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2.
Eur J Obstet Gynecol Reprod Biol ; 266: 187-190, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34563418

RESUMO

OBJECTIVES: To describe the unevenness in daily patient flow (quiet, optimal and busy days) in different sized delivery hospitals. STUDY DESIGN: Population based register-study of 610 227 hospital deliveries. Data were collected from the Finnish Medical Birth Register from 2006 to 2016. Delivery hospitals (N = 26) were stratified into four categories by annual delivery volume: C1 <1000, C2 1000-1999, C3 2000-2999, C4 ≥3000. Uneven daily patient flow was defined based on the mean of daily delivery volume for each hospital category: quiet day (≤50% of the mean), optimal day (>50% of the mean to 

Assuntos
Hospital Dia , Hospitais , Finlândia , Humanos
3.
BMC Health Serv Res ; 21(1): 1009, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34556085

RESUMO

BACKGROUND: Most people with dementia wish to remain at home for as long as possible. Therefore, it is important to know the predictors of institutionalization, especially those that can be influenced. The aim of the present study is to identify predictors of the institutionalization of people with mild cognitive impairment (MCI) to moderate dementia who attend day care facilities (DCFs) throughout Germany. METHODS: This study is a secondary analysis of longitudinal data from 371 dyads comprising a cognitively impaired care receiver (CR) and a caregiver (CG). The data were collected in DCFs and via telephone interviews at three measurement points. To investigate the extent to which 16 variables could predict the institutionalization of the CRs between the 6- and 12-month follow-up, in the first step bivariate Cox regressions were calculated. In the second step, significant predictors were included in a model using multivariate Cox regression. RESULTS: Between the 6- and 12-month evaluations, 39 CRs moved into an institution. The risk of institutionalization of people with MCI to moderate dementia attending a DCF increased significantly (p < .05) when the CRs showed more neuropsychiatric symptoms (Hazard ratio (HR) = 1.237), when the CRs and their CGs did not live together in the same house (HR = 2.560), or when the care level of the CRs is low (HR = 2.241). CONCLUSIONS: Neuropsychiatric symptoms could be a possible starting point for therapeutic interventions that are designed to delay or prevent institutionalization. CG who do not live with their CR in the same house and CG who care for a CR with impairment in performing daily routine tasks care are particularly likely to make the decision to institutionalize the CR. For this group, advice and support are particularly important. TRAIL REGISTRATION: ISRCTN16412551 .


Assuntos
Disfunção Cognitiva , Demência , Cuidadores , Disfunção Cognitiva/epidemiologia , Hospital Dia , Demência/epidemiologia , Demência/terapia , Humanos , Institucionalização
4.
Gesundheitswesen ; 83(10): 797-804, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34571554

RESUMO

AIM OF THE STUDY: Dental group prophylaxis in day-care centers with teeth brushing as one of its components is intended to reduce caries incidence and promote dental health. However, various barriers can hinder implementation of this preventive measure. One concern relates to an increased risk of transmission of acute respiratory infections (ARI) in day-care centers. The ZINFEKT study aimed at determining whether and to what extent there are differences in the occurrence of ARI between day-care centers that implement vs. those that do not implement teeth brushing. METHODS: In an ecological study, 2013-2018 data from the ARI surveillance of the Public Health Agency of Lower Saxony were merged with information from the Dental Services on teeth brushing for n=33 day-care facilities from the urban municipality of Braunschweig, the region of Hannover, and the administrative district of Osnabrück (all Lower Saxony, Germany). Following the concept of patient days from hospital infection surveillance, "ill child weeks" were specified as observational units, defined as weeks for which an ARI had been reported for a registered child. Besides cross-tabulations, relative risks for ill child weeks by teeth brushing and Breslow-Day Tests for interactions with area, size of day-care center, ARI season and time slot with ARI seasons were computed. RESULTS: Overall, the ARI-rate, defined at the proportion of ill child weeks, was 4.6% higher in day-care centers in which teeth brushing took place, vs. centers in which this measure was not implemented (17.9 vs. 13.3%, p<0.0001). In analyses stratified by the geographic and temporal co-variables, the direction of this difference did not change (with one exception: day-care centers with 50 or less registered children) . CONCLUSION: The assumption that regular teeth brushing is associated with higher ARI rates in day-care centers does seem to have an empirical basis. However, despite the study's limitations (primarily its ecological design and possibly limited representativeness of the day-care centers), the identified difference - due both to its magnitude and possibly improvable hygiene compliance - to our assessment does not speak against brushing teeth as a component of dental group prophylaxis in day-care centers.


