Experiences of self-determination by older persons living in sheltered housing

Respect for autonomy and self-determination is a central principle in nursing ethics. Autonomy and quality of life are strongly connected, and, at the same time, autonomy is an important quality indicator on how older persons' housing functions. In this study, autonomy was conceived as self-determination. The aim of the study was to describe how older people living in sheltered housing experience self-determination and how they are valued as human beings. Eleven persons living in five different housing facilities for older people in southern Sweden were interviewed. The data were analysed by manifest and latent qualitative content analysis. The overall theme expressing the latent content in the interviews emerged as disempowerment, which implied an environment that does not strengthen individual self-determination. The results showed a negative experience of how these older people thought they were valued in the sheltered housing where they lived. In sheltered housing, more attention should be paid to residents' self-determination and sense of value.     

Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study

OBJECTIVES: To improve understanding of how families living in adverse conditions perceive their encounters with public services and how past experiences influence current and future attempts to seek help. DESIGN: Qualitative interviews with adult members of households living in poverty in deprived areas, plus observations conducted in the surrounding neighbourhoods and service settings. PARTICIPANTS: Purposive sample of 25 adults living in a deprived area, on welfare benefits. SETTING: Eight sites in disadvantaged areas in Merseyside, North Wales, London and Greater Manchester in 2004/05. RESULTS: Participants generally perceived public services as a source of distrust and a potential risk to well-being. Encounters with a range of services were perceived as risky in terms of losing resources, being misunderstood or harshly judged, and carrying the ultimate threat of losing custody of their children. Participants perceived that they were subjected to increasing levels of surveillance, with fear of "being told on" by neighbours, in addition to service providers, adding to anxiety. Adverse consequences included avoiding child health and social services, anxiety and self-imposed isolation. CONCLUSIONS: Approaching services was perceived as akin to taking a gamble that might or might not result in their needs being met. Faced with this "choice", participants employed strategies to minimise the risks that on the surface may appear risky to health. If public services are to succeed in providing support to disadvantaged families, greater efforts are needed to build trust and demonstrate understanding for the strategies these families use to maintain their well-being against formidable odds.     

Patients' perceptions of emotional support and information provided to family members

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THE PURPOSE OF THIS QUALITY improvement project was to determine patients' perceptions of the emotional support and information provided to their family members by nurses in a day surgery setting.

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THE PROJECT WAS CONDUCTED in a day surgery unit of a hospital in western Finland. Data were collected from 60 participants using a questionnaire designed specifically for the project.

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THE RESULTS SHOWED that half of the patients appreciated the presence of their family members during hospital care. The emotional support provided to family members was rated as moderate, and more than 50% of the patients believed their family members were adequately informed. The results were used to help develop tools for patient and family member education. AORN J 81 (May 2005) 1030-1039.

     

Rosiglitazone in the treatment of HAART-associated lipodystrophy--a randomized double-blind placebo-controlled study

Highly active antiretroviral therapy (HAART) is associated with metabolic adverse events such as insulin resistance and lipodystrophy, that is, atrophy of subcutaneous fat and accumulation of intra-abdominal fat. Currently, there is no pharmacological treatment for lipoatrophy. Glitazones, a novel class of insulin-sensitizing anti-diabetic agents, increase subcutaneous fat in patients with type 2 diabetes. There are no controlled studies of glitazones in patients with HAART-associated lipodystrophy (HAL). In this randomized, double-blind, placebo-controlled study, 30 patients with HAL received either rosiglitazone (8 mg daily) or placebo for 24 weeks. Baseline characteristics were compared to a group of 30 age-, sex- and weight-matched HIV-negative controls. At baseline, patients with HAL had 1.8-fold (P<0.001) more intra-abdominal and 2.4-fold (P<0.05) more liver fat than HIV-negative controls, who had 1.8-fold (P<0.001) more subcutaneous fat than the patients. After 24 weeks of treatment, rosiglitazone had no effect on body weight, subcutaneous or intra-abdominal fat (magnetic resonance imaging), total body fat (bioimpedance analysis), anthropometric measurements or serum leptin concentrations (a circulating marker of adipose tissue mass). However, rosiglitazone decreased % liver fat (spectroscopy) and serum insulin concentrations, and normalized liver function tests. During the first 12 weeks of rosiglitazone treatment, serum triglycerides increased from 3.5 +/- 0.5 to 6.5 +/- 2.0 mmol/l (from 310 +/- 44 to 575 +/- 177 mg/dl) (P<0.05) and serum cholesterol from 6.0 +/- 0.4 to 7.8 +/- 0.7 mmol/l (from 232 +/- 15 to 301 +/- 27 mg/dl) (P<0.01). Contrary to data in other patient groups, rosiglitazone did not increase subcutaneous fat in patients with HAL after 24 weeks of treatment. Rosiglitazone seemed to ameliorate insulin resistance judged by the decreased serum insulin concentrations and % liver fat. Rosiglitazone unexpectedly caused significant increases in serum triglyceride and cholesterol concentrations, which must be carefully monitored if glitazones are used in these patients.     

