‘There is No Mother to Take Care of You’. Views of Unaccompanied Children on Healthcare,Their Mental Health and Rearing Environment

ABSTRACT

This study aimed to shed light on the opinions of unaccompanied refugee children (N = 98) in various care facilities in the Netherlands (small living groups, small living units, foster families, large reception centres) about their mental health, their healthcare needs and their rearing environment. A mixed methods design was applied. The quality of the child-rearing environment and the age on arrival in the host country proved to be predictive of mental health outcomes. Unaccompanied children living in large reception centres experienced the lowest quality of rearing environment, the highest mental health problems and poor access to mental healthcare. Implications for practice and research are reflected upon.     

Elderly participants of social and rehabilitative day centres

As it develops, an ageing society has increased need of services that can promote the health and well-being of the elderly. Community-based day programmes are one kind of service intended to support elderly people with restricted function in their daily lives. There are several different forms of day programmes for the elderly in Sweden, but guidelines are vague about their aim and implementation and little is known about the persons using them. The aim of this study was to identify characteristics of the elderly people living in their own home who participated in social day centres in comparison with participants who attended a rehabilitative day centre. The focus was on perceived functioning and competence in daily life. Twelve social day centre participants and 12 rehabilitative day centre participants answered two questionnaires, the sickness impact profile (SIP) and occupational self-assessment (OSA). The results show that the majority of participants from both centres were elderly persons living alone who experienced severely restricted physical function. This demonstrates that the day centres serve the needs of a specific group of elderly people, namely, those with highly restricted functioning living on their own. A significant difference between the groups was that those who attended the social day centre perceived better psychosocial function than the group attending the rehabilitative centre. The fact that the social centre group had better psychosocial function than the other group, but yet had severely restricted physical function indicates that it is preferably the psychosocial well-being of elderly persons with restricted functioning that is possible to influence. This result implies that these centres serve as an important meeting place for elderly persons who would otherwise be isolated in their homes because of their physical restrictions. To fulfil this challenge, the day centres might need to accommodate a wider range of persons with restricted functioning.     

Experiences of long-term care and supportive living residents and families during the COVID-19 pandemic: “It's a lot different for us than it is for the average Joe”

Long-term care and supportive living (LTC/SL) residents are among the most at risk for severe outcomes of COVID-19. As such, early public health measures focused on this population. This study examined the experiences and perspectives of residents and family members of residents living in LTC/SL centres in Alberta, Canada during the COVID-19 pandemic. Between July and October 2020, we conducted semi-structured interviews with 14 residents and 18 family members of residents from 10 centres. Interviews were audio-recorded and analyzed using qualitative content analysis. Analysis revealed 5 categories from resident interviews (Living with Rules and Restrictions; COVID-19 Knowledge and Information; Wellbeing; Centre Operational Response; Criticisms and Suggestions for Improvement) and 6 categories from family interviews (Family Role; Navigating the New Normal; COVID-19 Knowledge and Information; Policy Limitations; Policy Impact; Centre Response). The results highlight the importance of engaging residents and families during pandemic preparation, response, and follow-up evaluation.     

Health-care challenges in rural areas: physical and sociocultural barriers

Important health and well-being issues for people living in the countryside include zoonotic diseases, accidents and mental health problems. Long distances from specialist centres can cause hardship, as can the financial cost. Sociocultural barriers to seeking medical help comprise another serious challenge. More research is needed in this area to support health staff.     

Nursing in First Nations and Inuit communities in Atlantic Canada

Effectively and holistically addressing the health-care needs of aboriginal people living in First Nations and nuit communities requires an understanding and a valuing of the cultural richness of the people. This article examines the programs and services provided in First Nations and Inuit health centres in Atlantic Canada and the support available for nurses working in First Nations and Inuit communities.     

Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care

OBJECTIVE: To evaluate whether transmural care for people with spinal cord injury living in the community has more impact on health outcomes than traditional follow-up care within the Netherlands. DESIGN: Quasi-experiment with 12 months of follow-up. SETTING: Eight Dutch rehabilitation centres.Subjects: Thirty-one patients who received transmural care in two ;experimental' rehabilitation centres were compared with a matched sample of 31 patients having received ;usual follow-up care' in six other rehabilitation centres. INTERVENTION: The core component of the transmural care consists of a transmural nurse, who 'liaises' between former patients living in the community, primary care professionals and the rehabilitation team. The transmural care model provides activities to support patients and their family/partners and activities to promote continuity of care. MAIN MEASURES: The prevalence of pressure sores and urinary tract infections; the number and duration of re-admissions to hospital and rehabilitation centre due to pressure sores, bladder and bowel problems; and the experienced quality of follow-up care. RESULTS: The transmural care, as implemented, did not influence the health outcomes. The prevalence of pressure sores, urinary tract infections and the number of re-admissions (due to pressure sores, bladder and bowel problems) was respectively 13, 13 and 4 in the intervention group versus 14, 15 and 6 in the usual follow-up care group. Since the transmural care had been incompletely implemented and there were methodological and practical limitations, we formulated no final conclusions regarding its effectiveness. CONCLUSION: Implementing the transmural care model strictly according to protocol may improve its effectiveness.     

