[Living will, durable power of attorney and legal guardianship in the trauma surgery routine : Data from a geriatric trauma center]. / Patientenverfügung, Vorsorgevollmacht und gesetzliche Betreuung im unfallchirurgischen Alltag : Zahlen aus einem alterstraumatologischen Zentrum.

BACKGROUND: Due to the increasing number of elderly patients, trauma surgeons are often confronted with end-of-life treatment decisions. Advance directives can help reduce the lack of clarity in those situations. OBJECTIVES: The aim of this study was to identify the presence of living wills, durable power of attorney, legal guardianship and appointment of guardianship in the geriatric trauma center of a university hospital. MATERIALS AND METHODS: The data of all patients treated in our geriatric trauma center from 01/01/2013 to 03/31/2014 were analyzed regarding the presence of a living will, durable power of attorney, legal guardianship and appointment of guardianship as well as the procedure of documenting those items. RESULTS: Out of 181 patients, 63 % (n = 114) had one or more of these documents. Most frequently used was the durable power of attorney in 33 % (n = 59), followed by a living will in 27 % (n = 48), legal guardianship in 20 % (n = 37) and appointment of guardianship in 7 % (n = 12). The existence of those documents was recorded in 88 % (n = 100) of patients within 24 h after admission; documentation in the medical records was found in 58 % (n = 66). CONCLUSION: A large proportion of patients had one or more of the documents named above. In this respect, standardized documentation of advance directives in the medical record is an important issue for all persons involved.

Protecting victims of elder financial exploitation: the role of an Elder Abuse Forensic Center in referring victims for conservatorship.

OBJECTIVES: The aim of this study was to examine the extent to which an Elder Abuse Forensic Center protects financial exploitation (FE) victims through referral to the Office of the Public Guardian (PG) for investigation and possible conservatorship (called 'guardianship' in many states). METHOD: Los Angeles County Elder Abuse Forensic Center cases involving adults aged 65 and older (April 2007-December 2009) were matched using one-to-one propensity-score matching to 33,650 usual care Adult Protective Services (APS) cases. The final analysis sample consisted of 472 FE cases. RESULTS: Compared to usual care, Forensic Center cases were more likely to be referred to the PG for investigation (30.6%, n = 72 vs. 5.9%, n = 14, p < .001). The strongest predictors of PG referral were suspected cognitive impairment, as identified by APS (odds ratio [OR] = 11.69, confidence intervals [CI]: 3.50-39.03), and Forensic Center review (OR = 7.85, CI: 3.86-15.95). Among referred cases, the court approved conservatorship at higher rates - though not statistically significant - for Forensic Center cases than usual care (52.9%, n = 36/68 vs. 41.7%, n = 5/12). CONCLUSION: Conservatorship may be a necessary last resort to improve safety for some FE victims, and the Forensic Center appears to provide a pathway to this service. These findings suggest modification to the Elder Abuse Forensic Center conceptual model and contribute to an emerging body of evidence on the role of the Forensic Center in addressing elder abuse.

Prevention nearby: the influence of the presence of a potential guardian on the severity of child sexual abuse.

The main aim of this study was to examine the effect of a potential guardian on the severity of child sexual abuse. Using data obtained on crime events from adult child sexual offenders incarcerated in Queensland (Australia), mixed-effects logistic regression analyses were conducted to examine the effect of potential guardianship on the severity of abuse. Controlling for victim and situational characteristics, the analyses showed that the presence of a potential guardian reduced the duration of sexual contact and the occurrence of penetration. Presence of a potential guardian decreased the risk of sexual penetration by 86%. The study highlights the importance of the presence of a potential guardian for reducing the severity of child sexual abuse, and suggests more broadly that guardianship may be an important protective factor in sexual offending.

A study of consent for participation in a non-therapeutic study in the pediatric intensive care population.