Assuntos
Hospital Dia , Infecções Respiratórias , Criança , Creches , Alemanha/epidemiologia , Humanos , Incidência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle
5.
J Am Acad Child Adolesc Psychiatry ; 60(10): 1171-1175, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34224838

RESUMO

The impact of COVID-19 changed the use and delivery of health care services, requiring an abrupt shift in treatment and staffing models 1,2. This is particularly salient in youth acute and intensive treatment services (AITS), including inpatient psychiatric hospitals (IPH), intensive outpatient programs (IOP), and partial hospitalization programs (PHP), because of challenging issues of maintaining high-quality care and a safe therapeutic milieu during increased demand for acute services,3 all while limiting transmission of COVID-19 on locked units, in close quarters, and for youths traveling back and forth to day-programs. Over the past year, AITS adapted and evolved without the ability to pause services and plan, increase staffing, or allocate additional resources. This article discusses themes of changes made based on more than 20 facilities across the United States through the American Psychological Association Child and Adolescent Psychology Division's Acute, Intensive, and Residential Service Special Interest Group.4 These facilities include psychiatric inpatient units and day-treatment programs. We discuss lessons learned from these changes, the need for evaluating these changes, and application of these lessons in future crises.


Assuntos
COVID-19 , Adolescente , Criança , Hospital Dia , Hospitalização , Hospitais Psiquiátricos , Humanos , SARS-CoV-2 , Estados Unidos
6.
Soins ; 66(855): 46-48, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-34103136

RESUMO

In the palliative care day hospital of Marie-Galène health centre in Bordeaux, care is provided in two different ways: through the interdisciplinary individual day hospital and the collective day hospital in the form of group days. In both cases, the palliative approach guides the team's reflection regarding the anticipation of complex situations and quality of life. The health crisis has had a significant impact on the activity of this service.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Qualidade de Vida , Hospital Dia , Hospitais , Humanos , Cuidados Paliativos
7.
Health Qual Life Outcomes ; 19(1): 170, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167529

RESUMO

BACKGROUND: Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions. METHODS: This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants' families was also assessed. RESULTS: The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2-86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0-80.0) at baseline to 77.5 (IQR 65.0-90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5-20.0) to 18 (IQR 15.8-24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002). CONCLUSIONS: The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families' stress burden was alleviated.


Assuntos
Atividades Cotidianas , Cognição , Hospital Dia/psicologia , Demência/psicologia , Estado Funcional , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Avaliação Nutricional , Qualidade de Vida , Estudos Retrospectivos , Taiwan
8.
Integr Cancer Ther ; 20: 15347354211025634, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34142595

RESUMO

OBJECTIVE: Cancer patients undergo therapies that might lead to severe adverse events. The enhanced daycare of Traditional Chinese medicine (TCM) we describe was intended to help cancer patients suffering from severe adverse events to obtain relief. We used the Taiwan brief version of the Common Terminology Criteria for Adverse Events Version 4.0 (Taiwan brief version questionnaire of CTCAE) as a primary measurement to evaluate the efficacy of the enhanced day care of TCM. The secondary measurements were the Taiwanese version of the Brief Fatigue Inventory (BFI-T) questionnaire and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which were used to quantify fatigue and quality of life (QOL), respectively. METHODS/DESIGN: This is a retrospective study of medical records. There were 401 patients treated with enhanced daycare of TCM from June 2017 to November 2019. RESULTS: Among 22 common adverse symptoms in the Taiwan brief version questionnaire of CTCAE4.0, 14 symptoms achieved a significant improvement, and the change of the total scores was also statistically significant (P < .001). Cancer stages II to IV showed significant improvement on the CTCAE and BFI-T; stage I only showed improvement on the BFI-T. On the WHOQOL questionnaire, there was a statistically significant difference in self-evaluation of the quality of life (P = .001) and self-evaluation of the total health condition aspect (P < .001). CONCLUSIONS: The enhanced TCM daycare program helped cancer patients decrease the severity of their adverse events and improve their fatigue and QOL. ClinicalTrials.gov identifier: NCT04606121.


