The influence of caregiver singing and background music on vocally expressed emotions and moods in dementia care: a qualitative analysis

Background

Music and singing are considered to have a strong impact on human emotions. Such an effect has been demonstrated in caregiving contexts with dementia patients.

Objectives

The aim of the study was to illuminate vocally expressed emotions and moods in the communication between caregivers and persons with severe dementia during morning care sessions.

Design

Three types of caring sessions were compared: the “usual” way, with no music; with background music playing; and with the caregiver singing to and/or with the patient.

Participants and setting

Nine persons with severe dementia living in a nursing home in Sweden and five professional caregivers participated in this study.

Methods

Qualitative content analysis was used to examine videotaped recordings of morning care sessions, with a focus on vocally expressed emotions and moods during verbal communication.

Results

Compared to no music, the presence of background music and caregiver singing improved the mutuality of the communication between caregiver and patient, creating a joint sense of vitality. Positive emotions were enhanced, and aggressiveness was diminished. Whereas background music increased the sense of playfulness, caregiver singing enhanced the sense of sincerity and intimacy in the interaction.

Conclusion

Caregiver singing and background music can help the caregiver improve the patient's ability to express positive emotions and moods, and to elicit a sense of vitality on the part of the person with severe dementia. The results further support the value of caregiver singing as a method to improve the quality of dementia care.     

The association between nursing diagnoses, resource utilisation and patient and caregiver outcomes in a nurse-led home care service: longitudinal study

Background

The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes.

Objectives

To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction.

Design

Observational, longitudinal follow-up study.

Settings

Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain.

Participants

Patients and caregivers who initiated the Home Care Programme.

Methods

The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction.

Results

Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p = 0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient’s baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p = 0.012).

Conclusions

These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated.     

The basis for recommending repeating epidural steroid injections for radicular low back pain: a literature review

Novak S, Nemeth WC. The basis for recommending repeating epidural steroid injections for radicular low back pain: a literature review.

Objectives

To determine the current evidence to support guidelines for frequency and timing of epidural steroid injections (ESIs), to help determine what sort of response should occur to repeat an injection, and to outline specific research needs in these areas.

Data Sources

A PubMed, Medline (EBSCO), and Cochrane library search (January 1971-December 2005), as well as additional references found from the initial search.

Study Selection

There were no studies that specifically addressed the objectives outlined. Eleven randomized controlled trials, 1 prospective controlled trial, and 2 prospective cohort studies were identified that included a protocol involving repeat epidural injections for radicular pain secondary to herniated nucleus pulposus or spinal stenosis. One qualitative survey was also identified. Five review articles were also included that discussed this topic.

Data Extraction

Data were extracted from clinical trials if they included the following: (1) protocols in clinical trials on ESIs that included repeat injections and the response required to trigger these injections, (2) any evidence given for establishing these protocols, and (3) similar studies that included only 1 injection. Specific mention of repeat ESIs and partial response that was mentioned in review articles was also included.

Data Synthesis

There is limited evidence to suggest guidelines for frequency and timing of ESIs or to help to define what constitutes the appropriate partial response to trigger a repeat injection. No study has specifically evaluated these objectives. Methodologically limited research suggests that repeat injections may improve outcomes, but the evidence is insufficient to make any conclusions.

Conclusions

There does not appear to be any evidence to support the current common practice of a series of injections. Recommendations for further research are made, including a possible study design.     

Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions

Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.

Objective

To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.

Design

Service development, pilot evaluation study.

Setting

Regional and remote areas of the state of New South Wales, Australia.

Participants

Persons with SCI, caregivers, and health professionals.

Intervention

Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.

Main Outcome Measures

Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.

Results

Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.

Conclusion

Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.     

Relationship of Preinjury Caregiver and Family Functioning to Community Integration in Adults With Traumatic Brain Injury

Sady MD, Sander AM, Clark AN, Sherer M, Nakase-Richardson R, Malec JF. Relationship of preinjury caregiver and family functioning to community integration in adults with traumatic brain injury.

Objective

To investigate the relationship of preinjury caregiver and family functioning to community integration outcomes in persons with traumatic brain injury (TBI).

Design

Inception cohort.

Setting

Three TBI Model Systems inpatient rehabilitation facilities.

Participants

Persons with TBI (N=141) and their caregivers admitted to inpatient rehabilitation and followed up at 1 to 2 years after injury.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire and the Social and Occupation scales of the Craig Handicap Assessment and Reporting Technique.

