivity) that show mean differences across rooms. We connect these findings to existing work on situation selection in emotion regulation. These ideas provide only an initial foray into the domain of residential space, but they hint at the productive roles that homes and other spaces could play in psychological theorizing and research. © The Author(s) 2015.

Supporting the information domains of fall-risk management in home care via health information technology.

Science.gov (United States)

Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

2016-01-01

In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission

NARCIS (Netherlands)

Visser, Marjolein; Deeg, Dorly J H; Puts, Martine T E; Seidell, Jaap C; Lips, Paul

BACKGROUND: The prevalence of vitamin D deficiency in nursing home patients is high. OBJECTIVE: We aimed to ascertain whether lower serum 25-hydroxyvitamin D [25(OH)D] concentrations increase the risk of future nursing home admission and early death. DESIGN: We included 1260 independent,

Risk and protective factors associated with intentional self-harm among older community-residing home care clients in Ontario, Canada.

Science.gov (United States)

Neufeld, Eva; Hirdes, John P; Perlman, Christopher M; Rabinowitz, Terry

2015-10-01

We aim to concurrently examine risk and protective factors associated with intentional self-harm among community-residing older adults receiving home care services in Ontario, Canada. Administrative health data from the home care sector were linked to hospital administrative data to carry out the analyses. Home care data are collected in Ontario using the Resident Assessment Instrument-Home Care (RAI-HC), an assessment tool that identifies strengths, preferences and needs of long-stay home care clients. The sample included Ontario home care clients aged 60 years or older assessed with the RAI-HC between 2007 and 2010 (N = 222,149). Multivariable analyses were performed using SAS. Hospital records of intentional self-harm (ISH) were present in 9.3 cases per 1000 home care clients. Risks of ISH included younger age (60-74 years; OR = 3.14, CI: 2.75-3.59), psychiatric diagnosis (OR = 2.29, CI: 2.06-2.54), alcohol use and dependence (OR = 1.69, CI: 1.34-2.14), psychotropic medication (OR = 1.94, CI: 1.75-2.15) and depressive symptoms (OR = 1.58, CI: 1.40-1.78). Protective effects were found for marital status and positive social relationships, yet these effects were more pronounced for men. Cognitive performance measures showed the odds of ISH 1.86 times higher for older adults with moderate to severe cognitive impairment. This study based on provincial data points to tangible areas for preventative assessment by frontline home care professionals. Of interest were the risk and protective factors that differed by sex. As demand for home care in Canada is expected to increase, these findings may inform home care professionals' appraisal and approach to suicide prevention among community-residing older adults. Copyright © 2015 John Wiley & Sons, Ltd.

Considerations and recommendations for conducting qualitative research interviews with palliative and end-of-life care patients in the home setting: a consensus paper.

Science.gov (United States)

Sivell, Stephanie; Prout, Hayley; Hopewell-Kelly, Noreen; Baillie, Jessica; Byrne, Anthony; Edwards, Michelle; Harrop, Emily; Noble, Simon; Sampson, Catherine; Nelson, Annmarie

2015-12-08

To present and discuss the views of researchers at an academic palliative care research centre on research encounters with terminally ill patients in the home setting and to generate a list of recommendations for qualitative researchers working in palliative and end-of-life care. Eight researchers took part in a consensus meeting to discuss their experiences of undertaking qualitative interviews. The researchers were of varying backgrounds and all reported having experience in interviewing terminally ill patients, and all but one had experience of interviewing patients in their home environment. The main areas discussed by researchers included: whether participation in end-of-life research unintentionally becomes a therapeutic experience or an ethical concern; power relationships between terminally ill patients and researchers; researcher reflexivity and reciprocity; researchers' training needs. Qualitative methods can complement the home environment; however, it can raise ethical and practical challenges, which can be more acute in the case of research undertaken with palliative and patients at the end-of-life. The ethical and practical challenges researchers face in this context has the potential to place both participant and researcher at risk for their physical and psychological well-being. We present a set of recommendations for researchers to consider prior to embarking on qualitative research in this context and advocate researchers in this field carefully consider the issues presented on a study-by-study basis. 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/

Cyber and Physical Security Vulnerability Assessment for IoT-Based Smart Homes.

Science.gov (United States)

Ali, Bako; Awad, Ali Ismail

2018-03-08

The Internet of Things (IoT) is an emerging paradigm focusing on the connection of devices, objects, or "things" to each other, to the Internet, and to users. IoT technology is anticipated to become an essential requirement in the development of smart homes, as it offers convenience and efficiency to home residents so that they can achieve better quality of life. Application of the IoT model to smart homes, by connecting objects to the Internet, poses new security and privacy challenges in terms of the confidentiality, authenticity, and integrity of the data sensed, collected, and exchanged by the IoT objects. These challenges make smart homes extremely vulnerable to different types of security attacks, resulting in IoT-based smart homes being insecure. Therefore, it is necessary to identify the possible security risks to develop a complete picture of the security status of smart homes. This article applies the operationally critical threat, asset, and vulnerability evaluation (OCTAVE) methodology, known as OCTAVE Allegro, to assess the security risks of smart homes. The OCTAVE Allegro method focuses on information assets and considers different information containers such as databases, physical papers, and humans. The key goals of this study are to highlight the various security vulnerabilities of IoT-based smart homes, to present the risks on home inhabitants, and to propose approaches to mitigating the identified risks. The research findings can be used as a foundation for improving the security requirements of IoT-based smart homes.

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...... in the making of the mediatized home space. We conclude by returning to the research questions and making explicit how researching flows of bodies that in many ways inhabit homes of the in-between contributes to both gerontological and geomediatization research agendas....

Development of project wings home visits, a mental health intervention for Latino families using community-based participatory research.

Science.gov (United States)

Garcia, Carolyn; Hermann, Denise; Bartels, Anna; Matamoros, Pablo; Dick-Olson, Linda; Guerra de Patino, Janeth

2012-11-01

As the Latino population in the United States experiences rapid growth, the well-being of Latino adolescents is a growing concern because of their high rates of mental health problems. Latino adolescents have higher rates of mental health problems than their peers, including depressive symptoms, suicide attempts, and violence. Sophisticated, realistic health promotion efforts are needed to reduce these risk behaviors and enhance protective factors. Parents and schools can be key protective factors, or assets, in adolescents' lives. This article details the steps undertaken to develop Project Wings Home Visits, a collaborative school-based, community-linked mental health promotion intervention for Latino adolescents and their families. Core to the intervention is the use of a community health worker model to provide home-based outreach and education to parents of Latino adolescents. The intervention was developed using a community-based participatory research approach that involved the cooperation of a community health care system, a public high school, and a university. Our process demonstrates the benefits, strengths, and challenges of using community-based participatory research in creating and implementing health promotion interventions.

Improving prediction of fall risk among nursing home residents using electronic medical records.

Science.gov (United States)

Marier, Allison; Olsho, Lauren E W; Rhodes, William; Spector, William D

2016-03-01

Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls. The authors applied a repeated events survival model to analyze MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain that uses a centralized EMR system from a leading vendor. Estimated regression parameters were used to project resident fall probability. The authors examined the proportion of observed falls within each projected fall risk decile to assess improvements in predictive power from including EMR data. In a model incorporating fall risk factors from the MDS only, 28.6% of observed falls occurred among residents in the highest projected risk decile. In an alternative specification incorporating more frequently updated measures for the same risk factors from the EMR data, 32.3% of observed falls occurred among residents in the highest projected risk decile, a 13% increase over the base MDS-only specification. Incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone. These improvements stem chiefly from the greater frequency with which EMR data are updated, with minimal additional gains from availability of additional risk factor variables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Patient safety culture in Norwegian nursing homes.

Science.gov (United States)

Bondevik, Gunnar Tschudi; Hofoss, Dag; Husebø, Bettina Sandgathe; Deilkås, Ellen Catharina Tveter

2017-06-20

Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire - Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue. In February 2016, 463 healthcare providers working in five nursing homes in Tønsberg, Norway, were invited to answer the SAQ-AV, translated and adapted to the Norwegian nursing home setting. Previous validation of the Norwegian SAQ-AV for nursing homes identified five patient safety factors: teamwork climate, safety climate, job satisfaction, working conditions and stress recognition. SPSS v.22 was used for statistical analysis, which included estimations of mean values, standard deviations and multiple linear regressions. P-values safety factors teamwork climate, safety climate, job satisfaction and working conditions. Not being a Norwegian native speaker was associated with a significantly higher mean score for job satisfaction and a significantly lower mean score for stress recognition. Neither professional background nor work experience were significantly associated with mean scores for any patient safety factor. Patient safety factor scores in nursing homes were poorer than previously found in Norwegian general practices, but similar to findings in out-of-hours primary care clinics. Patient safety culture assessment may help nursing home leaders to initiate targeted quality improvement interventions. Further research should investigate associations between patient safety culture and the occurrence

Smart Homes for Elderly Healthcare-Recent Advances and Research Challenges.

Science.gov (United States)

Majumder, Sumit; Aghayi, Emad; Noferesti, Moein; Memarzadeh-Tehran, Hamidreza; Mondal, Tapas; Pang, Zhibo; Deen, M Jamal

2017-10-31

Advancements in medical science and technology, medicine and public health coupled with increased consciousness about nutrition and environmental and personal hygiene have paved the way for the dramatic increase in life expectancy globally in the past several decades. However, increased life expectancy has given rise to an increasing aging population, thus jeopardizing the socio-economic structure of many countries in terms of costs associated with elderly healthcare and wellbeing. In order to cope with the growing need for elderly healthcare services, it is essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Smart homes, which incorporate environmental and wearable medical sensors, actuators, and modern communication and information technologies, can enable continuous and remote monitoring of elderly health and wellbeing at a low cost. Smart homes may allow the elderly to stay in their comfortable home environments instead of expensive and limited healthcare facilities. Healthcare personnel can also keep track of the overall health condition of the elderly in real-time and provide feedback and support from distant facilities. In this paper, we have presented a comprehensive review on the state-of-the-art research and development in smart home based remote healthcare technologies.

Smart Homes for Elderly Healthcare—Recent Advances and Research Challenges

Science.gov (United States)

Aghayi, Emad; Noferesti, Moein; Memarzadeh-Tehran, Hamidreza; Mondal, Tapas; Deen, M. Jamal

2017-01-01

Advancements in medical science and technology, medicine and public health coupled with increased consciousness about nutrition and environmental and personal hygiene have paved the way for the dramatic increase in life expectancy globally in the past several decades. However, increased life expectancy has given rise to an increasing aging population, thus jeopardizing the socio-economic structure of many countries in terms of costs associated with elderly healthcare and wellbeing. In order to cope with the growing need for elderly healthcare services, it is essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Smart homes, which incorporate environmental and wearable medical sensors, actuators, and modern communication and information technologies, can enable continuous and remote monitoring of elderly health and wellbeing at a low cost. Smart homes may allow the elderly to stay in their comfortable home environments instead of expensive and limited healthcare facilities. Healthcare personnel can also keep track of the overall health condition of the elderly in real-time and provide feedback and support from distant facilities. In this paper, we have presented a comprehensive review on the state-of-the-art research and development in smart home based remote healthcare technologies. PMID:29088123

Smart Homes for Elderly Healthcare—Recent Advances and Research Challenges

Directory of Open Access Journals (Sweden)

Sumit Majumder

2017-10-01

Full Text Available Advancements in medical science and technology, medicine and public health coupled with increased consciousness about nutrition and environmental and personal hygiene have paved the way for the dramatic increase in life expectancy globally in the past several decades. However, increased life expectancy has given rise to an increasing aging population, thus jeopardizing the socio-economic structure of many countries in terms of costs associated with elderly healthcare and wellbeing. In order to cope with the growing need for elderly healthcare services, it is essential to develop affordable, unobtrusive and easy-to-use healthcare solutions. Smart homes, which incorporate environmental and wearable medical sensors, actuators, and modern communication and information technologies, can enable continuous and remote monitoring of elderly health and wellbeing at a low cost. Smart homes may allow the elderly to stay in their comfortable home environments instead of expensive and limited healthcare facilities. Healthcare personnel can also keep track of the overall health condition of the elderly in real-time and provide feedback and support from distant facilities. In this paper, we have presented a comprehensive review on the state-of-the-art research and development in smart home based remote healthcare technologies.

Home-Based Risk of Falling Assessment Test Using a Closed-Loop Balance Model.

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Ayena, Johannes C; Zaibi, Helmi; Otis, Martin J-D; Menelas, Bob-Antoine J

2016-12-01

The aim of this study is to improve and facilitate the methods used to assess risk of falling at home among older people through the computation of a risk of falling in real time in daily activities. In order to increase a real time computation of the risk of falling, a closed-loop balance model is proposed and compared with One-Leg Standing Test (OLST). This balance model allows studying the postural response of a person having an unpredictable perturbation. Twenty-nine volunteers participated in this study for evaluating the effectiveness of the proposed system which includes seventeen elder participants: ten healthy elderly ( 68.4 ±5.5 years), seven Parkinson's disease (PD) subjects ( 66.28 ±8.9 years), and twelve healthy young adults ( 28.27 ±3.74 years). Our work suggests that there is a relationship between OLST score and the risk of falling based on center of pressure measurement with four low cost force sensors located inside an instrumented insole, which could be predicted using our suggested closed-loop balance model. For long term monitoring at home, this system could be included in a medical electronic record and could be useful as a diagnostic aid tool.

Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

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Colli Cristiano

2009-12-01

Full Text Available Abstract Background Polypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls. Methods A retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents. Results 221 residents (75.4% were female and 72 (24.6% male, and 133 (45.4% were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4% and major in 46 (32.6%. Only fall dynamics (p = 0.013 and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (≥7 medications seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36. Conclusion This work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.

A Research Agenda on Assessing and Remediating Home Dampness and Mold to Reduce Dampness-Related Health Effects

Energy Technology Data Exchange (ETDEWEB)

Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Computational Cosmology Center

2015-05-28

This report briefly summarizes, based on recent review articles and selected more recent research reports, current scientific knowledge on two topics: assessing unhealthy levels of indoor D/M in homes and remediating home dampness-related problems to protect health. Based on a comparison of current scientific knowledge to that required to support effective, evidence-based, health-protective policies on home D/M, gaps in knowledge are highlighted, prior questions and research questions specified, and necessary research activities and approaches recommended.

A Research Agenda on Assessing and Remediating Home Dampness and Mold to Reduce Dampness-Related Health Effects

Energy Technology Data Exchange (ETDEWEB)

Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2015-06-01

This report briefly summarizes, based on recent review articles and selected more recent research reports, current scientific knowledge on two topics: assessing unhealthy levels of indoor D/M in homes and remediating home dampness-related problems to protect health. Based on a comparison of current scientific knowledge to that required to support effective, evidence-based, health-protective policies on home D/M, gaps in knowledge are highlighted, prior questions and research questions specified, and necessary research activities and approaches recommended.

Implementing guidelines in nursing homes: a systematic review.

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Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte; Lund, Hans

2016-07-25

Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROSPERO 2014: CRD42014007664.

Family and home characteristics correlate with mold in homes.

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Reponen, Tiina; Levin, Linda; Zheng, Shu; Vesper, Stephen; Ryan, Patrick; Grinshpun, Sergey A; LeMasters, Grace

2013-07-01

Previously, we demonstrated that infants residing in homes with higher Environmental Relative Moldiness Index were at greater risk for developing asthma by age seven. The purpose of this analysis was to identify the family and home characteristics associated with higher moldiness index values in infants' homes at age one. Univariate linear regression of each characteristic determined that family factors associated with moldiness index were race and income. Home characteristics associated with the moldiness index values were: air conditioning, carpet, age of the home, season of home assessment, and house dust mite allergen. Parental history of asthma, use of dehumidifier, visible mold, dog and cat allergen levels were not associated with moldiness index. Results of multiple linear regression showed that older homes had 2.9 units higher moldiness index (95% confidence interval [CI]=0.4, 5.4), whereas homes with central air conditioning had 2.5 units lower moldiness index (95% CI=-4.7, -0.4). In addition, higher dust mite allergen levels and carpeting were positively and negatively associated with higher moldiness index, respectively. Because older homes and lack of air conditioning were also correlated with race and lower income, whereas carpeting was associated with newer homes, the multivariate analyses suggests that lower overall socioeconomic position is associated with higher moldiness index values. This may lead to increased asthma risk in homes inhabited by susceptible, vulnerable population subgroups. Further, age of the home was a surrogate of income, race and carpeting in our population; thus the use of these factors should carefully be evaluated in future studies. Copyright © 2013 Elsevier Inc. All rights reserved.

Home-based exercise program and fall-risk reduction in older adults with multiple sclerosis: phase 1 randomized controlled trial.

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Sosnoff, Jacob J; Finlayson, Marcia; McAuley, Edward; Morrison, Steve; Motl, Robert W

2014-03-01

To determine the feasibility, safety, and efficacy of a home-based exercise intervention targeting fall risk in older adults with multiple sclerosis. A randomized controlled pilot trial. A home-based exercise program. Participants were randomly allocated to either a home-based exercise intervention group (n = 13) or a waiting list control group (n = 14). The exercise group completed exercises targeting lower muscle strength and balance three times a week for 12 weeks. The control group continued normal activity. Fall risk (Physiological Profile Assessment scores), balance (Berg Balance Scale), and walking testing prior to and immediately following the 12-week intervention. Each outcome measure was placed in an analysis of covariance with group as the between-subject factor and baseline values as the covariate. Effect sizes were calculated. Twelve participants from the control group and ten from the exercise group completed the study. There were no related adverse events. Fall risk was found to decrease in the exercise group following the intervention (1.1 SD 1.0 vs. 0.6 SD 0.6) while there was an increase in fall risk in the control group (1.9 SD 1.5 vs. 2.2 SD 1.9). Effect sizes for most outcomes were large (η(2) > 0.15). Home-based exercise was found to be feasible, safe, and effective for reducing physiological fall risk in older adults with multiple sclerosis. Our findings support the implementation of a larger trial to reduce fall risk in persons with multiple sclerosis.

Fall risk factors in community-dwelling elderly who receive Medicaid-supported home- and community-based care services.

Science.gov (United States)

Yamashita, Takashi; Jeon, Haesang; Bailer, A John; Nelson, Ian M; Mehdizadeh, Shahla

2011-06-01

This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Data were collected from enrollees of Ohio's Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.

Cyber and Physical Security Vulnerability Assessment for IoT-Based Smart Homes

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Bako Ali

2018-03-01

Full Text Available The Internet of Things (IoT is an emerging paradigm focusing on the connection of devices, objects, or “things” to each other, to the Internet, and to users. IoT technology is anticipated to become an essential requirement in the development of smart homes, as it offers convenience and efficiency to home residents so that they can achieve better quality of life. Application of the IoT model to smart homes, by connecting objects to the Internet, poses new security and privacy challenges in terms of the confidentiality, authenticity, and integrity of the data sensed, collected, and exchanged by the IoT objects. These challenges make smart homes extremely vulnerable to different types of security attacks, resulting in IoT-based smart homes being insecure. Therefore, it is necessary to identify the possible security risks to develop a complete picture of the security status of smart homes. This article applies the operationally critical threat, asset, and vulnerability evaluation (OCTAVE methodology, known as OCTAVE Allegro, to assess the security risks of smart homes. The OCTAVE Allegro method focuses on information assets and considers different information containers such as databases, physical papers, and humans. The key goals of this study are to highlight the various security vulnerabilities of IoT-based smart homes, to present the risks on home inhabitants, and to propose approaches to mitigating the identified risks. The research findings can be used as a foundation for improving the security requirements of IoT-based smart homes.

Cyber and Physical Security Vulnerability Assessment for IoT-Based Smart Homes

Science.gov (United States)

2018-01-01

The Internet of Things (IoT) is an emerging paradigm focusing on the connection of devices, objects, or “things” to each other, to the Internet, and to users. IoT technology is anticipated to become an essential requirement in the development of smart homes, as it offers convenience and efficiency to home residents so that they can achieve better quality of life. Application of the IoT model to smart homes, by connecting objects to the Internet, poses new security and privacy challenges in terms of the confidentiality, authenticity, and integrity of the data sensed, collected, and exchanged by the IoT objects. These challenges make smart homes extremely vulnerable to different types of security attacks, resulting in IoT-based smart homes being insecure. Therefore, it is necessary to identify the possible security risks to develop a complete picture of the security status of smart homes. This article applies the operationally critical threat, asset, and vulnerability evaluation (OCTAVE) methodology, known as OCTAVE Allegro, to assess the security risks of smart homes. The OCTAVE Allegro method focuses on information assets and considers different information containers such as databases, physical papers, and humans. The key goals of this study are to highlight the various security vulnerabilities of IoT-based smart homes, to present the risks on home inhabitants, and to propose approaches to mitigating the identified risks. The research findings can be used as a foundation for improving the security requirements of IoT-based smart homes. PMID:29518023

A study of balance, gait and psychotropic drug use in relation to fall risk in nursing home residents with dementia

NARCIS (Netherlands)

C.S. Sterke (Carolyn)

2011-01-01

textabstractFalls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls results in an injury. In order to take tailor-made preventive measures in time, the fall risk profile of each individual nursing home resident should be periodically

Early Educational Intervention, Early Cumulative Risk, and the Early Home Environment as Predictors of Young Adult Outcomes within a High-Risk Sample

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Pungello, Elizabeth P.; Kainz, Kirsten; Burchinal, Margaret; Wasik, Barbara H.; Sparling, Joseph J.; Ramey, Craig T.; Campbell, Frances A.

2010-01-01

The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment,…

Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness.

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Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja

2018-03-16

The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources

Decision Making about Hospital Arrival among Low-Risk Nulliparous Women after Spontaneous Labor Onset at Home.

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Edmonds, Joyce K; Miley, Kathleen; Angelini, Kimberly J; Shah, Neel T

2018-05-15

Postponing hospital admission until the active phase of labor is a recommended strategy to safely reduce the incidence of primary cesarean births. Success of this strategy depends on women's decisions about when to transfer from home to the hospital, a process that is largely absent from research about childbirth. This study aimed to determine the decision-making criteria used by women about when to go to the hospital after the self-identification of labor onset at home. A qualitative study was conducted at an academic medical center with a sample of 21 nulliparous women who went into spontaneous labor at home and had term, singleton, and vertex-presentation births. The purposive sample consisted of women who decided to stay at home or go to the hospital in early labor. Birth narratives from in-depth interviews conducted in the postpartum period using a semistructured interview guide were subjected to content analysis. The verbatim transcriptions of the interviews were coded and categorized into a set of decision criteria. Criteria used by women in deciding to go to the hospital or stay at home in early labor included the degree of certainty with the self-identification of labor onset, ability to cope with labor pain, influence of social network members, health care provider advice, and concerns about travel to the hospital. Perception of childbirth risk and the need for reassurance about the normalcy of symptoms and fetal well-being also influenced women's decisions. Women use a common set of criteria in deciding when to arrive at the hospital during labor. Antenatal education and telephone triage interventions that incorporate the considerations of women deciding to seek or delay hospital admission in childbirth may facilitate health seeking in more advanced labor. Symptom recognition education about early labor onset and progression could reduce decisional uncertainty. © 2018 by the American College of Nurse-Midwives.

Exploring new operational research opportunities within the Home Care context: the chemotherapy at home.

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Chahed, Salma; Marcon, Eric; Sahin, Evren; Feillet, Dominique; Dallery, Yves

2009-06-01

Home Care (HC) services provide complex and coordinated medical and paramedical care to patients at their homes. As health care services move into the home setting, the need for developing innovative approaches that improve the efficiency of home care organizations increases. We first conduct a literature review of investigations dealing with operation planning within the area of home care management. We then address a particular issue dealing with the planning of operations related to chemotherapy at home as it is an emergent problem in the French context. Our interest is focused on issues specific to the anti-cancer drug supply chain. We identify various models that can be developed and analyze one of them.

SpaceScience@Home: Authentic Research Projects that Use Citizen Scientists

Science.gov (United States)

Méndez, B. J. H.

2008-06-01

In recent years, several space science research projects have enlisted the help of large numbers of non-professional volunteers, ``citizen scientists'', to aid in performing tasks that are critical to a project, but require more person-time (or computing time) than a small professional research team can practically perform themselves. Examples of such projects include SETI@home, which uses time from volunteers computers to process radio-telescope observation looking for signals originating from extra-terrestrial intelligences; Clickworkers, which asks volunteers to review images of the surface of Mars to identify craters; Spacewatch, which used volunteers to review astronomical telescopic images of the sky to identify streaks made by possible Near Earth Asteroids; and Stardust@home, which asks volunteers to review ``focus movies'' taken of the Stardust interstellar dust aerogel collector to search for possible impacts from interstellar dust particles. We shall describe these and other similar projects and discuss lessons learned from carrying out such projects, including the educational opportunities they create.

School- And Home-Based Drug Prevention: Environmental, Parent, and Child Risk Reduction

Science.gov (United States)

Hahn, Ellen J.; Hall, Lynne A.; Rayens, Mary Kay; Myers, April V.; Bonnel, Galadriel

2007-01-01

The study purpose was to test the effect of a school- and home-based alcohol, tobacco, and other drug (ATOD) prevention program on reducing environmental, parent, and child risk factors for ATOD use. The design was a three-group pretest-posttest with interviews at baseline and 1 and 6 months post-intervention. The sample was 126 parents and their…

Everything safe? – Risk situations in advanced home care from the point of view of ventilated patients and their relatives

Science.gov (United States)

Ewers, Michael; Schaepe, Christiane; Lehmann, Yvonne

2017-01-01

Background: The number of home mechanically ventilated (HMV) patients has been growing for years. However, little is known about requirements, processes and effects of advanced home care, provided in distance from clinics and doctors. To date, safety related aspects of the above mentioned issues have scarcely been examined. Aim: Users of advanced home care were asked about their experiences and about situations in which they felt safe or unsafe. The aim was to gain insights into the daily care provision, explore safety risks from the users’ point of view, and to develop new approaches to enhance patient safety in home care for the severely ill. Method: A qualitative explorative study has been carried out, based on semi-structured interviews (ventilated patients N = 21; relatives N = 15). Sampling, data collecting and data analysis were guided by principles of Grounded Theory. Results: Risk situations occur when (non-)verbal communication offers of HMV patients are overseen or misunderstood, patient- or technology related monitoring tasks are neglected, if coordination and collaboration requirements are undervalued and if negotiation processes as well as education and supervision needs are disregarded. Furthermore, nurses’ lack of competence, self-confidence and professionalism may produce risk situations. Conclusion: Listen carefully to patients and relatives can help to identify quality shortcomings in advanced home care, to prevent risk situations and to develop patient-centered safety concepts for this particular setting.

Homeless drug users' awareness and risk perception of peer "Take Home Naloxone" use – a qualitative study

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Wright, Nat; Oldham, Nicola; Francis, Katharine; Jones, Lesley

2006-01-01

Background Peer use of take home naloxone has the potential to reduce drug related deaths. There appears to be a paucity of research amongst homeless drug users on the topic. This study explores the acceptability and potential risk of peer use of naloxone amongst homeless drug users. From the findings the most feasible model for future treatment provision is suggested. Methods In depth face-to-face interviews conducted in one primary care centre and two voluntary organisation centres providing services to homeless drug users in a large UK cosmopolitan city. Interviews recorded, transcribed and analysed thematically by framework techniques. Results Homeless people recognise signs of a heroin overdose and many are prepared to take responsibility to give naloxone, providing prior training and support is provided. Previous reports of the theoretical potential for abuse and malicious use may have been overplayed. Conclusion There is insufficient evidence to recommend providing "over the counter" take home naloxone" to UK homeless injecting drug users. However a programme of peer use of take home naloxone amongst homeless drug users could be feasible providing prior training is provided. Peer education within a health promotion framework will optimise success as current professionally led health promotion initiatives are failing to have a positive impact amongst homeless drug users. PMID:17014725

Homeless drug users' awareness and risk perception of peer "Take Home Naloxone" use – a qualitative study

Directory of Open Access Journals (Sweden)

Oldham Nicola

2006-10-01

Full Text Available Abstract Background Peer use of take home naloxone has the potential to reduce drug related deaths. There appears to be a paucity of research amongst homeless drug users on the topic. This study explores the acceptability and potential risk of peer use of naloxone amongst homeless drug users. From the findings the most feasible model for future treatment provision is suggested. Methods In depth face-to-face interviews conducted in one primary care centre and two voluntary organisation centres providing services to homeless drug users in a large UK cosmopolitan city. Interviews recorded, transcribed and analysed thematically by framework techniques. Results Homeless people recognise signs of a heroin overdose and many are prepared to take responsibility to give naloxone, providing prior training and support is provided. Previous reports of the theoretical potential for abuse and malicious use may have been overplayed. Conclusion There is insufficient evidence to recommend providing "over the counter" take home naloxone" to UK homeless injecting drug users. However a programme of peer use of take home naloxone amongst homeless drug users could be feasible providing prior training is provided. Peer education within a health promotion framework will optimise success as current professionally led health promotion initiatives are failing to have a positive impact amongst homeless drug users.