OBJECTIVE: To document the legal guardian-related barriers to consent procurement, and their stated reasons for non-participation in a paediatric critical care research study. STUDY DESIGN: A multicentre, prospective, cohort study. PARTICIPANTS: Legal guardians of children who participated in a multicentre study on adrenal insufficiency in paediatric critical illness. Data were collected on all consent encounters in the main study. METHODS: Screening data, reasons for consent not being obtained, paediatric risk of mortality (illness severity) scores and age were collected on all 1707 patients eligible for participation in the Adrenal Insufficiency Study. RESULTS: The main barriers to approaching legal guardians for consent were lack of availability of the legal guardians (321/1707) and language barriers (84/1707). Legal guardians of 917 patients were approached with an overall consent rate of 42% (range 14-56% across the seven sites). 81% of the 528 legal guardians who declined consent provided an unsolicited reason for refusal. The three most commonly stated reasons were: being overwhelmed (117/429), not wanting anything else done to their child (63/429) and not wanting an additional medication (53/429). In addition, 14.2% cited research-related concerns as the reason for their non-participation. CONCLUSIONS: Barriers to consent procurement in a non-therapeutic paediatric critical care study appear to occur at many levels with lack of availability of legal guardians, and legal guardians feeling overwhelmed, being the most commonly recorded reasons. Further research into the impact of these findings on the validity and generalisability of the results of such studies is necessary prior to the development and study of future consent models.

[The living will. An analysis of state of knowledge of patients in the HELIOS hospital Leisnig]. / Die Patientenverfügung. Eine Wissensstandanalyse von Patienten im HELIOS Krankenhaus Leisnig.

On September 1, 2009, the Guardianship Law (Betreuungsgesetz) changed for the third time. Thus, the rights of the people living in Germany have been improved with reference to the preventive instruments. The aim of the work was to find about the subject to what extent patients understand the subject and how many of them have such a preventive document. The area of research has been examined on the basis of a standardized questionnaire drawn up by means of anonymous data collection in the quantitative research design. After the pretest, the survey was done in form of a documented Face-to-face-questioning in the HELIOS hospital Leisnig. The sample size comprised 139 patients from which 84 patients (37 female, 47 male) agreed with the survey. 25 percent of the questioned patients knew the law of living will (Patientenverfügungsgesetz) and 27 percent knew about the content of preventive instruments. 46.4 percent of the surveyed patients, aged between 70 and 75, had at least one preventive instrument. 63.1 percent of the patients believed that a living will has to be in a written form. 21.4 percent said that, in addition, the document has to be authenticated by a notary public. A study by van Oorschot claims that between ten and 15 percent of the people living in Germany have a living will (van Oorschot 2008, p. 443, Sahm & Schroeder 2009, p. 98). The results of this study show a much higher proportion of existing living wills. For the majority of respondents a preventive instrument plays still a minor role, but 46 percent of the population already use a preventive instrument to make provisions for themselves. 27 percent did express their will in theform of a living will. Nevertheless, the survey shows a lack of knowledge of the correct handling of the living will.

[Consequences of the German federal Guardianship Law after reunification (1992-2009)]. / Auswirkungen des Betreuungsgesetzes im wiedervereinigten Deutschland (1992-2009).

BACKGROUND: The Guardianship Law became effective in the year 1992 with the intention of replacing the paternalistic-restrictive model by a model based on the principles of participation and empowerment. METHODS: Data from the Federal Ministry of Justice were used to examine the development of 12 legal guardianship parameters over a period of 17 years (1992-2009) at the level of federal states. Due to the completely different practise in both parts of Germany before reunification, the development will be analysed separately for the old and the new federal states. RESULTS: All examined parameters indicate an increase of legal guardianship. The highest increases were found for enlargement of the task scope (+606%) and for approval of contention measures (+868%). With the exception of involuntary commitment rates, in the new federal states the mean values of all variables score higher than in the old federal states. Legal guardianship installation only increased for the old federal states significantly (T(9)=6.64; p=0.007); however, the guardianship expenses were higher, but not significantly, for the new federal states. DISCUSSION: In spite of the legal changes in the direction of a dynamic instrument in mental health care, the practise of the Legal Guardianship Law indicates a continuous increase of guardianship orders since 1992. It is necessary to recognise that a slowdown of the upward trend is not in sight. Therefore it is pertinent to call those persons in charge of regulating legal guardianship to consider their daily practise carefully. On the other hand it is a task of mental health services research to analyse the driving factors of the presented developments.

