Does the New Rural Pension Scheme improve residents' livelihoods? Empirical evidence from Northwestern China.

The sustainable development of pension systems has been investigated from a financial perspective worldwide. However, the pension adequacy and its effect on the sustainability of a national pension system are still understudied. Using actual replacement rate and modified living standards replacement rate, this study empirically evaluates whether China's New Rural Pension Scheme (NRPS) grants enough livelihood protection for the rural residents in the Northwestern China. The results show that the NRPS fails to meet the basic needs of the elderly people (i.e., age of sixty years or older) or the middle-aged people (forty-five to fifty-nine years old), while it only provides limited protection for the young people (sixteen to forty-four years old). These findings suggest that the current NRPS benefits are very low in the Northwestern China and policy reforms should be further implemented to improve the sustainable development of the New Rural Pension Scheme.

New Zealand doctors and euthanasia-legal and practical considerations of the End of Life Choice Act.

AIM: To provide an overview of the New Zealand End of Life Choice Act in comparison with other countries, arguments for and against euthanasia, and consideration of relevant legal and practical issues. METHOD: Structured descriptive summary of criteria for medical euthanasia in various jurisdictions currently allowing the practice, compared with New Zealand legislation. Narrative review of arguments for and against euthanasia with reference to existing medical literature and legal cases. RESULTS: A strong case for medical assistance in dying, based on autonomy and quality of life arguments, is countered by a long history of medical and legal tradition protecting life. CONCLUSION: This highly contentious issue is coming before the New Zealand public as a referendum in October 2020. The results will have profound implications for medical practice as well as reflecting societal shifts in attitudes toward death and dying.

Development and Psychometric Validation of a Screening Questionnaire to Detect Excessive Menstrual Blood Loss That Interferes in Quality of Life: The SAMANTA Questionnaire.

Background: Heavy menstrual bleeding (HMB) affects up to 35% of women at some point in their lives, and has an important impact on their quality of life (QoL). Current techniques to assess and quantify menstrual blood loss are inconvenient and the correlation between actual and perceived blood loss is poor. This study aimed to develop and validate a screening questionnaire in Spanish to identify HMB in women of reproductive age. Methods: The study consisted of two phases: the conceptual development of a set of items to discriminate between women with and without HMB and the assessment of the sensitivity and specificity of these items. Correlation of the screening tool with women's perception of the intensity of bleeding and the interference in their daily life activities was also assessed. Results: An initial set of 46 items were identified, from which 21 items were selected following the cognitive interviews. For the psychometric validation phase, 389 patients were enrolled, of whom 364 were assessable: 211 cases with Pictorial Blood loss Assessment Chart-confirmed excessive menstrual loss (EML) and 153 controls. Six items met entry criteria in the model and together yielded a sensitivity of 86.7% and specificity of 89.5% to identify cases and controls. These items were weighted according to their contribution to the final model to yield a tool that can be scored from 0 to 10 being 3 the cutoff point to diagnose EML that interferes in QoL. Conclusions: The 6-item SAMANTA questionnaire represents a valid screening tool to easily identify women with EML that interfere with QoL.

Exploring Quality of Life in End-of-Life Discussions.

Advance directives (ADs) allow individuals to legally determine their preferences for end-of-life (EOL) medical treatment and designate a health-care proxy to act on their behalf prior to losing the cognitive ability to make informed decisions for themselves. An interprofessional group of researchers (law, nursing, medicine, and social work) conducted an exploratory study to identify the differences in quality-of-life (QOL) language found within the AD state statutes from 50 US states and the District of Columbia. Data were coded using constant comparative analysis. Identified concepts were grouped into 2 focus areas for EOL discussions: communication/awareness of surroundings and activities of daily living. Language regarding communication/awareness of surroundings was present in the half of the statutes. Activities of daily living were addressed in only 18% of the statutes. Only 3 states (Arkansas, Nevada, and Tennessee) specifically addressed QOL. Patients are best served when professionals, regardless of discipline, can share and transform knowledge for patients in times of crisis and loss in ways that are empathetic and precise. Interprofessional collaborative practice (IPCP) comprises multiple health workers from different professional backgrounds working together with patients, families, and communities to deliver the highest quality of care. One of the major competencies of IPCP encompasses values and ethics. Interprofessional collaborative practice is offered as the means to deliver person-centered value-based care when facilitating these crucial dialogs and making recommendations for change.