The effectiveness of an exercise programme for elders with dementia in a Taiwanese day-care centre

The purpose was to examine the effectiveness of an exercise programme for elders with dementia in Taiwan aimed to maintain their activities of daily living such as feeding, dressing, grooming, washing and toileting. This was a single study group, repeated measure research design. Twenty-six dementia elders were recruited from a day-care centre located in southern Taiwan. Caregivers of the day-care centre provided all subjects an exercise programme. The exercise programme consisted of stretching and walking five times per week, and leg-weight bearing at least three times per week for 20-30 min each. The data were obtained three times (baseline, 2 months post intervention and 4 months post intervention). Results showed slight changes in the scores of one-leg-standing, 30 s chair rise, functional reach and get up and go test but were not statistically significant. Results also indicated that scores in the performance of activities of daily living were significantly higher than at baseline and at 4 months post intervention. In conclusion, this study provides information for dementia day-care centres in Taiwan about how elders with dementia can maintain physical fitness and perform activities of daily living.     

Living with heart failure; patient and carer perspectives.

Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing for both patients and their family carers. Patients found most difficulty coping with functional limitation and adapting to living with heart failure, but also reported particular problems due to side effects of medications, co-morbidities and a lack of psychosocial support and rehabilitation services. Those with less socio-economic resources found it harder to cope. Patients from minority ethnic groups held different beliefs about the illness and its treatment, and some had profound problems communicating with health and social care professionals that made managing the disease even more difficult. Caring for a person with heart failure often has a considerable impact on the psychological and physical health of family caregivers. Psychosocial support and rehabilitation services provided at diagnosis and after an acute episode would enable families to better manage living with this syndrome.     

Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Development, validation and inter-rater reliability of a scoring list

OBJECTIVE: To develop a valid and reliable scoring list to define the content of individual physiotherapy and occupational therapy sessions for stroke patients in inpatient rehabilitation. DESIGN: A list was developed based on previous lists, neurological textbooks and recorded therapy sessions. Content validity was verified and inter-rater reliability evaluated on videos of treatment sessions. In each of four rehabilitation centres, a researcher recorded and scored five physiotherapy and five occupational therapy sessions. These 40 treatment sessions were also scored by the first author. The scores of the researchers and first author were statistically compared. Settings and subjects : Forty stroke patients in four European rehabilitation centres. RESULTS: The scoring list consists of 49 subcategories, divided into 12 categories: mobilization; selective movements; lying (balance); sitting (balance); standing (balance); sensory and visual perceptual training and cognition; transfers; ambulatory activities; personal activities of daily living; domestic activities of daily living; leisure- and work-related activities; and miscellaneous. Comparing the frequency of occurrence of the categories resulted in intraclass correlation coefficients, indicating high reliability for eight categories, good for one, and fair for two. One category was not observed. Spearman rank correlation coefficients were high to very high for 24 subcategories and moderate for four. Twenty-one subcategories contained too few observations to enable calculation of Spearman rank correlation coefficients. Average point-to-point percentage of agreement in time of the treatment sessions equalled 76.6 +/- 16.2%. CONCLUSIONS: The list is a valid and reliable tool for describing the content of physiotherapy and occupational therapy for stroke patients.     

A network-based rehabilitation model for frail elderly people: development and assessment of a new model