Assessment of Prevalence of Adolescent Patient Portal Account Access by Guardians.

Importance: Patient portals can be configured to allow confidential communication for adolescents' sensitive health care information. Guardian access of adolescent patient portal accounts could compromise adolescents' confidentiality. Objective: To estimate the prevalence of guardian access to adolescent patient portals at 3 academic children's hospitals. Design, Setting, and Participants: A cross-sectional study to estimate the prevalence of guardian access to adolescent patient portal accounts was conducted at 3 academic children's hospitals. Adolescent patients (aged 13-18 years) with access to their patient portal account with at least 1 outbound message from their portal during the study period were included. A rule-based natural language processing algorithm was used to analyze all portal messages from June 1, 2014, to February 28, 2020, and identify any message sent by guardians. The sensitivity and specificity of the algorithm at each institution was estimated through manual review of a stratified subsample of patient accounts. The overall proportion of accounts with guardian access was estimated after correcting for the sensitivity and specificity of the natural language processing algorithm. Exposures: Use of patient portal. Main Outcome and Measures: Percentage of adolescent portal accounts indicating guardian access. Results: A total of 3429 eligible adolescent accounts containing 25 642 messages across 3 institutions were analyzed. A total of 1797 adolescents (52%) were female and mean (SD) age was 15.6 (1.6) years. The percentage of adolescent portal accounts with apparent guardian access ranged from 52% to 57% across the 3 institutions. After correcting for the sensitivity and specificity of the algorithm based on manual review of 200 accounts per institution, an estimated 64% (95% CI, 59%-69%) to 76% (95% CI, 73%-88%) of accounts with outbound messages were accessed by guardians across the 3 institutions. Conclusions and Relevance: In this study, more than half of adolescent accounts with outbound messages were estimated to have been accessed by guardians at least once. These findings have implications for health systems intending to rely on separate adolescent accounts to protect adolescent confidentiality.

[Effect of guardianship on the quality of life of people with disabilities in Spain.] / Efecto de la tutela en la calidad de vida de personas con discapacidad en España.

OBJECTIVE: Despite the unquestionable progress in the treatment and legal and social recognition of persons with disabilities with modified capacity,the role and social position of the collective still hinders the development of a full life. The objective was to know the possible effect of the guardianship exercise on the quality of life of persons with disabilities who reside permanently in residential centres and whose ordinary guardianship falls to the public FASAD Foundation. METHODS: Correlational quantitative study. The GENCAT quality of life scale adapted so that the population under study itself was in charge of assessing the areas and dimensions related to their bio-psycho-social well-being. The starting hypothesis is was that exists a better perception of the levels of quality of life with a longer time of guardianship protection. In addition, the research questions were, What effects does the tutelary protection exercised by the FASAD Foundation have on the perception of the quality of life of the interviewed subjects? How do the variables (sex, place of residence and time of guardianship) affect the perception of quality of life? What dimensions present in the quality of life analysis are most affected by the variable time of guardianship? For the analysis of the statistical data, was used the SPSS® Statistics 22.0, a descriptive and bivariate exploration was carried out that showed the level of association and correlation between the variables studied. RESULTS: People under guardianship for a period of more than 3 years present better results in all the dimensions studied -except for rights- regardless of their sex or place of residence. Women under guardianship for a period less than 3 years obtained a general percentile of quality of life of 13.6, while those who were under guardianship for a period greater than 3 years obtained 18.9, in the same way it happened with men (14.1 vs 20.7) The ANOVA statistic and the Pearson correlation table confirm the association and relationship between the variable time of care and the general percentiles of quality of life. CONCLUSIONS: The exercise of guardianship has a positive effect on all the dimensions that integrate the quality of life construct. In addition, knowing the self-perception of the quality of life of the people under guardianship favors knowing the true impact of a support and promotion mechanism such as guardianship.