Assuntos
Neoplasias , Qualidade de Vida , Hospital Dia , Humanos , Registros Médicos , Medicina Tradicional Chinesa , Neoplasias/tratamento farmacológico , Estudos Retrospectivos , Inquéritos e Questionários
9.
BMJ Open ; 11(4): e045136, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853802

RESUMO

INTRODUCTION: Globally, children are not meeting the recommended serves of the five food group foods, particularly vegetables. Childcare is an opportune setting to improve children's diet quality. This study aims to assess the effectiveness of a menu box delivery service tailored to the long day care setting to improve menu compliance with recommendations and improve children's food intake while in care. METHODS AND ANALYSIS: This study will employ a cluster randomised controlled trial and will recruit eight long day care centres, randomly allocated to the intervention or comparison groups. The intervention group will trial the delivery of a weekly menu box service that includes all ingredients and recipes required to provide morning snack, lunch and afternoon snack. The menu boxes are underpinned by a 4-week menu developed by dietitians and meet menu planning guidelines. The comparison group will receive access to online menu planning training and a menu assessment tool for cooks. The primary outcomes are child dietary intake and menu guideline compliance. Secondary outcomes include within-trial cost-effectiveness and process evaluation measures including intervention acceptability, usability and fidelity. If effective, the menu box delivery will provide an easy strategy for childcare cooks to implement a centre menu that meets menu planning guidelines and improves child intake of five food group foods, including vegetables. ETHICS AND DISSEMINATION: This study was approved by the Flinders University Social and Behavioural Research Ethics Committee. Study outcomes will be disseminated in peer-reviewed publications, via local, national and international presentations. Non-traditional outputs including evidence summaries and development of a business case will be used to disseminate study findings to relevant stakeholder groups. Data will be used in a doctoral thesis. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12620000296932).


Assuntos
Hospital Dia , Serviços de Alimentação , Austrália , Criança , Creches , Promoção da Saúde , Humanos , Política Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Int J Palliat Nurs ; 27(2): 86-97, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33886359

RESUMO

BACKGROUND: Specialist palliative day care is an area of palliative care which has a notable scarcity of research. Evidence is needed on the role of palliative day care to improve patients' quality of life and symptom management, while recognising the different patient cohorts that use the service. AIM: To determine the symptoms and quality of life of the patient cohort that are affected by the completion of a full therapeutic cycle (8 to 9 weeks) at a specialist palliative care day unit (SPCDU). METHOD: A retrospective cohort study was carried out from January 2016 to December 2017. Patient related outcome measures (PROMs) were collected as part of routine clinical paperwork at admission and discharge, and these were used to determine symptoms and quality of life pre-attendance and on completion of an 8 to 9 week therapeutic cycle at the SPCDU. RESULTS: Descriptive analysis demonstrated improvement across the many symptoms that were analysed. Quality of life analysis also established improvement. Statistically significant difference was achieved in several areas. Total physical symptoms (p value=.009) confirmed the positive impact attendance at SPCDU has on physical symptoms. Specific symptoms which displayed a statistically significant difference included: poor appetite (p value=.002), weakness (p value=.03) and the anxiety felt by family/friends (p value=.029). The quality of a patient's life also displayed statistically significant difference (p value=.000). CONCLUSION: This study demonstrates that attendance at a SPCDU may positively impact a patients' symptoms and quality of life. A more uniform national approach to specialist palliative day care delivery, alongside multi-setting research, may further bolster the image of palliative day care. This will improve referrals to and occupancy of SPDCUs and benefit the palliative patient in the community.