INTRODUCTION AND PURPOSE: Living independently at home promotes the well-being of people aged 65 and over. In Finland, the municipalities are responsible for providing social and health services, including rehabilitation of the elderly. Rehabilitation is in practice carried out by independent rehabilitation centres. The Social Insurance Institution of Finland is a national agency responsible for financing and developing rehabilitation. Combining the efforts of these three agencies, a new network-based inpatient rehabilitation model was established to support the community living of frail elderly persons at high risk of institutionalization. This article describes the new model and evaluates the cooperation within the rehabilitation network, as well as the contents of the rehabilitation. MATERIAL AND METHODS: The new model was evaluated in two phases using diverse methods. First, the networks were assessed as they were being established in 2000, and secondly, when they were operational in 2002. The first phase involved 53 networks operating in 46 municipalities and 12 rehabilitation centres, and the second 44 networks in 41 municipalities and seven rehabilitation centres. The data were collected by questionnaires, interviews and reports. RESULTS: The rehabilitation networks were functional, although constant development and search for better working practices was time consuming. Two different approaches in the networks were found: the 'networks of creators' were able to carry out the new tasks highly successfully, while the 'networks of followers' only managed to do the minimum as instructed. Motivated network members and adequate resources appeared to be essential for a successful rehabilitation process. CONCLUSIONS: It is possible to create a functional rehabilitation network involving different agencies. Further development work is necessary to make the network-based rehabilitation model more efficient.     

Hydrogen symbioses in evolution and disease

Hydrogen is the source of energy that unites the metabolisms and fuels the innovative potentials of all living organisms. Autotrophs use hydrogen emitted into hydrothermal vents, where symbiotic communities that share hydrogen thrive. On the surface, life developed using photons to cleave water, releasing hydrogen carried into a reverse Krebs cycle to produce carbohydrates, from which hydrogen and its constituent electron and proton are extracted. Fluctuant electrogenic power is harnessed by extensive exchanges and symbiotic sharing schemes of hydrogen sources and carriers. These communicate with electrostatic nuclear centres, forming a positive feedback loop. If the proton-motive circuitry fails from loss of Redox potential, premature ageing and all-category disease can result.     

ABO-incompatibility in solid organ transplantation

The most important transplantation antigen system in solid organ transplantation is the ABO histo-blood group system. Crossing the ABO barrier in solid organ transplantation is usually not done except for emergency liver transplantations. Early experiences of crossing the ABO barrier in renal transplantation were very disappointing. In the 1970s, clinical trials were started transplanting kidneys of subgroup A2 into blood group O recipients. The tissues of the A2 subgroup expresses reduced amount of A antigens compared to subgroup A1 and the recipients had no special pretreatment and standard immunosuppression. A number of early graft losses were experienced but the trial also resulted in several long time surviving grafts. A few centres have adapted the concept of A2 to non A kidney transplantations with successful results, when the recipient anti-A titres are low or reduced prior to transplantation. In the early 1980s one group successfully transplanted A1 and B kidneys from living related donors across the ABO-barrier using an immunosuppressive protocol consisting of quadruple drugs and splenectomy and this protocol was adapted by a few other groups. In Japan, where cadaver donors are available in very limited number, the largest number of ABO-incompatible transplantations have been performed. Altogether more than 300 ABO-incompatible kidney transplantations have been performed in more than 40 centres since 1989. ABO-incompatible liver transplantations have been performed mainly in emergency cases and the results have generally been inferior to ABO-compatible grafts. In children below the age of three years, liver transplantations across the ABO-barrier have been quite successful especially with living related donors. Very few ABO-incompatible heart/heart-lung/lung-transplantations have been reported with a few successful cases, but the majority have been failures. Recently a series of ABO-incompatible heart transplants performed in small children have been reported with a high success rate.     

Randomized double-blind, placebo-controlled clinical trial of a selective 5-lipoxygenase inhibitor (AA-861) for the prevention of seasonal allergic rhinitis

In a randomized, double-blind, parallel group trial conducted in eight European centres, the 5-lipoxygenase inhibitor AA-861 was administered orally, starting 2 weeks before the pollen season and continuing for 8 weeks; after the start of the season escape medication was permitted if necessary. Patients were enrolled who had a previous history of pollen allergy, confirmed by skin prick tests and/or relevant allergen-specific immunoglobulin E to pollen. Daily symptoms scores were recorded on diary cards and assessments were made by the investigator during the study period. Better global improvement ratings were achieved using AA-861, as assessed both by the investigators and the patients. The total nasal symptoms scores and activities of daily living were also improved compared to placebo. No significant adverse reactions were encountered.     

The views of people with a physical disability on day activity centres in the Eastern Region of Ireland

Purpose: The overall aim of this study was to evaluate the effectiveness of day activity centres in providing a service to physically disabled clients in the Eastern Region of Ireland. Method: Qualitative and quantitative methodologies were used. Four focus groups with clients were undertaken. This informed questionnaire content and design for subsequent quantitative work. Interviewer administered questionnaires were distributed to 156 randomly selected clients. Areas covered in the questionnaire included: demographic characteristics, income, living circumstances, medical information, access to day centre, activities at the centre, staff, outcome of attendance and satisfaction with the centre. Results: There was a very positive response to the survey, all clients selected agreed to participate. The majority of clients were unmarried, unemployed and disabled due to a neurological disorder. While most lived in owner-occupied occupation, they were dependent on state benefits for their principal source of income. The majority of clients attended the centres for social and recreational reasons. Although there was a high level of satisfaction with the service overall, some aspects, such as availability of therapy and lack of continuity of staff are areas identified that need improvement. Conclusion: This study highlighted aspects of day activity services that clients value. The results of this evaluation should guide the proposed future development and expansion of this service.     

