Questioning “choice”: A multinational metasynthesis of research on directly funded home‐care programs for older people

In many developed contexts, home‐care services have been overhauled with the intent of increasing control and flexibility for those using social and health services. This change is associated with providing funds directly to individuals, and sometimes their families and supports, to arrange at home‐care assistance with the activities of daily living. Directly funded home‐care programs, or “direct funding” (DF), are not value‐neutral policy interventions, but complex and politicised tools for the enactment of care in contemporary times. In this qualitative metasynthesis, we consider 47 research articles published between 2009 and 2017 that explore various DF programs for older persons in the United Kingdom, Australia, and the United States to identify core concepts in the literature. We find that choice emerges as a central concern. We then assess the literature to explore the questions: How does the existing literature conceptualise choice, and the mechanisms through which choice is enhanced, in DF programs for older persons? How is choice, and the benefit of choice to older service users, understood in relevant studies? We argue that the concept of “choice” manifests as a normative goal with presumed benefits among the studies reviewed. Particularly when discussing DF for older people, however, it is essential to consider which mechanisms improve care outcomes, rather than focusing on which mechanisms increase choice writ large. In the case of DF, increased choice comes with increased legal responsibilities and often administrative tasks that many older people and their supports find burdensome. Furthermore, there is no evidence that choice over all elements of one's services is the mechanism that improves care experiences. We conclude by presenting alternative models of understanding care emerging from feminist and other critical scholarship to consider if we are, perhaps, asking the wrong questions about why DF is so often preferred over conventional home‐care delivery.     

Modulation of lead-induced performance deficit in children by varying signal rate in a serial choice reaction task

Evidence is presented showing that serial choice reaction performance is disrupted at low blood lead levels (PbB), and that parametric variation of task characteristics modulates the degree of disruption. This evidence is based on two independent studies in 6- to 9-year-old children living in two lead smelter areas in the cities of Nordenham (N = 114) and Stolberg (N = 109) in West Germany. Average PbB was 8.2 μg/100 ml (4.4–23.8 μg/100 ml) in the Nordenham sample and 7.4 μg/100 ml (4.2–18.0 μg/100 ml) in the Stolberg sample. Serial choice reaction performance was assessed by means of the Vienna reaction device in which a random sequence of light and tone signals has to be answered by pressing appropriate response buttons. Correct (hits) and false responses (errors) were evaluated as performance measures, and signal rate was varied in order to achieve easy and difficult task conditions. Exposure-related performance deficit was more pronounced for errors than for hits, more clearcut for high than for low signal rates, and proved significant in both studies after correction for confounding using confounder models of different complexities. Some features of the observed deficit resemble clinical observations in children presenting with attention deficit disorder.     

Separate and combined effects of the social drugs on psychomotor performance

Ten female subjects (five smokers and five non-smokers) performed a choice reaction time task (CRT), a compensatory tracking task (CTT), a short-term memory task (STM) and were tested for their critical flicker fusion threshold (CFF) at set points over 4 h after the administration of each possible combination of nicotine (2 mg gum or placebo), caffeine (250 mg capsule or placebo) and alcohol (30 g or placebo). Memory and motor function were shown to be facilitated by nicotine or caffeine, and the debilitating effects of alcohol were frequently antagonised by either drug. In spite of the differences in their neuropharmacological actions, combinations of nicotine, caffeine and alcohol may be compared through their effects on common information processing mechanisms involved in psychomotor performance.     

以患者为中心的前列腺癌诊断治疗选择

前列腺癌是老年男性恶性肿瘤,多数肿瘤的生物学活性低,疾病进展缓慢,少数高危前列腺癌进展快、预后差。临床应根据患者发病年龄、全身状况以及肿瘤病理,制订合适的诊断治疗方法。PSA检测、直肠指检、前列腺MRI检查以及前列腺穿刺活检是前列腺癌诊断的主要方法,要认识各方法学上的不足,合理使用,避免滥用。直肠指检作为基本诊断方法可以提供很多信息。前列腺癌的治疗有多种选择,总体疗效相似,每种治疗方法均有其不足,要给患者充分知情权,选择合适的治疗措施。果断处理晚期前列腺癌的严重并发症,提高患者生活质量。     