Assuntos
Hospital Dia , Cuidados Paliativos , Qualidade de Vida , Hospitalização , Humanos , Avaliação de Resultados em Cuidados de Saúde , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos
11.
Public Health Nutr ; 24(11): 3196-3204, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33820585

RESUMO

OBJECTIVE: To assess the quality and quantity of foods and beverages provided to children aged 0-5 years in family day care and identify structural and sociodemographic factors associated with the nutritional quality of food provided. DESIGN: A cross-sectional study measured the food and beverages provided to children using weighed food records. The number of serves from different food groups was calculated according to the Australian Guide to Healthy Eating, and a healthy food provision index score was created. Associations between structural and sociodemographic factors and healthy food provision index scores were analysed using linear mixed models. SETTING: Family day care services in two large geographic areas in New South Wales, Australia. PARTICIPANTS: One hundred and four children in thirty-three family day care services. RESULTS: During attendance at childcare, most children met recommended servings of fruit but not dairy, vegetables, lean meat and meat alternatives and wholegrains. Discretionary foods exceeded recommendations. Children's age, socio-economic status and the type of main meal provided were significantly associated with the healthy food provision index score. CONCLUSIONS: Foods provided to children in family day care are aligned with dietary recommendations for fruit but not vegetables, dairy, lean meat and meat alternatives, wholegrains or discretionary foods. Interventions to promote healthy eating are needed to support families and educators to improve the nutritional quality of food provided to children.


Assuntos
Creches , Hospital Dia , Austrália , Criança , Estudos Transversais , Dieta , Ingestão de Energia , Frutas , Humanos , Verduras
13.
Medicine (Baltimore) ; 100(11): e25186, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726008

RESUMO

ABSTRACT: The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.


Assuntos
Transtorno da Personalidade Borderline/terapia , Hospital Dia/métodos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia Psicodinâmica/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores de Risco , Estatísticas não Paramétricas , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento
14.
Psychotherapy (Chic) ; 58(2): 282-287, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33734744

RESUMO

The authors piloted a weight stigma psychotherapy group at an eating disorder partial hospitalization (PHP) and intensive outpatient program (IOP). This was an optional, transdiagnostic eating disorder group for patients with past/present weight stigma experiences related to being in large bodies. A total of 36 individuals participated in the weekly group from June 2018 to June 2019 during their PHP/IOP episode of care. We present the group's overarching framework of destigmatizing language and intersectional discussions of weight stigma. We also discuss clinical processes that unfolded during this group including simulated dialog from the group. Finally, we present relevant client quotes that provide preliminary support for future exploration in this area, as client subjective experiences of the group were positive. Our preliminary pilot experience suggests that delivering a group of this nature in a PHP/IOP eating disorder treatment setting is feasible and that further work is needed to build upon this antiweight stigma framework as a critical piece of eating disorder treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Hospital Dia , Transtornos da Alimentação e da Ingestão de Alimentos , Assistência Ambulatorial , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Pacientes Ambulatoriais , Estigma Social
15.
Adm Policy Ment Health ; 48(6): 942-961, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33534072

RESUMO

Outpatient civil commitment (OCC) requires people with severe mental illness (SMI) to receive needed-treatment addressing imminent-threats to health and safety. When available, such treatment is required to be provided in the community as a less restrictive alternative (LRA) to psychiatric-hospitalization. Variance in hospital-utilization outcomes following OCC-assignment has been interpreted as OCC-failure. This review seeks to specify factors accounting for this outcome-variation and to determine whether OCC is used effectively. Twenty-five studies, sited in seven meta-analyses and subsequently published investigations, assessing post-OCC-assignment hospital utilization outcomes were reviewed. Studies were grouped by structural pre-determinants of hospital-utilization and OCC-implementation-i.e. deinstitutionalization (bed-availability), availability of a less restrictive alternative to hospitalization, and illness severity. Design quality at study completion was ranked on causal-certainty. In OCC-follow-up-studies, deinstitutionalization associated hospital-bed-cuts, when not taken into account, ensured lower hospital-bed-day utilization. OCC-assignment coupled with aggressive case-management was associated with reduced-hospitalization. With limited community-service, hospitalizations increased as the default option for providing needed-treatment. Follow-up studies showed less hospitalization while on OCC-assignment and more outside of it. Studies using fixed-follow-up periods usually found increased-utilization as patients spent less time under OCC-supervision than outside it. Comparison-group-studies reporting no between-group differences bring more severely ill OCC-patients to equivalent use as less disturbed patients, a success. Mean evidence-rank for causal-certainty 2.96, range 2-4, of 5 with no study ranked 1, the highest rank. Diverse mental health systems yield diverse OCC hospital-utilization outcomes, each fulfilling the law's legal mandate to provide needed-treatment protecting health and safety.