Anxiety and depression after stroke: a 5 year follow-up

Purpose: The aim was to document the prevalence and predictors of anxiety and depression 5 years after stroke, across four European centres. Method: A cohort of 220 stroke patients was assessed at 2, 4 and 6 months and 5 years after stroke. Patients were assessed on the Hospital Anxiety and Depression Scale and measures of motor function and independence in activities of daily living. Results: At 5 years, the prevalence of anxiety was 29% and depression 33%, with no significant differences between centres. The severity of anxiety and depression increased significantly between 6 months and 5 years. Higher anxiety at 6 months and centre were significantly associated with anxiety at 5 years, but not measures of functional recovery. Higher depression scores at 6 months, older age and centre, but not measures of functional recovery, were associated with depression at 5 years. Conclusions: Anxiety and depression were more frequent at 5 years after stroke than at 6 months. There were significant differences between four European centres in the severity of anxiety and depression. Although the main determinant of anxiety or depression scores at 5 years was the level of anxiety or depression at 6 months, this accounted for little of the variance. Centre was also a significant predictor of mood at 5 years. There needs to be greater recognition of the development of mood disorders late after stroke and evaluation of variation in management policies across centres.

Implications for Rehabilitation

• Depression and anxiety persisted up to 5 years after stroke in about a third of patients.

• Variation in the rates of anxiety and depression between different European centres suggest management policies rather than stroke related factors may determine their persistence.

• The effect of variations in stroke management policies should be investigated.

• Patients’ mood should be monitored over time in order to detect those with late onset mood disorders after stroke.

     

Macrolide resistance in group A streptococci

Two hundred and twenty one Streptococcus pyogenes isolates collected from throat swabs of untreated children with uncomplicated pharyngotonsillitis living in two centres situated in the north of Italy were tested to evaluate their macrolide resistance phenotype. Isolates were also typed for T protein and assayed for opacity factor (OF) and protease production. Resistance to macrolides was found to be similar in the two centres. Fifty-one point two per cent of Torino strains and 43.5% of Pinerolo strains were not inhibited by erythromycin. Resistant strains belonged to one of three phenotypes: CR, constitutive resistance (37.9 and 42.5% in Torino and Pinerolo, respectively); IR, inducible resistance (40.9 and 17. 5%); NR, new resistance phenotype (21.2 and 40%). All the resistant and some of the susceptible strains were analysed by pulsed-field gel electrophoresis and genomic patterns were defined on the basis of band size and number. Five DNA profiles were found among erythromycin-resistant strains: three patterns characterized the NR resistance phenotype and one each the IR and CR phenotypes. The distribution of resistant strains according to their genomic patterns appears to be related to the resistance phenotype and only in some cases to the T serotype of bacteria. We conclude that the S. pyogenes strains analysed are genetically heterogeneous and therefore the high rate of erythromycin resistance observed is not caused by the spread of a single clone nor is it related to a particular serotype.     

Haemophilia treatment centres in Germany

An adequate number of qualified haemophilia centres is an essential requirement for effective and cost-efficient haemophilia care. During a reassessment of the delivery of haemophilia care in Germany a broad range of criteria relating to structure and quality of the centres were defined and a questionnaire was developed. Results: Of 137 doctors who received the questionnaire, 113 (82%) replied. Based on data related to diagnostic and treatment services, together with voluntary information from PEI forms (Paul Ehrlich Institut, Germany), 72 haemophilia centres were established. Three levels of haemophilia care were defined by the Medical Advisory Council of the German Haemophilia Society. This is in accordance with criteria defined by European working parties. 17 haemophilia centres were designated CCC (Comprehensive Care Centre), 24 were designated HTC (Haemophilia Treatment Centre) and 31 smallest centres were allocated the status HTR (Haemophilia Treatment Regional). In comparison to the survey in 2007, there was only slight variance in the CCC centres (+ 2 centres/-1 centre). From the previous HTC centres, 7 have withdrawn from this treatment level: 4 maintain treatment on the lower level HTR, and 3 centres had ceased treatment. On the HTR level of treatment, 6 of 29 (21%) had ceased to offer treatment. 9 had been able to increase the number of patients and were designated HTC. 5404 patients with haemophilia and 3047 with the severe form of haemophilia were reported. 67% were treated in CCC, 25% in haemophilia treatment centres and 8% in the 31 smallest centres. 13 of the adult CCC are situated in the department of internal medicine and 4 in the section of transfusion medicine. Conclusions: The survey and analysis of the haemophilia treatment centres in Germany show that the delivery of haemophilia care through 17 CCC, 24 HCT and 31 HTR appears to be adequately structured. But it is noticeable and alarming, however, that on both HTC and HTR levels of treatment, 32% and 21%, respectively, have left their treatment level. 9 centres (12.5%) have finished working in haemophilia care in the last four years. On the strength of these results, endeavours to maintain haemophilia centres must be intensified. A high level of effective care can be guaranteed only through continued existence of the centres.     

Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264 health centres (91%) in Finland. The HT Guideline had been introduced into clinical practice in most health centres (89%). The style of implementation varied widely between health centres: at opposite ends of the implementation scale were 21 implementer health centres, which used multiple implementation channels, and 23 disseminator health centres, which used few or no implementation channels. The implementers had typically larger population bases and had organized services around the family doctor system, while the disseminators were smaller and had organized services according to a traditional model (appointments could be with any doctor in the surgery). CONCLUSION: The Finnish HT Guideline has become well known in most health centres since being introduced into clinical practice. However, the style of implementation varies markedly between health centres.     

Determinants of feeling hindered by health problems in daily living at 60 years and above

Although the ability to perform activities of daily living (ADL) is frequently used to identify the impact on daily living caused by health problems such as diseases, impaired eyesight or hearing, it is still not well known what makes people feel hindered in daily living with more or less inability to perform ADL. The aim of this study was to investigate feeling hindered by health problems in daily living among people (n = 958, 60–96 years) in relation to ADL capacity, health problems as well as social and financial resources, sense of coherence and life satisfaction. The data are taken from a baseline survey in one of the four included centres (Blekinge) of the longitudinal multicentre cohort study, The Swedish National Study on Aging and Care. The result showed that people felt hindered by their health problems despite no impairment in ADL capacity. Feeling greatly hindered by health problems was associated with factors linked to mobility but also to fatigue, no help when needed, and avoiding being outdoors due to fear of falling. Factors associated with feeling greatly hindered differed depending on whether people were impaired in ADL capacity or not. In people with excellent ADL capacity feeling hindered was associated with picking up things from the floor and rising from a chair and fatigue, whereas avoiding being outdoors, no help when needed and rising from a chair were found to be associated with feeling hindered by health problems among people with impaired ADL capacity. Combining people's ADL capacity with questions about feeling hindered may provide knowledge of determinant factors of feeling hindered in relation to ADL capacity, impaired or not, to identify people in need of rehabilitation or other interventions.     

Frailty modifies effectiveness of psychosocial intervention in recovery from stroke

OBJECTIVE: To evaluate the impact of a psychosocial intervention on instrumental activities of daily living, physical performance, cognition and mortality after stroke. DESIGN: A randomized clinical trial. SETTING: Patients were recruited from hospitals and rehabilitation centres; the intervention took place in subjects' homes. SUBJECTS: Two-hundred and ninety-one stroke survivors over age 45. One-hundred and forty-six subjects were assigned to the intervention and 145 subjects were assigned to usual care. INTERVENTION: Up to 16 meetings conducted over six months in the patient's home (approximately weekly for 12 weeks, followed by tri-weekly sessions for another 12 weeks). Sessions lasted approximately 1 hour and included, when possible, the entire support system (stroke survivor, primary caregiver, additional family and friends, and professional caregivers). MAIN OUTCOME MEASURES: Instrumental activities of daily living, physical performance, and cognition were assessed six months post stroke; mortality was assessed at an average of 47 months post stroke. RESULTS: No significant differences in outcomes were observed between the intervention and usual care groups when analysing the total study population. Among non-frail participants (n = 156), subjects randomized to treatment had better scores on instrumental activities of daily living (mean score among treated = 12.4 (standard deviation (SD) = 2.1), mean score among usual care subjects = 11.3 (SD = 2.9), P-value for difference in means = 0.01) and reduced risk of mortality (P = 0.03) than subjects randomized to usual care. CONCLUSION: While there is evidence that the treatment benefited healthier subgroups, results also show evidence that the treatment was not effective, and possibly harmful, in frail subgroups.