Elderly persons’ expectations of day-care rehabilitation

The aim of this study was to explore elderly persons’ conceptions of what they expected to gain from attending day-care rehabilitation centres (DCR). A purposeful sampling procedure was employed. Interviews with 22 prospective elderly day-care patients were carried out and analysed according to a phenomenographic approach. The analysis yielded eight categories. Two categories, Social contact and Exercise, described what the elderly persons expected to encounter. The remaining categories, A change from the monotony of everyday life, An opportunity to be yourself, A balm for the body, A safety net, A mastery of everyday activities, and An energizing spark, described the meanings of the encounters. Two categories were attributed to the elderly persons’ physical presence at the centre and the gains were expected to end when the programme ended. In three categories the expected improvements were projected into the future and were expected to last. The findings imply that follow-up home visits and suggestions for alternative social activities in order to provide stimulation and social equality would be a valuable complement to the DCR programme. Rehabilitation personnel need to consider the ambivalent view on assistive devices as well as the elderly person's need for continuity when setting goals and planning individual programmes.     

Changes in life satisfaction in persons with spinal cord injury during and after inpatient rehabilitation: adaptation or measurement bias?

Purpose

To analyze changes in life satisfaction (LS) scores over time in persons with spinal cord injury (SCI) and to interpret what these changes mean.

Methods

Multicenter, prospective cohort study of persons with SCI (n?=?96) classified into 3 life satisfaction trajectories identified earlier. Assessment took place 6 times from the start of active rehabilitation up to 5?years after discharge. Three LS scores were compared: (1) LS ??now?? score, (2) ??comparison?? score between LS ??now?? and LS ??before the SCI??, and (3) retrospective score of LS ??before the SCI??.

Results

Persons in the low LS trajectory showed increase in the LS ??now?? score, but not in the LS ??comparison?? score and retrospective score. Persons in the recovery trajectory showed increase in the LS ??now?? and LS ??comparison?? scores, but not in the retrospective score. Persons in the high LS trajectory showed increase in the ??comparison?? LS score and decrease in the retrospective score, but no change in the LS ??now?? score.

Conclusions

Diverging patterns of change were found and that were interpreted as adaptation or scale recalibration. Recalibration could also be considered healthy rebalancing after SCI. Being able to compare different LS ratings can facilitate the interpretation of change in and stability of LS.     

Is the quality of hospital care a function of leadership?

Multiple regression analysis was used to evaluate the relationship between hospital quality and independent variables of interest. While past studies have analyzed hospital efficiency to evaluate organizational performance, this study is unique because it evaluates the relationship between quality and efficiency. The study incorporates an independent variable, "efficiency," calculated using a variable returns-to-scale, input-oriented, data envelopment analysis methodology. This article provides an innovative approach to measuring cost and quality as the federal government attempts to realign scarce health care resources to better meet local community needs. Data for 143 hospitals in 2000 were analyzed using multiple regression and data envelopment analysis to evaluate hospital quality. These results have managerial implications related to improving hospital quality as well as enhancing organizational performance. The study has policy implications on the relationship between quality and efficiency and supports current initiatives related to pay-for-performance in the health care industry. This study clearly documents the positive relationship between quality and efficiency, which supports the premise that hospital leadership through the effective allocation of resources and development of high-performance work processes is important to improve quality of care.     

Next of kin’s quality of life before and after implementation of a knowledge-based palliative care intervention in nursing homes

Quality of Life Research - The purpose of this study was to evaluate whether an educational palliative care intervention improved the quality of life for next of kin to older persons in nursing...     

What is a ‘generic’ hospital model?—a comparison of ‘generic’ and ‘specific’ hospital models of emergency patient flows

The paper addresses the question in the title via a survey of experienced healthcare modellers and an extensive literature review. It has two objectives.

Children’s participative citizenship within the context of integral care and daily life

The concept of participation was reviewed as a component of children's citizenship in order to promote a programme for Integral Development. A narrative revision of the literature was carried out as well as a group discussion was organized along with the staff of an Integral Care Programme, in order to identify notions of democracy and child citizenship related to care and rearing. Some elements that favoured the child participation and some parenting skills were identified. Among the elements that must be encouraged in children are: the development of emotional, cognitive and communicative skills and promotion of decision-making; among the parent skills development included are: sensitivity and responsivity; establishing routines and participation experiences. It is important to stand out that the identified elements to promote child participation and parental competences should be adapted to every specific cultural context.     

Quality of life and self-esteem of persons with paraplegia living in São Paulo, Brazil

Purpose

To evaluate the quality of life (QoL) and self-esteem of paraplegic persons.

Methods

The sample consisted of 60 outpatients with traumatic paraplegia living in São Paulo, Brazil, from whom clinical and demographic data were obtained. QoL was assessed by the 36-item Short-Form (SF-36) health survey questionnaire, and self-esteem was measured by Rosenberg’s Self-Esteem (RSE) scale. Statistical analysis was performed using Student’s t-test, analysis of variance and Fisher’s least significant difference (LSD) test at a significance level of 5%.