Examining Maternal Depression and Attachment Insecurity as Moderators of the Impacts of Home Visiting for At-Risk Mothers and Infants

Science.gov (United States)

Duggan, Anne K.; Berlin, Lisa J.; Cassidy, Jude; Burrell, Lori; Tandon, S. Darius

2009-01-01

Home visiting programs for at-risk mothers and their infants have proliferated nationally in recent years, yet experimental studies of home visiting have yielded mixed findings. One promising strategy for explicating the effects of early home visiting is to examine moderators of program impacts. This study assessed the roles of maternal depression…

Environmental risk assessment using the Persian version of the Home Falls And Screening Tool (HOME FAST in Iranian elderly

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Bahareh Maghfouri

2013-05-01

Full Text Available Introduction: One of the common problems among older people is falling. Falling inside the houses and streets makes up a large incidence between Iranian elderly, then the effort to identify environmental factors at home and home modification can reduce falls and injury in the elderly. The aim of this study is identifying elderly at risk of fall with using screening tool (HOME FAST and define reliability of this tool.Material and Methods: As a reliability, through the health housing of the town councils in five geographical regions of Tehran, 60 old person were selected. Participants aged 60 to 65 years and the HOME FAST tool was used in the two stages (inter rater and test-retest.Results: Test-retest reliability in the study showed that agreement between the items is over than 0.8, which shows very good reliability. The results showed that the relative of the each item in the Agreement between the domain is 1 - 0.65, which shows moderate to high reliability. And the results in this study showed that agreement between the items in Inter rater reliability is over than 0.8, which shows the level of reliability is very good. Also it showed that the relative of the each item in the agreement between the domain is 1 - 0.01, which shows poor to high reliability.Conclusion: This study shows that the reliability of the HOME FAST is high. The findings of these comments have been expected that the test objectives were appropriate to prevent falls and the tools showed acceptable reliability, then this test can be used as a tool for to professionals.

Identifying fallers with Parkinson's disease using home-based tests: who is at risk?

NARCIS (Netherlands)

Lim-de Vries, L.I.I.K.; van Wegen, E.E.; Jones, D.; Rochester, L.; Nieuwboer, A.; Willems, A.M.; Baker, K.; Hetherington, V.; Kwakkel, G.

2008-01-01

The objective of this work is to determine risk factors for falling in patients with Parkinson's disease (PD) using home-based assessments and develop a prediction model. Data on falls, balance, gait-related activities, and nonmotor symptoms were obtained from 153 PD patients (Hoehn-Yahr 2-4) in

Risk Analysis of Typhoid Fever Based on Personal Hygiene and Street Food Consumption Habit at Home

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Hilda Nuruzzaman

2016-11-01

Full Text Available Typhoid fever is disease caused by Salmonella typhi bacteria transmission trought contaminated food and drink. Data from RSUD dr. Abdoer Rahem showing that from 2011–2013 typhoid fever case always increase and often happened to children age 5–14 years old. The objective research to analysis risk factor of typhoid fever according to snacking habit at school and at house of children age 7–12 years old. This research was observasional case control study. Data for case in this research are taken from medical record of ‘Unit Teratai’ for the past 1 year in RSUD dr. Abdoer Rahem Situbondo, whereas for control are case group. There are eighty person taken for this research as sample. This result was the risk of typhoid fever children which has habit of hand washing had after defecation at home OR 3.67 (1.29 < OR < 10.64, children which has habit of hand washing before eating had OR 4.33 (1.54 < OR < 12.44, children with short dirty fingernails had OR 7.79 (1.46 < OR < 46.18 frequent street food consumption OR 3.89 (1.39 < OR < 11.06, buy snack at food street OR 3.95 (1.40 < OR < 11.30, buy some snack with packing had OR 3.5 (1.26 < OR < 9.38. The conclusion is that habit hand washing after defecation, habit hand washing before eating, short dirty fingernail, frequent food street consumption, buy food street and buy some food with sealed packing can secrease the risk of typhoid fever for children age 7–12 years Keywords: typhoid fever, risk factor of typhoid fever, personal hygiene, street food consumption habit

Posterior teeth occlusion and dysphagia risk in older nursing home residents: a cross-sectional observational study.

Science.gov (United States)

Okabe, Y; Takeuchi, K; Izumi, M; Furuta, M; Takeshita, T; Shibata, Y; Kageyama, S; Ganaha, S; Yamashita, Y

2017-02-01

The total number of natural teeth was related to swallowing function among older adults; however, limited information is available regarding the impact of occluding pairs of teeth on swallowing function. This study aimed to examine the association between posterior teeth occlusion and dysphagia risk in older nursing home residents. This cross-sectional study included 238 residents aged ≥60 years from eight nursing homes in Aso City, Japan. Swallowing function was evaluated using the modified water swallowing test (MWST); the primary outcome was dysphagia risk (MWST score ≤3). Posterior teeth occlusion was assessed using number of functional tooth units (FTUs), determined based on number and location of the remaining natural and artificial teeth on implant-supported, fixed or removable prostheses. Univariate and multivariate logistic regression analyses were performed to examine the association between posterior teeth occlusion and dysphagia risk, adjusted for the covariates of number of natural teeth, demographic characteristics, comorbidities, physical function, body mass index and cognitive function. Of the 238 subjects, 44 (18·5%) were determined to be at risk of dysphagia based on the MWST scores. The odds ratio (OR) of dysphagia risk decreased in subjects with higher total FTUs [OR = 0·92, 95% confidence interval (CI) 0·87-0·98]. After adjusting for covariates, this association remained significant (OR = 0·90, 95% CI 0·84-0·97). Loss of posterior teeth occlusion was independently associated with dysphagia risk in older nursing home residents. Maintaining and restoring posterior teeth occlusion may be an effective measure to prevent dysphagia. © 2016 John Wiley & Sons Ltd.

The Nursing Home Culture-Change Movement: Recent Past, Present, and Future Directions for Research

Science.gov (United States)

Rahman, Anna N.; Schnelle, John F.

2008-01-01

This article uses a retrospective approach to critique the research base underlying the nursing home culture-change movement--an effort to radically transform the nation's nursing homes by delivering resident-directed care and empowering staff. The article traces the development of the movement from its inception 10 years ago to 2005, when the…

Influence of sociodemographic factors on the risk of unintentional childhood home injuries

DEFF Research Database (Denmark)

Laursen, Bjarne; Nielsen, Jeppe W

2008-01-01

. Risk differences were found for all injury mechanisms; however the risk for burns was 1.9 (1.6-2.3) times higher in the lowest-income group than in the highest-income group, the relative risk for poisoning was 1.7(1.4-2.1). For scalds from hot water, tea or coffee, the relative risk for the lowest......-income group was 2.4(1.8-3.2). Living in a one- or two-parent family and size of the dwelling had little or no effect on risk. CONCLUSION: Childhood injury incidence depended on sociodemographic factors. The effect of the sociodemographic factors varied between injury mechanisms and products involved......BACKGROUND: While social differences in childhood injuries are recognized, less is known about how social and demographic differences relate to injury mechanism. The purpose of the study was to reveal how sociodemographic factors affect the incidence of unintentional home injuries in Danish...

History of Maltreatment in Childhood and Subsequent Parenting Stress in At-Risk, First-Time Mothers: Identifying Points of Intervention During Home Visiting.

Science.gov (United States)

Shenk, Chad E; Ammerman, Robert T; Teeters, Angelique R; Bensman, Heather E; Allen, Elizabeth K; Putnam, Frank W; Van Ginkel, Judith B

2017-04-01

Home visiting is an effective preventive intervention that can improve parenting outcomes for at-risk, new mothers, thereby optimizing subsequent child development. A history of maltreatment in childhood is common in mothers participating in home visiting, yet the extent to which such a history is related to parenting outcomes during home visiting is unknown. The current study evaluated whether mothers with a history of maltreatment in childhood respond less favorably to home visiting by examining the direct and indirect pathways to subsequent parenting stress, a key parenting outcome affecting child development. First-time mothers (N = 220; age range = 16-42) participating in one of two home visiting programs, Healthy Families America or Nurse Family Partnership, were evaluated at enrollment and again at 9-and 18-month post-enrollment assessments. Researchers administered measures of maternal history of maltreatment in childhood, depressive symptoms, social support, and parenting stress. Maternal history of maltreatment in childhood predicted worsening parenting stress at the 18-month assessment. Mediation modeling identified two indirect pathways, one involving social support at enrollment and one involving persistent depressive symptoms during home visiting, that explained the relation between a history of maltreatment in childhood and parenting stress at the 18-month assessment. Ways to improve the preventive effects of home visiting for mothers with a history of maltreatment in childhood through the identification of relevant intervention targets and their ideal time of administration are discussed.

Overview of research work activities in German language in the Home Automation area; Ueberblick deutschsprachiger Forschungsaktivitaeten im Bereich Home Automation. Forschungsinstitute, Themen, Ergebnisse - Schlussbericht

Energy Technology Data Exchange (ETDEWEB)

Staub, R.

2010-02-15

This final report for the Swiss Federal Office of Energy (SFOE) takes a look at research work carried out in Germany and Austria on 'smart homes'. The aim of the project was to determine which work has already been carried out in Germany and Austria so that work in Switzerland can be concentrated on questions that have not been looked at in Germany and Austria. The appropriate research institutions are listed. Concrete projects are briefly described and their relevance for Swiss efforts is examined. Various Home Automation project categories are listed, as are the most important research institutes involved. The particular research projects in Germany and Austria and their relevance to Swiss efforts are listed.

Planned home versus planned hospital births in women at low-risk pregnancy: A systematic review with meta-analysis.

Science.gov (United States)

Rossi, A Cristina; Prefumo, Federico

2018-03-01

New interest in home birth have recently arisen in women at low risk pregnancy. Maternal and neonatal morbidity of women planning delivery at home has yet to be comprehensively quantified. We aimed to quantify pregnancy outcomes following planned home (PHB) versus planned hospital birth (PHos). We did a systematic review of maternal and neonatal morbidity following planned home (PHB) versus planned hospital birth (PHos). We included prospective, retrospective, cohort and case-control studies of low risk pregnancy outcomes according to planning place of birth, identified from January 2000 to June 2017. We excluded studies in which high-risk pregnancy and composite morbidity were included. Outcomes of interest were: maternal and neonatal morbidity/mortality, medical interventions, and delivery mode. We pooled estimates of the association between outcomes and planning place of birth using meta-analyses. The study protocol is registered with PROSPERO, protocol number CRD42017058016. We included 8 studies of the 4294 records identified, consisting in 14,637 (32.6%) in PHB and 30,177 (67.4%) in PHos group. Spontaneous delivery was significantly higher in PHB than PHos group (OR: 2.075; 95%CI:1.654-2.063) group. Women in PHB group were less likely to undergo cesarean section compared with women in PHos (OR:0.607; 95%CI:0.553-0.667) group. PHB group was less likely to receive medical interventions than PHos group. The risk of fetal dystocia was lower in PHB than PHos group (OR:0.287; 95%CI:0.133-0.618). The risk of post-partum hemorrhage was lower in PHB than PHos group (OR:0.692; 95% CI.0.634-0.755). The two groups were similar with regard to neonatal morbidity and mortality. Births assisted at hospital are more likely to receive medical interventions, fetal monitoring and prompt delivery in case of obstetrical complications. Further studies are needed in order to clarify whether home births are as safe as hospital births. Copyright © 2018 Elsevier B.V. All rights

Identifying fallers with Parkinson's disease using home-based tests: who is at risk?

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Lim, Inge; van Wegen, Erwin; Jones, Diana; Rochester, Lynn; Nieuwboer, Alice; Willems, Anne Marie; Baker, Katherine; Hetherington, Vicki; Kwakkel, Gert

2008-12-15

The objective of this work is to determine risk factors for falling in patients with Parkinson's disease (PD) using home-based assessments and develop a prediction model. Data on falls, balance, gait-related activities, and nonmotor symptoms were obtained from 153 PD patients (Hoehn-Yahr 2-4) in their home. Fifty-one candidate determinants for falling were independently tested using bivariate logistic regression analysis. A multivariate logistic regression model was developed to identify patients susceptible to falls. Sixty-six subjects (43%) were classified as fallers. Eighteen determinants for falling were selected. The final multivariate model showed an accuracy of 74% and included: (1) Freezing of Gait Questionnaire, (2) Timed Get Up and Go (TGUG) score, (3) disease duration, (4) item 15 of the Unified Parkinson's Disease Rating Scale. Based on disease duration, freezing symptoms, walking problems, and a prolonged TGUG duration, assessed in the home situation, it was possible to accurately identify 74% of PD patients as fallers. (c) 2008 Movement Disorder Society.

Ethics and gender issues in palliative care in nursing homes: an Austrian participatory research project.

Science.gov (United States)

Reitinger, Elisabeth; Heimerl, Katharina

2014-06-01

The development of palliative care in nursing homes in German-speaking countries has gained in importance within the past 15-20 years. Ethical and gender issues are core aspects of a palliative care culture and should therefore be better understood. The aim of this study was to highlight insights regarding ethical and gender issues, based on the experiences of professionals in nursing homes. A 2-year participatory action research study was performed in collaboration with three nursing homes in Austria. The article focusses on 10 group discussions with interdisciplinary professional teams that were conducted to generate ethical narratives. Thematic and narrative analysis was undertaken both individually and within the interdisciplinary research team. Findings and interpretations were validated with practitioners and researchers. A total of 36 narratives were collected and summarised within eight themes concerning the theoretical journey of a nursing home resident with relatives from entry into the house until death. The most burdensome ethical dilemmas are not the ones around death and dying but rather those relating to small-scale everyday work/life issues. Sharing experiences and feelings in ethical discussions provides relief. Emotions are important facilitators of insight into ethical dilemmas. Gender issues can be observed in care situations as well as in the organisational structure of nursing homes. Opportunities to share experiences and perspectives around ethical questions in interdisciplinary group discussions help professionals to better understand difficult issues and find appropriate ways of managing them. There is a need for communication structures such as facilitated ethical discussions that enable nursing home staff to reflect their everyday decisions. Expression of emotions should be encouraged in ethical decision-making processes in nursing homes. Gender-sensitive reflection supports the development of palliative care as organisational culture. �

The Prevalence of Child Sexual Abuse in Out-of-Home Care: Increased Risk for Children with a Mild Intellectual Disability

Science.gov (United States)

Euser, Saskia; Alink, Lenneke R. A.; Tharner, Anne; van IJzendoorn, Marinus H.; Bakermans-Kranenburg, Marian J.

2016-01-01

Background: Children without disabilities in out-of-home care have a higher risk of child sexual abuse [CSA (Euser et al. 2013)]. In this study, we examined the year prevalence of CSA in out-of-home care for children with a mild intellectual disability, and compared it with the prevalence in out-of-home care for non-disabled children and children…

Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research.

Science.gov (United States)

Smithson, Janet; Garside, Ruth; Pearson, Mark

2011-04-01

This review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks at risk assessments. A systematic review of qualitative research. Bibliographic databases were searched for studies on interventions to reduce unintentional child injury in the home, or on related attitudes and behaviours. Studies were quality appraised, findings extracted, and a conceptual framework was developed to assess factors affecting the success of interventions. Nine peer-reviewed journal articles were included. Barriers and facilitators were highlighted at organisational, environmental and personal levels. Effective provision of safety equipment involves ongoing support with installation and maintenance. Take up and success of interventions depends on adjusting interventions according to practical limitations and parents' cultural expectations. A particular barrier was parents' inability to modify rented or shared accommodation. The review highlights ways in which health inequalities affect the take up and success of home safety interventions, and how health workers can use this knowledge to facilitate future interventions.

Work-home interference in relation to work, organizational, and home characteristics

NARCIS (Netherlands)

Dikkers, J.S.E.

2008-01-01

In this thesis we examine work-home interference in relation to work, organizational, and home characteristics. The study is guided by the following three research questions: i) how are workload and negative WHI temporally related? (research question 1); ii) is work-home culture related to the use

Dutch home-based pre-reading intervention with children at familial risk of dyslexia

OpenAIRE

van Otterloo, Sandra G.; van der Leij, Aryan

2009-01-01

Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected a year earlier. After training, we found a small effect on a composite score of phoneme awareness (d = 0.29) and a large effect on receptive letter knowledge (d  = 0.88). In first grade, however, t...

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting.

Science.gov (United States)

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

2012-09-01

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research. © 2012 John Wiley & Sons A/S.

Home telemonitoring of vital signs--technical challenges and future directions.

Science.gov (United States)

Celler, Branko G; Sparks, Ross S

2015-01-01

The telemonitoring of vital signs from the home is an essential element of telehealth services for the management of patients with chronic conditions, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, or poorly controlled hypertension. Telehealth is now being deployed widely in both rural and urban settings, and in this paper, we discuss the contribution made by biomedical instrumentation, user interfaces, and automated risk stratification algorithms in developing a clinical diagnostic quality longitudinal health record at home. We identify technical challenges in the acquisition of high-quality biometric signals from unsupervised patients at home, identify new technical solutions and user interfaces, and propose new measurement modalities and signal processing techniques for increasing the quality and value of vital signs monitoring at home. We also discuss use of vital signs data for the automated risk stratification of patients, so that clinical resources can be targeted to those most at risk of unscheduled admission to hospital. New research is also proposed to integrate primary care, hospital, personal genomic, and telehealth electronic health records, and apply predictive analytics and data mining for enhancing clinical decision support.

Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial.

Science.gov (United States)

Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe; Damsbo-Svendsen, Signe; Kreinfeldt Skovgaard Møller, Tina; Boll Hansen, Eigil; Keiding, Hans

2014-08-28

Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition. Hence a structured and multidisciplinary approach, focusing on the nutritional risk factors and involving e.g. dieticians, occupational therapists, and physiotherapist, may be necessary to achieve benefits. Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care, identified by screening with the Eating validation Scheme. Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator, the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support. Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality's ordinary assessment and referral system.The primary outcome parameter will be change in quality of life (by means of Euroquol-5D-3L). Secondary outcomes will be: physical performance (chair stand), nutritional status (weight, Body Mass Index and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary

User preferences and usability of iVitality: optimizing an innovative online research platform for home-based health monitoring

Directory of Open Access Journals (Sweden)

van Osch M

2015-06-01

Full Text Available Mara van Osch,1 AJM Rövekamp,2 Stephanie N Bergman-Agteres,1 Liselotte W Wijsman,3,4 Sharon J Ooms,5 Simon P Mooijaart,3,4,6 Joan Vermeulen71Netherlands Institute for Health Services Research, Utrecht, 2Netherlands Organization for Applied Scientific Research, 3Department of Gerontology and Geriatrics, Leiden University Medical Centre, 4Netherlands Consortium for Healthy Ageing, Leiden, 5Department of Geriatric Medicine, Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, 6Institute for Evidence-Based Medicine in Old Age, Leiden, 7Research School, CAPHRI, Maastricht University, Maastricht, the NetherlandsBackground: The iVitality online research platform has been developed to gain insight into the relationship between early risk factors (ie, poorly controlled hypertension, physical or mental inactivity and onset and possibly prevention of dementia. iVitality consists of a website, a smartphone application, and sensors that can monitor these indicators at home. Before iVitality can be implemented, it should fit the needs and preferences of users, ie, offspring of patients with dementia. This study aimed to explore users’ motivation to participate in home-based health monitoring research, to formulate requirements based on users’ preferences to optimize iVitality, and to test usability of the smartphone application of iVitality.Methods: We recruited 13 participants (aged 42–64 years, 85% female, who were offspring of patients with dementia. A user-centered methodology consisting of four iterative phases was used. Three semistructured interviews provided insight into motivation and acceptance of using iVitality (phase 1. A focus group with six participants elaborated on expectations and preferences regarding iVitality (phase 2. Findings from phase 1 and 2 were triangulated by two semistructured interviews (phase 3. Four participants assessed the usability of the smartphone application (phase 4 using a think aloud

Home safe home: Evaluation of a childhood home safety program.

Science.gov (United States)

Stewart, Tanya Charyk; Clark, Andrew; Gilliland, Jason; Miller, Michael R; Edwards, Jane; Haidar, Tania; Batey, Brandon; Vogt, Kelly N; Parry, Neil G; Fraser, Douglas D; Merritt, Neil

2016-09-01

The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. Therapeutic/care management study

The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector.

Science.gov (United States)

Gershon, Robyn R M; Pearson, Julie M; Sherman, Martin F; Samar, Stephanie M; Canton, Allison N; Stone, Patricia W

2009-09-01

Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted. A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure. Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others. The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.

Unpacking socio-economic risks for reading and academic self-concept in primary school: Differential effects and the role of the preschool home learning environment.

Science.gov (United States)

Crampton, Alexandria; Hall, James

2017-09-01

Uncertainty remains concerning how children's reading and academic self-concept are related and how these are differentially affected by social disadvantage and home learning environments. To contrast the impacts of early socio-economic risks and preschool home learning environments upon British children's reading abilities and academic self-concept between 7 and 10 years. n = 3,172 British children aged 3-10 years and their families. A secondary analysis of the nationally representative UK EPPE database. Multilevel structural equation modelling calculated the direct, indirect, and total impacts of early socio-economic risks (0-3 years) and preschool home learning environments (3-5 years) upon children's reading ability and academic self-concept between 7 and 10 years. Early socio-economic risk had different effects upon children's reading ability and academic self-concept. Early socio-economic risks affected children's reading at ages 7 and 10 both directly and indirectly via effects upon preschool home learning environments. By contrast, early socio-economic risks had only indirect effects upon children's academic self-concept via less stimulating home learning environments in the preschool period and by limiting reading abilities early on in primary school. Although the impacts of early socio-economic risks are larger and more easily observed upon reading than upon academic self-concept, they can impact both by making it less likely that children will experience enriching home learning environments during the preschool period. This has implications for social policymakers, early educators, and interventionists. Intervening early and improving preschool home learning environments can do more than raise children's reading abilities; secondary benefits may also be achievable upon children's self-concept. © 2017 The British Psychological Society.

Research Insights About Risk Governance

Directory of Open Access Journals (Sweden)

Therese R. Viscelli

2016-11-01

Full Text Available In recent years, expectations for increased risk governance have been placed explicitly on boards of directors. In response, boards are being held responsible for not only understanding and approving management’s risk management processes, but they are also being held responsible for assessing the risks identified by those processes as part of overseeing management’s pursuit of value. These increasing responsibilities have led a number of organizations to adopt enterprise risk management (ERM as a holistic approach to risk management that extends beyond traditional silo-based risk management techniques. As boards, often through their audit committee, consider management’s implementation of ERM as part of the board’s risk oversight, a number of questions emerge that can be informed by academic research related to ERM. This article summarizes findings from ERM research to provide insights related to the board’s risk governance responsibilities. We also identify a number of research questions that warrant further analysis by governance scholars. It is our hope that this article will spawn varying types of research about ERM and corporate governance.

Outcomes and risk factors for unplanned delivery at home and before arrival to the hospital.

Science.gov (United States)

Lazić, Zlatko; Takač, Iztok

2011-01-01

The aim of this study was to analyze the outcomes and risk factors for unplanned delivery at home and before arrival to the hospital in Maribor region, Slovenia. We used data from medical records of all deliveries in Maribor region from the year 1997 to the year 2005. We analysed a total of 17,846 births from annual reports of the Maribor University Hospital. Among the total of 17,846 births, there were 58 (3.2‰) unplanned births at home and on the way to the hospital. The study based on the data from medical records on safety of unplanned home birth reveals that hospital delivery is approximately 7 times safer than unplanned home delivery. This conclusion is reached by comparing perinatal mortality, which was 68‰ for unplanned deliveries at home versus 8.8‰ for deliveries at hospital. The prematurity was more common in unplanned home deliveries: 13 (22%) versus 1399 (8%) for hospital deliveries. Unplanned deliveries at home and on the way to the hospital were more common in multiparous women (ratio 4:1 compared to 1:1 for hospital births). When for all hospital deliveries the pregnancies were followed, for one third of unplanned deliveries at home or on the way to the hospital the pregnancies were not monitored. Mothers who gave birth at home or on the way to the hospital were without higher education (i.e. 55.2%) and mothers who gave birth in hospital were with higher education (i.e. 87.4%). There was higher rate of perinatal morbidity for unplanned home deliveries compared to hospital deliveries. Factors that make unplanned home deliveries more common are high parity, absence or inadequacy of antenatal care, marital status and lower education. Some conditions in newborn, such as hypothermia, were clearly the result of unplanned birth at home. Additional effort to improve antenatal care and also identifying social vulnerabilities would possibly decrease the number of unplanned deliveries and improve the perinatal outcomes.

Virtual rehabilitation: what are the practical barriers for home-based research?

OpenAIRE

Threapleton, Kate; Drummond, Avril E.R.; Standen, Penny

2016-01-01

Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations ...

Formal home help services and institutionalization

DEFF Research Database (Denmark)

Yamada, Yukari; Siersma, Volkert; Avlund, Kirsten

2012-01-01

The effect of home help services has been inconsistent. Raising the hypothesis that receiving small amounts of home help may postpone or prevent institutionalization, the aim of the present study is to analyze how light and heavy use of home help services was related to the risk...... for institutionalization. The study was a secondary analysis of a Danish intervention study on preventive home visits in 34 municipalities from 1999 to 2003, including 2642 home-dwelling older people who were nondisabled and did not receive public home help services at baseline in 1999 and who lived at home 18 months...... after baseline. Cox regression analysis showed that those who received home help services during the first 18 months after baseline were at higher risk of being institutionalized during the subsequent three years than those who did not receive such services. However, receiving home help for less than 1h...

Smart homes, private homes? An empirical study of technology researchers? perceptions of ethical issues in developing smart-home health technologies

OpenAIRE

Birchley, Giles; Huxtable, Richard; Murtagh, Madeleine; ter Meulen, Ruud; Flach, Peter; Gooberman-Hill, Rachael

2017-01-01

Background Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology?s potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engine...

Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: a retrospective cohort study.

Science.gov (United States)

Halfdansdottir, Berglind; Smarason, Alexander Kr; Olafsdottir, Olof A; Hildingsson, Ingegerd; Sveinsdottir, Herdis

2015-03-01

At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland. The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables. The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated. This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth. © 2015 Wiley Periodicals, Inc.

Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

Science.gov (United States)

Lawrence, Sharmila; Stephens, Samuel A.

2016-01-01

This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

Fundamental elements in examining a child’s right to education: A study of home education research and regulation in Australia

Directory of Open Access Journals (Sweden)

Glenda JACKSON

2010-07-01

Full Text Available Home education provides valuable educational and developmental opportunities for children. An examination of Australia’s research indicates many best educational practices, including more informed mediation, contextualised learning, and opportunities to exercise autonomy. Key features include learning embedded in communities and program modification in response to students’ needs. Current state and territory legal requirements are examined within the context of this research and Australia’s obligations to international human rights treaties. All jurisdictions accept home education as one way to meet compulsory education requirements. The extent to which respective laws then reflect understanding of home education research and practice varies. Most jurisdictions allow for a varietyof educational approaches. Some oversight regulation could however be modified to reflect a better understanding of home education. Consultation with home educators and reference to research would assist the development of more uniform legislation and policy across Australia, and enable better regulatory practice.

Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births

NARCIS (Netherlands)

de jonge, A.; van der Goes, B. Y.; Ravelli, A. C. J.; Amelink-Verburg, M. P.; Mol, B. W.; Nijhuis, J. G.; Bennebroek Gravenhorst, J.; Buitendijk, S. E.

2009-01-01

OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women

The Impact of a Home-Based Computerized Cognitive Training Intervention on Fall Risk Measure Performance in Community Dwelling Older Adults, a Pilot Study.

Science.gov (United States)

Blackwood, J; Shubert, T; Fogarty, K; Chase, C

2016-02-01

Cognitive intervention studies have reported improvements in various domains of cognition as well as a transfer effect of improved function post training. Despite the availability of web based cognitive training programs, most intervention studies have been performed under the supervision of researchers. Therefore, the purpose of this study was to first, examine the feasibility of a six week home based computerized cognitive training (CCT) program in a group of community dwelling older adults and, second, to determine if a CCT program which focused on set shifting, attention, and visual spatial ability impacted fall risk measure performance. This pilot study used a pretest/posttest experimental design with randomization by testing site to an intervention or control group. Community dwelling older adults (mean age = 74.6 years) participated in either the control (N=25) or the intervention group (N=19). Intervention group subjects participated in 6 weeks of home based CCT 3x/week for an average of 23 minutes/session, using an online CCT program. Comparisons of mean scores on three measures of physical function (usual gait speed, five times sit to stand, timed up and go) were completed at baseline and week 7. Following the completion of an average of 18 sessions of CCT at home with good adherence (86%) and retention (92%) rates, a statistically significant difference in gait speed was found between groups with an average improvement of 0.14 m/s in the intervention group. A home based CCT program is a feasible approach to targeting cognitive impairments known to influence fall risk and changes in gait in older adults.

