Careful assistance? Personal assistance within the family as hybridization of modern welfare policy and traditional family care

The aim of this article is to examine how different ideological perspectives on Swedish disability policy, are reflected in the experiences of disabled people and their families personal assistants. Personal assistance provided within the family can be seen as a hybridization between publicly regulated and paid work performed in the private family sphere, and thus conflicting norms and practices may coexist. In Sweden, family members of the assistant user can be employed as paid personal assistants. Many users combine personal assistance from family members with non-family assistance. Approximately 20–25% of the employed personal assistants are relatives of the assistance users. The empirical data consists of qualitative interviews with seventeen adult users and twenty-three family members employed as PAs with different types of family ties; parent-child relationships, sibling relationships and partner relationships. The findings show that family assistance could entail advantages such as personalised services, to combine instrumental and emotional assistance as well as achieving a power-balance between the parties. But there were also disadvantages, such as unwanted or enforced dependency, with a risk for both parties to be ‘locked up’ in the family. In an overall analysis, we distinguished three broad approaches towards family assistance, family as a substitute, family as a supplement and family first.     

Vécus psychologiques des démarches d'assistance médicale à la procréation

Assisted Reproductive Technologies (ART) come along with important emotional and psychological burden, as well as the physical constraints, for both the woman and her partner. Couples entering ART programs are usually infertile ones, but some specific settings, like serodiscordant couples where the male partner is HIV positive, involving fertile couples. These couples are usually well-adjusted and motivated ones. During the treatments, waiting for the outcome, and the unsuccessful cycles are among the most stressfull experiences. Common reactions are stress, anxiety and depression, but for some couples, the difficulties are so great that they discontinue the program after only one attempt. When parents, the couples usually experience good parenting competencies, and the “precious” children, despite a greater genetic risk, usually have a normal development, but some specific psychological difficulties may arise, that may request a specific help.     

实施员工关爱计划保障医务人员职业安全与健康

医务人员的身心健康和执业满意度直接影响医疗服务质量。复旦大学附属华山医院从员工需求切入,建立并实施员工关爱计划:横向包括身心健康、社会支持、个人成长与职业生涯发展等;纵向贯彻危机前、危机中、危机后三级援助体系。实践后,员工满意度、社会支持水平、幸福感有所提升,职业倦怠阳性率有所下降。员工关爱计划在管理理念、方案完善、人才培养等方面还有待进一步改进。     

Assessment of Informal Caregiver Assistance and Strain With Total Hip and Knee Arthroplasty

BackgroundThe purpose of our study is to assess which patient-related and caregiver-related factors are predictive of caregiver strain and assistance when caring for total hip and knee arthroplasty (THA and TKA) patients within 2 weeks after surgery.MethodsWe conducted a prospective study of caregivers of participants enrolled in 2 randomized trials. Caregivers provided demographics and completed the Caregiver Strain Index and Caregiver Assistance Scale pre-surgery and post-surgery. We performed backwards stepwise regression with mixed-effects negative binomial models to investigate predictors of caregiver strain and assistance for THA and TKA caregivers.ResultsThree hundred six caregiver/patient pairs were included. Our models of caregiver strain found Caregiver Assistance Scale scores and patient age to be predictive for all caregivers. We also found caregiver gender and smoking status to be predictive for THA caregivers and caregiver age to be predictive for TKA caregivers. Our models of assistance provided by caregivers found time (post-surgery vs pre-surgery) was predictive for all caregivers. We also found patient body mass index, and patient and caregiver gender to be predictive for THA caregivers, and patient and caregiver employment status and caregiver education level to be predictive for TKA caregivers.ConclusionOur study identifies patient-related and caregiver-related factors which are associated with caregiver strain and assistance when caring for arthroplasty patients. As this is the first study to assess assistance provided by caregivers, it is important for future research to validate our results and to further explore whether patient-reported outcomes may also be related to assistance and strain.     