Results

There were significant interactions of several preinjury caregiver and family variables with injury severity. For persons with complicated mild/moderate injury, better family functioning was associated with greater home integration, and less caregiver distress was associated with better social integration. For persons with severe injuries, greater caregiver perceived social support was associated with better outcomes in productivity and social integration.

Conclusions

Preinjury caregiver and family characteristics interact with injury severity to affect outcomes in persons with injury. Research on outcomes should include measures of caregiver and family functioning. Early interventions targeted toward decreasing caregiver distress, increasing support, and improving family functioning may have a positive impact on later outcomes.     

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: An exploratory comparative design

Background

Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences.

Objectives

The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers.

Design

Cross-sectional analytic study.

Settings

All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain).

Participants

Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers.

Methods

The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers.

Results

The results show greater burden among adult-child caregivers (p < .05), who experience more feelings of guilt (p < .001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p < .001). Living with the patient has a notable influence on burden among adult children (p < .001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p < .05) and progressively worse mental health (p < .01). However, the correlations between burden and mental health were strongest in daughters (p < .001).

Conclusion

The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle.     

Reliability of the family impact of assistive technology scale for families of young children with cerebral palsy

Ryan SE, Campbell KA, Rigby PJ. Reliability of the Family Impact of Assistive Technology Scale for families of young children with cerebral palsy.

Objective

To examine the internal consistency and test-retest reliability of the Family Impact of Assistive Technology Scale (FIATS) when used to measure the perceptions of parents about important aspects of family life that may be influenced by their children’s use of assistive devices.

Design

Repeated measure.

Setting

Homes of 50 participating families.

Participants

Parents of young children with cerebral palsy.

Interventions

Not applicable.

Main Outcome Measure

The FIATS.

Results

Through an a priori item-reduction process, we reduced the length of the FIATS from 89 to 64 items. We retained 8 of the 9 original subscales. The 8 subscales included the following: autonomy, caregiver relief, contentment, doing activities, effort, family and social interaction, caregiver supervision, and safety. Remaining items of the removed subscale (technology acceptance) correlated well with the subscale total, but did not relate well to the FIATS total score. This construct was retained as a separate but noncontributing scale within the FIATS. The overall FIATS and its 8 contributing subscales had acceptable internal consistencies and test-retest reliabilities.

Conclusions

The FIATS shows promise as a homogeneous and reproducible multidimensional measure of dimensions of child and family life. We plan further testing to examine the sensitivity and clinical meaningfulness of change scores on the FIATS.     

Family Functioning Is Associated With Depressive Symptoms in Caregivers of Acute Stroke Survivors

Epstein-Lubow GP, Beevers CG, Bishop DS, Miller IW. Family functioning is associated with depressive symptoms in caregivers of acute stroke survivors.

Objective

To determine whether family functioning is uniquely associated with caregiver depressive symptoms in the immediate aftermath of stroke.

Design

Cross-sectional data from the baseline assessment of an intervention study for stroke survivors and their families.

Setting

Neurology inpatient service of a large urban hospital.

Participants

Stroke survivors (n=192), each with a primary caregiver. The mean age of stroke survivors was 66 years, and most, 57%, were men (n=110). The mean age of caregivers was 57 years, and 73% (n=140) of the caregivers were women. Eighty-five percent of caregivers were white.

Interventions

Not applicable.

Main Outcome Measures

Measures were chosen to assess caregivers' depressive symptoms (Centers for Epidemiologic Studies Depression Scale), family functioning (Family Assessment Device), and additional factors such as health status (Medical Outcomes Study 36-Item Short-Form Health Survey) and stroke survivors' cognitive abilities (modified Mini-Mental State Examination) and functional impairments (FIM and Frenchay Activities Index).

Results

Depressive symptoms were mild to moderate in 14% and severe in 27% of caregivers. Family functioning was assessed as unhealthy in 34% of caregiver-patient dyads. In statistical regression models, caregiver depression was associated with patients' sex, caregivers' general health, and family functioning.

Conclusions

Forty-one percent of caregivers experienced prominent depressive symptoms after their family member's stroke. Higher depression severity in caregivers was associated with caring for a man, and having worse health and poor family functioning. After stroke, the assessment of caregivers' health and family functioning may help determine which caregivers are most at risk for a depressive syndrome.     

Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators

Su P-F, Gard SA, Lipschutz RD, Kuiken TA. Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators.