Institutional and Cultural Perspectives on Home Birth in Israel

Science.gov (United States)

Meroz, Michal (Rosie); Gesser-Edelsburg, Anat

2015-01-01

ABSTRACT This study exposes doctors’ and midwives’ perceptions and misperceptions regarding home birth by examining their views on childbirth in general and on risk associated with home births in particular. It relies on an approach of risk communication and an anthropological framework. In a qualitative-constructive study, 19 in-depth interviews were conducted with hospital doctors, hospital midwives, home-birth midwives, and a home-birth obstetrician. Our findings reveal that hospital midwives and doctors suffer from lack of exposure to home births, leading to disagreement regarding norms and risk; it also revealed sexist or patriarchal worldviews. Recommendations include improving communication between home-birth midwives and hospital counterparts; increased exposure of hospital doctors to home birth, creating new protocols in collaboration with home-birth midwives; and establishing a national database of home births. PMID:26937159

Medication use and risk of falls among nursing home residents: a retrospective cohort study.

Science.gov (United States)

Bor, Andrea; Matuz, Mária; Csatordai, Márta; Szalai, Gábor; Bálint, András; Benkő, Ria; Soós, Gyöngyvér; Doró, Péter

2017-04-01

Background Geriatric falls are leading causes of hospital trauma admissions and injury-related deaths. Medication use is a crucial element among extrinsic risk factors for falls. To reduce fall risk and the prevalence of adverse drug reactions, potentially inappropriate medication (PIM) lists are widely used. Objective Our aim was to investigate the possible predictors of geriatric falls annualized over a 5-year-long period, as well as to evaluate the medication use of nursing home residents. Setting Nursing home residents were recruited from the same institution between 2010 and 2015 in Szeged, Hungary. Method A retrospective epidemiological study was performed. Patient data were analysed for the first 12 months of residency. Chi-squared test and Fisher's-test were applied to compare the categorical variables, Student's t test to compare the continuous variables between groups. Binary logistic regression analysis was carried out to determine the association of falls with other variables found significant in univariate analysis. Microsoft Excel, IBM SPSS Statistics (version 23) and R (3.2.2) programs were used for data analysis. Main outcome measure Falls affected by age, gender, number of chronic medications, polypharmacy, PIM meds. Results A total of 197 nursing home residents were included, 150 (76.2%) women and 47 (23.8%) men, 55 fallers (annual fall prevalence rate was 27.9%) and 142 non-fallers. Gender was not a predisposing factor for falls (prevalence in males: 23.4 vs 29.3% in females, p > 0.05). Fallers were older (mean years ± SD; 84.0 ± 7.0) than non-fallers (80.1 ± 9.3, p factor for falls (p factor of falls (p fall risk were taken by 70.9% of fallers and 75.3% of non-fallers (p > 0.05). Taking pantoprazole, vinpocetine or trimetazidine was a significant risk factor for falls. Conclusion Older age, polypharmacy and the independent use of pantoprazole, vinpocetine, and trimetazidine were found to be major risk factors for falls. Further

Malpractice paid losses and financial performance of nursing homes.

Science.gov (United States)

Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J

2011-01-01

Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

Improving Elderly's Dental Hygiene Through Nursing Home Staff's Dental Health Education at the Nursing Home

OpenAIRE

Santoso, Bedjo; Eko Ningtyas, Endah Aryati; Fatmasari, Diyah

2017-01-01

Stomatitis often occurs in elderly at nursing home. They need nursing home staff assistance to maintain their dental and oral health. Therefore, nursing home staff need dental health education. Lecture or discussion methods, which are more effective to improve knowledge, attitude and skill of nursing home staff was the purpose of this research. The research design was quasi-experiment research and pretest-posttest with control group. The sample was 42 nursing home staffs and 74 elderlies, div...

ThinkHome Energy Efficiency in Future Smart Homes

OpenAIRE

Christian Reinisch; Mario J. Kofler; Félix Iglesias; Wolfgang Kastner

2011-01-01

Abstract Smart homes have been viewed with increasing interest by both home owners and the research community in the past few years. One reason for this development is that the use of modern automation technology in the home or building promises considerable savings of energy, therefore, simultaneously reducing the operational costs of the building over its whole lifecycle. However, the full potential of smart homes still lies fallow, due to the complexity and diversity of the systems, badly ...

Disparities in risk communication: a pilot study of asthmatic children, their parents, and home environments.

Science.gov (United States)

Biksey, Thomas; Zickmund, Susan; Wu, Felicia

2011-05-01

Parents' knowledge and control of asthma triggers in home environments can help reduce risks associated with asthmatic children's respiratory health. This pilot study used both qualitative and quantitative methods to determine parental knowledge of their children's asthma triggers in home environments, control of those triggers, and information received and trusted. Twelve parents of asthmatic children in the greater Pittsburgh area--8 white and 4 African American--participated in one-on-one interviews about home exposures to asthma triggers. All parents described the link between asthma symptoms and both environmental tobacco smoke (ETS) and pet dander exposures. House dust mites and mold were also commonly identified asthma triggers. All 8 white parents reported receiving information from physicians about controlling home environmental triggers of asthma, but the 4 African American parents reported having received no such information. However, all 12 parents reported having greater trust in information received from physicians than from other sources. White parents were significantly more aware of potential asthma triggers and performed significantly more actions to control the triggers in their homes. African American parents noted stressful experiences with primary and secondary care, less recall of information sharing about asthma triggers, and a focus on symptom management vs trigger avoidance.

Could In-Home Sensors Surpass Human Observation of People with Parkinson’s at High Risk of Falling? An Ethnographic Study

Directory of Open Access Journals (Sweden)

Emma Stack

2016-01-01

Full Text Available Self-report underpins our understanding of falls among people with Parkinson’s (PwP as they largely happen unwitnessed at home. In this qualitative study, we used an ethnographic approach to investigate which in-home sensors, in which locations, could gather useful data about fall risk. Over six weeks, we observed five independently mobile PwP at high risk of falling, at home. We made field notes about falls (prior events and concerns and recorded movement with video, Kinect, and wearable sensors. The three women and two men (aged 71 to 79 years having moderate or severe Parkinson’s were dependent on others and highly sedentary. We most commonly noted balance protection, loss, and restoration during chair transfers, walks across open spaces and through gaps, turns, steps up and down, and tasks in standing (all evident walking between chair and stairs, e.g.. Our unobtrusive sensors were acceptable to participants: they could detect instability during everyday activity at home and potentially guide intervention. Monitoring the route between chair and stairs is likely to give information without invading the privacy of people at high risk of falling, with very limited mobility, who spend most of the day in their sitting rooms.

Nursing home-acquired pneumonia, dysphagia and associated diseases in nursing home residents: A retrospective, cross-sectional study

NARCIS (Netherlands)

Hollaar, V.R.Y.; Putten, G.J. van der; Maarel-Wierink, C.D. van der; Bronkhorst, E.M.; Swart, B.J.M. de; Baat, C. de; Creugers, N.H.J.

2017-01-01

BACKGROUND: Nursing home-acquired pneumonia (NHAP) is a common infection among nursing home residents. There is also a high prevalence of dysphagia in nursing home residents and they suffer more often from comorbidity and multimorbidity. This puts nursing home residents at higher risk of (mortality

Achieving external validity in home advantage research: generalizing crowd noise effects

Directory of Open Access Journals (Sweden)

Tony D Myers

2014-06-01

Full Text Available Different factors have been postulated to explain the home advantage phenomenon in sport. One plausible explanation investigated has been the influence of a partisan home crowd on sports officials’ decisions. Different types of studies have tested the crowd influence hypothesis including purposefully designed experiments. However, while experimental studies investigating crowd influences have high levels of internal validity, they suffer from a lack of external validity; decision-making in a laboratory setting bearing little resemblance to decision-making in live sports settings. This focused review initially considers threats to external validity in applied and theoretical experimental research. Discussing how such threats can be addressed using representative design by focusing on a recently published study that arguably provides the first experimental evidence of the impact of live crowd noise on officials in sport. The findings of this controlled experiment conducted in a real tournament setting offer some confirmation of the validity of laboratory experimental studies in the area. Finally directions for future research and the future conduct of crowd noise studies are discussed.

Achieving external validity in home advantage research: generalizing crowd noise effects.

Science.gov (United States)

Myers, Tony D

2014-01-01

Different factors have been postulated to explain the home advantage phenomenon in sport. One plausible explanation investigated has been the influence of a partisan home crowd on sports officials' decisions. Different types of studies have tested the crowd influence hypothesis including purposefully designed experiments. However, while experimental studies investigating crowd influences have high levels of internal validity, they suffer from a lack of external validity; decision-making in a laboratory setting bearing little resemblance to decision-making in live sports settings. This focused review initially considers threats to external validity in applied and theoretical experimental research. Discussing how such threats can be addressed using representative design by focusing on a recently published study that arguably provides the first experimental evidence of the impact of live crowd noise on officials in sport. The findings of this controlled experiment conducted in a real tournament setting offer a level of confirmation of the findings of laboratory studies in the area. Finally directions for future research and the future conduct of crowd noise studies are discussed.

Brain research to ameliorate impaired neurodevelopment--home-based intervention trial (BRAIN-HIT).

Science.gov (United States)

Wallander, Jan L; McClure, Elizabeth; Biasini, Fred; Goudar, Shivaprasad S; Pasha, Omrana; Chomba, Elwyn; Shearer, Darlene; Wright, Linda; Thorsten, Vanessa; Chakraborty, Hrishikesh; Dhaded, Sangappa M; Mahantshetti, Niranjana S; Bellad, Roopa M; Abbasi, Zahid; Carlo, Waldemar

2010-04-30

This randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low- and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low- and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality and morbidity from birth asphyxia disproportionately affect more infants in low- and low-middle-income countries, particularly those from the lowest socioeconomic groups. There is evidence that relatively inexpensive programs of early developmental intervention, delivered during home visit by parent trainers, are capable of improving neurodevelopment in infants following brain insult due to birth asphyxia. This trial is a block-randomized controlled trial that has enrolled 174 children with birth asphyxia and 257 without perinatal complications, comparing early developmental intervention plus health and safety counseling to the control intervention receiving health and safety counseling only, in sites in India, Pakistan, and Zambia. The interventions are delivered in home visits every two weeks by parent trainers from 2 weeks after birth until age 36 months. The primary outcome of the trial is cognitive development, and secondary outcomes include social-emotional and motor development. Child, parent, and family characteristics and number of home visits completed are evaluated as moderating factors. The trial is supervised by a trial steering committee, and an independent data monitoring committee monitors the trial. Findings from this trial have the potential

The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes

Science.gov (United States)

Walker, Gemma M; Armstrong, Sarah; Gordon, Adam L; Gladman, John; Robertson, Kate; Ward, Marie; Conroy, Simon; Arnold, Gail; Darby, Janet; Frowd, Nadia; Williams, Wynne; Knowles, Sue; Logan, Pip A

2015-01-01

Objective: To explore the feasibility of implementing and evaluating the Guide to Action Care Home fall prevention intervention. Design: Two-centre, cluster feasibility randomized controlled trial and process evaluation. Setting: Purposive sample of six diverse old age/learning disability, long stay care homes in Nottinghamshire, UK. Subjects: Residents aged over 50 years, who had fallen at least once in the past year, not bed-bound, hoist-dependent or terminally ill. Interventions: Intervention homes (n = 3) received Guide to Action Care Home fall prevention intervention training and support. Control homes (n = 3) received usual care. Outcomes: Recruitment, attrition, baseline and six-month outcome completion, contamination and intervention fidelity, compliance, tolerability, acceptance and impact. Results: A total of 81 of 145 (56%) care homes expressed participatory interest. Six of 22 letter respondent homes (27%) participated. The expected resident recruitment target was achieved by 76% (52/68). Ten (19%) residents did not complete follow-up (seven died, three moved). In intervention homes 36/114 (32%) staff attended training. Two of three (75%) care homes received protocol compliant training. Staff valued the training, but advised greater management involvement to improve intervention implementation. Fall risks were assessed, actioned and recorded in care records. Of 115 recorded falls, 533/570 (93%) of details were complete. Six-month resident fall rates were 1.9 and 4.0 per year for intervention and control homes, respectively. Conclusions: The Guide to Action Care Home is implementable under trial conditions. Recruitment and follow-up rates indicate that a definitive trial can be completed. Falls (primary outcome) can be ascertained reliably from care records. PMID:26385358

Credit Risk Research

DEFF Research Database (Denmark)

Zamore, Stephen; Ohene Djan, Kwame; Alon, Ilan

2018-01-01

This article provides a comprehensive review of scholarly research on credit risk measurement during the last 57 years applying bibliometric citation analysis and elaborates an agenda for future research. The bibliography is compiled using the Institute for Scientific Information (ISI) Web...... of Science (WOS) database and includes all articles with citations over the period 1960–2016. Specifically, the review is carried out using 1695 articles across 72 countries published in 442 journals by 2928 authors. The findings suggest that credit risk research is multifaceted and can be classified...... into six streams: (1) defaultable security pricing, (2) default intensity modeling, (3) comparative analysis of credit models, (4) comparative analysis of credit markets, (5) credit default swap (CDS) pricing, and (6) loan loss provisions. The article contributes through synthesizing and identifying...

Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study.

Science.gov (United States)

Blix, Ellen; Huitfeldt, Anette Schaumburg; Øian, Pål; Straume, Bjørn; Kumle, Merethe

2012-12-01

The safety of planned home births remains controversial in Western countries. The aim of the present study was to compare outcomes in women who planned, and were selected to, home birth at the onset of labor with women who planned for a hospital birth. Data from 1631 planned home births between 1990 and 2007 were compared with a random sample of 16,310 low-risk women with planned hospital births. The primary outcomes were intrapartum intervention rates and complications. Secondary outcomes were perinatal and neonatal death rates. Primiparas who planned home births had reduced risks for assisted vaginal delivery (OR 0.32; 95% CI 0.20-0.48), epidural analgesia (OR 0.21; CI 0.14-0.33) and dystocia (OR 0.40; CI 0.27-0.59). Multiparas who planned home births had reduced risks for operative vaginal delivery (OR 0.26; CI 0.12-0.56), epidural analgesia (OR 0.08; CI 0.04-0.16), episiotomy (OR 0.48; CI 0.31-0.75), anal sphincter tears (OR 0.29; CI 0.12-0.70), dystocia (OR 0.10; CI 0.06-0.17) and postpartum hemorrhage (OR 0.27; CI 0.17-0.41). We found no differences in cesarean section rate. Perinatal mortality rate was 0.6/1000 (CI 0-3.4) and neonatal mortality rate 0.6/1000 (CI 0-3.4) in the home birth cohort. In the hospital birth cohort, the rates were 0.6/1000 (CI 0.3-1.1) and 0.9/1000 (CI 0.5-1.5) respectively. Planning for home births was associated with reduced risk of interventions and complications. The study is too small to make statistical comparisons of perinatal and neonatal mortality. Copyright © 2012 Elsevier B.V. All rights reserved.

Work–home interference: Examining socio-demographic predictors in the South African context

Directory of Open Access Journals (Sweden)

Marissa de Klerk

2010-04-01

Research purpose: The main research aim of the study was to investigate the socio-demographic predictors of negative and positive work–home interaction of South African employees. Motivation for the study: Little information is known about the prevalence of work–home interaction within groups. This study is aimed at enabling the researcher and organisations to identify those groups that are at risk of negative interference and which are prone to positive interaction, to allow for the development of appropriate strategies and intervention programmes. Research design, approach and method: A cross-sectional survey design was used in the study. A sample (N = 2040 was taken from four South African industries (i.e. the police service, the earthmoving equipment industry, mining and nursing. A socio-demographic questionnaire and the Survey Work–Home Interaction-Nijmegen (SWING were used. Main findings: The results indicated that robust predictors included occupation, gender and language for negative work–home interference; occupation, age and language for positive work–home interference; occupation and language for negative home–work interference; and occupation, age, education and language for positive home–work interference. Practical/managerial implications: The implications of the study are that negative and positive work–home interaction is uniquely associated with socio-demographic characteristics. Work–life balance initiatives should, therefore, be carefully tailored to address the needs of each socio-demographic group. Contribution/value-add: The findings of the study suggest answers to the management of the work–home interaction among various socio-demographic groups in organisations.

Consumer contribution to food contamination in Brazil: modelling the food safety risk in the home

Directory of Open Access Journals (Sweden)

Sergio Paulo Olinto da Motta

2014-06-01

Full Text Available Foodborne diseases are among the most widespread public health issues, killing about 2.2 million people annually, and costing hundreds of billions of US dollars for governments, companies, families and consumers (WHO, 2007. In Brazil, foodborne diseases acquired in the home account for 55% of notified outbreaks (BRASIL, 2012. Several studies have investigated aspects of consumer behaviour concerning food poisoning, mapping practices in the home, but it remains a challenge to obtain a full picture of the consumer contribution to food contamination (REDMOND and GRIFFITH, 2003. This study aimed to assess the risks of food contamination in the home. A questionnaire containing 140 questions concerning food safety knowledge, handling practices, personal hygiene and basic health care, covering the stages when the food is under the control of the consumer, was developed and used to gather data for analysis. Appropriate scores were attributed to the questions (consequences to food safety and answers (likelihood of food contamination. A risk estimate algorithm and an appropriate risk ranking scale were used to assess the results. From August 2011 to March 2012, survey questionnaires were collected from 2,775 consumers in Brazil across 19 out of 27 state capitals. The study found risky practices with the potential to lead to food poisoning occurrences in the domestic environment in the following handling steps: food transportation, food preparation, cooking and the handling of leftovers. The personal hygiene, age, formal education, family income and basic health care habits represented the factors most related to the risky practices of consumers, which could orientate food safety educational campaigns for the Brazilian population.

Influence of surficial soil and bedrock on indoor radon in New York State homes. Task 2, Subtask 2 of an investigation of infiltration and indoor air quality in New York State homes

International Nuclear Information System (INIS)

Kunz, C.

1989-10-01

Radon can enter a building from soil and bedrock through cracks or openings in the basement. Extrapolation from data obtained from studies of miners exposed to high concentrations of radon and other carcinogens over long periods indicates that radon gas in the home poses an increased risk of lung cancer. The project was initiated to determine the characteristics of soil and bedrock that contribute to the availability of radon for infiltration into the home, and the feasibility of using soil characteristics in mapping areas at higher risk for above-average indoor radon in New York State. After conducting soil surveys across the State, the researchers choose four areas for further study. Fifteen homes in each area were tested for indoor air concentrations of radon, air infiltration into the home, radon concentrations in the soil, and the permeability of the soil for gas flow. The researchers concluded that these parameters could be combined to obtain a Radon Index Number to predict mean indoor radon levels for a given area with similar soil geology. However, this measure has a limited ability to predict indoor radon levels for a particular home due to variations in construction as well as differences in soil and bedrock

Planned home births: the need for additional contraindications.

Science.gov (United States)

Grünebaum, Amos; McCullough, Laurence B; Sapra, Katherine J; Arabin, Birgit; Chervenak, Frank A

2017-04-01

Planned home births in the United States are associated with fewer interventions but with increased adverse neonatal outcomes such as perinatal and neonatal deaths, neonatal seizures or serious neurologic dysfunction, and low 5-minute Apgar scores. The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice states that, to reduce perinatal death and to improve outcomes at planned home births, strict criteria are necessary to guide the selection of appropriate candidates for planned home birth. The committee lists 3 absolute contraindications for a planned home birth: fetal malpresentation, multiple gestations, and a history of cesarean delivery. The aim of this study was to evaluate whether there are risk factors that should be considered contraindications to planned home births in addition to the 3 that are listed by the American College of Obstetricians and Gynecologists. We conducted a population-based, retrospective cohort study of all term (≥37 weeks gestation), normal weight (≥2500 grams), singleton, nonanomalous births from 2009-2013 using the Centers for Disease Control and Prevention's period-linked birth-infant death files that allowed for identification of intended and unintended home births. We examined neonatal deaths (days 0-27 after birth) across 3 groups (hospital-attended births by certified nurse midwives, hospital-attended births by physicians, and planned home births) for 5 risk factors: 2 of the 3 absolute contraindications to home birth listed by the American College of Obstetricians and Gynecologists (breech presentation and previous cesarean delivery) and 3 additional risk factors (parity [nulliparous and multiparous], maternal age [women home births (12.1 neonatal death/10,000 deliveries; Pbirths by certified nurse midwives (3.08 neonatal death/10,000 deliveries) or physicians (5.09 neonatal death/10,000 deliveries). Neonatal mortality rates were increased significantly at planned home births, with the

Integrating spaceflight human system risk research

Science.gov (United States)

Mindock, Jennifer; Lumpkins, Sarah; Anton, Wilma; Havenhill, Maria; Shelhamer, Mark; Canga, Michael

2017-10-01

NASA is working to increase the likelihood of exploration mission success and to maintain crew health, both during exploration missions and long term after return to Earth. To manage the risks in achieving these goals, a system modelled after a Continuous Risk Management framework is in place. ;Human System Risks; (Risks) have been identified, and 32 are currently being actively addressed by NASA's Human Research Program (HRP). Research plans for each of HRP's Risks have been developed and are being executed. Inter-disciplinary ties between the research efforts supporting each Risk have been identified; however, efforts to identify and benefit from these connections have been mostly ad hoc. There is growing recognition that solutions developed to address the full set of Risks covering medical, physiological, behavioural, vehicle, and organizational aspects of exploration missions must be integrated across Risks and disciplines. This paper discusses how a framework of factors influencing human health and performance in space is being applied as the backbone for bringing together sometimes disparate information relevant to the individual Risks. The resulting interrelated information enables identification and visualization of connections between Risks and research efforts in a systematic and standardized manner. This paper also discusses the applications of the visualizations and insights into research planning, solicitation, and decision-making processes.

Risk to researchers in qualitative research on sensitive topics: issues and strategies.

Science.gov (United States)

Dickson-Swift, Virginia; James, Erica L; Kippen, Sandra; Liamputtong, Pranee

2008-01-01

Traditionally, risk assessments in research have been limited to examining the risks to the research participants. Although doing so is appropriate and important, there is growing recognition that undertaking research can pose risks to researchers as well. A grounded theory study involving a range of researchers who had undertaken qualitative health research on a sensitive topic was completed. Analysis of the in-depth, face-to-face unstructured individual interviews with 30 Australian public health researchers provided evidence that researchers do confront a number of physical and emotional risks when undertaking research. Training, preparation, and supervision must be taken into account so that the risk to researchers can be minimized. Researchers need to consider occupational health and safety issues in designing research projects that deal with physical and emotional risks. Recommendations for professional supervision, policy development, and minimum training standards for researchers are provided.

Home gardening near a mining site in an arsenic-endemic region of Arizona: assessing arsenic exposure dose and risk via ingestion of home garden vegetables, soils, and water.

Science.gov (United States)

Ramirez-Andreotta, Monica D; Brusseau, Mark L; Beamer, Paloma; Maier, Raina M

2013-06-01

The human-health risk posed by gardening near a legacy mine and smelter in an arsenic-endemic region of Arizona was characterized in this study. Residential soils were used in a greenhouse study to grow common vegetables, and local residents, after training, collected soil, water, and vegetables samples from their home gardens. Concentrations of arsenic measured in water, soil, and vegetable samples were used in conjunction with reported US intake rates to calculate the daily dose, Incremental Excess Lifetime Cancer Risk (IELCR), and Hazard Quotient for arsenic. Relative arsenic intake dose decreased in order: water>garden soils>homegrown vegetables, and on average, each accounted for 77, 16, and 7% of a residential gardener's daily arsenic intake dose. The IELCR ranges for vegetables, garden soils, and water were 10(-8) to 10(-4), 10(-6) to 10(-4), and 10(-5) to 10(-2), respectively. All vegetables (greenhouse and home garden) were grouped by scientific family, and the risk posed decreased as: Asteraceae≫Fabaceae>Amaranthaceae>Liliaceae>Brassicaceae>Solanaceae≫Cucurbitaceae. Correlations observed between concentrations of arsenic in vegetables and soils were used to estimate a maximum allowable level of arsenic in soil to limit the excess cancer risk to 10(-6). The estimated values are 1.56 mg kg(-1), 5.39 mg kg(-1), 11.6 mg kg(-1) and 12.4 mg kg(-1) for the Asteraceae, Brassicaceae, Fabaceae, and Amaranthaceae families, respectively. It is recommended that home gardeners: sample their private wells annually, test their soils prior to gardening, and, if necessary, modify their gardening behavior to reduce incidental soil ingestion. This study highlights the importance of site-specific risk assessment, and the need for species-specific planting guidelines for communities. Copyright © 2013 Elsevier B.V. All rights reserved.

Coming Out and Leaving Home: A Policy and Research Agenda for LGBT Homeless Students

Science.gov (United States)

Tierney, William G.; Ward, James Dean

2017-01-01

Each year, it is estimated between 320,000 and 400,000 LGBT youth encounter homelessness. They are at increased risk of victimization and abuse and face stigmatization for being both homeless and a sexual or gender minority. These youth are more likely than their heterosexual counterparts to become homeless after being forced out of their homes.…

Telecommuting (Work-At-Home) at NASA Lewis Research Center

Science.gov (United States)

Srinidhi, Saragur M.

1994-01-01

This report presents a study in evaluating the viability of providing a work-at-home (telecommuting) program for Lewis Research Center's corporate employees using Integrated Services Digital Network (ISDN). Case studies have been presented for a range of applications from casual data access to interactive access. The network performance of telemedia applications were studied against future requirements for such level of remote connectivity. Many of the popular ISDN devices were characterized for network and service functionality. A set of recommendations to develop a telecommuting policy have been proposed.

Smart Home Test Bed: Examining How Smart Homes Interact with the Power Grid

Energy Technology Data Exchange (ETDEWEB)

2016-11-01

This fact sheet highlights the Smart Home Test Bed capability at the Energy Systems Integration Facility. The National Renewable Energy Laboratory (NREL) is working on one of the new frontiers of smart home research: finding ways for smart home technologies and systems to enhance grid operations in the presence of distributed, clean energy technologies such as photovoltaics (PV). To help advance this research, NREL has developed a controllable, flexible, and fully integrated Smart Home Test Bed.

Home delivery and neonatal mortality in North Carolina.

Science.gov (United States)

Burnett, C A; Jones, J A; Rooks, J; Chen, C H; Tyler, C W; Miller, C A

1980-12-19

Neonatal mortality examined by place and circumstances of delivery in North Carolina during 1974 through 1976 with attention given to home delivery. Planned home deliveries by lay-midwives resulted in three neonatal deaths per 1,000 live births; planned home deliveries without a lay-midwife, 30 neonatal deaths per 1,000 live births; and unplanned home deliveries, 120 neonatal deaths per 1,000 live births. The women babies were delivered by lay-midwives were screened in county health departments and found to be medically at low risk of complication, despite having demographic characteristics associated with high-risk of neonatal mortality. Conversely, the women delivered at home without known prenatal screening or a trained attendant had low-risk demographic characteristics but experienced a high rate of neonatal mortality. Planning, prenatal screening, and attendant-training were important in differentiating the risk of neonatal mortality in this uncontrolled, observational study.

Adaptation of a nursing home culture change research instrument for frontline staff quality improvement use.

Science.gov (United States)

Hartmann, Christine W; Palmer, Jennifer A; Mills, Whitney L; Pimentel, Camilla B; Allen, Rebecca S; Wewiorski, Nancy J; Dillon, Kristen R; Snow, A Lynn

2017-08-01

Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Home drinking in the UK: trends and causes.

Science.gov (United States)

Foster, John H; Ferguson, Colin S

2012-01-01

To explore the trend in the UK to consume alcohol at home rather than at licensed premises. A Medline search entering the terms 'home drinking', 'alcohol' and 'adult' covering the period 2000-2011 yielded 48 articles, of which 6 met the criteria to be included in the review. Grey literature including survey and market research data were reviewed. In the UK, since 1970 there has been trend for beer to be consumed at home more often than in licensed premises and that the overall trend towards greater home drinking has increased since 2000. The main reasons given are convenience, cost, safety, autonomy and stress relief. There has also been an increase in the practice known as 'pre-loading' (drinking before going out). Adults who drink mainly at home report that they are aware that they run a risk of higher overall alcohol consumption but tend to play down the possibility that increased consumption may lead to longer-term harm. Home drinking trends may have long-term public health consequences. Greater understanding of the drivers of this trend will help policy-makers to respond to these societal changes.