Impact of urinary incontinence on the quality of life of individuals undergoing radical prostatectomy.

OBJECTIVE: to assess the level of urinary incontinence and its impact on the quality of life of patients undergoing radical prostatectomy. METHOD: cross-sectional study carried out with prostatectomized patients. The data were collected from the following instruments: sociodemographic questionnaire, Pad Test, International Consultation on Incontinence Questionnaire - Short Form and King Health Questionnaire. Data were submitted to descriptive and bivariate statistical analysis. The level of significance was set at 0.05. RESULTS: a total of 152 patients participated, with a mean age of 67 years. Among incontinent patients, there was a predominance of mild urinary incontinence. Urinary incontinence had a very severe impact on the general assessment of quality of life in the first months and severe impact after six months of surgery. The greater the urinary loss, the greater the impact on the quality of life domains Physical Limitations, Social Limitations, Impact of Urinary Incontinence and Severity Measures. Most participants reported no erection after surgery and therefore did not respond to the question of the presence of urinary incontinence during sexual intercourse. CONCLUSION: the present study evidenced the occurrence of urinary incontinence after radical prostatectomy at different levels and its significant impact on the quality of life of men, which reveals the need of interventions for controlling it.

Adverse childhood experiences, mental health, substance use, and HIV-related outcomes among persons with HIV.

While persons with HIV (PWH) have benefited from significant advances in treatment and resulting longevity, mental health problems remain elevated in this population. Adverse childhood experiences (ACEs) are common among PWH and may negatively affect mental health and HIV-related outcomes. We examined the association between ACEs, depression and anxiety symptoms, substance use, antiretroviral therapy (ART) adherence, and HIV-clinical indicators in a sample of 584 PWH at risk for unhealthy alcohol use enrolled in a primary care-based alcohol intervention study. The sample was 96.9% male, 63.0% non-Hispanic white, with an average age of 49.0 years. ACEs were highly prevalent: 82.5% reported ≥1 ACE, including 34.2% reporting 1-2 ACEs, 25.0% reporting 3-4 ACEs, and 23.3% reporting ≥5 ACEs. Adjusting for demographics, having 1-2, 3-4 or ≥5 ACEs was significantly associated with anxiety (ORs (95%CI): 3.41 (1.13-10.33), 4.36 (1.42-3.36), and 3.96 (1.28-12.19), respectively) and poorer mental health quality of life (Betas (SE): -3.21 (1.40), -6.23 (1.51), and -7.09 (1.54), respectively), but not with other outcomes. Trauma-informed interventions to reduce anxiety and improve mental health quality of life in PWH may reduce the negative health sequelae of ACEs.

Health-related quality of life in pre-adolescent liver transplant recipients with biliary atresia: A cross-sectional study.

OBJECTIVE: Pediatric recipients of liver transplantation (LT) often report lower Health-Related Quality of Life (HRQOL) than healthy controls when assessed on generic HRQOL measurement tools. The recent addition of the Pediatric Liver Transplant Quality of Life (PeLTQL), a novel disease-specific HRQOL instrument for pediatric LT recipients, into the clinical armamentarium of tools now routinely available to clinical care teams, provides the unique opportunity to identify disease-related challenges in children who have undergone this life-saving intervention. This study assesses HRQOL in pre-adolescent aged patients with a primary diagnosis of biliary atresia (BA) who underwent LT as an infant, using both generic and disease-specific HRQOL instruments validated for children. We also examined modifiable factors associated with HRQOL after pediatric LT. METHODS: HRQOL was the primary outcome of this study assessed using the disease-specific PeLTQL and the generic Pediatric Quality of Life Inventory 4.0 (PedsQL). Exposure variables of interest included medication status (e.g., monotherapy, dual therapy) and participation in sports. RESULTS: A total of 70 (56% female, mean age 9.89 ± 1.25 years) pediatric LT recipients (mean interval since LT was 9.0 ± 1.26 years) comprised the study cohort. LT recipients reported significantly lower PedsQL Scores relative to the general population. Immunosuppression monotherapy was associated with higher patient-reported PeLTQL Scores, and sports participation was associated with higher parent-reported PedsQL Scores. CONCLUSIONS: Pre-adolescents who underwent LT as an infant with BA, self-report low HRQOL on both disease-specific and generic HRQOL tools. Further research targeting sports participation and simplifying immunosuppression may further optimize quality of life years restored by life-saving LT.