Assuntos
Internação Compulsória de Doente Mental , Transtornos Mentais , Hospital Dia , Hospitalização , Hospitais , Humanos , Transtornos Mentais/terapia
16.
BMC Psychiatry ; 21(1): 46, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461506

RESUMO

BACKGROUND: Video gaming is a promising intervention for cognitive and social impairment in patients with schizophrenia. A number of gaming interventions have been evaluated in small-scale studies with various patient groups, but studies on patients with schizophrenia remain scarce and rarely include the evaluation of both clinical and neurocognitive outcomes. In this study, we will test the effectiveness of two interventions with gaming elements to improve cognitive and clinical outcomes among persons with schizophrenia. METHODS: The participants will be recruited from different outpatient units (e.g., outpatient psychiatric units, day hospitals, residential care homes). The controlled clinical trial will follow a three-arm parallel-group design: 1) cognitive training (experimental group, CogniFit), 2) entertainment gaming (active control group, SIMS 4), and 3) treatment as usual. The primary outcomes are working memory function at 3-month and 6-month follow-ups. The secondary outcomes are patients' other cognitive and social functioning, the ability to experience pleasure, self-efficacy, and negative symptoms at 3-month and 6-month follow-ups. We will also test the effectiveness of gaming interventions on neurocognitive outcomes (EEG and 3 T MRI plus rs-fMRI) at a 3-month follow-up as an additional secondary outcome. Data will be collected in outpatient psychiatric services in Hong Kong. Participants will have a formal diagnosis of schizophrenia and be between 18 and 60 years old. We aim to have a total of 234 participants, randomly allocated to the three arms. A sub-sample of patients (N = 150) will be recruited to undergo an EEG. For neuroimaging assessment, patients will be randomly allocated to a subset of patients (N=126). We will estimate the efficacy of the interventions on the primary and secondary outcomes based on the intention-to-treat principle. Behavioural and EEG data will be analysed separately. DISCUSSION: The study will characterise benefits of gaming on patients' health and well-being, and contribute towards the development of new treatment approaches for patients with schizophrenia. TRIAL REGISTRATION: ClinicalTrials.gov NCT03133143 . Registered on April 28, 2017.


Assuntos
Esquizofrenia , Jogos de Vídeo , Adolescente , Adulto , Cognição , Hospital Dia , Hong Kong , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/complicações , Esquizofrenia/terapia , Resultado do Tratamento , Adulto Jovem
17.
BMC Palliat Care ; 20(1): 12, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435952

RESUMO

BACKGROUND: Huntington's disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become lost as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). To improve ACP for HD patients, there is a need to better understand how these patients face their poor prognosis. AIM: To gain insight into the views of HD patients who receive outpatient care regarding their future and the way they deal with the poor prognosis of their disease. METHODS: A qualitative study using semi-structured interviews with 12 patients with HD (7 outpatient clinic, 3 day care, 2 assisted living facility). Audio-recorded interviews were transcribed verbatim. Through reading and re-reading interviews, writing memos and discussions in the research team, strategies were identified. RESULTS: Three strategies emerged for facing a future with HD. Participants saw the future: 1) as a period that you have to prepare for; 2) as a period that you would rather not think about; 3) as a period that you do not have to worry about yet. Participants could adopt more than one strategy at a time. Even though participants realized that they would deteriorate and would need more care in the future, they tried to keep this knowledge 'at a distance', with the motivation of keeping daily life as manageable as possible. CONCLUSIONS: Official ACP guidelines recommend discussing goals and preferences for future treatment and care, but patients tend to want to live in the present. Further research is needed to elucidate the best approach to deal with this discrepancy.