Collagenase 2/matrix metalloproteinase 8 in critically ill patients with secondary peritonitis

Secondary peritonitis is an important indication for surgical intensive care admissions, and it is associated with high morbidity and mortality. Collagenase 2/matrix metalloproteinase (MMP) 8 is a tissue matrix-degrading enzyme that is released from leukocytes upon inflammatory stimuli and may thus contribute to peritonitis-associated organ damage. We studied the levels and activity of MMP-8 in the peritoneal fluid of 15 critically ill patients with secondary peritonitis. The MMP-8 levels were measured from the patients' peritoneal fluid, serum, and urine, and from the serum and urine of 10 healthy controls by immunofluorometric assay. Median MMP-8 level in peritoneal fluid supernatant was 1,317 microg/L (interquartile range [IQR]) (1,254-1,359 microg/L) being significantly higher than in the sera of the patients (P=0.008). Molecular forms and isoform distribution of MMP-8, MMP-1, and MMP-13 in peritoneal fluid, assessed by Western immunoblotting, revealed that the neutrophil-type MMP-8 was the major collagenase species in peritoneal fluid, and it was partially in an activated form. Catalytically competent, active MMP-8 produced the characteristic cleavage products from intact human type I collagen. The serum levels of MMP-8 were higher in the patients, 49 microg/L (IQR, 23-214 microg/L), than in the controls, 11 microg/L (IQR, 8-24 microg/L) (P<0.01). The MMP-8 levels in the urine were higher in the patients, 0.27 microg/L (IQR, 0.04-1.89 microg/L), than in the controls, 0.03 microg/L (IQR, 0.0-0.05 microg/L) (P=0.013). Our data demonstrate for the first time that MMP-8 levels are remarkably elevated and in an active and catalytically competent form in the peritoneal fluid samples of patients with secondary peritonitis.     

The complex interplay between pain intensity,depression, anxiety and catastrophising with respect to quality of life and disability

Purpose. To identify subgroups of patients with chronic pain based on the occurrence of depression, anxiety and catastrophising and the duration of pain and pain intensity. In addition to this, the relationship between the subgroups with respect to background variables, diagnosis, pain-related disability and perceived quality of life are investigated.

Methods. This study used 433 patients with chronic pain including 47 patients with spinal cord injury-related pain, 150 with chronic whiplash associated disorders and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological and health-related items.

Results. On the basis of depression, anxiety, catastrophising, pain intensity and duration, we identified subgroups of patients with chronic pain that differed with respect to perceived quality of life, disability and diagnosis. The psychological factors, especially depression, significantly influenced perceived quality of life and disability. Pain intensity and duration play a minor role with respect to quality of life, although pain intensity is associated to perceived disability.

Conclusions. The results of this study highlight the importance of not looking at patients with chronic pain as a homogenous entity. A detailed assessment, including psychological factors with emphasis on depressive symptoms, might be essential for planning and carrying through treatment and rehabilitation.