OBJETIVO: Pese al incuestionable avance en el tratamiento y reconocimiento jurídico y social de las personas con discapacidad con la capacidad modificada, el rol y la posición social que ocupa el colectivo aún sigue dificultando el desarrollo de una vida plena. El objetivo fue conocer el posible efecto del ejercicio tutelar sobre la calidad de vida en personas con discapacidad que residen de forma permanente en centros residenciales y cuya tutela ordinaria recae sobre la Fundación de carácter público FASAD. METODOS: Estudio de carácter cuantitativo de tipo correlacional. Se adaptó la escala de calidad de vida GENCAT para que fuese la propia población objeto de estudio la encargada de valorar las áreas y dimensiones relacionadas con su bienestar bio-psico-social. La hipótesis de partida fue que existe una mejor percepción sobre los niveles de calidad de vida a mayor tiempo de protección tutelar. Además, las preguntas de investigación fueron, ¿Qué efectos tiene la protección tutelar ejercida por la Fundación FASAD en la percepción de la calidad de vida de los sujetos entrevistados? ¿Cómo afectan las variables (sexo, lugar de residencia y tiempo de tutela) en la percepción de la calidad de vida? ¿Qué dimensiones presentes en el análisis de la calidad de vida se ven más afectadas por la variable tiempo de tutela? Para el análisis de los datos estadísticos se utilizó el SPSS® Stadistics 22.0, se efectuó una exploración descriptiva y bivariada que mostró el nivel de asociación y correlación entre las variables estudiadas. RESULTADOS: Las personas tuteladas por un período superior a 3 años presentan mejores resultados en todas las dimensiones estudiadas -excepto en derechos- independientemente de su sexo o lugar de residencia. Las mujeres tuteladas por un periodo inferior a 3 años obtuvieron un percentil general de calidad de vida de 13,6, mientras que las que se encontraban tuteladas por un periodo superior a 3 años obtuvieron un 18,9, de la misma forma ocurrió con los hombres (14,1 frente al 20,7). El estadístico ANOVA y la tabla de correlaciones de Pearson refrendan la asociación y relación existente entre la variable tiempo de tutela y los percentiles generales de calidad de vida. CONCLUSIONES: El ejercicio de la tutela tiene un efecto positivo en todas las dimensiones que integran el constructo calidad de vida. Además, conocer la autopercepción sobre la calidad de vida de las propias personas tuteladas favorece conocer el verdadero impacto de un mecanismo de apoyo y promoción cómo es la tutela.

Guardianship and End-of-Life Care for Veterans with Dementia in Nursing Homes.

BACKGROUND/OBJECTIVES: Experts have suggested that patients represented by professional guardians receive higher intensity end-of-life treatment than other patients, but there is little corresponding empirical data. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Among veterans aged 65 and older who died from 2011 to 2013, we used Minimum Data Set assessments to identify those who were nursing home residents and had moderately severe or severe dementia. We applied methods developed in prior work to determine which of these veterans had professional guardians. Decedent veterans with professional guardians were matched to decedent veterans without guardians in a 1:4 ratio, according to age, sex, race, dementia severity, and nursing facility type (VA based vs non-VA). MEASUREMENTS: Our primary outcome was intensive care unit (ICU) admission in the last 30 days of life. Secondary outcomes included mechanical ventilation and cardiopulmonary resuscitation in the last 30 days of life, feeding tube placement in the last 90 days of life, three or more nursing home-to-hospital transfers in the last 90 days of life, and in-hospital death. RESULTS: ICU admission was more common among patients with professional guardians than matched controls (17.5% vs 13.7%), but the difference was not statistically significant (adjusted odds ratio = 1.33; 95% confidence interval = .89-1.99). There were no significant differences in receipt of any other treatment; nor was there a consistent pattern. Mechanical ventilation and cardiopulmonary resuscitation were more common among patients with professional guardians, and feeding tube placement, three or more end-of-life hospitalizations, and in-hospital death were more common among matched controls. CONCLUSION: Rates of high-intensity treatment were similar whether or not a nursing home resident with dementia was represented by a professional guardian. This is in part because high-intensity treatment occurred more frequently than expected among patients without guardians.