Patient-Reported Measures for Person-Centered Coordinated Care: A Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.

BACKGROUND: Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. OBJECTIVE: The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database. METHODS: A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders. RESULTS: In total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. Of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs. CONCLUSIONS: A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers.

A step-by-step translation of evidence into a psychosocial intervention for everyday activities in dementia: a focus group study.

OBJECTIVE: In order to increase the efficacy of psychosocial interventions in dementia, a step-by-step process translating evidence and public engagement should be adhered to. This paper describes such a process by involving a two-stage focus group with people with dementia (PwD), informal carers, and staff. METHODS: Based on previous evidence, general aspects of effective interventions were drawn out. These were tested in the first stage of focus groups, one with informal carers and PwD and one with staff. Findings from this stage helped shape the intervention further specifying its content. In the second stage, participants were consulted about the detailed components. FINDINGS: The extant evidence base and focus groups helped to identify six practical and situation-specific elements worthy of consideration in planning such an intervention, including underlying theory and personal motivations for participation. Carers, PwD, and staff highlighted the importance of rapport between practitioners and PwD prior to commencing the intervention. It was also considered important that the intervention would be personalised to each individual. CONCLUSIONS: This paper shows how valuable public involvement can be to intervention development, and outlines a process of public involvement for future intervention development. The next step would be to formally test the intervention.

Estados de bienestar e intervención socio-sanitaria / Welfare states and socio-health intervention

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Factores que influyen en la satisfacción del paciente de diálisis con enfermería / Factors influencing the degree of satisfaction of the hemodialysis patient with nursing

Introducción: La satisfacción del paciente con los cuidados enfermeros se ha convertido en un determinante clave de la calidad de la atención sanitaria. Además, esto es especialmente relevante, sobre todo en pacientes crónicos, como es el caso del paciente con enfermedad renal crónica avanzada en hemodiálisis. Objetivo: Analizar los factores que intervienen en la satisfacción de los pacientes en hemodiálisis respecto al personal de enfermería. Metodología: Se ha llevado a cabo un estudio cualitativo, de tipo fenomenológico, mediante grupo focal de 7 pacientes en hemodiálisis de la Unidad de Gestión Clínica de Nefrología de Córdoba. Los sujetos fueron seleccionados mediante muestreo intencionado, tras su consentimiento informado. Resultados: Se han categorizado los resultados según las dimensiones de la calidad percibida. Respecto a la accesibilidad creen que son bien atendidos, pero pierden mucho tiempo en la unidad de diálisis. En cuanto a la fiabilidad, confían en las enfermeras con destreza para pinchar la fístula y desconfían de las enfermeras nuevas. Respecto a la comunicación, resaltan la buena relación existente entre ellos y el personal de enfermería. El trato es percibido como un punto fuerte, agradable y humano, en general. De forma generalizada destacan en las enfermeras un alto grado de competencia profesional, ligada al grado de fiabilidad que tengan con la enfermera. En general, califican el servicio asistencial que reciben de muy bueno e incluso excelente. Conclusiones: Este grupo de pacientes en hemodiálisis destaca la relación que se crea entre ellos y enfermería. Tienen un alto grado de confianza en el personal de enfermería, basado en su destreza para pinchar la fístula arteriovenosa y en su fiabilidad profesional (AU)