Objectives

To examine differences in gait characteristics between persons with bilateral transtibial amputations because of trauma and peripheral vascular disease (PVD); and to compare that with data from able-bodied controls that were previously collected and maintained in a laboratory database.

Design

Observational study of persons with bilateral transtibial amputations.

Setting

A motion analysis laboratory.

Participants

Nineteen bilateral transtibial amputees.

Intervention

No experimental intervention was performed. To standardize the effect of prosthetic foot type, subjects were fitted with Seattle Lightfoot II feet 2 weeks before quantitative gait analyses.

Main Outcome Measures

Temporospatial, kinematic, and kinetic gait data were recorded and analyzed.

Results

Results showed that the freely selected walking speeds of subjects with PVD and trauma were 0.69m/s and 1.11m/s, respectively, while that of able-bodied control subjects was 1.20m/s. When data were compared on the basis of freely selected walking speed, numerous differences were found in temporospatial, kinematic, and kinetic parameters between the PVD and trauma groups. However, when data from similar speeds were compared, the temporospatial, kinematic, and kinetic gait data demonstrated no statistically significant differences between the 2 amputee groups. Although not statistically significant, the PVD group displayed increased knee (P=.09) and hip (P=.06) flexion during the swing phase, whereas the trauma group displayed increased pelvic obliquity (P=.06). These actions were believed to represent different strategies to increase swing phase foot clearance. Also, the PVD group exhibited slightly greater hip power (P=.05) before toe-off.

Conclusions

Many of the differences observed in the quantitative gait data between the trauma and PVD groups appeared to be directly associated with their freely selected walking speed; the trauma group walked at significantly faster freely selected speeds than the PVD group. When their walking speeds were matched, both amputee groups displayed similar gait characteristics, with the exception that they might use slightly different strategies to increase foot clearance.     

Neuroprosthetic Effect of Peroneal Nerve Stimulation in Multiple Sclerosis: A Preliminary Study

Sheffler LR, Hennessey MT, Knutson JS, Chae J. Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study.

Objective

To determine the neuroprosthetic effect of a peroneal nerve stimulator on tasks of functional ambulation in multiple sclerosis (MS).

Design

A single point-in-time assessment of functional ambulation tasks under the conditions of no device and peroneal nerve stimulator.

Setting

Outpatient academic medical center.

Participants

Participants (N=11) with diagnosis of MS (>6mo), dorsiflexion weakness, and prior usage of an ankle-foot orthosis.

Intervention

Surface peroneal nerve stimulator for ambulation.

Main Outcome Measures

Timed 25-foot Walk portion of the MS Functional Composite; Floor, Carpet, Up and Go, Obstacle, and Stair components of the Modified Emory Functional Ambulation Profile.

Results

Peroneal nerve stimulator-Stair performance was significantly enhanced (P=.05) versus no device, and statistical significance was approached for peroneal nerve stimulator-Obstacles (P=.09) versus no device. There were no significant differences between peroneal nerve stimulator and no device conditions in the remaining outcome measures.

Conclusions

The neuroprosthetic effect of the peroneal nerve stimulator is modest relative to no device in the performance of specific functional tasks of ambulation in MS gait. A longitudinal, controlled trial is needed to show effectiveness.     

Within-day repeatability of the endurance shuttle walk test

Objective

To determine the need for a practice walk for the endurance shuttle walk test (ESWT) following the performance of two incremental shuttle walk tests (ISWTs) - one practice and one test - on the same day.

Design

Retrospective data analysis of shuttle walk test measurements. All participants had performed two ISWTs and two ESWTs at a single visit, prior to commencing pulmonary rehabilitation.

Setting

Outpatient physiotherapy department of a university hospital.

Participants

Forty-four patients (33 males, 11 females) with a primary diagnosis of chronic obstructive pulmonary disease, referred for routine pulmonary rehabilitation.

Measurements

Shuttle walk test distance and time, Borg breathlessness score, heart rate and pulsed oxygen saturation.

Results

The mean age of the group was 67.6 years [standard deviation (SD) 9.0] and mean forced expiratory volume in 1 second was 37% predicted (SD 13). The mean times walked during ESWTs 1 and 2 were 195 and 207 seconds (SD 115 and 138), respectively. Using the analysis recommended by Bland and Altman, the mean of the individual differences (d) between Tests 1 and 2 was 12 seconds, with limits of agreement from −88 to +112 seconds.

