Impact of supports and partnership on family quality of life

BackgroundIn recent decades, Family Quality of Life (FQOL) has emerged as a decisive construct, both to improve the living conditions of the families of people with disabilities and to assess the results on the services and supports that they receive.The aim of this research is to determine the perception of the families regarding their support needs, the quality of their partnerships with professionals, and their FQOL and then identify to what extent the supports of early childhood intervention centers have a positive impact on the families’ FQOL while exploring whether the family–professional partnership has become a fundamental intervening factor of FQOL.MethodThe participants were 202 families with children aged 0–6 with intellectual and developmental disabilities. We used the structural equation model to analyze the influence that the adequacy of the supports and the partnerships exerted on FQOL.ResultsThe results indicate that the families have language and speech support needs for their children and information needs for themselves, and that they are mostly satisfied with their partnerships with the professionals and their FQOL. Our results also indicate that their degree of satisfaction with the support was a good predictor of FQOL and their ratings of partnership quality was a key factor interceding on this effect.ConclusionsThis study provides professionals and public institutions with guidance when designing plans to improve early childhood intervention centers so the quality of life of these families and the progress of children with disabilities living in Spain become progressively stronger.     

Can a Video Curriculum on the Social Determinants of Health Affect Residents' Practice and Families' Perceptions of Care?

IntroductionScreening and management of the social determinants of health (SDH) are critical for child health promotion. We sought to evaluate the impact of a facilitated video curriculum on resident SDH screening competence, parental perceptions of resident practice, resident-initiated referrals to a medical–legal partnership (MLP), and formula distribution to food-insecure families.MethodsThis was a pre–post study with concurrent control performed at a large pediatric residency program. Second- and third-year residents were assigned to control and intervention groups on the basis of their continuity clinic day. The curriculum included videotaped vignettes of screening for SDH and a “day in the life” series of families describing the impact of intervention on their lives. Residents completed self-assessments on screening competence and resource knowledge. After a well-child encounter, families (3 per resident) assessed their level of trust and respect for the resident and the number of SDHs screened for. MLP referral rates and formula distribution were compared.ResultsThe intervention group's self-assessed competence in screening for housing, benefits, and educational concerns was significantly higher compared to controls (each P ≤ .05). Parents' rating of trust and respect was high and did not differ between groups. Screening for each SDH was higher in the intervention group with domestic violence (odds ratio 2.16, 95% confidence interval 1.01–4.63) and depression (odds ratio 2.63, 95% confidence interval 1.15–5.99), reaching statistical significance. MLP referral rates increased (P = .06), and formula distribution (P = .02) reached statistical significance in the intervention group.ConclusionsThis SDH video curriculum improved resident self-assessed screening competence, parental perception of screening, and both MLP referrals and formula distribution.     

Investigation of mental health in Indonesian health workers immigrating to Japan under the Economic Partnership Agreement

The aim of this study was to assess the mental health status of Indonesian nurses and care workers who immigrated to Japan after the Economic Partnership Agreement was signed by the governments of Japan and Indonesia in 2008. From November 2012 to March 2013, questionnaires were mailed to 206 workers in 87 medical and caregiving facilities that openly accept Indonesian EPA immigrant workers. Responses were received from 71 workers in 35 facilities. Responses from 22.5% of workers suggested that they were at risk of developing mental health problems, and “gender” and “acquisition state of national qualifications” were the main factors influencing their mental health status. The results suggest that support after obtaining national qualifications is inadequate and that mid and long‐term support systems that focus on the needs of immigrant healthcare workers after passing national examinations are necessary.     

The impact of social networks and partnership status on treatment choice in men with localized prostate cancer

Study Type – Decision analysis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Very little is known about prostate cancer decision‐making. Hence, marital status is often assumed a proxy for the amount of social support. While marital status is often used as a proxy for social support, we found that the quality of support may impact treatment type more than the extent of the social matrix.

OBJECTIVES

• ? To determine whether martial status and social support impact treatment choice.
• ? The decision to pursue radical prostatectomy for prostate cancer is often influenced by factors outside the realm of tumour risk, such as a man's support system at home.

PATIENTS AND METHODS

• ? We performed a retrospective cohort study of 418 low‐income men who were diagnosed with non‐metastatic prostate cancer and underwent definitive treatment with either radical prostatectomy or radiotherapy.
• ? We performed univariate and multivariate mixed‐effects logistic regression analysis, with the dependent variable being treatment type.
• ? Confidence intervals (CIs) for the predicted probabilities and relative risks were derived using bias‐corrected bootstrapping with 1000 repetitions.