Introduction: Patient satisfaction with nursing care has become a key determinant of the quality of health care. In addition, this is especially relevant, especially in chronic patients, such as patients with advanced chronic kidney disease on hemodialysis. Objective: To analyze the factors involved in the satisfaction of patients on hemodialysis regarding nursing staff. Methodology: A qualitative, phenomenological study was carried out by focal group of 7 patients on hemodialysis of the Clinical Management Unit of Nephrology of Córdoba. Subjects were selected by intentional sampling, after their informed consent. Results: The results were categorized per the dimensions of perceived quality. Regarding accessibility, they believe that they are well taken care of, but they lose a lot of time in the dialysis unit. As for reliability, they rely on nurses who have the skill to puncture the fistula, and are wary of new nurses. Regarding communication, they highlight the good relationship between them and the nursing staff. The treatment is perceived as a strong point, pleasant and human in general. In general, nurses have a high degree of professional competence, linked to the degree of reliability they have with the nurse. In general, they rate the service they receive from very good and even excellent. Conclusions: This group of hemodialysis patients highlights the relationship between them and nursing. They have a high degree of confidence in the nursing staff based on their ability to puncture the arteriovenous fistula and in their professional reliability (AU)

Dignidade, Direitos Humanos e fundamentais: uma nova tecnologia disruptiva / Dignity, human and fundamental rights: a new disruptive technology

A sociedade contemporânea está imersa em profundas transformações que alteram substantivamente as significações e o imaginário, individual e coletivo. A inquietação que é produzida pela exclusão e reclusão (na marginalidade social) é indutora de deterioração da qualidade de vida e organiza a construção de subjetividades marcadas pela miséria em suas mais diversas manifestações. A convergência objetiva das sociedades e de cada um de seus cidadãos e cidadãs na percepção das categorias da Dignidade, da Interculturalidade, dos Direitos Humanos e dos Fundamentais, quando relacionados e bem entendidos, podem formatar uma 'Nova Tecnologia', uma tecnologia disruptiva. Uma tecnologia sociopolítica, econômica e jurídica fundada nos Sistemas de Informação, mediante bem articuladas técnicas de comunicação que superem a natural entropia do sistema pela exclusão fundada na falta de 'expertise' das partes (AU)

Contemporary society is immersed in profound changes that substantively alter the meanings and the imaginary, individual and collective. The restlessness that is produced by exclusion and seclusion (on the social fringe), is capable of inducing deterioration of quality of life and organizes the construction of subjectivity marked by poverty in its many manifestations. The objective convergence of societies, and each of its citizens. In the perception of the categories of Dignity, Interculturalism, Human Rights and Fundamental when related and well understood, can format a 'New Technology', a disruptive technology. A socio-political, economic and legal technology founded on information systems through well-articulated communication techniques that overcome the natural entropy of the system by exclusion based on lack of 'expertise' of the parties (AU)

The Extremity Trauma and Amputation Center of Excellence: Overview of the Research and Surveillance Division.

Congress authorized creation of the Extremity Trauma and Amputation Center of Excellence (EACE) as part of the 2009 National Defense Authorization Act. The legislation mandated the Department of Defense (DoD) and Department of Veterans Affairs (VA) to implement a comprehensive plan and strategy for the mitigation, treatment, and rehabilitation of traumatic extremity injuries and amputation. The EACE also was tasked with conducting clinically relevant research, fostering collaborations, and building partnerships across multidisciplinary international, federal, and academic networks to optimize the quality of life of service members and veterans who have sustained extremity trauma or amputations. To fulfill the mandate to conduct research, the EACE developed a Research and Surveillance Division that complements and collaborates with outstanding DoD, VA, and academic research programs across the globe. The EACE researchers have efforts in four key research focus areas relevant to extremity trauma and amputation: (1) Novel Rehabilitation Interventions, (2) Advanced Prosthetic and Orthotic Technologies, (3) Epidemiology and Surveillance, and (4) Medical and Surgical Innovations. This overview describes the EACE efforts to innovate, discover, and translate knowledge gleaned from collaborative research partnerships into clinical practice and policy.