肿瘤进化的表现

肿瘤进化是肿瘤细胞选择、竞争和扩增的过程，表现为肿瘤的印记、异质、抵抗、转化和适应等方面。肿瘤进化使肿瘤在各种压力下能够存活。理解肿瘤进化史将为精准治疗的实现提供理论指导。     

试述急危重症患者动脉血气采集部位的选择

动脉血气分析可用于测定和评价患者的氧合、通气和酸碱状态,是危重患者病情的重要监测指标,因此对急重症患者的抢救和监护尤为重要.影响血气报告结果准确性中标本的采集是一个不容忽视的重要环节.     

Expanding contraceptive choice in the developing world: Lessons from the Lao People's Democratic Republic and the Republic of Zambia

Abstract

Background and objectives Women need different forms of contraception over their lifetime. In the developed world, they have access to some 20 different methods. In developing countries, only a few options are available. This paper focuses on four under-used methods: intrauterine devices, implants, emergency contraception and female condoms. It examines reasons for their low uptake, strategies used for their adoption, and challenges in sustaining these efforts, in two countries: Laos and Zambia.

Methods In-country documentation and reports from international partners were reviewed; questionnaires were sent and interviews carried out with ministry officials, senior providers, and local representatives of international organisations and international non-governmental organisations.

Results In Laos, the family planning programme is relatively young; its challenges include ensuring the sustainability of services and supplies, improving the quality of IEC to dispel misconceptions surrounding contraception, and developing novel distribution systems to reach rural populations. Zambia has a much older programme, which lost ground in the face of competing health priorities. Its challenges include strengthening the supply chain management, coordinating the multiple groups of providers and ensuring the sustainability of services in rural areas.

Conclusions The contrast offered by Laos and Zambia illustrates the importance of regular evaluation to identify priority areas for improving contraceptive delivery.     

在线心理咨询用户择医偏好研究

基于离散选择实验设计调查问卷,调查分析在线心理咨询用户择医偏好和支付意愿及其影响因素,在此基础上提出建议,为相关研究提供参考。     

Hacia rutas saludables: efecto de las etiquetas nutricionales en las conductas alimentarias en un comedor universitario

ObjetivoEvaluar la efectividad de incluir información nutricional y de propiedades de los alimentos en un comedor universitario de Salamanca (España), para promover las conductas alimentarias saludables.DiseñoEstudio experimental y correlacional transversal.EmplazamientoComedor universitario de Salamanca (España).ParticipantesEn el experimento se recogió información de la elección de 1.122 menús por parte de estudiantes universitarios. El cuestionario fue respondido por 48 estudiantes universitarios que participaron en el experimento.Medidores principalesMetodología mixta (experimento de campo y cuestionario en línea). La variable independiente fue la inclusión o no de información nutricional de los menús. Con el cuestionario se evaluó la actitud de los estudiantes sobre este tipo de herramientas.ResultadosEl experimento muestra una mejora en la dieta de los estudiantes universitarios con la inclusión de elementos informativos que apelan a la elección más saludable, aumentando su consumo de fruta, verduras, legumbres, pescado y carne blanca.Los encuestados mostraron un alto grado de receptividad de estas herramientas para la promoción de la salud. A pesar de esto, su autopercepción de mejoría de la dieta era más optimista que lo cuantificado en el experimento. Los estudiantes universitarios muestran un grado de aprobación muy alto frente a otras herramientas de promoción de alimentación saludable, especialmente aquellas de carácter educativo e informativo. Se comprobó que una preocupación mayor por la dieta estaba asociada con un mayor apoyo de estas herramientas.ConclusiónExiste una mejora en la alimentación de los estudiantes universitarios y una actitud positiva frente a herramientas de promoción de la salud, especialmente por parte de quienes tienen una autopercepción más saludable. Es necesario emplear nuevas herramientas basadas en las ciencias conductuales en la promoción de la salud, por parte de la industria privada y las entidades públicas.Palabras clave: Comedor universitario, Arquitectura de elección, Nudge, Etiquetado nutricional, Promoción de la salud, Cambio de comportamiento