Climate@Home: Crowdsourcing Climate Change Research

Science.gov (United States)

Xu, C.; Yang, C.; Li, J.; Sun, M.; Bambacus, M.

2011-12-01

Climate change deeply impacts human wellbeing. Significant amounts of resources have been invested in building super-computers that are capable of running advanced climate models, which help scientists understand climate change mechanisms, and predict its trend. Although climate change influences all human beings, the general public is largely excluded from the research. On the other hand, scientists are eagerly seeking communication mediums for effectively enlightening the public on climate change and its consequences. The Climate@Home project is devoted to connect the two ends with an innovative solution: crowdsourcing climate computing to the general public by harvesting volunteered computing resources from the participants. A distributed web-based computing platform will be built to support climate computing, and the general public can 'plug-in' their personal computers to participate in the research. People contribute the spare computing power of their computers to run a computer model, which is used by scientists to predict climate change. Traditionally, only super-computers could handle such a large computing processing load. By orchestrating massive amounts of personal computers to perform atomized data processing tasks, investments on new super-computers, energy consumed by super-computers, and carbon release from super-computers are reduced. Meanwhile, the platform forms a social network of climate researchers and the general public, which may be leveraged to raise climate awareness among the participants. A portal is to be built as the gateway to the climate@home project. Three types of roles and the corresponding functionalities are designed and supported. The end users include the citizen participants, climate scientists, and project managers. Citizen participants connect their computing resources to the platform by downloading and installing a computing engine on their personal computers. Computer climate models are defined at the server side. Climate

Digital media in the home: technical and research challenges

Science.gov (United States)

Ribas-Corbera, Jordi

2005-03-01

This article attempts to identify some of the technology and research challenges facing the digital media industry in the future. We first discuss several trends in the industry, such as the rapid growth of broadband Internet networks and the emergence of networking and media-capable devices in the home. Next, we present technical challenges that result from these trends, such as effective media interoperability in devices, and provide a brief overview of Windows Media, which is one of the technologies in the market attempting to address these challenges. Finally, given these trends and the state of the art, we argue that further research on data compression, encoder optimization, and multi-format transcoding can potentially make a significant technical and business impact in digital media. We also explore the reasons that research on related techniques such as wavelets or scalable video coding is having a relatively minor impact in today"s practical digital media systems.

Early discharge hospital at home.

Science.gov (United States)

Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

2017-06-26

Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes.   DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

Science.gov (United States)

van der Roest, Henriëtte; van Hout, Hein; Declercq, Anja

2016-01-01

Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe. PMID:28435423

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

Directory of Open Access Journals (Sweden)

Liza Van Eenoo

2016-08-01

Full Text Available Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy, meso-level (care organisations and micro-level (clients are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

The safety of peroxide-containing at-home tooth whiteners.

Science.gov (United States)

Li, Yiming

2003-04-01

Scientific data from research conducted during the past decade have demonstrated the safety of the dentist-dispensed at-home whiteners containing 10% carbamide peroxide. There has been no evidence of systemic adverse effects associated with the proper use of these whitening systems. Most commonly observed local adverse effects are mild-to-moderate tooth sensitivity and/or gingival irritation, which usually do not prevent the patient from completing the whitening treatment. The sensitivity and irritation are transient in most cases, and they dissipate when the patient discontinues the use of the whitener. There is no evidence of any long-term consequences that have resulted from tooth sensitivity and/or gingival irritation. However, potential adverse effects may occur from inappropriate applications, abuses, or the use of inappropriate products. The risks of using at-home whiteners without a dentist's involvement, or using formulations with a higher peroxide content than recommended, are yet to be determined. To maximize benefits while minimizing potential risks, the author advises using at-home tooth whiteners under the supervision of a dental professional.

Radon in homes and risk of lung cancer: 13 collaborative analyses of individual data from European case-control studies

International Nuclear Information System (INIS)

Darby, S.; Hill, D.; Doll, R.; Auvinen, A.; Barros Dios, J.M.; Ruano Ravina, A.; Baysson, H.; Tirmarche, M.; Bochicchio, F.; Deo, H.; Falk, R.; Forastiere, F.; Hakama, M.; Heid, I.; Schaffrath Rosario, A.; Wichmann, H.E.; Kreienbrock, L.; Kreuzer, M.; Lagarde, F.; Pershagen, G.; Makelainen, I.; Ruosteenoja, E.; Muirhead, C.; Oberaigner, W.; TomaBek, L.; Whitley, E.

2007-01-01

Objective: To determine the risk of lung cancer associated with exposure at home to the radioactive disintegration products of naturally occurring radon gas. Design: Collaborative analysis of individual data from 13 case-control studies of residential radon and lung cancer. Setting: Nine European countries. Subjects: 7148 cases of lung cancer and 14 208 controls. Main outcome measures: Relative risks of lung cancer and radon gas concentrations in homes inhabited during the previous 5-34 years measured in becquerels (radon disintegrations per second) per cubic metre (Bq/m3) of household air. Results: The mean measured radon concentration in homes of people in the control group was 97 Bq/m3, with 11% measuring > 200 and 4% measuring > 400 Bq/m3. For cases of lung cancer the mean concentration was 104 Bq/m3. The risk of lung cancer increased by 8.4% (95% confidence interval 3.0% to 15.8%) per 100 Bq/m3 increase in measured radon (P=0.0007). This corresponds to an increase of 16% (5% to 31%) per 100 Bq/m3 increase in usual radon- that is, after correction for the dilution caused by random uncertainties in measuring radon concentrations. The dose-response relation seemed to be linear with no threshold and remained significant (P = 0.04) in analyses limited to individuals from homes with measured radon < 200 Bq/m3. The proportionate excess risk did not differ significantly with study, age, sex, or smoking. In the absence of other causes of death, the absolute risks of lung cancer by age 75 years at usual radon concentrations of 0, 100, and 400 Bq/m3 would be about 0.4%, 0.5%, and 0.7%, respectively, for lifelong non-smokers, and about 25 times greater (10%, 12%, and 16%) for cigarette smokers. Conclusions: Collectively, though not separately, these studies show appreciable hazards from residential radon, particularly for smokers and recent ex-smokers, and indicate that it is responsible for about 2% of all deaths from cancer in Europe. (author)

Home Rx: The Health Benefits of Home Performance

Energy Technology Data Exchange (ETDEWEB)

Wilson, Jonathan [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Jacobs, David [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Reddy, Amanda [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Tohn, Ellen [Tohn Environmental Strategies, Wayland, MA (United States); Cohen, Jonathan [Dept. of Energy (DOE), Washington DC (United States); Jacobsohn, Ely [Dept. of Energy (DOE), Washington DC (United States)

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.

Treatment Integrity in a Home-Based Pre-Reading Intervention Programme

Science.gov (United States)

van Otterloo, Sandra G.; van der Leij, Aryan; Veldkamp, Esther

2006-01-01

Treatment integrity is an underexposed issue in the phonological awareness intervention research. The current study assessed the integrity of treatment of the families (N = 32) participating in the experimental condition of a home-based pre-reading intervention study. The participating kindergartners were all genetically at risk for developing…

Home or foster home care versus institutional long-term care for functionally dependent older people.

Science.gov (United States)

Young, Camilla; Hall, Amanda M; Gonçalves-Bradley, Daniela C; Quinn, Terry J; Hooft, Lotty; van Munster, Barbara C; Stott, David J

2017-04-03

Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce costs and improve the quality of care compared. To assess the effects of long-term home or foster home care versus institutional care for functionally dependent older people. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, MEDLINE, Embase, CINAHL, and two trials registers to November 2015. We included randomised and non-randomised trials, controlled before-after studies and interrupted time series studies complying with the EPOC study design criteria and comparing the effects of long-term home care versus institutional care for functionally dependent older people. Two reviewers independently extracted data and assessed the risk of bias of each included study. We reported the results narratively, as the substantial heterogeneity across studies meant that meta-analysis was not appropriate. We included 10 studies involving 16,377 participants, all of which were conducted in high income countries. Included studies compared community-based care with institutional care (care homes). The sample size ranged from 98 to 11,803 (median N = 204). There was substantial heterogeneity in the healthcare context, interventions studied, and outcomes assessed. One study was a randomised trial (N = 112); other included studies used designs that had potential for bias, particularly due lack of randomisation, baseline imbalances, and non-blinded outcome assessment. Most studies did not select (or exclude) participants for any specific disease state, with the exception of one study that only included patients if they had a stroke. All studies had methodological limitations, so readers should interpret results with caution.It is uncertain

Combined use of drugs inhibiting the renin–angiotensin system: prescribing patterns and risk of acute kidney injury in German nursing home residents

Directory of Open Access Journals (Sweden)

Dörks M

2018-05-01

Full Text Available Michael Dörks,1 Stefan Herget-Rosenthal,2 Falk Hoffmann,1 Kathrin Jobski1 1Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; 2Department of Medicine, Rotes Kreuz Krankenhaus, Bremen, Germany Background/aims: In 2012, the European Medicines Agency reviewed the safety of dual renin–angiotensin system (RAS blockade because of potentially increased risks for inter alia acute kidney injury (AKI. Since residents of nursing homes are particularly vulnerable to adverse drug outcomes, the aims of our study were to describe RAS-inhibiting drug use in German nursing home residents and examine the risk of AKI associated with dual RAS blockade.Methods: Based on claims data, a nested case-control study within a cohort of RAS-inhibiting drug users was conducted. Using conditional logistic regression, confounder-adjusted odds ratios (aORs and 95% confidence intervals (CI were obtained for the risk of AKI associated with dual RAS blockade. Subgroup analyses were performed in patients with diabetes or chronic kidney disease and both comorbidities.Results: Of all 127,227 nursing home residents, the study cohort included 64,567 (50.7% who were treated with at least one RAS-inhibiting drug. More than three quarters of the study population were female (77.1%. Mean age was 86.0 ± 6.8 years. Most residents were treated with angiotensin-converting enzyme inhibitors (77.8%, followed by angiotensin II receptor blockers (21.6% and aliskiren (0.2%. Annual prevalence of dual RAS blockade declined from 9.6 (95% CI 7.8–11.8 in 2010 to 4.7 (95% CI 4.0–5.4 per 1,000 users in 2014. In the overall cohort, AKI was not significantly associated with dual RAS blockade (aOR 1.99; 0.77–5.17. However, significantly increased aORs were observed when considering patients with diabetes (3.47; 1.27–9.47, chronic kidney disease (4.74; 1.24–18.13 or both (11.17; 2.65–47.15.Conclusions: Prescribing of drugs inhibiting the RAS is

Place of death among older Americans: does state spending on home- and community-based services promote home death?

Science.gov (United States)

Muramatsu, Naoko; Hoyem, Ruby L; Yin, Hongjun; Campbell, Richard T

2008-08-01

The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them. To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors. Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community. Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death. States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

Risk Factors for Pressure Ulcers Including Suspected Deep Tissue Injury in Nursing Home Facility Residents: Analysis of National Minimum Data Set 3.0.

Science.gov (United States)

Ahn, Hyochol; Cowan, Linda; Garvan, Cynthia; Lyon, Debra; Stechmiller, Joyce

2016-04-01

To provide information on risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home residents in the United States. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Examine the literature related to risk factors for the development of PrUs.2. Compare risk factors associated with the prevalence of PrUs and sDTI from the revised Minimum Data Set 3.0 2012 using a modified Defloor's conceptual model of PrUs as a theoretical framework. This study aims to characterize and compare risk factors associated with pressure ulcers (PrUs), including suspected deep tissue injury (sDTI), in nursing home (NH) residents in the United States. Secondary analysis of the 2012 Minimum Data Set (MDS 3.0). Medicare- or Medicaid-certified NHs in the United States. Nursing home residents (n = 2,936,146) 18 years or older with complete PrU data, who received comprehensive assessments from January to December 2012. Pressure ulcer by stage was the outcome variable. Explanatory variables (age, gender, race and ethnicity, body mass index, skin integrity, system failure, disease, infection, mobility, and cognition) from the MDS 3.0 were aligned with the 4 elements of Defloor's conceptual model: compressive forces, shearing forces, tissue tolerance for pressure, and tissue tolerance for oxygen. Of 2,936,146 NH residents who had complete data for PrU, 89.9% had no PrU; 8.4% had a Stage 2, 3, or 4 or unstagable PrU; and 1.7% had an sDTI. The MDS variables corresponding to the 4 elements of Defloor's model were significantly predictive of both PrU and sDTI. Black residents had the highest risk of any-stage PrU, and Hispanic residents had the highest risk of sDTI. Skin integrity, system failure, infection, and disease risk factors had larger effect sizes for sDTI than for other PrU stages

Increased Risk of Vascular Events in Emergency Room Patients Discharged Home with Diagnosis of Dizziness or Vertigo: A 3-Year Follow-Up Study

Science.gov (United States)

Lee, Ching-Chih; Ho, Hsu-Chueh; Su, Yu-Chieh; Chiu, Brian C-H; Su, Yung-Cheng; Lee, Yi-Da; Chou, Pesus

2012-01-01

Background Dizziness and vertigo symptoms are commonly seen in emergency room (ER). However, these patients are often discharged without a definite diagnosis. Conflicting data regarding the vascular event risk among the dizziness or vertigo patients have been reported. This study aims to determine the risk of developing stroke or cardiovascular events in ER patients discharged home with a diagnosis of dizziness or vertigo. Methodology A total of 25,757 subjects with at least one ER visit in 2004 were identified. Of those, 1,118 patients were discharged home with a diagnosis of vertigo or dizziness. A Cox proportional hazard model was performed to compare the three-year vascular event-free survival rates between the dizziness/vertigo patients and those without dizziness/vertigo after adjusting for confounding and risk factors. Results We identified 52 (4.7%) vascular events in patients with dizziness/vertigo and 454 (1.8%) vascular events in patients without dizziness/vertigo. ER patients discharged home with a diagnosis of vertigo or dizziness had 2-fold (95% confidence interval [CI], 1.35–2.96; pvertigo during the first year. Conclusions ER patients discharged home with a diagnosis of dizziness or vertigo were at a increased risk of developing subsequent vascular events than those without dizziness/vertigo after the onset of dizziness or vertigo. Further studies are warranted for developing better diagnostic and follow-up strategies in increased risk patients. PMID:22558272

Identifying early dehydration risk with home-based sensors during radiation treatment: a feasibility study on patients with head and neck cancer.

Science.gov (United States)

Peterson, Susan K; Shinn, Eileen H; Basen-Engquist, Karen; Demark-Wahnefried, Wendy; Prokhorov, Alexander V; Baru, Chaitanya; Krueger, Ingolf H; Farcas, Emilia; Rios, Philip; Garden, Adam S; Beadle, Beth M; Lin, Kai; Yan, Yan; Martch, Stephanie L; Patrick, Kevin

2013-12-01

Systems that enable remote monitoring of patients' symptoms and other health-related outcomes may optimize cancer care outside of the clinic setting. CYCORE (CYberinfrastructure for COmparative effectiveness REsearch) is a software-based prototype for a user-friendly cyberinfrastructure supporting the comprehensive collection and analyses of data from multiple domains using a suite of home-based and mobile sensors. This study evaluated the feasibility of using CYCORE to address early at-home identification of dehydration risk in head and neck cancer patients undergoing radiation therapy. Head and neck cancer patients used home-based sensors to capture weight, blood pressure, pulse, and patient-reported outcomes for two 5-day periods during radiation therapy. Data were sent to the radiation oncologist of each head and neck cancer patient, who viewed them online via a Web-based interface. Feasibility outcomes included study completion rate, acceptability and perceived usefulness of the intervention, and adherence to the monitoring protocol. We also evaluated whether sensor data could identify dehydration-related events. Fifty patients consented to participate, and 48 (96%) completed the study. More than 90% of patients rated their ease, self-efficacy, and satisfaction regarding use of the sensor suite as extremely favorable, with minimal concerns expressed regarding data privacy issues. Patients highly valued the ability to have immediate access to objective, self-monitoring data related to personal risk for dehydration. Clinician assessments indicated a high degree of satisfaction with the ease of using the CYCORE system and the resulting ability to monitor their patients remotely. Implementing CYCORE in a clinical oncology care setting is feasible and highly acceptable to both patients and providers.

Adolescent physical activity and screen time: associations with the physical home environment

Directory of Open Access Journals (Sweden)

Farbakhsh Kian

2010-11-01

Full Text Available Abstract Background Previous research on the environment and physical activity has mostly focused on macro-scale environments, such as the neighborhood environment. There has been a paucity of research on the role of micro-scale and proximal environments, such as that of the home which may be particularly relevant for younger adolescents who have more limited independence and mobility. The purpose of this study was to describe associations between the home environment and adolescent physical activity, sedentary time, and screen time. Methods A total of 613 parent-adolescent dyads were included in these analyses from two ongoing cohort studies. Parents completed a Physical Activity and Media Inventory (PAMI of their home environment. Adolescent participants (49% male, 14.5 ± 1.8 years self-reported their participation in screen time behaviors and wore an ActiGraph accelerometer for one week to assess active and sedentary time. Results After adjusting for possible confounders, physical activity equipment density in the home was positively associated with accelerometer-measured physical activity (p Conclusions The home environment was associated with physical activity and screen time behavior in adolescents and differential environmental effects for males and females were observed. Additional research is warranted to more comprehensively assess the home environment and to identify obesogenic typologies of families so that early identification of at-risk families can lead to more informed, targeted intervention efforts.

Brain Research to Ameliorate Impaired Neurodevelopment - Home-based Intervention Trial (BRAIN-HIT

Directory of Open Access Journals (Sweden)

Mahantshetti Niranjana S

2010-04-01

Full Text Available Abstract Background This randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low- and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low- and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality and morbidity from birth asphyxia disproportionately affect more infants in low- and low-middle-income countries, particularly those from the lowest socioeconomic groups. There is evidence that relatively inexpensive programs of early developmental intervention, delivered during home visit by parent trainers, are capable of improving neurodevelopment in infants following brain insult due to birth asphyxia. Methods/Design This trial is a block-randomized controlled trial that has enrolled 174 children with birth asphyxia and 257 without perinatal complications, comparing early developmental intervention plus health and safety counseling to the control intervention receiving health and safety counseling only, in sites in India, Pakistan, and Zambia. The interventions are delivered in home visits every two weeks by parent trainers from 2 weeks after birth until age 36 months. The primary outcome of the trial is cognitive development, and secondary outcomes include social-emotional and motor development. Child, parent, and family characteristics and number of home visits completed are evaluated as moderating factors. Discussion The trial is supervised by a trial steering committee, and an independent data monitoring

Intelligent home risk assessment systems and integration with biometric identification

Science.gov (United States)

Roper, William E.

2003-08-01

An overview is given of the Home of the 21st Century Laboratory. The laboratory is operated as a joint program with America-On-Line and George Washington University. The program is described with illustrations and discussion of the systems that are part of the laboratory. The concept of application for face recognition systems in the intelligent home of the future is presented and some initial approaches in using biometrics are shown. Issues of privacy and sharing of information within and outside the home are addressed. Issues include safety and security concerns vs. inappropriate observations of activities in and outside the home. Technology options currently available for application in the home are described and assessed.

Report on a comprehensive research study (home welfare apparatus system - interface); Sogo chosa kenkyu (zaitaku fukushi kiki system - interface) hokokusho

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-03-01

In the light of the increasing role of welfare at home with the advance of the aging society, the paper conducted an investigational study on the R and D of the home welfare apparatus system - interface. In the study, making the most of the leading home care apparatus systems (welfare technohouses) installed at seven places in the country, the paper carried out a stay experiment on how the life is in the welfare house into which home welfare apparatus is integrated, and an experiment to assess biological data on aged people. Especially as to the support apparatus used for smooth life motions in houses such as movement, excretion and bathing, examined were the linkage with house bodies, care apparatus used, mutual interface with welfare apparatus, etc. By the experiments to assess these home welfare apparatus, an analytical study was conducted on the points to be improved in welfare apparatus and housing equipment, and at the same time on the course of the research/development. Concerning a system for the research study, a research promotion committee was established in Technology Research Association of Medical and Welfare Apparatus, the members of which are learned persons from the industrial circle, the government and universities. 111 figs., 36 tabs.

Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.

Science.gov (United States)

de Jonge, Ank; Mesman, Jeanette A J M; Manniën, Judith; Zwart, Joost J; van Dillen, Jeroen; van Roosmalen, Jos

2013-06-13

To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Cohort study using a linked dataset. Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. 146 752 low risk women in primary care at the onset of labour. Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%). Low risk

Information Technology in the Home Barriers, Opportunities, and Research Directions

National Research Council Canada - National Science Library

Lewis, Rosalind

2000-01-01

...; but what are the implications of increased Information Technology (IT) in the home? Can increased in-home IT create opportunities that will change the way we live and function within our homes and communities and facilitate greater societal benefits...

Dutch home-based pre-reading intervention with children at familial risk of dyslexia.

Science.gov (United States)

van Otterloo, Sandra G; van der Leij, Aryan

2009-12-01

Children (5 and 6 years old, n = 30) at familial risk of dyslexia received a home-based intervention that focused on phoneme awareness and letter knowledge in the year prior to formal reading instruction. The children were compared to a no-training at-risk control group (n = 27), which was selected a year earlier. After training, we found a small effect on a composite score of phoneme awareness (d = 0.29) and a large effect on receptive letter knowledge (d = 0.88). In first grade, however, this did not result in beneficial effects for the experimental group in word reading and spelling. Results are compared to three former intervention studies in The Netherlands and comparable studies from Denmark and Australia.

Lower urinary tract symptoms and falls risk among older women receiving home support: a prospective cohort study.

Science.gov (United States)

Hunter, Kathleen F; Voaklander, Donald; Hsu, Zoe Y; Moore, Katherine N

2013-05-15

Although lower urinary tract symptoms have been associated with falls, few studies have been undertaken to understand this relationship in vulnerable community dwelling older adults. The purpose of this study was to describe the relationship over time of falls risk and lower urinary tract symptoms among community based older women receiving home support services. A prospective cohort study which took place in an urban setting in western Canada. Participants were 100 older women receiving home care or residing in assisted living with home support services and were followed for six months. Demographic characteristics were collected at baseline, with the Timed Up and Go (TUG), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), and self-report of falls collected at baseline, 3 and 6 months. Descriptive statistics were used to summarize demographic data. Differences between the three visits were analyzed using the Friedman test with post hoc analysis and associations between variables by the Spearman Rank-Order Correlation Coefficient. One hundred women initially enrolled; 88 and 75 remained at three months and six months. Mean age = 84.3 years; 91% reported at least one urinary symptom at baseline and 35% reported falling in the six months prior to enrollment; 15.9% reported falling between the baseline and three months and 14.6% between three and six months. Mean TUG scores at each time point indicated falls risk (27.21, 29.18 and 27.76 seconds). Significant correlations between TUG and ICIQ-FLUTS (r = 0.33, p falls risk in this group of vulnerable community dwelling older women at baseline and three months has potential clinical relevance. Lack of correlation at six months may be due loss of less robust participants, illuminating the difficulty in following frailer groups over time. Further studies are needed to understand the contribution of urinary symptoms to falls risk, and clinicians should

Running Away from Home: A Longitudinal Study of Adolescent Risk Factors and Young Adult Outcomes

Science.gov (United States)

Tucker, Joan S.; Edelen, Maria Orlando; Ellickson, Phyllis L.; Klein, David J.

2011-01-01

Little is known about the adolescent risk factors and young adult health-related outcomes associated with running away from home. We examined these correlates of running away using longitudinal data from 4,329 youth (48% female, 85% white) who were followed from Grade 9 to age 21. Nearly 14% of the sample reported running away in the past year at…

Factors associated with resident aggression toward caregivers in nursing homes.

Science.gov (United States)

Zeller, Adelheid; Dassen, Theo; Kok, Gerjo; Needham, Ian; Halfens, Ruud J G

2012-09-01

Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes. A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study. Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied. The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age ( 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age ( 45 years: OR = 2.04). Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed. The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and

Risk - a new field of research?

International Nuclear Information System (INIS)

Bechmann, G.

1993-01-01

Risk research is a research activity that hitherto has failed to come up with a standard concept of risk, or theory of risk. The contribution explains three major approaches and basic orientations, which represent a formal and law-oriented approach, a psychological and cognitive approach, and the approach starting from cultural and sociological aspects. (DG) [de

A Systematic Review of Home-Based Childhood Obesity Prevention Studies

Science.gov (United States)

Fawole, Oluwakemi; Segal, Jodi; Wilson, Renee F.; Cheskin, Lawrence J.; Bleich, Sara N.; Wu, Yang; Lau, Brandyn; Wang, Youfa

2013-01-01

BACKGROUND AND OBJECTIVES: Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes. METHODS: We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention. RESULTS: We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings. CONCLUSIONS: The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences. PMID:23753095

"Is there a gun in the home?" Assessing the risks of gun ownership in older adults.

Science.gov (United States)

Pinholt, Ellen M; Mitchell, Joshua D; Butler, Jane H; Kumar, Harjinder

2014-06-01

An important ethical and safety concern that geriatricians, primary care providers, and home health professionals need to address is gun ownership by elderly adults. Those aged 65 and older now have the highest rate of gun ownership in America, and they also have a high prevalence of depression and suicide. Dementia can add additional layers of risk. Even older gun owners who are otherwise intellectually intact may benefit from information about gun safety with the increasing numbers of children being cared for by grandparents. Health professionals should ask patients, "Is there a gun in the home?" in the clinic and during home visits. Healthcare professionals must have knowledge and skills to address safe gun ownership in elderly adults. The 5 L's (Locked, Loaded, Little children, feeling Low, Learned owner) will assist professionals in addressing all aspects of safe ownership. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

A proposed programme for energy risk research

International Nuclear Information System (INIS)

1979-01-01

The report consists of two parts. Part I presents an overview of technological risk management, noting major contributions and current research needs. Part II details a proposed program of energy research, including discussions of some seven recommended projects. The proposed energy risk research program addresses two basic problem areas: improving the management of energy risks and energy risk communication and public response. Specific recommended projects are given for each. (Auth.)

Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study.

Science.gov (United States)

Hutton, Eileen K; Reitsma, Angela H; Kaufman, Karyn

2009-09-01

Midwives in Ontario, Canada, provide care in the home and hospital and are required to submit data for all births to the Ontario Ministry of Health database. The purpose of this study was to compare maternal and perinatal/neonatal mortality and morbidity and intrapartum intervention rates for women attended by Ontario midwives who planned a home birth compared with similar low-risk women who planned a hospital birth between 2003 and 2006. The database provided outcomes for all women planning a home birth at the onset of labor (n = 6,692) and for a cohort, stratified by parity, of similar low-risk women planning a hospital birth. The rate of perinatal and neonatal mortality was very low (1/1,000) for both groups, and no difference was shown between groups in perinatal and neonatal mortality or serious morbidity (2.4% vs 2.8%; relative risk [RR], 95% confidence intervals [CI]: 0.84 [0.68-1.03]). No maternal deaths were reported. All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section (5.2% vs 8.1%; RR [95% CI]: 0.64 [0.56, 0.73]). Nulliparas were less likely to deliver at home, and had higher rates of ambulance transport from home to hospital than multiparas planning home birth and had rates of intervention and outcomes similar to, or lower than, nulliparas planning hospital births. Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births.

Home | SREL Herpetology Program

Science.gov (United States)

Savannah River Ecology Laboratory Herpetology Program Herp Home Research Publications Herps of SC /GA P.A.R.C. Outreach SREL Home powered by Google Search Herpetology at SREL The University of SREL herpetology research programs have always included faculty of the University of Georgia, post

Sustainable thermal technologies and care homes: Productive alignment or risky investment?