Assuntos
Planejamento Antecipado de Cuidados , Atitude Frente a Saúde , Objetivos , Doença de Huntington , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Moradias Assistidas , Hospital Dia , Eutanásia Ativa Voluntária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Países Baixos , Casas de Saúde , Pesquisa Qualitativa
18.
BMC Palliat Care ; 20(1): 11, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435954

RESUMO

BACKGROUND: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. METHODS: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. RESULTS: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. CONCLUSIONS: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service.


Assuntos
Hospital Dia , Pessoal de Saúde , Hospitais para Doentes Terminais , Cuidados Paliativos , Cuidados Intermitentes , Pessoal Técnico de Saúde , Cuidadores , Atenção à Saúde , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Enfermeiras Administradoras , Enfermeiras e Enfermeiros , Pesquisa Qualitativa , Encaminhamento e Consulta , Reino Unido
19.
Health Soc Work ; 45(4): 259-267, 2021 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-33447850

RESUMO

This article reports a wait list control design study on the influence of an online meditation training program for geriatric social workers (GSWs) in a range of adult day care facilities across eight Asian and African cities. Results indicated that the online program was effective in building resilience and promoting job satisfaction among the intervention group. The program was more effective for participants from Asian cities, women, Hindus, and Buddhists working in transitional day care facilities and regularly logging into the self-practice sessions. Self-practice was an important mediator determining the relationship between demographic predictors and outcomes. This synchronous and asynchronous online program can be used by GSWs with some modifications for participants from African cities; men; Muslims and Christians; and those working in active adult, palliative, and memory care facilities. Refinements may entail adding familiar spiritual ideologies, some activities for men involving greater verbalization of feelings and emotions linked to the work, and intensive exercises addressing specific challenges of workers in palliative and memory care facilities.


Assuntos
Satisfação no Emprego , Meditação , Adulto , Idoso , Hospital Dia , Emoções , Feminino , Humanos , Masculino , Assistentes Sociais
20.
Clin Infect Dis ; 73(9): e3036-e3041, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33388748

RESUMO

BACKGROUND: With the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ongoing in Europe in June 2020, day care centers were reopened in the state of Hesse, Germany, after the lockdown. The role young children play in the dynamics of the transmission was unknown. METHODS: We conducted a longitudinal study over 12 weeks and 2 days (18 June 2020-10 September 2020) to screen attendees and staff from day care centers in the state of Hesse, Germany, for both respiratory and gastrointestinal shedding of SARS-CoV-2. A total of 859 children (age range, 3 months-8 years) and 376 staff members from 50 day care centers, which were chosen representatively from throughout the state, participated in the study. Parents were asked to collect both a buccal mucosa and an anal swab from their children once a week. Staff were asked to self-administer the swabs. Reverse transcriptas polymerase chain reaction for SARS-CoV-2 was performed in a multiple-swab pooling protocol. RESULTS: A total of 7366 buccal mucosa swabs and 5907 anal swabs were analyzed. No respiratory or gastrointestinal shedding of SARS-CoV-2 was detected in any of the children. Shedding of SARS-CoV-2 was detected in 2 staff members from distinct day care centers. One was asymptomatic at the time of testing, and one was symptomatic and did not attend the facility on that day. CONCLUSION: Detection of either respiratory or gastrointestinal shedding of SARS-CoV-2 RNA in children and staff members attending day care centers was rare in the context of limited community activity and with infection prevention measures in the facilities in place.


Assuntos
COVID-19 , SARS-CoV-2 , Criança , Pré-Escolar , Controle de Doenças Transmissíveis , Hospital Dia , Alemanha/epidemiologia , Humanos , Lactente , Estudos Longitudinais , RNA Viral
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