从组团式援藏看西藏医用辐射防护监测工作的希望之光

目的 了解西藏医用辐射防护现状。保障西藏医疗卫生机构医用辐射工作人员、患者、群众的身体健康与安全。方法 通过多年医用辐射防护监测工作的资料累积，以部分地市为例，分析具有西藏特色的发展历程。依据西藏医用辐射监测的特点，结合组团式援藏帮扶西藏医用辐射监测工作实际经验，分析影响西藏放射工作人员、公众健康与安全的因素并提供相应的应对策略。结果 西藏医用辐射监测工作基础薄弱，在实际医疗卫生机构开展放射诊疗过程中缺乏日常监测以及监督管理等，存在较大的安全隐患。结论 必须坚持在医疗卫生机构建设、验收、运行等各个环节加强监督管理，并在组团式援藏工作模式下，建立西藏本地医用辐射监测队伍，提高西藏医用辐射监测水平，才能切实消除隐患，保证医疗卫生机构长期安全稳定的运行。     

Consumption of sugar-sweetened beverages and obesity in SNAP-eligible children and adolescents

BackgroundLow-income individuals who are eligible for nutrition assistance have been shown to consume a larger portion of their daily calories from beverages with added sugar. We examined the association between Supplemental Nutrition Assistance Program (SNAP) participation and self-reported sugar sweetened beverage (SSB) consumption as well as the association between self-reported consumption of SSBs and overweight/obesity in low-income children.DesignCross-sectional analysis of 1455 SNAP-eligible U.S. children, ages 2–17, who completed a questionnaire and physical examination during the 2009–2010 National Health and Nutrition Examination Survey (NHANES).ResultsSNAP-eligible children who received SNAP in the last month were more likely to drink soda in the last month [76.0% (2.2)] than those who did not receive benefits [70.5% (2.8)]. These children were also more likely to drink fruit drinks [74.8% (1.6) vs. 69.3% (3.1)]. Among youth in households receiving SNAP benefits, soda consumption in the past month was associated with a greater risk of obesity, particularly Hispanic youth [OR = 1.93 (1.07, 3.50), p = 0.0314] aged 2–5 [OR = 2.71 (1.29, 5.69), p = 0.0114]. Additionally, among youth in households receiving SNAP benefits, male children who consumed sugar-sweetened fruit drinks in the past month were significantly more likely to be overweight [3.13 (1.12, 8.73), p = 0.0315] as compared to male peers who did not consume any sugar sweetened fruit drinks.ConclusionAmong youth, SNAP recipients drink more SSBs than their eligible non-recipient peers. Our results indicate that certain populations of children receiving SNAP benefits and consuming SSBs are more likely to be overweight or obese when compared to their peers who receive SNAP benefits but do not consume SSBs.     

Commotio cordis après impact précordial de Flashball

Less lethal weapons, like Flashball^®, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries.     

新农合患者大病医疗救助水平分析——以湖北省A地和贵州省B地为例

目的:分析A、B两地大病医疗救助情况,为提高大病医疗救助水平和保障效果提出可行性建议。方法:选取湖北省A地和贵州省B地,2013年通过现场调查获取问卷872份,分析大病医疗救助受益患者的概况,计算救助前后年度自付费用以及灾难性卫生支出发生率、相对差距。结果:大病医疗救助对患者经济负担缓解作用有限;目前大病医疗救助政策救助比偏低,救助范围较窄,非五保、低保大病患者救助起付线高且年救助封顶线低,导致实际救助比远低于政策救助比。结论:逐步拓宽大病患者合规费用救助范围并提高救助比;做好大病医疗救助与大病医疗保险、基本医疗保险的有效衔接;将大病门诊自付费用纳入大病医疗救助范围。     

Factors correlated with left ventricular mass in hypertensive patients

Left ventricular hypertrophy (LVH) is an independent risk factor in hypertensive patient. THE AIM: Of our study is to evaluate prospectively the relationship between left ventricular mass and clinical, echocardiographical and ambulatory blood pressure data in hypertensive subjects. METHODS: We studied 88 hypertensive patient who underwent clinical and laboratory investigation, echocardiography and 24 hours ambulatory blood pressure monitoring. Correlations were made between these data and left ventricular mass. RESULTS: Clinical data, which correlated well with left ventricular mass, were duration of hypertension, systolic arterial pressure and pulse arterial pressure. In echocardiography left atrial area and left ventricular dysfunction correlated significatively with left ventricular mass. Data from 24 hours blood pressure monitoring as daytime systolic pressure, nighttimes diastolic pressure, ambulatory systolic pressure and ambulatory pulse pressure. CONCLUSION: In hypertensive patient, left ventricular mass correlated well with left atrial dilation and diastolic left ventricular dysfunction. It also correlated with 24 hours ambulatory blood pressure monitoring data.