International Nuclear Information System (INIS)

Neven, Louis; Walker, Gordon; Brown, Sam

2015-01-01

The use of more sustainable thermal technologies is a policy imperative across the UK building stock. However, not all building uses provide the same opportunities for technology uptake as others. Care homes for older people have characteristics which in technical and economic terms suggest that they might be particularly appropriate for the implementation of more sustainable thermal technologies. They have comparatively high demands for space heating and hot water often sustained on a 24/7 basis. However there are many considerations, both generic and contextual, that will typically play into processes of technology uptake. Through qualitative research in six case study homes, focused on management and staff perspectives and experiences, we explore the degree to which there might be a productive alignment between care home operation and the use of sustainable thermal technologies. Two key themes emerge focused on business considerations and the importance of avoiding risk and damage to reputation; and the ways in which different thermal technologies are relevant to and can potentially impact on care practices. We conclude that despite potential benefits the sector could remain rather resistant to sustainability innovations. We suggest therefore areas in which productive action and further research could be undertaken. -- Highlights: •Care homes for older people might be particularly appropriate for the use of sustainable thermal technologies. •We examine if a productive alignment between care homes and the use of sustainable thermal technologies does exist in practice. •Two key themes are risks to business reputation; and relevance and potential benefits to care practices. •We conclude that the sector could remain rather reluctant to embrace sustainability innovation

Innovation in a Learning Health Care System: Veteran-Directed Home- and Community-Based Services.

Science.gov (United States)

Garrido, Melissa M; Allman, Richard M; Pizer, Steven D; Rudolph, James L; Thomas, Kali S; Sperber, Nina R; Van Houtven, Courtney H; Frakt, Austin B

2017-11-01

A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center (PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD-HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD-HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD-HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents

Directory of Open Access Journals (Sweden)

M. D. Rijnaard

2016-01-01

Full Text Available Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1 original and peer-reviewed research, (2 qualitative, quantitative, or mixed methods research, (3 research about nursing home residents (or similar type of housing, and (4 research on the sense of home, meaning of home, at-homeness, or homelikeness. Results. Seventeen mainly qualitative articles were included. The sense of home of nursing home residents is influenced by 15 factors, divided into three themes: (1 psychological factors (sense of acknowledgement, preservation of one’s habits and values, autonomy and control, and coping; (2 social factors (interaction and relationship with staff, residents, family and friends, and pets and activities; and (3 the built environment (private space and (quasi-public space, personal belongings, technology, look and feel, and the outdoors and location. Conclusions. The sense of home is influenced by numerous factors related to the psychology of the residents and the social and built environmental contexts. Further research is needed to determine if and how the identified factors are interrelated, if perspectives of various stakeholders involved differ, and how the factors can be improved in practice.

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...

Nutritional screening of older home-dwelling Norwegians: a comparison between two instruments

Directory of Open Access Journals (Sweden)

Söderhamn U

2012-09-01

Full Text Available Ulrika Söderhamn, Bjørg Dale, Kari Sundsli, Olle SöderhamnCentre for Caring Research-Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, NorwayBackground: It is important to obtain knowledge about the prevalence of nutritional risk and associated factors among older home-dwelling people in order to be able to meet nutritional challenges in this group in the future and to plan appropriate interventions. The aim of this survey was to investigate the prevalence of home-dwelling older people at nutritional risk and to identify associated factors using two different nutritional screening instruments as self-report instruments.Methods: This study had a cross-sectional design. A postal questionnaire, including the Norwegian versions of the Nutritional Form for the Elderly (NUFFE-NO and Mini Nutritional Assessment – Short Form (MNA-SF, background variables, and health-related questions was sent to a randomized sample of 6033 home-dwelling older people in southern Norway. A total of 2106 (34.9% subjects were included in the study. Data were analyzed using descriptive statistics and logistic regression analyses.Results: When using the NUFFE-NO and MNA-SF, 426 (22.3% and 258 (13.5% older persons, respectively, were identified to be at nutritional risk. The risk of undernutrition increased with age. Several predictors for being at risk of undernutrition, including chronic disease/handicap and receiving family help, as well as protective factors, including sufficient food intake and having social contacts, were identified.Conclusion: Health professionals must be aware of older people's vulnerability to risk of undernutrition, perform screening, and have a plan for preventing undernutrition. For that purpose, MNA-SF and NUFFE-NO can be suggested for screening older people living at home.Keywords: aged, risk factors, undernutrition, screening

Airborne protein concentration: a key metric for type 1 allergy risk assessment-in home measurement challenges and considerations.

Science.gov (United States)

Tulum, Liz; Deag, Zoë; Brown, Matthew; Furniss, Annette; Meech, Lynn; Lalljie, Anja; Cochrane, Stella

2018-01-01

Exposure to airborne proteins can be associated with the development of immediate, IgE-mediated respiratory allergies, with genetic, epigenetic and environmental factors also playing a role in determining the likelihood that sensitisation will be induced. The main objective of this study was to determine whether airborne concentrations of selected common aeroallergens could be quantified in the air of homes using easily deployable, commercially available equipment and analytical methods, at low levels relevant to risk assessment of the potential to develop respiratory allergies. Additionally, air and dust sampling were compared and the influence of factors such as different filter types on allergen quantification explored. Low volume air sampling pumps and DUSTREAM ® dust samplers were used to sample 20 homes and allergen levels were quantified using a MARIA ® immunoassay. It proved possible to detect a range of common aeroallergens in the home with sufficient sensitivity to quantify airborne concentrations in ranges relevant to risk assessment (Limits of Detection of 0.005-0.03 ng/m 3 ). The methodology discriminates between homes related to pet ownership and there were clear advantages to sampling air over dust which are described in this paper. Furthermore, in an adsorption-extraction study, PTFE (polytetrafluoroethylene) filters gave higher and more consistent recovery values than glass fibre (grade A) filters for the range of aeroallergens studied. Very low airborne concentrations of allergenic proteins in home settings can be successfully quantified using commercially available pumps and immunoassays. Considering the greater relevance of air sampling to human exposure of the respiratory tract and its other advantages, wider use of standardised, sensitive techniques to measure low airborne protein concentrations and how they influence development of allergic sensitisation and symptoms could accelerate our understanding of human dose-response relationships

Medical homes for at-risk children: parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes.

Science.gov (United States)

Nelson, Catherine S; Higman, Susan M; Sia, Calvin; McFarlane, Elizabeth; Fuddy, Loretta; Duggan, Anne K

2005-01-01

Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice. The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes. A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded. Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 +/- 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (beta = .026, SE = .004), compassion (beta = .019, SE = .005), and trust (beta = .016, SE = .005). Parents

Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study.

Science.gov (United States)

Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

2015-04-01

To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. Prospective cohort study. OUs and planned home births in England. 8180 'higher risk' women in the Birthplace cohort. We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John

Legal regulation of home births

Directory of Open Access Journals (Sweden)

Baturan Luka O.

2015-01-01

Full Text Available In this paper, authors tried to find efficient legal frame for home births. The main problem is the risk of life and health of a mother and a baby. If a mother wants a home labor, there are no legal obstacles ^for her to take the risk of her own life, after consultation with health-care professionals. However, society is obligated to protect unborn child from irrational behavior of the mother, if she acts against child's best interests. Legal rules were analyzed by methods of neo-institutional economic theory, while the risks of life and health of a mother and a baby were analyzed by medical science methods.

Investigating the debate of home birth safety: A critical review of cohort studies focusing on selected infant outcomes.

Science.gov (United States)

Elder, Heather R; Alio, Amina P; Fisher, Susan G

2016-07-01

There is a debate within the medical community regarding the safety of planned home births. The presumption of increased risk of maternal and infant morbidity and mortality at home due to limited access to life-saving interventions is not clearly supported by research. The aim of the present study was to assess strengths and limitations of the methodological approaches of cohort studies that compare home births with hospital births by focusing on selected infant outcomes. Studies were identified that assess the risk for at least one of three infant outcomes (mortality, Apgar score, and admission to the neonatal intensive care unit [NICU]) of home births compared with hospital births. Fifteen cohort studies were included. Two studies of low-risk births and two including higher risk births found home births to be at an increased risk of neonatal mortality. However, mortality is rare in developed nations and may not be the best measure of safety. When studies focused on low-risk pregnancies, planned birth location, and well-trained birth attendants, there was no difference in neonatal morbidity (Apgar score and NICU admission). Many methodological challenges were identified among these studies. This review contributes to the home birth published work by identifying key strengths and limitations that need to be accounted for in the interpretation of study findings and the development of future studies. Based on this review, the key variables that would strengthen future studies are birth attendant identification, documented planned birth location, and specification of the birth risk level. Uniformity of data collection and minimizing missing data are also critical. © 2016 Japan Academy of Nursing Science.

Another bogus radiation scare - radon in homes. Letter to the editor

International Nuclear Information System (INIS)

Cuttler, J.

2012-01-01

This article discusses Health Canada's research that radon in homes is causing unnecessary lung cancer deaths. Health Canada has carried out a cross-Canada survey of radon-concentrations in homes (Health Canada 2012). The aims of their study were to obtain an estimate of the proportion of the Canadian population living in homes, with radon gas levels above the guideline of 200 Bq/m to identify new areas of this health risk. Their results indicate that 6.9% of Canadians are in 3 such homes (similar to their 1970 results). The authors state that their results can be used by governments and health professionals to help prioritize radon outreach and education efforts, and testing and remediation. Their next step is to correlate radon level and home characteristics, and also develop radon mapping methods. Several sentences in the introduction link radon with lung cancer, based on early studies of uranium miners and later studies in homes. It is estimated that about 10% of all lung cancers worldwide are related to radon exposure.

Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: a retrospective cohort study.

Directory of Open Access Journals (Sweden)

Shuhei Nomura

Full Text Available BACKGROUND: Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees. METHODS: A total of 715 residents admitted to five nursing homes in Minamisoma city, Fukushima Prefecture in the five years before 11th March 2011 joined this retrospective cohort study. Demographic and clinical characteristics were drawn from facility medical records. Evacuation histories were tracked until the end of 2011. The evacuation's impact on mortality was assessed using mortality incidence density and hazard ratios in Cox proportional hazards regression. RESULTS: Overall relative mortality risk before and after the earthquake was 2.68 (95% CI: 2.04-3.49. There was a substantial variation in mortality risks across the facilities ranging from 0.77 (95% CI: 0.34-1.76 to 2.88 (95% CI: 1.74-4.76. No meaningful influence of evacuation distance on mortality was observed although the first evacuation from the original facility caused significantly higher mortality than subsequent evacuations, with a hazard ratio of 1.94 (95% CI: 1.07-3.49. CONCLUSION: High mortality, due to initial evacuation, suggests that evacuation of the elderly was not the best life-saving strategy for the Fukushima nuclear disaster. Careful consideration of the relative risks of radiation exposure and the risks and benefits of evacuation is essential. Facility-specific disaster response strategies, including in-site relief and care, may have a strong influence on survival. Where evacuation is necessary, careful planning and coordination with other nursing homes, evacuation sites and government disaster agencies is essential to reduce the risk of mortality.

Psychosocial Adjustment of Low-Income African American Youth from Single Mother Homes: The Role of the Youth-Coparent Relationship

Science.gov (United States)

Sterrett, Emma M.; Jones, Deborah J.; Kincaid, Carlye

2009-01-01

African American youth from single mother homes are at greater risk for internalizing and externalizing problems relative to their peers from two-parent homes. Although the predominance of psychosocial research on these youth has focused on maternal parenting and mother-child relationship quality, far less attention has been devoted to the quality…

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)

Evaluation of pet contact as a risk factor for carriage of multidrug-resistant staphylococci in nursing home residents.

Science.gov (United States)

Gandolfi-Decristophoris, Paola; De Benedetti, Anna; Petignat, Christiane; Attinger, Monica; Guillaume, Jan; Fiebig, Lena; Hattendorf, Jan; Cernela, Nicole; Regula, Gertraud; Petrini, Orlando; Zinsstag, Jakob; Schelling, Esther

2012-03-01

Pets, often used as companionship and for psychological support in the therapy of nursing home residents, have been implicated as reservoirs for antibiotic-resistant bacteria. We investigated the importance of pets as reservoirs of multidrug-resistant (MDR) staphylococci in nursing homes. We assessed the carriage of MDR staphylococci in pets and in 2 groups of residents, those living in nursing homes with pets and those living without pet contacts. We collected demographic, health status, and human-pet contact data by means of questionnaires. We assessed potential bacteria transmission pathways by investigating physical resident-to-pet contact. The observed prevalence of MDR staphylococci carriage was 84/229 (37%) in residents living with pets and 99/216 (46%) in those not living with pets (adjusted odds ratio [aOR], 0.6; 95% confidence interval [CI], 0.4-0.9). Active pet contact was associated with lower carriage of MDR staphylococci (aOR, 0.5; 95% CI, 0.4-0.8). Antibiotic treatment during the previous 3 months was associated with significantly increased risk for MDR carriage in residents (aOR, 3.1; 95% CI, 1.8-5.7). We found no evidence that the previously reported benefits of pet contact are compromised by the increased risk of carriage of MDR staphylococci in residents associated with interaction with these animals in nursing homes. Thus, contact with pets, always under good hygiene standards, should be encouraged in these settings. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Unpacking Socio-Economic Risks for Reading and Academic Self-Concept in Primary School: Differential Effects and the Role of the Preschool Home Learning Environment

Science.gov (United States)

Crampton, Alexandria; Hall, James

2017-01-01

Background: Uncertainty remains concerning how children's reading and academic self-concept are related and how these are differentially affected by social disadvantage and home learning environments. Aims: To contrast the impacts of early socio-economic risks and preschool home learning environments upon British children's reading abilities and…

Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences

Directory of Open Access Journals (Sweden)

Dale B

2013-10-01

Full Text Available Bjørg Dale,1 Sigrun Hvalvik21Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 2Centre for Caring Research – Southern Norway, Faculty of Health and Social Studies, Telemark University College, Porsgrunn, NorwayBackground: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes.Methods: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach.Results: Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional

Does Child Abuse and Neglect Increase Risk for Perpetration of Violence Inside and Outside the Home?

Science.gov (United States)

Milaniak, Izabela; Widom, Cathy Spatz

2014-01-01

Objective: To examine the extent to which abused and neglected children perpetrate three different types of violence within and outside the home: criminal, child abuse, and intimate partner violence and determine whether childhood maltreatment leads to an increased risk for poly-violence perpetration. Method: Using data from a prospective cohort design study, children (ages 0-11) with documented histories of physical and sexual abuse and/or neglect (n = 676) were matched with children without such histories (n = 520) and assessed in young adulthood (average age 29). Official criminal records in conjunction with self-report data were used to assess violent outcomes. Results: Compared to the control group, individuals with histories of child abuse and/or neglect were significantly more likely to be poly-violence perpetrators, perpetrating violence in all three domains (relative risk = 1.26). All forms of childhood maltreatment (physical and sexual abuse and neglect) significantly predicted poly-violence perpetration. Conclusions: These findings expand the cycle of violence literature by combining the distinct literatures on criminal violence, child abuse, and partner violence to call attention to the phenomenon of poly-violence perpetration by maltreated children. Future research should examine the characteristics of maltreated children who become poly-violence perpetrators and mechanisms that lead to these outcomes. PMID:26191459

A reconsideration of home birth in the United States.

Science.gov (United States)

Minkoff, Howard; Ecker, Jeffrey

2013-01-01

Home births continue to constitute only a small percentage of all deliveries in the United States, in part because of concerns about their safety. While the literature is decidedly mixed in regard to the degree of risk, there are several studies that report that home birth may at times entail a small absolute increase in perinatal risks in circumstances that cannot always be anticipated prior to the onset of labor. While the definition of "small" will vary between individuals, and publications vary in the level of risk they ascribe to birth at home, studies with the least methodological flaws and with adequate power often cite an excess death rate in the range of one per thousand. Home birth is, in that regard, but one example of patients' choices and plans that sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. Our intention in this opinion piece is not to advocate for or against home birth. Rather, we recognize that home birth is but one example of a patient choice that might differ from what a provider feels is in a woman's best interests. In this article we will discuss ethical considerations in such circumstances using home birth as an example. We consider in this article how the ethical principles of respect for autonomy and non-maleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals' evaluation of patient choices. We also consider how in some circumstances, the value and safety added by a physician's participation may outweigh a potentially small increment in absolute risk that might result from a patient's decision to deliver at home because of a perceived physician endorsement. We recognize, however, that doctors and midwives participating in choices they have not recommended, or may even believe will lead to or increase risk for adverse outcomes, presents dilemmas and

Preferences for Home-Based HIV Testing Among Heterosexuals at Increased Risk for HIV/AIDS: New Orleans, Louisiana, 2013.

Science.gov (United States)

Robinson, William T; Zarwell, Meagan; Gruber, DeAnn

2017-07-01

Participants in the New Orleans arm of the National HIV Behavioral Surveillance of Heterosexuals at Increased Risk for HIV were asked about potential utilization of self-administered home-based tests for HIV. The majority (86%) would use a free home-based test if provided by mail and 99% would seek treatment based on a positive result. In addition, more than half of respondents would return test results in some format to the test provider, whereas most of the remaining participants preferred to discuss results only with their doctor. These findings point toward a potential method for advancing the National HIV/AIDS Strategy.

Campbell Creek Research Homes: FY2013 Annual Performance Report OCT.1, 2012 SEP. 30, 2013

Energy Technology Data Exchange (ETDEWEB)

Jackson, Roderick K [ORNL; Boudreaux, Philip R [ORNL; Munk, Jeffrey D [ORNL; Gehl, Anthony C [ORNL; Lyne, Christopher T [ORNL; Odukomaiya, Wale O [ORNL

2014-05-01

1.INTRODUCTION AND PROJECT OVERVIEW The Campbell Creek project is funded and managed by the Tennessee Valley Authority (TVA) Technology Innovation, Energy Efficiency, Power Delivery and Utilization Office. Technical support is provided under contract by the Oak Ridge National Laboratory (ORNL) and the Electric Power Research Institute (EPRI). The project was designed to determine the relative energy efficiency of typical new home construction, of retrofitting of existing homes, and of high-performance new homes built from the ground up for energy efficiency. This project was designed to compare three houses that represent current construction practices: a base case (Builder House CC1); a modified house that could represent a major energy-efficient retrofit (Retrofit House CC2); and a house constructed from the ground up to be a high-performance home (High Performance House CC3). To enable a valid comparison, it was necessary to simulate occupancy in all three houses and extensively monitor the structural components and the energy usage by component. In October 2013, the base case was also modified by replacing the builder-grade heating, ventilation, and air-conditioning (HVAC) system with a high-efficiency variable-speed unit. All three houses are two-story, slab-on-grade, framed construction. CC1 and CC2 are approximately 2,400 ft2. CC3 has a pantry option, used primarily as a mechanical equipment room, that adds approximately 100 ft2. All three houses are all-electric (with the exception of a gas log fireplace that is not used during the testing) and use air-source heat pumps for heating and cooling. The three homes are located in Knoxville in the Campbell Creek Subdivision. CC1 and CC2 are next door to each other with a south-facing orientation; CC3 has a north-facing orientation and is located across the street and a couple of houses down. The energy data collected will be used to determine the benefits of retrofit packages and high-performance new home

Work-Home Interference, Perceived Total Workload, and the Risk of Future Sickness Absence Due to Stress-Related Mental Diagnoses Among Women and Men: a Prospective Twin Study.

Science.gov (United States)

Svedberg, Pia; Mather, Lisa; Bergström, Gunnar; Lindfors, Petra; Blom, Victoria

2018-02-01

Work-home interference has been proposed as an important explanation for sickness absence (SA). Previous studies show mixed results, have not accounted for familial factors (genetics and shared everyday environment), or investigated diagnosis specific SA. The aim was to study whether work-home interference and perceived total workload predict SA due to stress-related mental diagnoses, or SA due to other mental diagnoses, among women and men, when adjusting for various confounders and familial factors. This study included 11,916 twins, 19-47 years (49% women). Data on work-to-home and home-to-work conflicts, perceived total workload, and relevant confounders were derived from a 2005 survey, and national register data on SA spells until 2013 were obtained. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Discordant twin pair design was applied to adjust for familial factors. Each one unit increase in work-to-home and home-to-work conflicts, and perceived total workload was associated with higher odds for SA due to stress-related mental diagnoses and to SA due to other mental diagnoses among women, when adjusting for sociodemographic factors (ORs 1.15-1.31). Including health or familial factors, no associations remained. For men, each one unit increase in work-to-home conflicts was associated with higher odds for SA due to stress-related diagnoses (ORs 1.23-1.35), independently of confounders. Work-to-home conflict was independently associated with future SA due to stress-related diagnoses among men only. Health- and work-related factors seem to be important confounders when researching work-home interference, perceived total workload, and SA. Not including such confounders involves risking drawing incorrect conclusions. Further studies are needed to confirm sex differences and whether genetic factors are important for the associations studied.

Smart Secure Homes: A Survey of Smart Home Technologies that Sense, Assess, and Respond to Security Threats.

Science.gov (United States)

Dahmen, Jessamyn; Cook, Diane J; Wang, Xiaobo; Honglei, Wang

2017-08-01

Smart home design has undergone a metamorphosis in recent years. The field has evolved from designing theoretical smart home frameworks and performing scripted tasks in laboratories. Instead, we now find robust smart home technologies that are commonly used by large segments of the population in a variety of settings. Recent smart home applications are focused on activity recognition, health monitoring, and automation. In this paper, we take a look at another important role for smart homes: security. We first explore the numerous ways smart homes can and do provide protection for their residents. Next, we provide a comparative analysis of the alternative tools and research that has been developed for this purpose. We investigate not only existing commercial products that have been introduced but also discuss the numerous research that has been focused on detecting and identifying potential threats. Finally, we close with open challenges and ideas for future research that will keep individuals secure and healthy while in their own homes.

Research and implementation of geographic information service mode in digital home

Science.gov (United States)

Lei, B.; Liu, K.; Gan, Y.; Zhong, M.

2014-04-01

Accompanying infrastructure improvements and networking technology innovation, the development of digital home service industry has gotten more and more attention. However, the digital home service levels have not sufficiently met rising demand from users. Therefore, it is urgent to propose and develop new service modes for the digital home. Geographic information services can provide various spatial information services such as map search, spatial information query. It has become an inevitable trend to implement geographic information services in the digital home. This paper proposes three new geographic information services modes for the digital home after sufficient requirement analysis: pushed information service mode, interactive information service mode, personalized information service mode. The key technologies to implement geographic information services on digital televisions are studied, involving digital television middleware technology, network transmission technology and visualization technology. According to the service modes' characteristics mentioned above, a service system in the digital home is established to implement geographic information services on the basis of digital television. The implementation of geographic information services in the digital home not only enriches the digital home services content, but also promotes geographic information from specialization to public popularity.

Residential building codes, affordability, and health protection: a risk-tradeoff approach.

Science.gov (United States)

Hammitt, J K; Belsky, E S; Levy, J I; Graham, J D

1999-12-01

Residential building codes intended to promote health and safety may produce unintended countervailing risks by adding to the cost of construction. Higher construction costs increase the price of new homes and may increase health and safety risks through "income" and "stock" effects. The income effect arises because households that purchase a new home have less income remaining for spending on other goods that contribute to health and safety. The stock effect arises because suppression of new-home construction leads to slower replacement of less safe housing units. These countervailing risks are not presently considered in code debates. We demonstrate the feasibility of estimating the approximate magnitude of countervailing risks by combining the income effect with three relatively well understood and significant home-health risks. We estimate that a code change that increases the nationwide cost of constructing and maintaining homes by $150 (0.1% of the average cost to build a single-family home) would induce offsetting risks yielding between 2 and 60 premature fatalities or, including morbidity effects, between 20 and 800 lost quality-adjusted life years (both discounted at 3%) each year the code provision remains in effect. To provide a net health benefit, the code change would need to reduce risk by at least this amount. Future research should refine these estimates, incorporate quantitative uncertainty analysis, and apply a full risk-tradeoff approach to real-world case studies of proposed code changes.

Food Away from Home and Childhood Obesity.

Science.gov (United States)

Mancino, Lisa; Todd, Jessica E; Guthrie, Joanne; Lin, Biing-Hwan

2014-12-01

Childhood obesity is associated with a number of serious health risks that can persist into adulthood. While trends in food away from home and fast-food consumption have paralleled trends in childhood obesity, it is important to identify whether this is a causal relationship. This paper reviews recent literature in this area to summarize if there is a consensus in research findings. We group the literature into two areas - consumption of and access to food away from home (FAFH). While no consensus findings have been reached in either area, the evidence of an association between FAFH consumption and childhood obesity has gained strength. Further, there is evidence that FAFH meals add calories to children's diets. The literature on the role of FAFH access and childhood obesity has continued producing mixed results.

The Future of Home Health Care

Science.gov (United States)

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-01-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

Home visits during pregnancy: consequences on pregnancy outcome, use of health services, and women's situations.

Science.gov (United States)

Blondel, B; Bréart, G

1995-08-01

This review of eight randomized controlled trials assessed two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications. In both categories, pregnancy outcome was not improved when women received home visits. The summary odds ratio for preterm delivery (better integration of hospital and home services might allow a more rational use of health services for women with complications. In addition, we need to define more precisely the content of home visits providing social support. For this, further research is required on how emotional support, health education, and advice influence the health of women and infants and mother-child interactions.

Home Education and Law in China

Science.gov (United States)

Sheng, Xiaoming

2018-01-01

Home education is at an early stage for the public, researchers, media and educational authorities in China. Yet the research relating to the development of home education has been entirely ignored. In particular, the literature focusing on the legal status of home education is negligible in the educational context of China. There is no literature…

PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting.

Science.gov (United States)

Mor, Vincent; Volandes, Angelo E; Gutman, Roee; Gatsonis, Constantine; Mitchell, Susan L

2017-04-01

prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities' electronic medical records permitted "real-time" adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

Smart GSM Based Home Automation System

OpenAIRE

Teymourzadeh, Rozita

2013-01-01

This research work investigates the potential of ‘Full Home Control’, which is the aim of the Home Automation Systems in near future. The analysis and implementation of the home automation technology using Global System for Mobile Communication (GSM) modem to control home appliances such as light, conditional system, and security system via Short Message Service (SMS) text messages is presented in this paper. The proposed research work is focused on the functionality of the GSM protocol, whic...

The work-home interface : The role of home-based predictors of burnout among mothers

NARCIS (Netherlands)

Missler, M.A.; Stroebe, M.S.; van der Laan, G.

2014-01-01

Research into the work–home interface has mainly focused on work-related variables, leaving aspects associated with the home domain relatively understudied. This investigation examined both facilitation and conflict between home and work in a sample of 260 working mothers with children up to four

Social perception risk : evolution of research

International Nuclear Information System (INIS)

Prades, A.; Sola, R.

2004-01-01

This article shows an overview of the evolution of a research line: the Social Perception of Risk. It starts with a brief reference to the origin and main results of this research field to focus on the crucial challenges we have to face today. Right now we are witnessing a real turning point which is not exclusive of the radiological risk arena. A genuine social change phenomena is leading us a step forward towards the so called risk Governance. (Author)

[Home births].

Science.gov (United States)

Welffens, K; Kirkpatrick, C; Daelemans, C; Derisbourg, S

In Belgium, very few women give birth outside the delivery room. In the United Kingdom and in the Netherlands, they are more numerous. Several studies evaluated obstetric and neonatal outcomes of home births compared with hospital births. We selected seven recent and large studies (with cohorts of more than 5.000 women) using PubMed, Science Direct and Cochrane Database of Systematic Reviews. Several questions were examined. Is there any difference in maternal and neonatal outcomes depending on the intended place of birth? Does parity affect outcomes ? What are the characteristics of women who choose to deliver at home ? We conclude that giving birth at home improves obstetric outcomes but is riskier for the baby, especially for the first one. The women delivering at home are mainly white Europeans, between 25 and 35 years old, in a relationship, multiparous and wealthier. In order to avoid this increased risk for the baby while preserving the obstetric advantages, alongside birth centers offer an intermediate solution. They combine the reassuring home-like atmosphere with the safety of the hospital. In Belgium, the first alongside birth center " Le Cocon " (a low technicity unit distinct from the delivery room) offers now this type of alternative place of birth for women in Hôpital Erasme in Brussels.

A comparison of home care clients and nursing home residents: can community based care keep the elderly and disabled at home?

Science.gov (United States)

Shugarman, L R; Fries, B E; James, M

1999-01-01

Admission cohorts from the Michigan Medicaid Home and Community-Based Waiver program and Ohio nursing homes were compared on measures of resource utilization including a modified Resource Utilization Groups (RUG-III) system, Activities of Daily Living (ADLs), and overall case mix. We found that, contrary to previous research, the two samples were remarkably similar across RUG-III categories. However, the nursing home sample was more functionally impaired on measures of ADL functioning and overall case mix. Results of this study may inform policymakers and providers of the potential for maintaining the appropriate population in the home with government-funded home care.

The unattached fraction of radon decay products: Potential effects of in-home air cleaners on lung cancer risk

International Nuclear Information System (INIS)

Brady, P.A.