Conclusion

A practice endurance shuttle walk is unnecessary following performance of ISWTs on the same day.     

Manual Wheelchair Propulsion Patterns on Natural Surfaces During Start-Up Propulsion

Koontz AM, Roche BM, Collinger JL, Cooper RA, Boninger ML. Manual wheelchair propulsion patterns on natural surfaces during start-up propulsion.

Objectives

To classify propulsion patterns over surfaces encountered in the natural environment during start-up and compare selected biomechanical variables between pattern types.

Design

Case series.

Setting

National Veterans Wheelchair Games, Minneapolis, MN, 2005.

Participants

Manual wheelchair users (N=29).

Intervention

Subjects pushed their wheelchairs from a resting position over high-pile carpet, over linoleum, and up a ramp with a 5° incline while propulsion kinematics and kinetics were recorded with a motion capture system and an instrumented wheel.

Main Outcome Measures

Three raters classified the first 3 strokes as 1 of 4 types on each surface: arc, semicircular (SC), single looping over propulsion (SL), and double looping over propulsion (DL). The Fisher exact test was used to assess pattern changes between strokes and surface type. A multiple analysis of variance test was used to compare peak and average resultant force and moment about the hub, average wheel velocity, stroke frequency, contact angle, and distance traveled between stroke patterns.

Results

SL was the most common pattern used during start-up propulsion (44.9%), followed by arc (35.9%), DL (14.1%), and SC (5.1%). Subjects who dropped their hands below the rim during recovery achieved faster velocities and covered greater distances (.016≤P≤.075) during start-up on linoleum and carpet and applied more force during start-up on the ramp compared with those who used an arc pattern (P=.066).

Conclusions

Classifying propulsion patterns is a difficult task that should use multiple raters. In addition, propulsion patterns change during start-up, with an arc pattern most prevalent initially. The biomechanical findings in this study agree with current clinical guidelines that recommend training users to drop the hand below the pushrim during recovery.     

A partnership approach to service needs assessment with family caregivers of an aging relative living at home: A qualitative analysis of the experiences of caregivers and practitioners

Background

As the global population ages, support for family caregivers who provide the bulk of care to community-dwelling older people is becoming ever more important. However, in many countries, homecare-service practitioners currently do not follow a systematic approach to assessing and responding to caregiver needs.

Objectives

The aim of this study was to explore the experiences of caregivers and practitioners who took part in a field test of the Family Caregivers Support Agreement (FCSA) tool, a modified version of the Carers Outcome Agreement Tool (COAT) initially developed as the result of an Anglo-Swedish study. Both the COAT and the FCSA are designed to facilitate partnerships between caregivers and practitioners so that needs assessment and subsequent support services are negotiated and agreed so as to meet caregiver expectations.

Design and participants

A qualitative design was adopted and data were collected through focus groups with six practitioners (nurses and social workers) working in two Local Community Service Centres in the province of Quebec (Canada). These practitioners had previously completed the FCSA tool with 17 primary caregivers of frail elderly relatives who were clients of homecare services. Individual interviews were conducted with the caregivers to explore their experiences. Data were analyzed to identify significant themes, from the perspectives of caregivers and practitioners, which provided insights into their experiences and the strategies used by practitioners to facilitate partnership working.

Findings

To facilitate meaningful exchanges, practitioners adopted strategies such as sensitive listening and the use of enabling questions to identify and contextualize caregiver needs and to highlight the ability of caregivers to find their own creative solutions to the challenges they face. The caregivers described experiencing a climate of trust that allowed them to express their concerns, to reflect upon their situation and to participate in the development of an action plan for their support.

Conclusions

The study reaffirms findings from Sweden and UK that the use of a tool such as the FCSA enhances partnership working and creates a caregiver-practitioner relationship based on a genuine alliance. As a result, both parties gain new insights into the caring situation. The approach underpinning the FCSA tool has potential for a more widespread application in different contexts.     

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

Objective

To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis.

Design

Pre-post interventional study.

Setting

General community.

Participants

Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study.

Intervention

After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later.

Main Outcome Measures

Falls risk (Falls Risk of Older People—Community Setting) and balance measures.

Results

Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People—Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006).

Conclusions

An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.     

Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial

Rivera PA, Elliott TR, Berry JW, Grant JS. Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial.

Objective

To test the hypothesis that a problem-solving training program would lower depression, health complaints, and burden, and increase well-being reported by community-residing family caregivers of persons with traumatic brain injuries (TBIs).

