Burden on family carers and care-related financial strain at the end of life: a cross-national population-based study.

BACKGROUND: The rising number of deaths from cancer and other life-limiting illnesses is accompanied by a growing number of family carers who provide long-lasting care, including end-of-life care. This population-based epidemiological study aimed to describe and compare in four European countries the prevalence of and factors associated with physical or emotional overburden and difficulties in covering care-related costs among family carers of people at the end of life. METHODS: A cross-national retrospective study was conducted via nationwide representative sentinel networks of general practitioners (GPs). Using a standardized form, GPs in Belgium, The Netherlands, Italy and Spain recorded information on the last 3 months of life of every deceased adult practice patient (1 January 2009-31 December 2010). Sudden deaths were excluded. RESULTS: We studied 4466 deaths. GPs judged family carers of 28% (Belgium), 30% (The Netherlands), 35% (Spain) and 71% (Italy) of patients as physically/emotionally overburdened (P < 0.001). For 8% (Spain), 14% (Belgium), 36% (The Netherlands) and 43% (Italy) patients, GPs reported difficulties in covering care-related costs (P < 0.001). Patients <85 years of age (Belgium, Italy) had higher odds of having physically/emotionally overburdened family carers and financial burden. Death from non-malignant illness (vs. cancer) (Belgium and Italy) and dying at home compared with other locations (The Netherlands and Italy) were associated with higher odds of difficulties in covering care-related costs. CONCLUSION: In all countries studied, and particularly in Italy, GPs observed a considerable extent of physical/emotional overburden as well as difficulties in covering care-related costs among family carers of people at the end of life. Implications for health- and social care policies are discussed.

Older people's views in relation to risk of falling and need for intervention: a meta-ethnography.

AIM: This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. BACKGROUND: Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. DATA SOURCES: Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. REVIEW METHODS: Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. RESULTS: Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. CONCLUSION: In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person.

Caregiver perspectives on safety in home dementia care.

Home safety is a significant problem for caregivers of people with Alzheimer's disease and other dementias. This focus group study is designed to gain insight into caregivers' experiences of managing safety issues and to explore application of the transtheoretical model of health behavior change (TTM) to this problem, toward development of interventions to improve safety care. Caregivers identified safety problems and management strategies, as well as barriers and factors facilitating management, that can help guide the development of interventions. Caregivers described different stages of adopting actions to prevent accidents and injuries consistent with the TTM. The TTM warrants further study for understanding how to help caregivers make changes to promote safe care.

[A family's experience of home accidents--report of an experience]. / A família vivenciando o acidente doméstico--relato de uma experiência.

This study aims at knowing the behaviour of the family facing the home accidents among children, identifying the risk factors in the home environment, in the family's perception and analysing the socioeconomic-cultural context contributing to the occurrence of children's home accident. The work was made in a family that had experienced a case of poisoning of a 4 year-old child. Participant observation and the semi-structured interview were used as methodology. The results evidenced that the family constantly lives among children's home accidents and the socioeconomic-cultural context has a strong influence in the amount and quality of these cases.

Firearms in the home: parental perceptions.

BACKGROUND: Each year, thousands of children are injured or killed from unintentional gunshot wounds. Discovering a gun while playing in the home places children at risk of being injured by the firearm. OBJECTIVES: To determine parental firearm storage practices and parental perceptions of the behavior of their children around guns. METHODS: Cross-sectional survey of parents of children from 4 to 12 years of age. A sample of 424 parents, bringing their children to one of five pediatric ambulatory care centers, were asked to complete a 20-point self-administered questionnaire at the time of their visit. RESULTS: A total of 400 parents (94%) completed the questionnaire; 113 parents (28%) reported keeping a firearm (most often a handgun) in the home. Firearm owners were predominantly male, 30 years of age or older, white, and married. Of the gun owners, 52% stored their firearms loaded or unlocked, and 13% kept one or more guns loaded and unlocked. Three fourths of gun-owning parents believed that their 4- to 12-year-old child could tell the difference between a toy gun and a real gun, and 23% believed that their child could be trusted with a loaded gun. Although the majority of gun-owning parents (53%) endorsed safe storage as the best firearm injury prevention strategy, 61% of parents who do not own firearms endorse not owning guns as the best way to prevent pediatric firearm injuries. CONCLUSION: A majority of gun-owning parents store their firearms loaded or unlocked, substantially underestimating the risk of injury to their children. Many firearm-owning parents trust their child with a loaded gun and believe that their young child can tell the difference between a toy gun and a real gun.

Beliefs about the risks of guns in the home: analysis of a national survey.

OBJECTIVES: While epidemiological evidence suggests homes with guns are more likely to be the site of a suicide or homicide than homes without guns, the public's perception of these risks remains unknown. This study assesses the prevalence of the belief that homes with guns are safer than homes without guns, and factors associated with this belief. METHODS: Telephone interviews were conducted with a random sample of 4138 registered voters in urban areas in the US. Multinomial logistic regression was used to assess correlates of beliefs about the safety of keeping a gun in the home. RESULTS: Twenty nine per cent of respondents believed keeping a gun in the home makes the home more safe, 40% said less safe, 23% said it depends, and 9% were unsure. The belief that a home is more safe with a gun was associated with being male, young, completing 12 years or fewer of education, having no children living at home, Republican party affiliation, and low levels of trust in the police for protection. Prior exposure to violence and fear of victimization were not associated with the outcome. CONCLUSIONS: Findings may increase understanding about the public's perception of the risk in keeping guns in the home and assist educational efforts to decrease the risk of these injuries.

Que susto!

O vídeo inicia com um desenho animado mostrando o perigo dos acidentes domésticos. Logo após, acontece um debate com educadores, no qual discutem a questão dos perigos e falam como prevení-los, nesse quadro são respondidas perguntas de professores e pais. O desenho chama a atenção para os perigos que existem em casa. Recomenda aos pais e crianças os cuidados que se deve ter com produtos de limpeza e medicamentos. O objetivo a ser alcançado é que as crianças reconhecam os perigos que medicamentos tomados sem controle médico causam à saúde. Elas devem também fixar os cuidados com a saúde e com a higiene do corpo. Deve-se discutir com elas sobre subtâncias que podem fazer mal a nossa saúde e identificar os perigos de aceitar algo estranho

A socioeconomic analysis of digital replantations resulting from home use of power tools.

Forty-seven digits in 21 patients who sustained partial or complete amputations from the home use of power tools were replanted or revascularized during a 1-year period. This represented 69% of the microvascular surgery performed for hand injuries during that year. The cost of repairing an average of 2.4 digits was $7000 (surgeon's fee) plus $697 per hour (operating room fee), as per fiscal year 1987. Postoperative hospitalization averaged 15 days at a cost of $15,679. Hand rehabilitation averaged 8 months at a cost of $3348. Fifty-four percent of the patients had no insurance. Fourteen of 21 patients (67%) required at least one additional procedure. Two patients had to make a career change after the injury. The majority of patients with digital replantations were dissatisfied with the emotional costs and the number of subsequent operations. Lack of patient and family awareness of the length of the rehabilitative period was particularly evident.