1991-01-01

Radon decay products are a factor in the development of lung cancer. Because of their efficient deposition within the lung, the fraction of decay products not attached to particulate (i.e., the unattached fraction) is very important in lung dosimetry. This study simulated the use of two in-home air cleaning devices to reduce airborne particulate concentrations, measure the effect on the unattached fraction, and estimate the radon lung cancer risk. Radon was released into a chamber having a volume-to-surface-area ratio similar to a small home. At radon-decay product equilibrium, radon and airborne particle concentrations were measured, and the concentration of the unattached fraction was estimated. The effect of particle concentration on the unattached fraction was then determined. The average unattached fractions corresponding to the particle concentration ranges expected for the air cleaning devices were used to calculate the annual alpha radiation dose and annual radon lung cancer for men, women and children at rest and under light activity. The annual doses and related risks were compared to those used in the models published by the Environmental Protection Agency. For particulate concentrations of a home with no particulate generating activities (e.g., smoking, cooking), the electronic air cleaner is predicted to reduce the unattached fraction from seven percent (the value used by the NCRP and confirmed in this study) to four percent. These conditions represent the maximum reduction in the unattached fraction. The decrease in the unattached fraction is tentatively attributed to an increase in plateout. Based on these results, a reduction of less than ten percent in the calculated annual lung cancer risk is found in all cases

Home Environment, Self-Concept and Urban Student Achievement: A Bibliography and Review of Research. NJ Urban Education Research Reports No. 5.

Science.gov (United States)

Shapiro, Carol; Bloom, Joel S.

This review analyzes recent research on student personality, social and home environment, and the influence of these factors on academic achievement, particularly among minority and disadvantaged students. Several factors which purportedly affect student achievement and which are examined in the review include: (1) socioeconomic status and its…

Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home

DEFF Research Database (Denmark)

Munk, T; Tolstrup, U; Beck, A M

2016-01-01

Background: Many older patients are undernourished after hospitalisation. Undernutrition impacts negatively on physical function and the ability of older patients to perform activities of daily living at home after discharge from acute hospital. The present study aimed to evaluate the evidence...... for an effect of individualised dietary counselling following discharge from acute hospital to home on physical function, and, second, on readmissions, mortality, nutritional status, nutritional intake and quality of life (QoL), in nutritionally at-risk older patients. Methods: A systematic review of randomised......% CI = 0.08-1.95, P = 0.03). Meta-analyses revealed no significant effect on physical function assessed using hand grip strength, and similarly on mortality. Narrative summation of effects on physical function using other instruments revealed inconsistent effects. Meta-analyses were not conducted on Qo...

Evaluating the risks of clinical research: direct comparative analysis.

Science.gov (United States)

Rid, Annette; Abdoler, Emily; Roberson-Nay, Roxann; Pine, Daniel S; Wendler, David

2014-09-01

Many guidelines and regulations allow children and adolescents to be enrolled in research without the prospect of clinical benefit when it poses minimal risk. However, few systematic methods exist to determine when research risks are minimal. This situation has led to significant variation in minimal risk judgments, raising concern that some children are not being adequately protected. To address this concern, we describe a new method for implementing the widely endorsed "risks of daily life" standard for minimal risk. This standard defines research risks as minimal when they do not exceed the risks posed by daily life activities or routine examinations. This study employed a conceptual and normative analysis, and use of an illustrative example. Different risks are composed of the same basic elements: Type, likelihood, and magnitude of harm. Hence, one can compare the risks of research and the risks of daily life by comparing the respective basic elements with each other. We use this insight to develop a systematic method, direct comparative analysis, for implementing the "risks of daily life" standard for minimal risk. The method offers a way of evaluating research procedures that pose the same types of risk as daily life activities, such as the risk of experiencing anxiety, stress, or other psychological harm. We thus illustrate how direct comparative analysis can be applied in practice by using it to evaluate whether the anxiety induced by a respiratory CO2 challenge poses minimal or greater than minimal risks in children and adolescents. Direct comparative analysis is a systematic method for applying the "risks of daily life" standard for minimal risk to research procedures that pose the same types of risk as daily life activities. It thereby offers a method to protect children and adolescents in research, while ensuring that important studies are not blocked because of unwarranted concerns about research risks.

Home and Building Energy Management Systems | Grid Modernization | NREL

Science.gov (United States)

Home and Building Energy Management Systems Home and Building Energy Management Systems NREL researchers are developing tools to understand the impact of changes in home and building energy use and how researchers who received a record of invention for a home energy management system in a smart home laboratory

In-Home Display – a Review of Experiences from Research Projects

Directory of Open Access Journals (Sweden)

Krzysztof Billewicz

2014-12-01

Full Text Available There are many studies on smart metering. The aim of smart metering is not only automated billing and two-way communication with a smart meter. The measure of success of the implementation of smart metering is the level of customer engagement and their cooperation with energy companies, as well as the consequences of such involvement changing electricity-using habits. This article focuses on one device for smart metering – in-home display (IHD. The paper characterizes an IHD’s functions and describes international experiences of research and conclusions of studies.

Home ownership and fall-related outcomes among older adults in South Korea.

Science.gov (United States)

Do, Young Kyung; Kim, Cheong-Seok

2013-10-01

Many of the previously identified environmental risk factors for fall-related outcomes (e.g. flooring, stairs and steps, kitchen, and bathrooms) are amenable to change, but the extent of the changes on these home-related risk factors are conditional on home ownership of the elderly. This study aims to test whether lack of home ownership is associated with a higher risk of falls, and a higher likelihood of reporting fear of falling and activity limitations due to fear of falling among older adults in South Korea. Using data from the first two waves (2006 and 2008) of the Korean Longitudinal Study of Aging, the associations between home ownership variables and three fall-related outcomes were examined in two regression models. A logistic regression model of any falls in the past 2 years was estimated to examine whether older adults living in short-term rental homes based on monthly rent have an increased risk of falls. A probit model accounting for sample selection was estimated to examine whether the two related outcomes, fear of falling and limiting activities due to fear of falling, are associated with home ownership status. Compared with owned home, short-term rental home predicted a higher likelihood of incident of falls and activity limitation due to fear of falling. The study findings suggest that the lack of home ownership with unstable housing tenure is an important risk factor for fall-related outcomes among older adults in South Korea. © 2012 Japan Geriatrics Society.

Association of out-of-home eating with anthropometric changes: a systematic review of prospective studies.

Science.gov (United States)

Nago, Eunice S; Lachat, Carl K; Dossa, Romain A M; Kolsteren, Patrick W

2014-01-01

In the present review, the association of out-of-home eating with anthropometric changes was examined. Peer-reviewed studies in eight databases were searched, and 15 prospective studies were included in the review. The quality of the data was assessed by considering risks of bias in sample selection, data collection methods, and the appropriateness of statistical tests. From this, seven studies, which used relatively large samples or had a follow-up period longer than 10 years, were retained for further analysis. It was concluded that eating out-of-home frequently, in the broad sense, is positively associated with the risk of becoming overweight or obese and weight change. With regard to specific out-of-home sources, the review shows that eating at fast-food outlets is associated with a greater increase in body weight and waist circumference over time than eating at restaurants and takeaway foods positively predict BMI change in women. More research is needed on out-of-home foods other than fast-foods and restaurant foods, such as street, canteen, and school foods.

Prevalence of and risk factors for violent disciplinary practices at home in Viet Nam.

Science.gov (United States)

Cappa, Claudia; Dam, Hang

2014-02-01

Data on parenting practices and the use of violence in child rearing remain scarce worldwide, hindering prevention efforts. This study examines disciplinary methods used on children at home in Viet Nam. It is based on data collected from 2010 to 2011 through the fourth round of the Multiple Indicator Cluster Survey (MICS4)-a household survey program supported by the United Nations Children's Fund (UNICEF) that focuses on women and children in low- and middle-income countries. Respondents in the survey were asked 11 questions relating to disciplinary measures used in the preceding month on one randomly selected child (2-14 years old) in each household. A final question about attitudes probed adults' views on the need for physical punishment in child rearing. Univariate and multivariate analyses were conducted to estimate the prevalence of violent and nonviolent forms of discipline, and to identify risk factors associated with violent punishment. Results showed that three in four children in Viet Nam are disciplined through violent means. The exposure of Vietnamese children to violent forms of discipline was significantly associated with varied characteristics of both children and their caregivers. Moreover, the use of violent disciplinary practices on children was strongly associated with positive attitudes toward corporal punishment. Risk factors for violent child discipline identified in this study can inform future interventions to promote positive practices and to protect Vietnamese children against violence in the home.

Early-life home environment and risk of asthma among inner-city children.

Science.gov (United States)

O'Connor, George T; Lynch, Susan V; Bloomberg, Gordon R; Kattan, Meyer; Wood, Robert A; Gergen, Peter J; Jaffee, Katy F; Calatroni, Agustin; Bacharier, Leonard B; Beigelman, Avrahman; Sandel, Megan T; Johnson, Christine C; Faruqi, Ali; Santee, Clark; Fujimura, Kei E; Fadrosh, Douglas; Boushey, Homer; Visness, Cynthia M; Gern, James E

2018-04-01

Environmental exposures in early life appear to play an important role in the pathogenesis of childhood asthma, but the potentially modifiable exposures that lead to asthma remain uncertain. We sought to identify early-life environmental risk factors for childhood asthma in a birth cohort of high-risk inner-city children. We examined the relationship of prenatal and early-life environmental factors to the occurrence of asthma at 7 years of age among 442 children. Higher house dust concentrations of cockroach, mouse, and cat allergens in the first 3 years of life were associated with lower risk of asthma (for cockroach allergen: odds ratio per interquartile range increase in concentration, 0.55; 95% CI, 0.36-0.86; P < .01). House dust microbiome analysis using 16S ribosomal RNA sequencing identified 202 and 171 bacterial taxa that were significantly (false discovery rate < 0.05) more or less abundant, respectively, in the homes of children with asthma. A majority of these bacteria were significantly correlated with 1 of more allergen concentrations. Other factors associated significantly positively with asthma included umbilical cord plasma cotinine concentration (odds ratio per geometric SD increase in concentration, 1.76; 95% CI, 1.00-3.09; P = .048) and maternal stress and depression scores. Among high-risk inner-city children, higher indoor levels of pet or pest allergens in infancy were associated with lower risk of asthma. The abundance of a number of bacterial taxa in house dust was associated with increased or decreased asthma risk. Prenatal tobacco smoke exposure and higher maternal stress and depression scores in early life were associated with increased asthma risk. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Use of maternity waiting home in rural Zambia.

Science.gov (United States)

van Lonkhuijzen, Luc; Stegeman, Margreet; Nyirongo, Rebecca; van Roosmalen, Jos

2003-04-01

This study was conducted to assess the results from the use of a maternity waiting home, a health facility to which women with high risk pregnancies are referred during the last weeks of pregnancy in rural Zambia. It compared the risk status and pregnancy outcome in women staying as waiters with those women who give birth in hospital after direct admission (non-waiters). Forty seven per-cent of the non-waiters (n = 292) had no maternal risk factors and 85% had no antenatal risk factors as compared to 17% and 78% among the waiters (n = 218). Eighty six per cent of waiters had spontaneous vaginal vertex delivery as compared to 95% of non-waiters. Although the differences in risk status were statistically significant, no differences were found in birth weight and maternal and perinatal mortality. The similar obstetric outcome among waiters with more high risk pregnancies and non-waiters could be interpreted as a possible outcome of the maternity waiting home. When dependent on a proper functioning referral system, such waiting homes can reduce perinatal mortality.

An in-home video study and questionnaire survey of food preparation, kitchen sanitation, and hand washing practices.

Science.gov (United States)

Scott, Elizabeth; Herbold, Nancie

2010-06-01

Foodborne illnesses pose a problem to all individuals but are especially significant for infants, the elderly, and individuals with compromised immune systems. Personal hygiene is recognized as the number-one way people can lower their risk. The majority of meals in the U.S. are eaten at home. Little is known, however, about the actual application of personal hygiene and sanitation behaviors in the home. The study discussed in this article assessed knowledge of hygiene practices compared to observed behaviors and determined whether knowledge equated to practice. It was a descriptive study involving a convenience sample of 30 households. Subjects were recruited from the Boston area and a researcher and/or a research assistant traveled to the homes of study participants to videotape a standard food preparation procedure preceded by floor mopping. The results highlight the differences between individuals' reported beliefs and actual practice. This information can aid food safety and other health professionals in targeting food safety education so that consumers understand their own critical role in decreasing their risk for foodborne illness.

ThinkHome Energy Efficiency in Future Smart Homes

Directory of Open Access Journals (Sweden)

Reinisch Christian

2011-01-01

Full Text Available Abstract Smart homes have been viewed with increasing interest by both home owners and the research community in the past few years. One reason for this development is that the use of modern automation technology in the home or building promises considerable savings of energy, therefore, simultaneously reducing the operational costs of the building over its whole lifecycle. However, the full potential of smart homes still lies fallow, due to the complexity and diversity of the systems, badly engineered and configured installations, as well as the frequent problem of suboptimal control strategies. Summarized, these problems converge to two undesirable conditions in the "not-so-smart" home: energy consumption is still higher than actually necessary and users are unable to yield full comfort in their automated homes. This work puts its focus on alleviating the current problems by proposing a comprehensive system concept, that shall ensure that smart homes can keep their promise in the future. The system operates on an extensive knowledge base that stores all information needed to fulfill the goals of energy efficiency and user comfort. Its intelligence is implemented as and within a multiagent system that also caters for the system's openness to the outside world. As a first evaluation, a profile-based control strategy for thermal comfort is developed and verified by means of simulation.

Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.

Science.gov (United States)

Meesterberends, Esther; Halfens, Ruud J G; Spreeuwenberg, Marieke D; Ambergen, Ton A W; Lohrmann, Christa; Neyens, Jacques C L; Schols, Jos M G A

2013-08-01

To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. A prospective multicenter cohort study. Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular

Preventing child maltreatment: Examination of an established statewide home-visiting program.

Science.gov (United States)

Chaiyachati, Barbara H; Gaither, Julie R; Hughes, Marcia; Foley-Schain, Karen; Leventhal, John M

2018-05-01

Although home visiting has been used in many populations in prevention efforts, the impact of scaled-up home-visiting programs on abuse and neglect remains unclear. The objective of this study was to assess the impact of voluntary participation in an established statewide home-visiting program for socially high-risk families on child maltreatment as identified by Child Protective Services (CPS). Propensity score matching was used to compare socially high-risk families with a child born between January 1, 2008 and December 31, 2011 who participated in Connecticut's home-visiting program for first-time mothers and a comparison cohort of families who were eligible for the home-visiting program but did not participate. The main outcomes were child maltreatment investigations, substantiations, and out-of-home placements by CPS between January 1, 2008 and December 31, 2013. In the unmatched sample, families who participated in home-visiting had significantly higher median risk scores (P home visiting. First substantiations also occurred later in the child's life among home-visited families. There was a trend toward decreased out-of-home placement (HR 0.73, 95% CI 0.53-1.02, P = .06). These results from a scaled-up statewide program highlight the potential of home visiting as an important approach to preventing child abuse and neglect. Copyright © 2018 Elsevier Ltd. All rights reserved.

Influence of green supply chain risk management on performance of Chinese manufacturing enterprises

Science.gov (United States)

Zhang, Dongying; Yuting, Duan; Junyi, Shen

2017-12-01

This paper briefly introduces the background of the research on the impact of green supply chain risk management on corporate performance, reviews the relevant research literature at home and abroad, and uses the gray relational analysis to analyze the impact of the green supply chain risk management on enterprise performance based on 26 industry-related statistical data, from purchasing risk management performance,manufacturing risk management performance and marketing risk management performance.

Social Work Home Visits to Children and Families in the UK: A Foucauldian Perspective.

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Winter, Karen; Cree, Viviene E

2016-07-01

The home visit is at the heart of social work practice with children and families; it is what children and families' social workers do more than any other single activity (except for recording), and it is through the home visit that assessments are made on a daily basis about risk, protection and welfare of children. And yet it is, more than any other activity, an example of what Pithouse has called an 'invisible trade': it happens behind closed doors, in the most secret and intimate spaces of family life. Drawing on conceptual tools associated with the work of Foucault, this article sets out to provide a critical, chronological review of research, policy and practice on home visiting. We aim to explain how and in what ways changing discourses have shaped the emergence, legitimacy, research and practice of the social work home visit to children and families at significant time periods and in a UK context. We end by highlighting the importance for the social work profession of engagement and critical reflection on the identified themes as part of their daily practice.

Screening for malnutrition among nursing home residents - a comparative analysis of the mini nutritional assessment, the nutritional risk screening, and the malnutrition universal screening tool.

Science.gov (United States)

Diekmann, R; Winning, K; Uter, W; Kaiser, M J; Sieber, C C; Volkert, D; Bauer, J M

2013-04-01

The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting. The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting. MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months. Among 200 residents (mean age 85.5 ± 7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of 'malnutrition' according to the MNA was 15.4%. The prevalence of 'risk of malnutrition' (NRS) and 'high risk of malnutrition' (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in 'malnourished', respectively 'high risk of malnutrition' or 'nutritional risk', was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents. The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home

Home Within Me

DEFF Research Database (Denmark)

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

2017-01-01

In an increasingly globalized, digitalized and perceived unmanageable world, consumers strive for belongingness, identification and security and re-discover the importance of home. Home is central to peoples’ individual as well as collective identities and their self-development (McCracken, 1989...... in Austria and the sample consisted of 15 locals (study 1) and 17 first generation immigrants (study 2) to identify possible commonalities and differences. This research adds to existing literature by 1) empirically confirming the existence of dimensions of home (e.g., physical, social, temporary...

The determinants of home and nursing home death: a systematic review and meta-analysis.

Science.gov (United States)

Costa, Vania; Earle, Craig C; Esplen, Mary Jane; Fowler, Robert; Goldman, Russell; Grossman, Daphna; Levin, Leslie; Manuel, Douglas G; Sharkey, Shirlee; Tanuseputro, Peter; You, John J

2016-01-20

Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness. A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95% confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria. Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver's coping skills. Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care

The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents.

NARCIS (Netherlands)

M.D. Rijnaard; Joost van Hoof; H. Verbeek; H.C. Beerens; S.L. Molony; W. Pocornie; Eveline Wouters; B.M. Janssen; A. Eijkelenboom

2016-01-01

Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1) original and peer-reviewed research, (2) qualitative, quantitative, or mixed methods research, (3) research

Home-based Healthcare Technology

DEFF Research Database (Denmark)

Verdezoto, Nervo

of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...

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...

NIH Researchers Identify OCD Risk Gene

Science.gov (United States)

... News From NIH NIH Researchers Identify OCD Risk Gene Past Issues / Summer 2006 Table of Contents For ... and Alcoholism (NIAAA) have identified a previously unknown gene variant that doubles an individual's risk for obsessive- ...

Proximity to vacant buildings is associated with increased fire risk in Baltimore, Maryland, homes.

Science.gov (United States)

Schachterle, Stephen E; Bishai, David; Shields, Wendy; Stepnitz, Rebecca; Gielen, Andrea C

2012-04-01

Fires and burns are a leading cause of unintentional injury death in the USA. Although it has been anecdotally reported that vacant dwellings are at a higher risk for fire, the association between vacancy and fire risk at the individual household level has not been empirically measured. In this cross-sectional study, geocoded residential vacant properties (VP) and fire events are analysed in Baltimore City at the census tract level and the individual household level. On average, a 10% increase in the proportion of vacancies in a census tract was associated with a 9.9% increase in fires (95% CI: 5% to 15%). Random-effects Poisson models, controlling for housing and neighbourhood conditions, found contagion effects. The risk of fire in an occupied dwelling increased by 8% (95% CI: 1% to 10%) for every vacant structure within 10 m, and the risk of fire decreased by half (95% CI: 45% to 62%) for every km between an occupied dwelling and vacant building. Close proximity to VP was associated with trash fires within dwellings (p=0.039) and structure fires (p=0.012). We believe that this is the first study to demonstrate increased risk posed by nearby VP at the household level, confirming earlier ecological analyses of the role of VP as strong correlates of home fires. Measurement of this risk can motivate property owners, policy makers and insurers to invest in risk reduction measures that include building maintenance and trash removal.

Attitudes of palliative home care physicians towards palliative sedation at home in Italy.

Science.gov (United States)

Mercadante, Sebastiano; Masedu, Francesco; Mercadante, Alessandro; Marinangeli, Franco; Aielli, Federica

2017-05-01

Information about the attitudes towards palliative sedation (PS) at home is limited. The aim of this survey was to assess the attitudes of palliative care physicians in Italy regarding PS at home. A questionnaire was submitted to a sample of palliative care physicians, asking information about their activity and attitudes towards PS at home. This is a survey of home care physicians in Italy who were involved in end-of-life care decisions at home. One hundred and fifty participants responded. A large heterogeneity of home care organizations that generate some problems was found. Indications, intention and monitoring of PS seem to be appropriate, although some cultural and logistic conditions were limiting the use of PS. Specialized home care physicians are almost involved to start PS at home. Midazolam was seldom available at home and opioids were more frequently used. These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles.

Human-centered design and smart homes : How to study and design for the home experience?

NARCIS (Netherlands)

Eggen, J.H.; van den Hoven, E.A.W.H; Terken, J.M.B.; van Hoof, J.; Demiris, G.; Wouters, E.J.M.

2016-01-01

The focus of this chapter is on designing for smart homes. The perspective will be user-driven design research. The chapter starts with a context analysis of the home environment. This analysis shows that, from a user perspective, home is about emotions and not about the physical house with all its

Newborn Care in the Home and Health Facility: Formative Findings for Intervention Research in Cambodia

Directory of Open Access Journals (Sweden)

Alessandra N. Bazzano

2016-12-01

Full Text Available Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming.

Risk for Researchers Studying Social Deviance or Criminal Behavior

Directory of Open Access Journals (Sweden)

Patricia L. Brougham

2017-10-01

Full Text Available Abstract: Researchers often encounter dangerous situations while conducting social research. The concept of risk to researchers refers to the possible harm that may occur to researchers while in the field or after leaving a research project. This study explores issues experienced by social scientists engaged in research on social deviance or criminal behavior. The goal of this research was to discover the types of risk experienced by social scientists and any mediating factors affecting the experience of risk. An online survey was conducted to gather data on issues experienced by social scientists. This study found that researchers experienced a variety of risks within the categories of physical/health, emotional, legal, and personal/professional. Each of the survey options for risk were reported by at least one respondent; however, the greatest number of risks reported were of an emotional or personal/professional nature. There were no mediating factors found to be significant in relation to the experience of risk. This was a surprising finding especially for the variable of gender as it is suggested that gender plays a role in the experience of difficulties.

Defining moments in risk communication research: 1996-2005.

Science.gov (United States)

McComas, Katherine A

2006-01-01

Ten years ago, scholars suggested that risk communication was embarking on a new phase that would give increased attention to the social contexts that surround and encroach on public responses to risk information. A decade later, many researchers have answered the call, with several defining studies examining the social and psychological influences on risk communication. This article reviews risk communication research appearing in the published literature since 1996. Among studies, social trust, the social amplification of risk framework, and the affect heuristic figured prominently. Also common were studies examining the influence of risk in the mass media. Among these were content analyses of media coverage of risk, as well as investigations of possible effects resulting from coverage. The use of mental models was a dominant method for developing risk message content. Other studies examined the use of risk comparisons, narratives, and visuals in the production of risk messages. Research also examined how providing information about a risk's severity, social norms, and efficacy influenced communication behaviors and intentions to follow risk reduction measures. Methods for conducting public outreach in health risk communication rounded out the literature.

Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review.

Science.gov (United States)

Müller, Christian; Lautenschläger, Sindy; Meyer, Gabriele; Stephan, Astrid

2017-06-01

During the transition of people with dementia from home to nursing home family caregivers often feel burdened. We aimed to 1) identify interventions which support people with dementia and their caregivers in the transition from home care to nursing home care, 2) synthesize the evidence for efficacy of these interventions, and 3) examine whether the identified interventions have been systematically developed, evaluated and implemented according to the Medical Research Council guidance on complex interventions. A systematic review of randomised controlled trials was conducted according to the recommendations specified in the Cochrane Handbook for Intervention Reviews. The review protocol was registered in PROSPERO (2015: CRD42015019839). Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. MEDLINE, CENTRAL, PsycINFO, CINAHL, OTseeker, and PEDro, were searched. Other sources included Google Scholar, and ALOIS. Two reviewers independently assessed the eligibility of the articles. Data extraction was performed by one reviewer and verified independently by another. The Cochrane Risk of Bias tool was used for critical appraisal. Development and evaluation of the identified interventions were assessed, taking the Medical Research Council guidance into account. Review findings were synthesized narratively. The search yielded 1278 records. Five studies were included, all conducted in the United States (4 RCTs and 1 cRCT with a total of 695 participants). The psychosocial interventions were individual and family counseling via telephone or ad hoc all of which addressed only informal caregivers. The intervention components, content and mode of delivery differed widely with inconsistent results. Significant intervention effects were found for the reduction of caregivers' depressive symptoms, burden, feeling of guilt, emotional distress, overload, and interactions with staff. Other outcomes, i.e. stress, placement

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands.

NARCIS (Netherlands)

Wiegers, T.A.; Keirse, M.J.N.C.; Zee, J. van der; Berghs, G.A.H.

1996-01-01

Objective: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. Design: Analysis of prospective data from midwives and their clients.

The nutritional care of people living with dementia at home: A scoping review.

Science.gov (United States)

Mole, Louise; Kent, Bridie; Abbott, Rebecca; Wood, Chloë; Hickson, Mary

2018-01-24

There are an increasing number of people with dementia living in their own home for longer, often supported by a family member. The symptoms of dementia can affect an individual's nutritional status, which can lead to a reduced quality of life for the person with dementia and their family members. A scoping review was conducted from July 2016 until September 2016, using a recognised framework, to explore what is currently known, and identify any gaps in the research regarding the nutritional care of people living with dementia at home. This included any interventions that may have been trialled or implemented, and the views of those living with dementia, carers and clinicians. Six electronic databases were searched from inception to July 2016. A review team was involved in screening and data extraction for selected articles. Published qualitative and quantitative studies were included that explored the nutritional care of people living with dementia at home. Methods included data extraction and conventional content analysis. Stakeholders were involved in the development of final categories. Following screening, 61 studies reported in 63 articles were included. Most studies were cross-sectional (n = 24), cohort (n = 15) or qualitative (n = 9). Only three were randomised controlled trials. Three overarching categories represented the results: Timely identification of nutritional risk and subsequent regular monitoring of nutritional status, multi-component tailored interventions and the influence of the care-giving dyad on nutritional status. Many studies identify people living at home with dementia as a vulnerable group prone to malnutrition; however, a lack of interventions exists to address the increased risk. There is a lack of research exploring the role of home care providers and healthcare professionals in the provision of nutritional care. Further research is required to explore how the emotional aspect of the care-giving dyad influences nutritional care

Early-versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression.

Science.gov (United States)

Wattmo, Carina; Wallin, Åsa K

2017-01-01

Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and lower education level were protective factors for slower instrumental ADL (IADL) decline. In EOAD, antihypertensives/cardiac therapy implied faster IADL progression but lower risk of NHP. This study highlights the clinical importance of an earlier diagnosis and treatment initiation and the need for functional evaluations in EOAD. Despite the age differences between EOAD and LOAD, a similar need for nursing homes was observed.

The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review.

Science.gov (United States)

Hammond, Alison; Prior, Yeliz

2016-09-01

Rheumatoid arthritis (RA) commonly reduces hand function. We systematically reviewed trials to investigate effects of home hand exercise programmes on hand symptoms and function in RA. We searched: Medline (1946-), AMED, CINAHL, Physiotherapy Evidence Database, OT Seeker, the Cochrane Library, ISI Web of Science from inception to January 2016. Nineteen trials were evaluated. Only three were randomized controlled trials with a low risk of bias (n = 665). Significant short-term improvements occurred in hand function, pain and grip strength, with long-term improvements in hand and upper limb function and pinch strength. Heterogeneity of outcome measures meant meta-analysis was not possible. Evaluation of low and moderate risk of bias trials indicated high-intensity home hand exercise programmes led to better short-term outcomes than low-intensity programmes. Such programmes are cost-effective. Further research is required to evaluate methods of helping people with RA maintain long-term home hand exercise. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Trends in characteristics of women choosing contraindicated home births.