Design

Randomized controlled trial.

Setting

General community.

Participants

Of the 180 people who expressed interest in the study, 113 did not meet eligibility criteria. A consenting sample of family caregivers were randomized into a problem-solving training group (4 men, 29 women; average age, 51.3y) or an education-only control group (34 women; average age, 50.8y). Care recipients included 26 men and 7 women in the intervention group (average age, 36.5y) and 24 men and 10 women in the control group (average age, 37.2y).

Intervention

Problem-solving training based on the D'Zurilla and Nezu social problem-solving model was provided to caregivers in the intervention group in 4 in-home sessions and 8 telephone follow-up calls over the course of their year-long participation. Control group participants received written educational materials and telephone calls at set intervals throughout their 12 months of participation.

Main Outcome Measures

Caregiver depression, health complaints, well-being, and social problem-solving abilities.

Results

Hierarchical linear models revealed caregivers receiving problem-solving training reported significant decreases in depression, health complaints, and in dysfunctional problem-solving styles over time. No effects were observed on caregiver well-being, burden, or constructive problem-solving styles.

Conclusions

Problem-solving training provided in the home appears to be effective in alleviating distress and in decreasing dysfunctional problem-solving styles among family caregivers of persons with TBI. Methodologic limitations and the implications for interventions and future research are discussed.     

Validation of the Revised Quick Cognitive Screening Test

Mate-Kole CC, Conway J, Catayong K, Bieu R, Sackey NA, Wood R, Fellows R. Validation of the revised Quick Cognitive Screening Test.

Objective

To validate the revised version of the Quick Cognitive Screening Test (QCST).

Design

Cross-sectional.

Setting

Senior homes; hospital; college campus.

Participants

Participants (N=377; 114 men, 263 women) were recruited comprising healthy controls (n=201; 40 men, 161 women), subjects with dementia (n=93; 34 men, 59 women) including Alzheimer disease (n=73) and vascular dementia (n=20); subjects with psychiatric illness (n=35, 15 men, 20 women), specifically schizophrenia or bipolar disorder; and subjects with other neurologic conditions (n=48, 25 men, 23 women) such as traumatic brain injury (n=12) and cerebrovascular disease (n=31). Diagnoses were confirmed by physicians using appropriate criteria. Recruitment was done in the northeastern region.

Interventions

Not applicable.

Main Outcome Measures

In an effort to examine the reliability and validity of the revised QCST, participants were administered the revised QCST with a number of standardized measures (ie, Alzheimer's Disease Assessment Scale-Cognitive, Mini-Mental State Examination, Tests of Oral Fluency, Trail-Making Test, and Functional Activities Questionnaire).

Results

The results revealed that the revised QCST discriminated between healthy controls and the neuropsychiatric participants. Additionally, the revised QCST significantly correlated with other standardized measures, confirming the revised QCST's reliability and validity as a screening instrument for subjects with cognitive deficits.

Conclusions

The revised QCST provides the clinician with a short yet reliable screening instrument in detecting cognitive deficits in subjects with dementia and other neurologic conditions.     

Reliability and Validity of the Functional Gait Assessment (German Version) in Subacute Stroke Patients

Thieme H, Ritschel C, Zange C. Reliability and validity of the Functional Gait Assessment (German version) in subacute stroke patients.

Objective

To investigate validity and reliability of the Functional Gait Assessment (FGA) (German version) as a measure for balance abilities during walking in subacute stroke patients.

Design

Cohort study.

Setting

Inpatient rehabilitation center.

Participants

Ambulatory subjects (N=28) at a maximum of 6 months after stroke participated in this study. One direct observer and 2 video observers rated the FGA.

Interventions

Not applicable.

Main Outcome Measures

Performance of the FGA was video recorded and directly rated. For testing concurrent validity of the FGA, subjects also completed testing in the Berg Balance Scale, fast walking speed, the Functional Ambulatory Category, the Rivermead Mobility Index, and the Barthel Index. Intrarater reliability, interrater reliability, and concurrent validity of the FGA were analyzed.

Results

Intrarater (intraclass correlation coefficient=.97) and interrater reliability (intraclass correlation coefficient=.94) were almost perfect for total scores. Reliability of single items varied between substantial and almost perfect values. Analysis revealed significant correlations between the FGA and other measures of gait and balance functions between Spearman rho values of .71 and .93. The FGA differs significantly between levels of gait ability (Functional Ambulatory Category) (P≤.01).