Results

Participants were predominately men (86.7%) with a mean age of 32.9 (standard deviation [SD] = 9.47) years, low education level and low income. The SF-36 dimensions that received the lowest scores were physical functioning, role physical and role emotional. Cronbach’s alpha for the SF-36 questionnaire was 0.80. A significant statistical difference was found between the presence of pressure ulcers and low scores on mental health (P = 0.001), as determined by Student’s t-test. The mean self-esteem score was 8.35 and there was a significant statistical difference between low self-esteem scores and occupation (P = 0.008).

Conclusion

Participants reported low QoL and self-esteem. The results provide background information that may be useful in the development of strategies to reduce the impact of spinal cord injury (SCI) on the life and health of persons with SCI, improving their QoL.     

The use of hospital care: do insurance status, prospective payment, and the unit of payments make a difference?

Limited to 251,768 discharges during 1999 from short-term hospitals located in Oklahoma, the objective of this study was to examine the influence of insurance status, prospective payment, and the unit of payment on variation in the length of stay. The regression analysis indicated that elderly patients whose care was financed by the Medicare pricing system and the uninsured experienced a significantly shorter episode of hospitalization than their commercially insured counterparts. Conversely, Medicaid recipients, whose care was financed by a fixed per diem and uninsured or self-responsible patients, experienced a significantly shorter hospital stay than the commercially insured. The results also indicate that the type and source of admissions, the discharge destination of the patient, and case complexity significantly influenced the hospital stay. African-Americans and Native Americans also experienced a longer episode of hospital care than their white counterparts. The article concludes with a discussion of policy implications and the need to develop alternate methods of financing hospital care thereby reducing the risks of premature discharge and iatrogenic injury.     

African American women: a life course of care?

Twenty-five years of research on family care to dependent elders has produced a theoretically sophisticated understanding of the process of family caregiving. Although caregiving models initially were developed and tested on predominantly White samples, more recent work has applied these models to African American caregivers. This investigation builds on the comparative perspective by describing elder care in African American families through the eyes of the culture in which it occurs. Thirty-two African American caregivers were interviewed and asked to discuss their caregiving careers from a life course perspective. Qualitative narratives described three pathways to care: elder care only, limited life course of care, and live course of care. Recognition of the various pathways to care will enlighten tailored interventions.     

Somatically ill persons’ self-nominated quality of life domains: review of the literature and guidelines for future studies

Objective  

To review which domains somatically ill persons nominate as constituting their QoL. Specific objective is to examine whether the method of enquiry affect these domains.     

Promoting career development and life design in the early years of a person’s life

ABSTRACT

The article discusses the changing world of work and the attendant uncertainty and loss of work-life identity. Little research has been done on career development and life design in the early years of a person’s life, especially in developing countries characterized by disadvantage. The underlying theoretical models of career development are reviewed accompanied by a discussion of the theory of life design counselling in terms of the role of stories and meaning-making and pursuing purpose in the counselling process. The importance of promoting career development and life design in the early years is also discussed with the focus on developmental tasks that must be completed successfully in childhood to motivate learners to set and realize specific goals. Ultimately, the goal is to prepare young people to manage the complexities of their career journeys and career-related transitions, not only in the early years but, indeed, throughout their working lives.     

‘It's really a hard life’: Love,gender and HIV risk among male‐to‐female transgender persons

Scientific studies demonstrate high rates of HIV infection among male‐to‐female (MTF) transgender individuals and that stigma and discrimination place MTFs at increased risk for infection. However, there is little research examining how gender roles contribute to HIV risk. This paper reports on in‐depth interviews with 20 MTFs attending a community clinic. Data reveal that stigma and discrimination create a heightened need for MTFs to feel safe and loved by a male companion and that in turn places them at a higher risk for acquiring HIV. Male‐to‐female transgender individuals appear to turn to men to feel loved and affirmed as women; their main HIV risk stems from their willingness to engage with sexual partners who provide a sense of love and acceptance but who also may also request unsafe sexual behaviours. A model illustrating how HIV risk is generated from stigma and discrimination is presented.     

Differences between public and private hospital care in Spain: the realities of health care or a numerical fallacy?

OBJECTIVE: To give an example of the misleading interpretations of the concepts "public and private" when dealing with simple data from hospital resources and activities in Spain. MATERIAL AND METHODS: Data comes from the survey of hospitals (EESCRI) for the year 2002 in Catalonia. Using the figures corresponding to resources (number of centers and beds) and activities (discharges, stays, mean stay, occupancy, and rotation) comparisons are made among different variables (managing authority and funding source) reclassified, according to the concepts of public and private. RESULTS: The figures on resources and activities offer a very different portrait about the public or private nature of the care provided, according to the variables being used for classification. CONCLUSIONS: It is necessary to specify the concepts and variables to be used when analyzing the performance of health services and to improve the information sources in order to adapt them to the new management forms of the health services.     

Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home

Background  

Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is often ambiguous what the benefits are and whether they can be transferred to other settings. This is due to the heterogeneity of intermediate care models and the variety of collaborating partners that set up such models. Quantitative evaluation captures only a limited series of generic structure, process and outcome parameters. More detailed information is needed to assess the dynamics of intermediate care delivery, and to find ways to improve the quality of care. Against this background, the functioning of a low intensity early discharge model of intermediate care set up in a residential home for patients released from an Amsterdam university hospital has been evaluated. The aim of this study was to produce knowledge for management to improve quality of care, and to provide more generalisable insights into the accumulated impact of such a model.