Science.gov (United States)

Zafman, Kelly B; Stone, Joanne L; Factor, Stephanie H

2018-04-12

To characterize the American College of Obstetricians and Gynecologists (ACOG) contraindicated home births and the women who are receiving these births in hopes of identifying venues for intervention. The National Center for Health Statistics (NCHS) birth certificate records from 1990 to 2015 were used. "Planned home births" were defined as those births in which birthplace was coded as "residence" and birth attendant was coded as "certified nurse midwife (CNM)" or "other midwife". Contraindicated home births were defined as "planned home births" from 1990 to 2015 that had one or more of the ACOG risk factors for home births, which include vaginal birth after prior cesarean delivery (VBAC), breech presentation and multiple gestations. A review of trends in contraindicated home births from 1990 to 2015 suggests that they are increasing in number (481-1396) and as a percentage of total births (0.01%-0.04%, P95%), which is most frequently initiated in the first trimester. The majority of home births were paid out-of-pocket (65%-69%). The increasing number of contraindicated home births in the United States requires public health action. Home births are likely a matter of choice rather than a lack of resources. It is unclear if women choose home births while knowing the risk or due to a lack of information. Prenatal education about contraindicated home births is possible, as almost all women receive prenatal care.

Anticholinergic Medication Burden and 5-Year Risk of Hospitalization and Death in Nursing Home Elderly Residents With Coronary Artery Disease.

Science.gov (United States)

Vetrano, Davide L; La Carpia, Domenico; Grande, Giulia; Casucci, Paola; Bacelli, Tiziana; Bernabei, Roberto; Onder, Graziano

2016-11-01

To assess the association of the anticholinergic medication burden with hospitalization and mortality in nursing home elderly patients and to investigate the role of coronary artery disease (CAD). Longitudinal (5-year) retrospective observational study. Nursing homes in Italy. A total of 3761 nursing home older residents. A comprehensive clinical and functional assessment was carried out through the interRAI long-term care facility instrument. The anticholinergic burden was assessed through the anticholinergic cognitive burden (ACB) scale. Occurrence of hospitalization/all-cause mortality was the primary composite outcome. First hospitalization and all-cause mortality were the secondary outcomes of the study. Hazard ratios (HRs) and subdistribution HRs were obtained through Cox and competing risk (death as competing event for hospitalization) models. Within the sample (mean age 83 ± 7 years; 72% females) the incidence rate of the primary outcome was 10/100 person-year. After adjusting for potential confounders and compared with participants with an ACB of 0, those with an ACB of 1 [HR 1.46; 95% confidence interval (CI) 1.12-1.90] and ABC of 2+ (HR 1.41; 95% CI 1.11-1.79) presented an increased risk of developing the primary outcome. After stratification, the risk for the primary outcome increased along with the anticholinergic burden, only for participants affected by CAD (HR 1.53; 95% CI 0.94-2.50 and HR 1.71; 95% CI 1.09-2.68 for the ACB of 1 and ACB of 2+ groups). An ACB score of 2+ was marginally associated with first hospitalization, considering death as a competing risk, only for those with CAD (subdistribution HR 3.47; 95% CI 0.99-12.3). Anticholinergic medication burden is associated to hospitalization and all-cause mortality in institutionalized older adults. CAD increases such risk. The effectiveness and safety profile of complex drug regimens should be reconsidered in this population. Copyright © 2016 AMDA – The Society for Post-Acute and Long

Data at Risk and Research Libraries

Science.gov (United States)

Choudhury, S.

2017-12-01

Research libraries have recently engaged in data rescue events amidst growing concerns about access to federal data sets. While these efforts are well intentioned, libraries run the risk of ignoring a long established history of activities and accomplishments by other communities focused on data at risk, many of which are represented at forums such as AGU. Under the auspices of the Data Conservancy, the Sheridan Libraries at Johns Hopkins University hosted an event in July 2017 that convened members of various communities including ESIP, RDA, Data Rescue Boulder, Association of Research Libraries, the Fedora repository platform, the Open Science Framework and the Interplanetary File System or IPFS (via the Data Together Network). This group identified a potential role for research libraries to partner with existing players in the data at risk community by focusing on a distributed preservation network as part of a coordinated collection development program. This session will offer an opportunity to hear about this potential role for research libraries and to provide feedback about its viability and utility.

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.

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

Science.gov (United States)

Newbould, Louise; Mountain, Gail; Hawley, Mark S; Ariss, Steven

2017-01-01

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.

Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: A systematic meta-review

Directory of Open Access Journals (Sweden)

Petticrew Mark

2008-07-01

Full Text Available Abstract Background The effects of psychosocial risk factors on population health and health inequalities has featured prominently in epidemiological research literature as well as public health policy strategies. We have conducted a meta-review (a review of reviews exploring how psychosocial factors may relate to population health in home and community settings. Methods Systematic review (QUORUM of literature reviews (published in any language or country on the health associations of psychosocial risk factors in community settings. The literature search included electronic and manual searches. Two reviewers appraised included reviews using criteria for assessing systematic reviews. Data from the more robust reviews were extracted, tabulated and synthesised. Results Thirty-one reviews met our inclusion criteria. These explored a variety of psychosocial factors including social support and networks, social capital, social cohesion, collective efficacy, participation in local organisations – and less favourable psychosocial risk factors such as demands, exposure to community violence or anti-social behaviour, exposure to discrimination, and stress related to acculturation to western society. Most of the reviews focused on associations between social networks/support and physical or mental health. We identified some evidence of favourable psychosocial environments associated with better health. Reviews also found evidence of unfavourable psychosocial risk factors linked to poorer health, particularly among socially disadvantaged groups. However, the more robust reviews each identified studies with inconclusive findings, as well as studies finding evidence of associations. We also identified some evidence of apparently favourable psychosocial risk factors associated with poorer health. Conclusion From the review literature we have synthesised, where associations have been identified, they generally support the view that favourable psychosocial

Home births in the United States, 1990-2009.

Science.gov (United States)

MacDorman, Marian F; Mathews, T J; Declercq, Eugene

2012-01-01

After 14 years of decline, the percentage of home births rose by 29% from 2004 to 2009, to the point where it is at the highest level since data on this item began to be collected in 1989. The overall increase in home births was driven mostly by a 36% increase for non-Hispanic white women. About 1 out of every 90 births to non-Hispanic white women are now home births. The percentage of home births for non-Hispanic white women was three to five times higher than for any other racial or ethnic group. Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk profile of home compared with hospital births suggests that home birth attendants are selecting low-risk women as candidates for home birth. The increase in the percentage of home births from 2004 to 2009 was widespread and involved selected states from every region of the country. The large variations in the percentage of home births by state may be influenced by differences among states in laws pertaining to births are more prevalent among non-Hispanic white women (7). midwifery practice or out-of-hospital birth (8,9), as well as by differences in the racial and ethnic composition of state populations, as home Studies have suggested that most home births are intentional or planned home births, whereas others are unintentional or unplanned, because of an emergency situation (i.e., precipitous labor, labor complications, or unable to get to the hospital in time) (3,6). Although not representative of all U.S. births (see "Data source and methods"), 87% of home births in a 26-state reporting area (comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of home births were planned (10). Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family

Integrating Parenting Support Within and Beyond the Pediatric Medical Home.

Science.gov (United States)

Linton, Julie M; Stockton, Maria Paz; Andrade, Berta; Daniel, Stephanie

2018-01-01

Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.

Reliability and risk analysis methods research plan

International Nuclear Information System (INIS)

1984-10-01

This document presents a plan for reliability and risk analysis methods research to be performed mainly by the Reactor Risk Branch (RRB), Division of Risk Analysis and Operations (DRAO), Office of Nuclear Regulatory Research. It includes those activities of other DRAO branches which are very closely related to those of the RRB. Related or interfacing programs of other divisions, offices and organizations are merely indicated. The primary use of this document is envisioned as an NRC working document, covering about a 3-year period, to foster better coordination in reliability and risk analysis methods development between the offices of Nuclear Regulatory Research and Nuclear Reactor Regulation. It will also serve as an information source for contractors and others to more clearly understand the objectives, needs, programmatic activities and interfaces together with the overall logical structure of the program

Drug utilization research and risk management

NARCIS (Netherlands)

Mazzaglia, Giampiero; Mol, Peter G. M.; Elseviers, Monique; Wettermark, Björn; Almarsdóttir, Anna Birna; Andersen, Morten; Benko, Ria; Bennie, Marion; Eriksson, Irene; Godman, Brian; Krska, Janet; Poluzzi, Elisabetta; Taxis, Katja; Vlahovic-Palcevski, Vera; Stichele, Robert Vander

2016-01-01

Good risk management requires continuous evaluation and improvement of planned activities. The evaluation impact of risk management activities requires robust study designs and carefully selected outcome measures. Key learnings and caveats from drug utilization research should be applied to the

Combined use of drugs inhibiting the renin-angiotensin system: prescribing patterns and risk of acute kidney injury in German nursing home residents.

Science.gov (United States)

Dörks, Michael; Herget-Rosenthal, Stefan; Hoffmann, Falk; Jobski, Kathrin

2018-01-01

In 2012, the European Medicines Agency reviewed the safety of dual renin-angiotensin system (RAS) blockade because of potentially increased risks for inter alia acute kidney injury (AKI). Since residents of nursing homes are particularly vulnerable to adverse drug outcomes, the aims of our study were to describe RAS-inhibiting drug use in German nursing home residents and examine the risk of AKI associated with dual RAS blockade. Based on claims data, a nested case-control study within a cohort of RAS-inhibiting drug users was conducted. Using conditional logistic regression, confounder-adjusted odds ratios (aORs) and 95% confidence intervals (CI) were obtained for the risk of AKI associated with dual RAS blockade. Subgroup analyses were performed in patients with diabetes or chronic kidney disease and both comorbidities. Of all 127,227 nursing home residents, the study cohort included 64,567 (50.7%) who were treated with at least one RAS-inhibiting drug. More than three quarters of the study population were female (77.1%). Mean age was 86.0 ± 6.8 years. Most residents were treated with angiotensin-converting enzyme inhibitors (77.8%), followed by angiotensin II receptor blockers (21.6%) and aliskiren (0.2%). Annual prevalence of dual RAS blockade declined from 9.6 (95% CI 7.8-11.8) in 2010 to 4.7 (95% CI 4.0-5.4) per 1,000 users in 2014. In the overall cohort, AKI was not significantly associated with dual RAS blockade (aOR 1.99; 0.77-5.17). However, significantly increased aORs were observed when considering patients with diabetes (3.47; 1.27-9.47), chronic kidney disease (4.74; 1.24-18.13) or both (11.17; 2.65-47.15). Prescribing of drugs inhibiting the RAS is common in German nursing homes. Though the prevalence of dual RAS blockade declined, our study showed an increased risk of AKI in patients with diabetes and/or chronic kidney disease. Therefore, cautious use is warranted in these vulnerable patients.

Risk as a target of safety research

International Nuclear Information System (INIS)

Krueger, W.

1986-01-01

Job creation is not the idea behind the demand for risk studies to be intensified in safety research. Risks are not only a target safety research should investigate, they are a subject that actually can be most adequately investigated by safety research. Assuming a neutral position between irrational fears and interest-minded problem minimization, that is the central approach and the ethics of a safety scientist. The Babylonian confusion of terminology experienced after the Chernobyl accident is a good example proving the necessity of fostering the neutral professionalism in safety research. (orig./DG) [de

Housing improvement and home safety Effectiveness Matters

OpenAIRE

, Crd; Sphr@, L; , MrcSphsu

2014-01-01

The homes we live in impact on health, wellbeing and health inequalities. Treating illnesses directly related to living in cold, damp and dangerous homes costs the NHS £2.5 billion per year. Ensuring affordable warmth through insulation and more efficient heating can improve health and wellbeing. Home safety assessment and modification can reduce falls and risk of falling in older people. Education, promotion of exercise and wearing of appropriate footwear, environmental modifications and tra...

Double Jeopardy: Poorer Social-Emotional Outcomes for Children in the NICHD SECCYD Experiencing Home and Child-Care Environments that Confer Risk

Science.gov (United States)

Watamura, Sarah Enos; Phillips, Deborah A.; Morrissey, Taryn W.; McCartney, Kathleen; Bub, Kristen

2011-01-01

Using data from the National Institute of Child Health and Human Development Early Child Care Research Network (NICHD SECCYD), the authors examined whether interactions between home and child-care quality affect children's social-emotional adjustment at 24, 36, and 54 months (N = 771). Triadic splits on quality of home and child care were used to…

Stroke and Nursing Home care: a national survey of nursing homes.

LENUS (Irish Health Repository)

Cowman, Seamus

2010-01-01

BACKGROUND: Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. METHODS: A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30) efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. RESULTS: Across all nursing homes (n = 60), 18% (n = 570) of the residents had previously had a stroke. In homes (n = 30), where interviews with residents with stroke (n = 257), only 7% (n = 18) residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239) residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. CONCLUSIONS: This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care) for stroke survivors who reside in nursing homes in Ireland.

Center for risk research: A review of work 1988-1991

International Nuclear Information System (INIS)

Sjoeberg, L.

1992-01-01

This report gives a summary of the research published during the first 4 years of the Center for Risk Research at the Stockholm School of Economics. Risk research carried out so far at the Center has been concerned with mapping of attitudes and risk perceptions with regard to nuclear risks, AIDS, military flight risks, and economic risks. There has also been some methodological work and some work on the relationship between risk perception and interests

Center for risk research: A review of work 1988-1991

Energy Technology Data Exchange (ETDEWEB)

Sjoeberg, L

1992-01-01

This report gives a summary of the research published during the first 4 years of the Center for Risk Research at the Stockholm School of Economics. Risk research carried out so far at the Center has been concerned with mapping of attitudes and risk perceptions with regard to nuclear risks, AIDS, military flight risks, and economic risks. There has also been some methodological work and some work on the relationship between risk perception and interests.

Modeling Research Project Risks with Fuzzy Maps

Science.gov (United States)

Bodea, Constanta Nicoleta; Dascalu, Mariana Iuliana

2009-01-01

The authors propose a risks evaluation model for research projects. The model is based on fuzzy inference. The knowledge base for fuzzy process is built with a causal and cognitive map of risks. The map was especially developed for research projects, taken into account their typical lifecycle. The model was applied to an e-testing research…

Home Automation and Security System

OpenAIRE

Surinder Kaur,; Rashmi Singh; Neha Khairwal; Pratyk Jain

2016-01-01

Easy Home or Home automation plays a very important role in modern era because of its flexibility in using it at different places with high precision which will save money and time by decreasing human hard work. Prime focus of this technology is to control the household equipment’s like light, fan, door, AC etc. automatically. This research paper has detailed information on Home Automation and Security System using Arduino, GSM and how we can control home appliances using Android application....

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, a...

The Future of Home Health project: developing the framework for health care at home.

Science.gov (United States)

Lee, Teresa; Schiller, Jennifer

2015-02-01

In addition to providing high-quality care to vulnerable patient populations, home healthcare offers the least costly option for patients and the healthcare system, particularly in postacute care. As the baby boom generation ages, policymakers are expressing concerns about rising costs, variation in home healthcare service use, and program integrity. The Alliance for Home Health Quality and Innovation seeks to develop a research-based strategic framework for the future of home healthcare for older Americans and those with disabilities. This article describes the initiative and invites readers to provide comments and suggestions.

The impact of home computer use on children's activities and development.

Science.gov (United States)

Subrahmanyam, K; Kraut, R E; Greenfield, P M; Gross, E F

2000-01-01

The increasing amount of time children are spending on computers at home and school has raised questions about how the use of computer technology may make a difference in their lives--from helping with homework to causing depression to encouraging violent behavior. This article provides an overview of the limited research on the effects of home computer use on children's physical, cognitive, and social development. Initial research suggests, for example, that access to computers increases the total amount of time children spend in front of a television or computer screen at the expense of other activities, thereby putting them at risk for obesity. At the same time, cognitive research suggests that playing computer games can be an important building block to computer literacy because it enhances children's ability to read and visualize images in three-dimensional space and track multiple images simultaneously. The limited evidence available also indicates that home computer use is linked to slightly better academic performance. The research findings are more mixed, however, regarding the effects on children's social development. Although little evidence indicates that the moderate use of computers to play games has a negative impact on children's friendships and family relationships, recent survey data show that increased use of the Internet may be linked to increases in loneliness and depression. Of most concern are the findings that playing violent computer games may increase aggressiveness and desensitize a child to suffering, and that the use of computers may blur a child's ability to distinguish real life from simulation. The authors conclude that more systematic research is needed in these areas to help parents and policymakers maximize the positive effects and to minimize the negative effects of home computers in children's lives.

Older adult perceptions of smart home technologies: implications for research, policy & market innovations in healthcare.

Science.gov (United States)

Coughlin, J; D'Ambrosio, L A; Reimer, B; Pratt, M R

2007-01-01

Advances in information communications technology and related computational power are providing a wide array of systems and related services that form the basis of smart home technologies to support the health, safety and independence of older adults. While these technologies offer significant benefits to older people and their families, they are also transforming older adults into lead adopters of a new 24/7 lifestyle of being monitored, managed, and, at times, motivated, to maintain their health and wellness. To better understand older adult perceptions of smart home technologies and to inform future research a workshop and focus group was conducted with 30 leaders in aging advocacy and aging services from 10 northeastern states. Participants expressed support of technological advance along with a variety of concerns that included usability, reliability, trust, privacy, stigma, accessibility and affordability. Participants also observed that there is a virtual absence of a comprehensive market and policy environment to support either the consumer or the diffusion of these technologies. Implications for research, policy and market innovation are discussed.

Home care in Australia: an integrative review.

Science.gov (United States)

Palesy, Debra; Jakimowicz, Samantha; Saunders, Carla; Lewis, Joanne

2018-01-01

The home care sector comprises one of Australia's fastest growing workforces, yet few papers capture the overall landscape of Australian home care. This integrative review investigates home care with the aim of better understanding care recipients and their needs, funding, and regulation; care worker skills, tasks, demographics, employment conditions, and training needs. Over 2,700 pieces of literature were analyzed to inform this review. Results suggest sector fragmentation and a home care workforce who, although well-placed to improve outcomes for care recipients, are in need of better training and employment support. Suggestions for future research regarding Australian home care include studies that combine both aged and disability aspects of care, more research around care recipients, priority needs and strategies for addressing them, and how best to prepare home care workers for their roles.

Pervasive Home Care - Technological support for treatment of diabetic foot ulcers at home

DEFF Research Database (Denmark)

Larsen, Simon Bo

2006-01-01

of the patient in collaboration with patient and home care clinicians. My main research method has been qualitative analysis of the empirical results generated during an experimental project using Participatory Design (PD) to investigate potential futures in the treatment of patients with diabetic foot ulcers...... the need arises for moving treatment and care involving specialised knowledge from the hospital to the home. In this dissertation I use the term Home Care" for the multidisciplinary investigation of how this movement can be supported with technology enabling the expert to carry on a treatment in the home...... approach that I outline in this dissertation. Furthermore I describe the results of the project contributing to three related scientific fields: home care technologies, telemedicine and computer supported cooperative work (CSCW). The main conclusion towards home care technologies is that the many visionary...

Suicide risk in long-term care facilities: a systematic review.

Science.gov (United States)

Mezuk, Briana; Rock, Andrew; Lohman, Matthew C; Choi, Moon

2014-12-01

Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. Copyright © 2014 John Wiley & Sons, Ltd.

Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS)

NARCIS (Netherlands)

Willemsen, I.; Nelson-Melching, J.; Hendriks, Y.; Mulders, A.; Verhoeff, S.; Kluytmans-Vandenbergh, M.; Kluytmans, J.

2014-01-01

BACKGROUND: We developed a standardised method to assess the quality of infection control in Dutch Nursing Home (NH), based on a cross-sectional survey that visualises the results. The method was called the Infection control RIsk Infection Scan (IRIS). We tested the applicability of this new tool in

Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

NARCIS (Netherlands)

de Jonge, J.; Mesman, J.A.J.M.; Manniën, J.; Zwart, J.J.; van Dillen, J.; van Roosmalen, J.

2013-01-01

Objectives: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Design: Cohort study

Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

Science.gov (United States)

Davitt, Joan K.

2014-01-01

Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

Early- versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression

Directory of Open Access Journals (Sweden)

Carina Wattmo

2017-05-01

Full Text Available Background/Aims: Whether age at onset influences functional deterioration in Alzheimer disease (AD is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL and nursing home placement (NHP in cholinesterase inhibitor (ChEI-treated patients with early-onset AD (EOAD versus late-onset AD (LOAD. Methods: This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years and 874 LOAD (onset ≥65 years. Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Results: Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and lower education level were protective factors for slower instrumental ADL (IADL decline. In EOAD, antihypertensives/cardiac therapy implied faster IADL progression but lower risk of NHP. Conclusion: This study highlights the clinical importance of an earlier diagnosis and treatment initiation and the need for functional evaluations in EOAD. Despite the age differences between EOAD and LOAD, a similar need for nursing homes was observed.

Scoring the home falls and accidents screening tool for health professionals (HOME FAST-HP): Evidence from one epidemiological study.

Science.gov (United States)

Mackenzie, Lynette; Byles, Julie

2018-03-30

Falls in older people are a major public health concern. To target falls prevention interventions, screening tools need to be able to identify older people at greater risk of falling. This study aimed to investigate the screening capacity of the Home Falls and Accidents Screening Tool for health professionals (HOME FAST-HP), and to identify the best cut-off score to identify older people at higher risk of falls using the HOME FAST-HP. The study used cross-sectional data from a random sample of 650 women from the 1921 to 1926 cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Selected women were sent a postal survey including the HOME FAST-HP, falls history, and other health factors. Scores on the home fast were calculated and the cut-point for optimal sensitivity and specificity of the HOME FAST-HP in relation to falls was assessed using a Receiver Operating Characteristic curve. A total of 567 older women participated (response rate 87%). The mean age of participants was 77.5 yrs (95% CI 77.31-77.70). A total of 153 participants (27%) reported a fall in the previous six months. The mean number of hazards using the HOME FAST-HP was 9.74 (95% CI 9.48-10.01), range 2-22. Non-fallers had a mean of 9.6 hazards (95% CI 9.32-9.91) and fallers had a mean of 10.63 hazards (95% CI 10.08-11.19) which was a significant difference (t = 3.41, P = 0.001). The area under the receiver operator curve (AUC) was 0.58 (95% CI 0.53-0.64). A HOME FAST-HP cut-off score of 9 was associated with the optimal sensitivity for falls (73.9%), with specificity (37.9%), and positive predictive value was 30.6% and negative predictive value was 79.7%. The HOME FAST-HP can be used as a screening tool to identify fallers with a cut-off score of nine indicating a higher risk of falling. © 2018 Occupational Therapy Australia.

Multidisciplinary European Low Dose Initiative (MELODI). Strategic research agenda for low dose radiation risk research

Energy Technology Data Exchange (ETDEWEB)

Kreuzer, M. [Federal Office for Radiation Protection, BfS, Department of Radiation Protection and Health, Neuherberg (Germany); Auvinen, A. [University of Tampere, Tampere (Finland); STUK, Helsinki (Finland); Cardis, E. [ISGlobal, Barcelona Institute for Global Health, Barcelona (Spain); Durante, M. [Institute for Fundamental Physics and Applications, TIFPA, Trento (Italy); Harms-Ringdahl, M. [Stockholm University, Centre for Radiation Protection Research, Stockholm (Sweden); Jourdain, J.R. [Institute for Radiological Protection and Nuclear Safety, IRSN, Fontenay-aux-roses (France); Madas, B.G. [MTA Centre for Energy Research, Environmental Physics Department, Budapest (Hungary); Ottolenghi, A. [University of Pavia, Physics Department, Pavia (Italy); Pazzaglia, S. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome (Italy); Prise, K.M. [Queens University Belfast, Belfast (United Kingdom); Quintens, R. [Belgian Nuclear Research Centre, SCK-CEN, Mol (Belgium); Sabatier, L. [French Atomic Energy Commission, CEA, Paris (France); Bouffler, S. [Public Health England, PHE, Chilton (United Kingdom)

2018-03-15

MELODI (Multidisciplinary European Low Dose Initiative) is a European radiation protection research platform with focus on research on health risks after exposure to low-dose ionising radiation. It was founded in 2010 and currently includes 44 members from 18 countries. A major activity of MELODI is the continuous development of a long-term European Strategic Research Agenda (SRA) on low-dose risk for radiation protection. The SRA is intended to identify priorities for national and European radiation protection research programs as a basis for the preparation of competitive calls at the European level. Among those key priorities is the improvement of health risk estimates for exposures close to the dose limits for workers and to reference levels for the population in emergency situations. Another activity of MELODI is to ensure the availability of European key infrastructures for research activities, and the long-term maintenance of competences in radiation research via an integrated European approach for training and education. The MELODI SRA identifies three key research topics in low dose or low dose-rate radiation risk research: (1) dose and dose rate dependence of cancer risk, (2) radiation-induced non-cancer effects and (3) individual radiation sensitivity. The research required to improve the evidence base for each of the three key topics relates to three research lines: (1) research to improve understanding of the mechanisms contributing to radiogenic diseases, (2) epidemiological research to improve health risk evaluation of radiation exposure and (3) research to address the effects and risks associated with internal exposures, differing radiation qualities and inhomogeneous exposures. The full SRA and associated documents can be downloaded from the MELODI website (http://www.melodi-online.eu/sra.html). (orig.)

Home environment, brain injury, & school performance in LBW survivors.

Science.gov (United States)

Mahoney, Ashley Darcy; Pinto-Martin, Jennifer; Hanlon, Alexandra

2014-01-01

There has been substantial research on low birthweight (LBW) as a predictor of adverse educational and cognitive outcomes. LBW infants perform worse on cognitive battery tests compared to children born at normal birthweight; however, children exposed to similar risks do not all share the same experiences. The complex, interrelated factors responsible for poor cognitive and achievement performance vary for different populations, but researchers hypothesize that the home environment may influence the infants' long-term health outcomes. Examine the home environment as a moderator in the causal pathway from neonatal brain injury to school performance in a secondary analysis of a prospectively studied, geographically defined cohort from the Neonatal Brain Hemorrhage Study. The secondary analysis sample included 543 infants with birthweights of 501 to 2,000 g who were born consecutively in three community hospitals in New Jersey between 1984 and 1986. School performance at age 9 was measured by the Woodcock-Johnson Tests of Achievement. The home environment variables were tested and analyzed using multistep hierarchical regression modeling. A moderating effect between the variable neighborhood observations and brain injury was demonstrated for the outcome math score. The moderating relationship was found in the category of children without brain injury (β = 1.76, p = .005). There were statistically significant and potentially clinical meaningful models when looking at the home environmental variables as they relate to reading and math scores. The findings suggest that at least one variable within a LBW child's socio-environmental milieu can moderate the effects of perinatal brain injury on school performance outcomes.

Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home.

Science.gov (United States)

Flink, Benjamin J; Long, Chandler A; Duwayri, Yazan; Brewster, Luke P; Veeraswamy, Ravi; Gallagher, Katherine; Arya, Shipra

2016-06-01

Women undergoing vascular surgery have higher morbidity and mortality. Our study explores gender-based differences in patient-centered outcomes such as readmission, length of stay (LOS), and discharge destination (home vs nonhome facility) in aortic aneurysm surgery. Patients were identified from the American College of Surgeons National Surgical Quality Improvement Project database (2011-2013) undergoing abdominal, thoracic, and thoracoabdominal aortic aneurysms (N = 17,763), who were discharged and survived their index hospitalization. The primary outcome was unplanned readmission, and secondary outcomes were discharge to a nonhome facility, LOS, and reasons for unplanned readmission. Univariate, multivariate, and stratified analyses based on gender and discharge destination were used. Overall, 1541 patients (8.7%) experienced an unplanned readmission, with a significantly higher risk in women vs men (10.8% vs 8%; P women compared with men persisted in multivariate analysis after controlling for covariates (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4). Similarly, the rate of discharge to a nonhome facility was nearly double in women compared with men (20.6% vs 10.7%; P women compared with men occurred in patients who were discharged home (OR, 1.2; 95% CI, 1.02-1.4) but not in those who were discharged to a nonhome facility (OR, 1.06; 95% CI, 0.8-1.4). Significant differences in LOS were seen in patients who were discharged home. No gender differences were found in reasons for readmission with the three most common reasons being thromboembolic events, wound infections, and pneumonia. Gender disparity exists in the risk of unplanned readmission among aortic aneurysm surgery patients. Women who were discharged home have a higher likelihood of unplanned readmission despite longer LOS than men. These data suggest that further study into the discharge planning processes, social factors, and use of rehabilitation services is needed for women

The Home Literacy Environment as a Predictor of the Early Literacy Development of Children at Family-Risk of Dyslexia

Science.gov (United States)

Hamilton, Lorna G.; Hayiou-Thomas, Marianna E.; Hulme, Charles; Snowling, Margaret J.