Conclusions

Almost perfect intrarater and interrater reliability for total FGA scores and good concurrent validity were shown in this study. Therefore, the FGA (German version) can be used as a reliable and valid tool to assess functional gait performance of patients in subacute stages after stroke.     

The implementation of a gastroenteritis education program

Purpose

The objective of this study is to determine if intensive gastroenteritis education results in greater caregiver knowledge and a reduction in future emergency department (ED) visits.

Methods

This was a concurrent control, prospective, single-blind trial. One hundred five children aged 3 to 48 months were assigned to receive an ED-based educational intervention and a home nursing education visit or neither. In the ED and 1 and 6 months postvisit, caregivers completed a 38-item Caregiver Gastroenteritis Knowledge Questionnaire.

Results

One month postintervention, the scores in the intervention group had risen compared with controls (3.3 vs 0.9, P = .11). At 6 months, the difference was negligible. At 1-year follow-up, 37% of children in both groups had an ED any-cause visit; gastroenteritis visits occurred in 27% and 13%.

Conclusion

An intensive ED and home gastroenteritis education program did not result in a long-term increase in disease-specific caregiver knowledge or a reduction in future ED visits.     

Employee empowerment, innovative behavior and job productivity of public health nurses: a cross-sectional questionnaire survey

Background

Employee empowerment is an important organizational issue. Empowered employees with new ideas and innovative attributes may increase their ability to respond more effectively to face extensive changes in current public health care work environments.

Objectives

The objective of this study was to investigate the relationships between employee empowerment, innovative behaviors and job productivity of public health nurses (PHNs).

Design

This study conducted a cross-sectional research design.

Settings and participants

Purposive sampling was conducted from six health bureaus in northern Taiwan. 670 PHNs were approached and 576 valid questionnaires were collected, with a response rate of 85.9%.

Methods

Structured questionnaires were used to collect data by post.

Results

Meaning and competence subscales of psychological empowerment, information and opportunity subscales of organizational empowerment, and innovative behaviors were the predictors of job productivity, only accounting for 16.4% of the variance. The competence subscale of psychological empowerment made the most contribution to job productivity (β = 0.31). Meaning subscale of psychological empowerment has a negative impact on job productivity.

Conclusions

Employee empowerment and innovative behavior of PHNs have little influence on job productivity. Employees with greater competence for delivering public health showed higher self-evaluated job productivity. The negative influences on job productivity possibly caused by conflict meaning on public health among PHNs in current public health policy. It should be an issue in further researches. Public health department should strengthen continuing educations to foster competence of psychological sense of empowerment and innovative behavior to increase job productivity.     

HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in adolescents: A cross-sectional questionnaire survey

Background

High incidence rates of HIV/AIDS infections among youth draw attention to the need for emphasizing the reduction of risky sexual behavior, a major contributor to the spread of HIV/AIDS. Few researchers have examined the relationship between self-efficacy for HIV/AIDS preventions, depressive symptoms, and adolescent risky sexual behavior. This insufficient understanding limits nurses’ ability to provide effective programs for reducing adolescents’ risky sexual behaviors.

Objectives

This study was conducted to investigate the relationships among HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in Taiwanese adolescents.

Design

A cross-sectional, correlational study.

Settings

Seven vocational high schools located in a metropolitan area in southern Taiwan.

Participants

A convenience sample of 16-18-year-old vocational high school Taiwanese adolescents (n = 734) participated in this study.

Methods

Several self-administrated questionnaires, including HIV/AIDS Preventive Self-efficacy scale, the Center for Epidemiological Studies-Depression scale, Safe Sex Behavior Questionnaire, and a form for demographic data, were used to collect data.

Results

Taiwanese adolescents who had higher HIV/AIDS preventive self-efficacy scores had less overall risky sexual behavior. Adolescents who had less depressive symptoms had higher HIV/AIDS preventive self-efficacy. More depressive symptoms were correlated to more risky sexual behavior.

Conclusion

Improving Taiwanese adolescents’ HIV/AIDS preventive self-efficacy could be useful to reduce risky sexual behaviors in this population. Results of this study may assist nurses in understanding factors related to adolescents HIV/AIDS related risky sexual behavior and its’ preventions. However, future longitudinal studies are needed to clarify whether depressive symptoms is a major influential factor that might interfere with the effectiveness of HIV/AIDS prevention programs.