African American parents'/guardians' health literacy and self-efficacy and their child's level of asthma control.

Nearly 1 of 10 American children has asthma. Asthma is addressed in Healthy People 2010 as a public health problem. This study examined the relationship between parents'/guardians' health literacy levels and their perceived self-efficacy to manage their child's asthma. A four-page asthma questionnaire was developed to assess the self-efficacy of parents/guardians of African American children with asthma. There was a statistically significant relationship among the parents'/guardians health literacy levels and their perceived efficacy expectations to manage their child's asthma. There is evidence that high parental/guardian self-efficacy and successful asthma management contribute to a child with well-controlled asthma. It is necessary for patient educators to capitalize on physician/nurse visits and use the time for asthma education, particularly to increase the efficacy expectations of parents/guardians with limited health literacy skills.

Assesment of household burden of orphaning and coping strategies by guardians and families with orphans and vulnerable children in Hossana Town, SNNPR.

BACKGROUND: Globally the number of orphans is increasing due to HIV/AIDS, internal corflicts and others. Orphanage and vulnerability causes much of its burden on poor households and children. OBJECTIVE: This study was initiated to assess household challenges of orphaning and coping strategies by families and guardians living with Orphan and Vulnerable Children (OVC). It has also tried to look at the types and level of challenge facing OVC. METHODOLOGY: Community based descriptive cross-sectional quantitative survey was conducted from October to November 2008 using a pre-tested Amharic questionnaire among guardians of OVC in Hossana town. Hadiya zone, SNNPR. A total of 334 samples were selected using a simple random sampling technique. RESULT: Sixty nine percent (69%) of guardians were women. Almost all of the OVC had participated in one domestic activity and 26.9% of OVC were involved in domestic work in other houses. A little more than twenty two percent (22.2%) have history of involvement in productive child labor; of whom 79.7% were found working at the time of data collection Above thirty five percent (35.6%) of respondents believe that the OVC are discriminated and 23.5% of the discriminators were step parents. As household coping mechanism 24.9% reported selling domestic animals, 15.6% selling household equipments and 12.9% sell plots of land which all occurs due to lack of resources in households. CONCLUSION AND RECOMMENDATION: The study concluded that caregivers lack sufficient resources to provide basic needs to OVC. Hence, community based training on micro finance assistance, discrimination and psychological support should be given to guardians and the community in general.

Some evidence for multidimensional biculturalism: confirmatory factor analysis and measurement invariance analysis on the Bicultural Involvement Questionnaire-Short Version.

In the present study, the authors empirically investigated a multidimensional conceptualization of acculturation using the Bicultural Involvement Questionnaire-Short Version (BIQ-S; J. Szapocznik, W. M. Kurtines, & T. Fernandez, 1980). Baseline data from four prevention trials, representing a total of 893 adolescent and 880 guardian participants of Hispanic descent, were used to examine the factor structure of BIQ-S scores. Results of exploratory and confirmatory factor analyses supported a four-factor solution. The factors were labeled as follows: (a) Comfort With Use of Spanish Language, (b) Comfort With Use of English Language, (c) Enjoyment of Hispanic Cultural Activities, and (d) Enjoyment of American Cultural Activities. The findings support an expansion of the theoretical conceptualization of biculturalism and suggest that within both the heritage and the receiving cultures, comfort with language and enjoyment of other cultural components represent different factors. Measurement invariance analyses revealed stability of the factor structure, as well as some measurement differences, between adolescents and their guardians. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

[Factors Related to Salt-Reduction Cognizance and Salt Intake in Women Aged 40-59 Years: Characteristics of Guardians of Medical University Students].