2016-01-01

The home literacy environment (HLE) predicts language and reading development in typically developing children; relatively little is known about its association with literacy development in children at family-risk of dyslexia. We assessed the HLE at age 4 years, precursor literacy skills at age 5, and literacy outcomes at age 6, in a sample of…

Beware of Data Gaps in Home Care Research: The Streetlight Effect and Its Implications for Policy Making on Long-Term Services and Supports

Science.gov (United States)

Newquist, Deborah D.; DeLiema, Marguerite; Wilber, Kathleen H.

2016-01-01

Policy initiatives increasingly seek greater use of home- and community-based services for older persons and those with chronic care needs, yet large gaps persist in our knowledge of home care, an indispensable component of long-term services and supports. Unrecognized data gaps, including the scope of home care provided by private hire and nonmedical providers, can distort knowledge and poorly inform long-term services and supports policy. The purpose of this article is to examine these gaps by describing the universe of formal home care services and provider types in relationship to major national sources. Findings reveal four distinct home care sectors and that the majority of formal home care is provided in the sectors that are understudied. We discuss the policy implications of data gaps and conclude with recommendations on where to expand and refine home care research. PMID:26062611

A clinician-driven home care delivery system.

Science.gov (United States)

August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R

1993-12-01

The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

Interprofessional collaboration in nursing homes (interprof): a grounded theory study of general practitioner experiences and strategies to perform nursing home visits.

Science.gov (United States)

Fleischmann, Nina; Tetzlaff, Britta; Werle, Jochen; Geister, Christina; Scherer, Martin; Weyerer, Siegfried; Hummers-Pradier, Eva; Mueller, Christiane A

2016-08-30

Interprofessionalism, considered as collaboration between medical professionals, has gained prominence over recent decades and evidence for its impact has grown. The steadily increasing number of residents in nursing homes will challenge medical care and the interaction across professions, especially nurses and general practitioners (GPs). The nursing home visit, a key element of medical care, has been underrepresented in research. This study explores GP perspectives on interprofessional collaboration with a focus on their visits to nursing homes in order to understand their experiences and expectations. This research represents an aspect of the interprof study, which explores medical care needs as well as the perceived collaboration and communication by nursing home residents, their families, GPs and nurses. This paper focusses on GPs' views, investigating in particular their visits to nursing homes in order to understand their experiences. Open guideline-interviews covering interprofessional collaboration and the visit process were conducted with 30 GPs in three study centers and analyzed with grounded theory methodology. GPs were recruited via postal request and existing networks of the research partners. Four different types of nursing home visits were found: visits on demand, periodical visits, nursing home rounds and ad-hoc-decision based visits. We identified the core category "productive performance" of home visits in nursing homes which stands for the balance of GPs´ individual efforts and rewards. GPs used different strategies to perform a productive home visit: preparing strategies, on-site strategies and investing strategies. We compiled a theory of GPs home visits in nursing homes in Germany. The findings will be useful for research, and scientific and management purposes to generate a deeper understanding of GP perspectives and thereby improve interprofessional collaboration to ensure a high quality of care.

Managing risk in statistics - "Relative risk" | Durrheim | South African ...

African Journals Online (AJOL)

South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 45, No 8 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Managing risk in statistics - "Relative risk". DN Durrheim ...

Planned home and hospital births in South Australia, 1991-2006: differences in outcomes.

Science.gov (United States)

Kennare, Robyn M; Keirse, Marc J N C; Tucker, Graeme R; Chan, Annabelle C

2010-01-18

To examine differences in outcomes between planned home births, occurring at home or in hospital, and planned hospital births. Population-based study using South Australian perinatal data on all births and perinatal deaths during the period 1991-2006. Analysis included logistic regression adjusted for predictor variables and standardised perinatal mortality ratios. Perinatal death, intrapartum death, death attributed to intrapartum asphyxia, Apgar score home births accounted for 0.38% of 300,011 births in South Australia. They had a perinatal mortality rate similar to that for planned hospital births (7.9 v 8.2 per 1000 births), but a sevenfold higher risk of intrapartum death (95% CI, 1.53-35.87) and a 27-fold higher risk of death from intrapartum asphyxia (95% CI, 8.02-88.83). Review of perinatal deaths in the planned home births group identified inappropriate inclusion of women with risk factors for home birth and inadequate fetal surveillance during labour. Low Apgar scores were more frequent among planned home births, and use of specialised neonatal care as well as rates of postpartum haemorrhage and severe perineal tears were lower among planned home births, but these differences were not statistically significant. Planned home births had lower caesarean section and instrumental delivery rates, and a seven times lower episiotomy rate than planned hospital births. Perinatal safety of home births may be improved substantially by better adherence to risk assessment, timely transfer to hospital when needed, and closer fetal surveillance.

Early home-based intervention in the Netherlands for children at familial risk of dyslexia.

Science.gov (United States)

van Otterloo, Sandra G; van der Leij, Aryan; Henrichs, Lotte F

2009-08-01

Dutch children at higher familial risk of reading disability received a home-based intervention programme before formal reading instruction started to investigate whether this would reduce the risk of dyslexia. The experimental group (n=23) received a specific training in phoneme awareness and letter knowledge. A control group (n=25) received a non-specific training in morphology, syntax, and vocabulary. Both interventions were designed to take 10 min a day, 5 days a week for 10 weeks. Most parents were sufficiently able to work with the programme properly. At post-test the experimental group had gained more on phoneme awareness than the control group. The control group gained more on one of the morphology measures. On average, these specific training results did not lead to significant group differences in first-grade reading and spelling measures. However, fewer experimental children scored below 10th percentile on word recognition. (c) 2008 John Wiley & Sons, Ltd.

Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: A randomized controlled trial

NARCIS (Netherlands)

Nijs, K.A.N.D.; Graaf, de C.; Siebelink, E.; Blauw, Y.H.; Vanneste, V.; Kok, F.J.; Staveren, van W.A.

2006-01-01

Background. Social facilitation and meal ambiance have beneficial effects on food intake in healthy adults. Extrapolation to the nursing home setting may lead to less malnutrition among the residents. Therefore, we investigate the effect of family-style meals on energy intake and the risk of

Unpacking socio-economic risks for reading and academic self-concept in primary school: differential effects and the role of the preschool home learning environment

OpenAIRE

Crampton, Alexandria; Hall, James

2017-01-01

Background: uncertainty remains concerning how children’s reading and academic self-concept are related and how these are differentially affected by social disadvantage and home learning environments. Aims: to contrast the impacts of early socioeconomic risks and preschool home learning environments upon British children’s reading abilities and academic self-concept between 7-10 years.Sample: n=3,172 British children aged 3-10 years and their families.Methods: a secondary analysis of the nati...

Low Fruit/Vegetable Consumption in the Home: Cumulative Risk Factors in Early Childhood

Science.gov (United States)

Ward, Wendy L.; Swindle, Taren M.; Kyzer, Angela L.; Whiteside-Mansell, Leanne

2015-01-01

Cumulative risk theory suggests that a variety of social risk factors would have an additive effect on obesity risk. Multiple studies have suggested that obesity is related to basic resources such as transportation and financial resources. Additional research points to parental engagement and parental monitoring as additional sources of risk. This…

Nursing perception of patient transitions from hospitals to home with home health.

Science.gov (United States)

Smith, Shannon Bright; Alexander, Judith W

2012-01-01

The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

Internet protocol television for personalized home-based health information: design-based research on a diabetes education system.

Science.gov (United States)

Gray, Kathleen Mary; Clarke, Ken; Alzougool, Basil; Hines, Carolyn; Tidhar, Gil; Frukhtman, Feodor

2014-03-10

The use of Internet protocol television (IPTV) as a channel for consumer health information is a relatively under-explored area of medical Internet research. IPTV may afford new opportunities for health care service providers to provide health information and for consumers, patients, and caretakers to access health information. The technologies of Web 2.0 add a new and even less explored dimension to IPTV's potential. Our research explored an application of Web 2.0 integrated with IPTV for personalized home-based health information in diabetes education, particularly for people with diabetes who are not strong computer and Internet users, and thus may miss out on Web-based resources. We wanted to establish whether this system could enable diabetes educators to deliver personalized health information directly to people with diabetes in their homes; and whether this system could encourage people with diabetes who make little use of Web-based health information to build their health literacy via the interface of a home television screen and remote control. This project was undertaken as design-based research in two stages. Stage 1 comprised a feasibility study into the technical work required to integrate an existing Web 2.0 platform with an existing IPTV system, populated with content and implemented for user trials in a laboratory setting. Stage 2 comprised an evaluation of the system by consumers and providers of diabetes information. The project succeeded in developing a Web 2.0 IPTV system for people with diabetes and low literacies and their diabetes educators. The performance of the system in the laboratory setting gave them the confidence to engage seriously in thinking about the actual and potential features and benefits of a more widely-implemented system. In their feedback they pointed out a range of critical usability and usefulness issues related to Web 2.0 affordances and learning fundamentals. They also described their experiences with the system in

Housing choices and care home design for people with dementia.

Science.gov (United States)

Hadjri, Karim; Rooney, Cliona; Faith, Verity

2015-01-01

This article reviews the current state of housing for people with dementia by exploring housing choices available to this group, and identifying potential issues with design of care homes. Older people who wish to age in place are faced with the challenge of adapting their domestic environment to ensure independence, accessibility, and social connectivity. This is even more challenging for people with dementia who continue to live at home, given the risks of self-harm and getting lost. More imaginative and inclusive forms of collective housing are needed. For people with dementia, a move to a new environment is often a stressful experience that causes shock, withdrawal, and anger. Hence, more research is needed to develop more fitting long-term housing options for people with dementia. This article presents a brief review on housing choices and housing design for people with dementia. Interviews with managers of 22 care homes were conducted to explore housing choices and design issues. Results show that the main housing choices available to people with dementia offer different levels of care. The choice of care homes relates to the atmosphere of a home as some occupants favor a homely or relaxing environment and others prefer dynamic settings. A combination of appropriate level of care, a good atmosphere, and design quality within the care home are elements that lead to a more enabling environment. Design of a successful caring environment also requires appropriate care and a positive therapeutic and domestic-looking environment. © The Author(s) 2015.

Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

Directory of Open Access Journals (Sweden)

Asangaedem Akpan

2007-04-01

wards 14 [47%] (P < 0.01. Loose stools were the most prevalent factor present at baseline in 13 of the 19 (68% subjects whose fecal incontinence had resolved at 3 months.Conclusion: The distribution of the factors contributing to fecal incontinence in older people living at home differs from those cared for in nursing home and hospital wards settings. These differences need to be borne in mind when assessing people in different settings. Management appears to result in a cure for those who are not significantly disabled with loose stools as a cause for their fecal incontinence, but this would need to be confirmed by further research.Keywords: Older adults, fecal incontinence, risk factors, care settings, digital rectal examination, mortality

Towards a smart home framework

OpenAIRE

Alam, Muddasser; Alan, Alper; Rogers, Alex; Ramchurn, Sarvapali D.

2013-01-01

We present our Smart Home Framework (SHF) which simplifies the modelling, prototyping and simulation of smart infrastructure (i.e., smart home and smart communities). It provides the buildings blocks (e.g., home appliances) that can be extended and assembled together to build a smart infrastructure model to which appropriate AI techniques can be applied. This approach enables rapid modelling where new research initiatives can build on existing work.

Engaging Families in In-Home Family Intervention

Science.gov (United States)

Thompson, Ronald W.; Koley, Sarah

2014-01-01

Boys Town has created a program called In-Home Family Services to deliver help to families in stress. In-home family intervention programs have become widely used to help more families who are at risk and experiencing difficulties with a wide range of problems including domestic violence, child behavior problems, parent-child and family…

Radon Research Program, FY 1991

International Nuclear Information System (INIS)

1992-03-01

The scientific information being sought in this program encompasses research designed to determine radon availability and transport outdoors, modeling transport into and within buildings, physics and chemistry of radon and radon progeny, dose response relationships, lung cancer risk, and mechanisms of radon carcinogenesis. The main goal of the DOE/OHER Radon Research Program is to develop information to reduce these uncertainties and thereby provide an improved health risk estimate of exposure to radon and its progeny as well as to provide information useful in radon control strategies. Results generated under the Program were highlighted in a National Research Council report on radon dosimetry. The study concluded that the risk of radon exposure is 30% less in homes than in mines. This program summary of book describes the OHER FY-1991 Radon Research Program. It is the fifth in an annual series of program books designed to provide scientific and research information to the public and to other government agencies on the DOE Radon Research Program

Stroke and Nursing Home care: a national survey of nursing homes

Directory of Open Access Journals (Sweden)

McGee Hannah

2010-01-01

Full Text Available Abstract Background Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. Methods A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30 efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. Results Across all nursing homes (n = 60, 18% (n = 570 of the residents had previously had a stroke. In homes (n = 30, where interviews with residents with stroke (n = 257, only 7% (n = 18 residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239 residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. Conclusions This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care for stroke survivors who reside in nursing homes in Ireland.

Comportamiento del riesgo de caídas en el hogar en adultos mayores Behavior of falls risk at home of the elderly persons

Directory of Open Access Journals (Sweden)

Arlene Salas Mainegra

2011-03-01

Full Text Available Introducción: se realizó un estudio descriptivo, en la población de adultos mayores atendidos por el Consultorio del Médico de Familia # 4, perteneciente al policlínico "Ramón González Coro", del municipio Marianao, durante 2008. Objetivo: se realizó el análisis del comportamiento del riesgo de caídas de los adultos mayores en el hogar. Métodos: estudio de investigación descriptiva, en cuyo desarrollo se utilizó un modelo cualicuantitativo, y en su ejecución se emplearon métodos teóricos, empíricos y procedimientos estadísticos. Resultados: hubo un predomino del sexo femenino, el mayor por ciento de los adultos mayores presentó algún grado de dependencia, y tuvieron un mediano riesgo de sufrir una caída en su hogar.Introduction: a descriptive study was conducted in the elderly person population seen in the # 4 Family Physician Consulting Room of the "Ramón González Coro" polyclinic from the Marianao municipality during 2008. Objective: an analysis of the falls risk behavior of elderly persons at home was made. Methods: a descriptive research study was conducted using the qualitative and quantitative model and in its implementation theoretical, empirical methods as well as statistic procedures were used. Results: there was predominance of female sex, the higher percentage of elderly persons had some degree of dependence and also had a middle risk of suffering a fall at home.

Beware of Data Gaps in Home Care Research: The Streetlight Effect and Its Implications for Policy Making on Long-Term Services and Supports.

Science.gov (United States)

Newquist, Deborah D; DeLiema, Marguerite; Wilber, Kathleen H

2015-10-01

Policy initiatives increasingly seek greater use of home- and community-based services for older persons and those with chronic care needs, yet large gaps persist in our knowledge of home care, an indispensable component of long-term services and supports. Unrecognized data gaps, including the scope of home care provided by private hire and nonmedical providers, can distort knowledge and poorly inform long-term services and supports policy. The purpose of this article is to examine these gaps by describing the universe of formal home care services and provider types in relationship to major national sources. Findings reveal four distinct home care sectors and that the majority of formal home care is provided in the sectors that are understudied. We discuss the policy implications of data gaps and conclude with recommendations on where to expand and refine home care research. © The Author(s) 2015.

Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting

Directory of Open Access Journals (Sweden)

De Almeida Mello Johanna

2012-08-01

Full Text Available Abstract Background Older people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons. Methods/design This is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention - comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project. Discussion This research will provide knowledge on the functional status of frail older persons who are still living at

Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting.

Science.gov (United States)

De Almeida Mello, Johanna; Van Durme, Therese; Macq, Jean; Declercq, Anja

2012-08-06

Older people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons. This is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention--comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project. This research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information to identify determinants of

Home electrical system safety in Italy

Energy Technology Data Exchange (ETDEWEB)

Auditor,

1990-06-01

Italy, amongst the industrialized countries, has the highest mortality rate due to accidents associated with the improper use or maintenance of home electrical systems. The increasing use of domestic electrical appliances has raised the risk of accidents, especially in homes equipped with out-dated, low-capacity electrical plants and worn wiring. Within this context, this paper reports on the results of survey to establish the worthiness and type of electrical systems in use in a sample of 1,000 residential buildings. The paper then assesses the efficacy of recent normatives designed to increase the safety and efficiency of home electrical installations.

Causes of death determined in medicolegal investigations in residents of nursing homes: a systematic review.

Science.gov (United States)

Kennedy, Briohny; Ibrahim, Joseph E; Bugeja, Lyndal; Ranson, David

2014-08-01

To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations. Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation. Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. Thirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings. This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Acquiring taste in home economics?

DEFF Research Database (Denmark)

Stenbak Larsen, Christian

Objective: To explore how home economics was taught in Denmark before the recent Danish school reform, which also revised the objectives and content of home economics, naming it Food Knowledge (Madkundskab) Methods: Participant observation was done in home economic lessons in two case schools...... appreciated by the group of boys, and others again learned to stick with their idiosyncrasies when pressured by the teacher. Conclusions: Children were acquiring taste in the home economic lessons, but not only the kind of tastes that the teacher had planned for. This leads to reflections on the very complex...... process of taste acquiring and to a call for further research into taste acquiring in complex real life contexts as home economics lessons....

Europe at risk (Following EU-Funded Research on Hazard and Risks)

NARCIS (Netherlands)

Delmonaco, G.; Atun, F.; Ceudech, A.; Deeming, H.; Roo, A.P.J. de; Lumbroso, D.; Galderisi, A.; Kallache, M.; Kropp, J.P.; Kundak, S.; Molinari, D.; Tweed, F.; Wade, S.; Walker, G.; Dandoulaki, M.; Barredo, J.

2011-01-01

This chapter regarding present risk conditions, has been structured using significant “images” of Europe, addressing the hazard, exposure and vulnerability factors recognised as crucial components of any risk assessment. To draw such a picture, results of past research at the European level were

Community Research Contributing to Effective Risk Governance

Energy Technology Data Exchange (ETDEWEB)

Kelly, Neale; Forsstroem, Hans [European Commission, Brussels (Belgium). DG Research

2001-07-01

Research in the field of risk assessment and management has had a prominent role in the Commission's nuclear research programme, especially in the area of radiation protection. In the 1980s, the research had a largely technical focus. Through the 1990s, this focus shifted and greater attention was given to broader, less technical, issues, in particular those concerned with risk perception and communication, risk governance and the role of public participation in the process. This trend will continue within the Commission's 6th Framework Programme (FP6) given the increasing recognition of the importance of these broader socio-economic issues for decision making related to both nuclear and other technologies. The paper summarises the main outcomes of Commission sponsored research in the above areas, how this has influenced research currently being carried out in the Sth Framework Programme (FP5) and that being considered for inclusion in FP6. Two aspects are given particular attention: firstly, research into risk governance (both in the nuclear field in general and the waste management area in particular), especially the importance of social trust and participation of all relevant stakeholders in terms of achieving efficient and acceptable decisions when addressing complex, contentious issues; secondly, research into the social and psychological factors that influenced the efficacy and acceptance of measures taken to mitigate the long term impact of areas in the Former Soviet Union contaminated as a result of the Chernobyl accident. There are important lessons here for the management of any future accident that may affect Europe, especially the need for those affected locally to have a role in the decision process and to be able to exercise at least partial control over their own welfare. While this research was largely carried out in a 'nuclear' context, its findings are more generally applicable.

Community Research Contributing to Effective Risk Governance

International Nuclear Information System (INIS)

Kelly, Neale; Forsstroem, Hans

2001-01-01

Research in the field of risk assessment and management has had a prominent role in the Commission's nuclear research programme, especially in the area of radiation protection. In the 1980s, the research had a largely technical focus. Through the 1990s, this focus shifted and greater attention was given to broader, less technical, issues, in particular those concerned with risk perception and communication, risk governance and the role of public participation in the process. This trend will continue within the Commission's 6th Framework Programme (FP6) given the increasing recognition of the importance of these broader socio-economic issues for decision making related to both nuclear and other technologies. The paper summarises the main outcomes of Commission sponsored research in the above areas, how this has influenced research currently being carried out in the Sth Framework Programme (FP5) and that being considered for inclusion in FP6. Two aspects are given particular attention: firstly, research into risk governance (both in the nuclear field in general and the waste management area in particular), especially the importance of social trust and participation of all relevant stakeholders in terms of achieving efficient and acceptable decisions when addressing complex, contentious issues; secondly, research into the social and psychological factors that influenced the efficacy and acceptance of measures taken to mitigate the long term impact of areas in the Former Soviet Union contaminated as a result of the Chernobyl accident. There are important lessons here for the management of any future accident that may affect Europe, especially the need for those affected locally to have a role in the decision process and to be able to exercise at least partial control over their own welfare. While this research was largely carried out in a 'nuclear' context, its findings are more generally applicable

Usefulness of dietary enrichment on energy and protein intake in elderly patients at risk of malnutrition discharged to home.

Science.gov (United States)

Trabal, Joan; Hervas, Sonia; Forga, Maria; Leyes, Pere; Farran-Codina, Andreu

2014-02-01

Malnutrition is a cause for concern among many admitted elderly patients, being common at hospital admission and discharge. The objective of this study was to assess if diet enrichment with small servings of energy and protein dense foods, improves energy and nutrient intake in elderly patients at risk of malnutrition discharged to home. This was a retrospective case series study in elderly patients at risk of malnutrition treated with diet enrichment. There was a data review of dietary and health records of elderly patients discharged to home. Forty-one patients, mean age of 83 ± 5 years, met the inclusion criteria; 13 patients had been lost after 4 weeks of treatment and a total of 24 patients after 12 weeks. Records contained food intake data assessed at baseline, and after 4 and 12 weeks of treatment. Mini Nutritional Assessment, anthropometric measurements, routine biochemical parameters and the Barthel Index were assessed at baseline and after 12 weeks. Compared to baseline, patients significantly improved their energy and protein intake after 4 weeks of treatment, fulfilling the mean nutritional requirements. The improvement in energy and protein intake was still manifest at week 12. After 12 weeks of dietary enrichment, a significant weight gain was observed (4.1%, p = 0.011), as well. No significant changes were detected in functional status. Using small servings of energy and protein dense foods to enrich meals seems a feasible nutritional treatment to increase energy and protein intake and meet nutritional goals among elderly patients discharged to home. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Late-Life Depression in Home Healthcare

OpenAIRE

Pickett, Yolonda; Raue, Patrick J.; Bruce, Martha L.

2012-01-01

Major depression is disproportionately common among elderly adults receiving home healthcare and is characterized by greater medical illness, functional impairment, and pain. Depression is persistent in this population and is associated with numerous poor outcomes such as increased risk of hospitalization, injury-producing falls, and higher health care costs. Despite the need for mental health care in these patients, significant barriers unique to the home healthcare setting contribute to und...

Home health agency work environments and hospitalizations.

Science.gov (United States)

Jarrín, Olga; Flynn, Linda; Lake, Eileen T; Aiken, Linda H

2014-10-01

An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care.

Variation in the place of death among nursing home residents in France.

Science.gov (United States)

Morin, Lucas; Johnell, Kristina; Aubry, Régis

2015-05-01

recent studies have reported that hospitals have become a common place of death for nursing home residents. This study aimed to (i) measure variations in the proportion of in-hospital deaths across regions after adjustment for facility-level characteristics and (ii) identify environmental risk factors that might explain these variations in France. a cross-sectional retrospective survey was conducted in 2013. coordinating physicians in 3,705 nursing homes in France. a regression model was used to construct risk-adjusted rates of in-hospital deaths considering the facilities' characteristics. At the regional level, the outcome was defined as the difference between the observed rate of in-hospital deaths and the expected risk-adjusted rate. Values exceeding zero indicated rates that exceeded the national predicted rate of in-hospital deaths and thus highlighted regions in which the risk-adjusted probability for nursing home residents to die in a hospital was greater than average. among 70,119 nursing home decedents, 25.4% (n = 17,789) died in hospitals. The characteristics of the facilities had a significant influence on the proportion of in-hospital deaths among the nursing home decedents. However, after adjustment for these facility-level risk factors, the proportion of nursing homes that reported worse-than-average outcomes showed significant variation (range 26.0-79.6%). At the regional level, both the rate of acute hospital beds and the rate of general practitioners were found to be strongly correlated with the probability of reporting worse-than-average outcomes (P nursing home facilities. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Costs of Planned Home vs. Hospital Birth in British Columbia Attended by Registered Midwives and Physicians.

Directory of Open Access Journals (Sweden)

Patricia A Janssen

Full Text Available Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.Costs for all women planning home birth with a regulated midwife in British Columbia, Canada were compared with those of all women who met eligibility requirements for home birth and were planning to deliver in hospital with a registered midwife, and with a sample of women of similar low risk status planning birth in the hospital with a physician. We calculated costs of physician service billings, midwifery fees, hospital in-patient costs, pharmaceuticals, home birth supplies, and transport. We compared costs among study groups using the Kruskall Wallis test for independent groups.In the first 28 days postpartum, we report a $2,338 average savings per birth among women planning home birth compared to hospital birth with a midwife and $2,541 compared to hospital birth planned with a physician. In longer term outcomes, similar reductions were observed, with cost savings per birth at $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group during the first eight weeks postpartum. During the first year of life, costs for infants of mothers planning home birth were reduced overall. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146. Costs were similarly reduced when findings were stratified by parity.Planned home birth in British Columbia with a registered midwife compared to planned hospital birth is less expensive for our health care system up to 8 weeks postpartum and to one year of age for the infant.

Fall prevention in nursing homes

DEFF Research Database (Denmark)

Andresen, Mette; Hauge, Johnny

2014-01-01

that the number of hospitalization after a fall injury will become an even greater task for the Danish hospitals, The aim of the study was to show if there is a relationship between physically frail elderly nursing home resident’s subjective evaluation of fall-risk and an objective evaluation of their balance....... Further, to suggest tools for fall prevention in nursing home settings on the basis of the results of this study and the literature. A quantitative method inspired by the survey method was used to give an overview of fall patterns, subjective and objective evaluations of fallrisk. Participants were 16...... physically frail elderly nursing home residents from three different nursing homes. Measures: a small staff-questionnaire about incidences and places where the participants had falling-episodes during a 12 month period, The Falls Effi cacy Scale Swedish version (FES(S)) and Berg Balance Scale (BBS) Results...

Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes.

Science.gov (United States)

Dumyati, Ghinwa; Stone, Nimalie D; Nace, David A; Crnich, Christopher J; Jump, Robin L P

2017-04-01

Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. A small number of studies provide evidence that specifically address these challenges. Their outcomes support a paradigm shift that moves infection prevention and control practices away from a pathogen-specific approach and toward one that focuses on resident risk factors.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Directory of Open Access Journals (Sweden)

Jennifer Martin-Biggers

2015-08-01

Full Text Available Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith’s Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251 and content (n = 261 occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Home Feeling for the Modern Nomad

DEFF Research Database (Denmark)

Borup Lynggaard, Aviaja

2011-01-01

This paper describes a research project, Mobile Home Center, about home and mobility in relation to transnational HCI. The project concerns design for mobile life and it is an investigation, through user studies and prototypes, of how to support the act of home making away from the primary home. We...... bring in the perspective that transnational HCI is not only concerning individuals distributed across boarders, but also the reality of individuals who live their lives as a modern nomad in multiple countries. We bring in a new perspective of how most people perform homing tactics rather than living...

Formative research on creating smoke-free homes in rural communities

OpenAIRE

Escoffery, Cam; Kegler, Michelle Crozier; Butler, Susan

2008-01-01

The home is a significant place for exposure to secondhand smoke for children and non-smoking adults. This study explored factors that would convince families to adopt household smoking bans and actions to create and maintain smoke-free homes. Interviews were conducted with adults in 102 households in rural Georgia. Participating families had a young adolescent and included households with a mix of smokers and non-smokers and smoking ban status. Families reported they would consider a total b...

Genetics Home Reference: myasthenia gravis

Science.gov (United States)

... increase the risk of myasthenia gravis , but the identity of these genes is unknown. Many factors likely ... Myasthenia Gravis Fact Sheet MalaCards: myasthenia gravis Merck Manual Home Health Handbook for Patients and Caregivers Myasthenia ...

A Research Review: The Importance of Families and the Home Environment

Science.gov (United States)

Cole, Jennifer

2011-01-01

Parents are a child's first educator. A child's family and home environment has a strong impact on his/her language and literacy development and educational achievement. This impact is stronger during the child's early years but continues throughout their school years. Many background variables affect the impact of the family and home environment…

Using alternative or direct anthropometric measurements to assess risk for malnutrition in nursing homes.

Science.gov (United States)

Lorini, Chiara; Collini, Francesca; Castagnoli, Mariangela; Di Bari, Mauro; Cavallini, Maria Chiara; Zaffarana, Nicoletta; Pepe, Pasquale; Lucenteforte, Ersilia; Vannacci, Alfredo; Bonaccorsi, Guglielmo

2014-10-01