RESULTS

• ? Men with two or more members in their support system were more likely to be older, Hispanic, have less than a high school education, earn more than US $1500 monthly, have high‐risk disease and be in a significant relationship.
• ? In multivariate analysis, partnered men with fewer than two social support members (relative risk, RR, 1.23; 95% CI, 1.02–1.63) were more likely to undergo surgery, whereas men who were morbidly obese (RR, 0.46; 95% CI, 0.09–0.88), high school graduates (RR, 0.80; 95% CI, 0.64–0.99) or had high‐risk disease (RR, 0.58; 95% CI, 0.44–0.85) were less likely to undergo surgery than their respective referent groups.
• ? Partnered men with two or more social support members were no more likely to undergo surgery than unpartnered men who lacked any social support.

CONCLUSIONS

• ? In the present study cohort, married men with fewer than two members in their social network were more likely to have undergone surgery.
• ? Although marital status is often used as a proxy for social support, we find that the quality of support and partner may impact treatment type more than the extent of the social matrix.

     

Research Priorities in Post-acute and Long-term Care: Results of a Stakeholder Needs Assessment

ObjectivesConduct a needs assessment among post-acute and long-term care (PA-LTC) stakeholder groups to identify (1) research topics of highest priority and (2) perspectives on research, including concerns/barriers to conducting research in the PA-LTC setting.DesignMixed methods multistakeholder engagement process. Needs assessment conducted with tailored strategies per stakeholder group: interview, survey, and focus group.Setting and ParticipantsFour stakeholder groups—medical directors/providers (n = 89), administrative leadership (n = 5), frontline staff (n = 17), and family members of residents and residents themselves (n = 11)—were recruited from the Colorado PA-LTC community through an academic-community partnership between the University of Colorado and Colorado Medical Directors Association.Main Outcome(s)Stakeholder perspectives on research and high priority PA-LTC research topics.ResultsResearch priorities common across stakeholder groups included polypharmacy (overuse of medication generally and overuse of antibiotics specifically), care transitions, mental health (including dementia, Alzheimer's disease, behaviors), chronic pain, urinary tract infection, and quality of life issues. Providers specifically prioritized heart failure, Parkinson's, and other chronic illnesses. Administrators and directors of nurses emphasized hospitalizations. Staff prioritized medication/therapy compliance. Families/residents prioritized neurologic disease. Concerns included staff burden, consenting process, privacy, and family involvement.Conclusions/ImplicationsPA-LTC patients have a lot to offer as participants and decision makers in research, frontline staff are enthusiastic about participation, family members want to be involved, and providers value research findings in their practice but need a more supportive environment to produce and participate in research.     

高端医疗服务发展的国际经验与启示

高端医疗服务业是健康服务业发展的关键领域,但由于公立医院特需服务不断扩张、社会办医政策存"玻璃门"等原因,我国高端医疗服务业的发展尚处于初期阶段。事实上,高端医疗服务业在部分国家(特别是发达国家)已经初具规模,并在发展基础、运营模式、保障体系等方面积累了比较丰富的经验。本研究介绍了英国、美国、德国、新加坡、澳大利亚和印度发展高端医疗服务业的经验:建立国家安全网医院起兜底作用,实行分层定价和差异化补贴政策,借助商业健康保险,运用公私合作模式,优先发展若干领域。并结合我国实际情况,提出我国发展高端医疗服务业的启示:在确保基本医疗服务的前提下,实行有差别的支付政策;推广商业健康保险,拓展公私合作,确定发展高端医疗的优先领域。     

An evaluation of the Public Health Responsibility Deal: Informants’ experiences and views of the development,implementation and achievements of a pledge-based,public–private partnership to improve population health in England

ObjectivesThe Coalition Government's Public Health Responsibility Deal (RD) was launched in England in 2011 as a public–private partnership designed to improve public health in the areas of food, alcohol, health at work and physical activity. As part of a larger evaluation, we explored informants’ experiences and views about the RD's development, implementation and achievements.MethodsWe conducted 44 semi-structured interviews with 50 interviewees, purposively sampled from: RD partners (businesses, public sector and non-governmental organisations); individuals with formal roles in implementing the RD; and non-partners and former partners. Data were analysed thematically: NVivo (10) software was employed to manage the data.ResultsKey motivations underpinning participation were corporate social responsibility and reputational enhancement. Being a partner often involved making pledges related to work already underway or planned before joining the RD, suggesting limited ‘added value’ from the RD, although some pledge achievements (e.g., food reformulation) were described. Benefits included access to government, while drawbacks included resource implications and the risk of an ‘uneven playing field’ between partners and non-partners.ConclusionsTo ensure that voluntary agreements like the RD produce gains to public health that would not otherwise have occurred, government needs to: increase participation and compliance through incentives and sanctions, including those affecting organisational reputation; create greater visibility of voluntary agreements; and increase scrutiny and monitoring of partners’ pledge activities.