OBJECTIVES: In our previous study in which we aimed to clarify the factors related to salt intake in women aged 40-59 years, salt intake was found to be not related to salt-reduction cognizance. The aim of this research was to clarify factors related to salt intake in those who were cognizant of the importance of reducing their salt intake. METHODS: Two hundred and forty-seven female guardians (effective rate, 32.2%) in a medical university, aged 40-59 years old, participated in this study. The participants were divided into three groups according to their salt-reduction cognizance. RESULTS: There was no significant difference in salt intake between the three groups who were salt-reduction cognizant. Intakes of potassium (mg/1,000 kcal), vegetables, and fruits were higher in those who were cognizant of the importance of reducing their salt intake. The frequencies of consuming stewed foods, miso soup, and vinegared and marinated dishes were also higher. Those who were salt-reduction cognizant were knowledgeable about salt consumption, had experienced making low-salt dishes, used low-sodium seasoning, and made light-tasting dishes by regulating ingredients when cooking. However, when it came to eating, there was no difference in the percentage of those who left most of the broth when eating noodle soups and the frequency with which they added seasoning in terms of salt-reduction cognizance. CONCLUSION: Salt-reduction cognizant women aged 40-59 years made conscious efforts to use less salt at the time of cooking, but made no efforts when eating, even though they were cognizant of the importance of reducing their salt intake.

Predictors of HIV/AIDS confirmation and differences by guardian status in HIV+ adolescents in Jamaica.

BACKGROUND: Approximately 25% of the cumulative AIDS cases in Jamaica involve adolescents and young adults. However the lives of adolescents living with HIV within Jamaica and the Caribbean have been understudied. OBJECTIVES: (1) To describe the sociodemographic characteristics of HIV+ Jamaican adolescents who have ever been a part of the Kingston Paediatric/Perinatal HIV Programme (KPAIDS) from September 1, 2002 to August 31, 2006 (2). To identify predictors of HIV/AIDS confirmation as well as factors associated or uniquely present in these adolescents by their guardian status. METHODS: Seventy-two HIV+ adolescents, ages 10-19 years, were included. Factors studied included demographics as well as time to and time between HIV and AIDS confirmation. Data were analyzed by bivariate and multivariate statistics. RESULTS: The mean age of the adolescents was 12.6 +/- 2.8 years with slightly more males (52.8%) in the programme. There were equal proportions of adolescents living with HIV as with AIDS (43.1%). There were equal proportions who were lost to follow-up or deceased (8.3%). Twenty-two of them lived with parents, 25 with guardians and 18 in residential institutions. The primary mode of transmission was perinatal infection (68.1%), followed by sexual (20.8%), blood transfusion (2.9%) and unknown (8.3%). The mean time from HIV exposure to HIV confirmation and AIDS confirmation in mother-to-child transmission (MTCT) cases were 8.0 +/- 2.9 years and 9.6 +/- 3.3 years, respectively. In the multivariate analysis model, age and gender were significant in predicting time from HIV exposure to HIV confirmation. CONCLUSION: The majority of HIV-positive adolescents reside with parents and guardians and this might indicate support in spite of stigma and discrimination. However; the mean time to HIV confirmation in MTCT cases is quite long and must be reduced.

Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science.

BACKGROUND: Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. OBJECTIVE: This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. METHODS: Six electronic databases were searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis. RESULTS: Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. CONCLUSION: Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

Age and other risk factors related to reentry to care from kin guardian homes.

Although kinship guardianship is an increasingly important foster care exit pathway for children in the United States, research on the factors leading to kinship guardianship breakdown is lacking. This study examines the factors associated with guardianship breakdown for children who exited foster care to kinship guardianship in California between 2003 and 2010 (N = 18,831). Specifying time-dependent Cox relative risk models, children's age trajectories are directly accounted for in the analysis. This allows differentiation between duration dependence (i.e., time spent in guardianship) and children's development (expressed as age). Overall, 17.3% of children reentered care by 2017. Early adolescents, age 13-15 years (HR = 1.63, p < .001), and late adolescents, age 16-17 years (HR = 1.93, p < .001), had an increased hazard of reentry compared with children under the age of six. Children with a history of mental health concerns had more than twice the hazard of reentering than children without such a history (HR = 2.18, p < .001). Our findings indicate that transition to adolescence was associated with increased risk of reentry into care, highlighting the need for guardianship support services leading up to, and during, this child developmental stage.