The Center for Rehabilitation Sciences Research: Advancing the Rehabilitative Care for Service Members With Complex Trauma.

The Center for Rehabilitation Sciences Research (CRSR) was established to advance the rehabilitative care for service members with combat-related injuries, particularly those with orthopedic, cognitive, and neurological complications. The center supports comprehensive research projects to optimize treatment strategies and promote the successful return to duty and community reintegration of injured service members. The center also provides a unique platform for fostering innovative research and incorporating clinical/technical advances in the rehabilitative care for service members. CRSR is composed of four research focus areas: (1) identifying barriers to successful rehabilitation and reintegration, (2) improving pain management strategies to promote full participation in rehabilitation programs, (3) applying novel technologies to advance rehabilitation methods and enhance outcome assessments, and (4) transferring new technology to improve functional capacity, independence, and quality of life. Each of these research focus areas works synergistically to influence the quality of life for injured service members. The purpose of this overview is to highlight the clinical research efforts of CRSR, namely how this organization engages a broad group of interdisciplinary investigators from medicine, biology, engineering, anthropology, and physiology to help solve clinically relevant problems for our service members, veterans, and their families.

Hacinamiento en menores de 5 años como factor de riesgo para infecciones respiratorias agudas en una comunidad rural de Honduras / Overcrowding as a risk factor for acute respiratory infections in children under 5 years in a rural community from Honduras

Antecedentes: Mundialmente las infecciones respiratorias agudas (IRA) ocupan los primeros lugares como causa de morbimortalidad, principalmente, en los países en vías de desarrollo y en menores de 5 años. Existen varios factores de riesgo relacionados con la aparición, evolución y pronóstico de las mismascomo son la desnutrición,privación de lactancia materna, hacinamiento entre otros. Objetivo: Buscando mejorar el conocimiento regional de estas enfermedades que son el principal motivo de consulta en nuestro país. Métodos: El estudio fue de tipo descriptivo, transversal y cuantitativo durante febrero - abril 2016, se usaron las variables: tipos de IRA, edad, sexo, peso, talla, estado nutricional, manifestaciones clínicas, lactancia materna y hacinamiento, fue realizado en una población rural de 105 niños y niñas menores de 5 años en el departamento de Atlántida, Honduras. Resultados y discusión: El factor de riesgo más frecuentemente presentado fue el hacinamiento; 72/105 niños (68.5%) viviendo en hacinamiento, se observó una prevalencia de desnutrición de 14.2%; de estos el 26.6% presentaron más de 6 episodios de IRA al año en contraste con 16.2% en menores de 5 años con estado nutricional normal, se encontró que aquellos niños que recibieron menos de 6 meses o ninguna lactancia materna presentaban más episodios de IRA al año. En conclusión, estos datos indican el aumento en la incidencia de IRAS en niños desnutridos y que viven en hacinamiento, se observó el importante papel de la lactancia materna como factor protector contra infecciones. Resulta necesario desarrollar políticas públicas y estrategias para la prevención y reducción de factores que predisponen a padecer IRA en menores de 5 años...(AU)

The care of Filipino juvenile offenders in residential facilities evaluated using the risk-need-responsivity model.

According to the risk-need-responsivity model of offender, assessment and rehabilitation treatment should target specific factors that are related to re-offending. This study evaluates the residential care of Filipino juvenile offenders using the risk-need-responsivity model. Risk analyses and criminogenic needs assessments (parenting style, aggression, relationships with peers, empathy, and moral reasoning) have been conducted using data of 55 juvenile offenders in four residential facilities. The psychological care has been assessed using a checklist. Statistical analyses showed that juvenile offenders had a high risk of re-offending, high aggression, difficulties in making pro-social friends, and a delayed socio-moral development. The psychological programs in the residential facilities were evaluated to be poor. The availability of the psychological care in the facilities fitted poorly with the characteristics of the juvenile offenders and did not comply with the risk-need-responsivity model. Implications for research and practice are discussed.