Going it Alone: A Scoping Review of Unbefriended Older Adults.

Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.

Family group decision making and disproportionality in foster care: a case study.

Research on the disproportionate number of children of color in the child welfare system suggests that we should focus on key decision points such as investigations, substantiations, and placements to understand how experiences of children vary by race and ethnicity. This article describes one community's efforts to use Family Group Decision Making in placement decisions to reduce disproportionality in foster care by diverting children from regular foster care services and keeping them within their extended families.

Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings.

PURPOSE: This study sought to assess whether risky sexual behaviors and sexual exploitation of orphaned adolescents differed between family-based and institutional care environments in Uasin Gishu County, Kenya. METHODS: We analyzed baseline data from a cohort of orphaned adolescents aged 10-18 years living in 300 randomly selected households and 19 charitable children's institutions. The primary outcomes were having ever had consensual sex, number of sex partners, transactional sex, and forced sex. Multivariate logistic regression compared these between participants in institutional care and family-based care while adjusting for age, sex, orphan status, importance of religion, caregiver support and supervision, school attendance, and alcohol and drug use. RESULTS: This analysis included 1,365 participants aged ≥10 years: 712 (52%) living in institutional environments and 653 (48%) in family-based care. Participants in institutional care were significantly less likely to report engaging in transactional sex (adjusted odds ratio, .46; 95% confidence interval, .3-.72) or to have experienced forced sex (adjusted odds ratio, .57; 95% confidence interval, .38-.88) when controlling for age, sex, and orphan status. These associations remained when adjusting for additional variables. CONCLUSIONS: Orphaned adolescents living in family-based care in Uasin Gishu, Kenya, may be at increased risk of transactional sex and sexual violence compared to those in institutional care. Institutional care may reduce vulnerabilities through the provision of basic material needs and adequate standards of living that influence adolescents' sexual risk-taking behaviors. The use of single items to assess outcomes and nonexplicit definition of sex suggest the findings should be interpreted with caution.

[Investigation of the life situation of schizophrenic and paranoid patients at the Mental Health Care Institution in the City of Debrecen]. / Szkizofrén és paranoid gondozott betegek élethelyzetének vizsgálata a Debreceni Városi Pszichiátriai Gondozóintézetben.

UNLABELLED: Even today we have to reckon with the serious personal and social consequences of schizophrenic diseases. In spite of medical treatment and nursing, psychiatric nursing homes have not been able to obtain real improvement in those serious consequences. AIM: To survey whether an improvement can be detected as compared to the situation 25 years ago: how the disease affects the fate and progress of our patients in certain areas (marital status, employment, disability, guardianship). METHOD: Doctors' notes and information obtained by nurses during visits about patients belonging to categories F20.029.9 of ICD, compared to a group of patients not suffering from schizophrenia (F40.0-F60.9). RESULTS: The data of 2,397 patients in total have been processed. Of these, 893 belonged to categories F20-29. Compared to the 1,504 patients not suffering from schizophrenia, only a 1/3 of them were employed and 12 times as many were on disability pension. Among those of 35-54 years of age, there were four times as many singles, fewer were married, and five times fewer had an employment, three times as many received disability pension. Less than 10% of those in category F20 were employed, compared to 49% in the other group. The need for long-time treatment and nursing is shown by the fact that while the majority of those belonging to categories F40-69, no longer need nursing at about the age of 50, approximately 40% of those in F20 have to be nursed in their old age as well. CONCLUSION: There is a lot to be done to improve the quality of life of the patients and their rehabilitation. In these important tasks, both psychiatric nursing taking place in the residential area (community psychiatry) and social care will play an indispensable role.