Vast Majority of Children Within Normal Range
The more time children spent in child care from birth to age four-and-a-half, the more adults tended to rate them, both at age four-and-a-half and at kindergarten, as less likely to get along with others, as more assertive, as disobedient, and as aggressive, according to a study appearing in the July/August issue of Child Development.
However, the researchers cautioned that for the vast majority of children, the levels of the behaviors reported were well within the normal range.
In fact, a mother's sensitivity to her child was a better indicator of reported problem behaviors than was time in child care, with more sensitive mothering being linked to less problem behaviors. Higher maternal education and family income also predicted lower levels of children's problem behaviors.
The findings are from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development.
'It's important to put these findings in perspective,' said Duane Alexander, M.D., Director of the NICHD. 'The amount of time in child care is one of several family and child care factors linked to children's behaviors, both positive and negative.'
The NICHD launched the study of early child care in 1991. The 27 researchers conducting the study have been following the development of more than 1000 children from across the United States.
The children were enrolled in the study at birth and come from an ethnically and economically diverse sample of families.
In addition to focusing on time in child care, the current article focused on several other aspects of the child care experience: the quality of the child care arrangement, the proportion of time that the child was in a child care center, the proportion of time that the child was cared for in a group setting, and the number of times that the mother reported that the child started a new child care arrangement.
In the current article, the researchers describe how child care experiences in the first four-and-a-half years of the children's lives relate to children's social competence and behavior problems, when the children were four-and-a-half years old, and later, when they reached kindergarten.
The study measured children's social behavior by having mothers, child care providers and teachers complete standardized ratings of children's behavior problems and social competence - their ability to get along with children and adults and their ability to follow social rules. Information about the number of hours the children were in child care was obtained from the mothers every 3-4 months.
The link between time in child care and problem behavior was greater than the link between infant temperament and problem behavior or maternal depression and problem behavior. This link between time in child care and problem behavior was also greater for children in center-based care than for children in other types of care.
The study authors noted that, of the children who displayed problem behaviors, the majority were well within the normal range. A small proportion of children showed levels of problem behavior that should be monitored to see if they developed into more serious problems.
The proportion of children showing these higher levels of problem behavior is commensurate with the proportion of children in the U.S. population as a whole who also display these problems.
The link between time in child care and problem behavior occurred across all family backgrounds and all types and quality of care. The authors added that the time in child care during infancy did not appear to have a greater bearing on the children's behavior than did the time they spent in care after infancy.
The researchers also found evidence that children who experienced better quality child care - in which caregivers provided intellectual stimulation and were warm, positive, and sensitive to child behavior-had fewer child caregiver/teacher - reported problem behaviors and conflict than did children who experienced lower quality care.
The researchers noted, however, that high quality child care did not eliminate the link between hours in care and behavior problems.
The researchers could find no threshold of child-care hours above which problem behaviors were especially likely to emerge.
To illustrate the reported findings that were based on the information from the group as a whole, the researchers classified the children into four groups, based on the amount of time they spent in child care:
16 percent of children were in child care an average of 0-9 hours a week
38 percent for 10-29 hours
36 percent for 30-45 hours
10 percent for more than 45 hours a week.
In each of these groups, a minority of the children had a high score on behavior problems. However, the percent of children with high scores increased with the increase in the number of hours children spent in child care.
Children were rated by mothers and teachers on items such as: child demands a lot of attention; argues a lot; bragging and boasting; cruelty, bullying or meanness to others; destroys things belonging to others; disobedient at home; disobedient at school; gets into many fights; lying or cheating; screams a lot.
One of the important findings of this study is that the strongest predictor of how well a child behaves was a feature of maternal parenting that the researchers described as sensitivity - how attuned a mother is to a child's wants and needs.
The behaviors of the sensitive mother are child centered; the sensitive mother is aware of the child's needs, moods, interests, and capabilities. She allows this awareness to guide her interactions with her child. Children of more sensitive mothers were more competent socially, less likely to engage in disruptive behavior, and less likely to be involved in conflicts with their caregivers and teachers.
Similarly, children whose parents had higher incomes and who were more highly educated also were more socially competent and less likely to engage in problem behaviors.
The study authors noted that their study was not designed to prove a cause and effect relationship. That is, the study cannot prove whether spending more time in child care causes children to have more problem behaviors. The behavior problems the researchers documented might be due to some other characteristic of the children or of their environment.
Accompanying editorials in the July/August issue of Child Development offer possible explanations.
Findings previously reported from the NICHD Study of Early Child Care and Youth Development showed that more time in care predicted more problem behavior among two-year olds, but not among three-year olds; less sensitive maternal behavior and less harmonious mother-child interaction when children were 6-36 months of age; as well as higher rates of insecure attachment to the mother if the mother's parenting was relatively insensitive.
Preliminary findings pertaining to the research questions posed and answered by the current article were presented at the meeting of the Society for Research in Child Development in April of 2001. In the future, the researchers plan to focus on the relation between hours spent in child care and children's behavior during the school years.
The NICHD is part of the National Institutes of Health (NIH), the biomedical research arm of the federal government. NIH is an agency of the U.S. Department of Health and Human Services. The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. NICHD publications, as well as information about the Institute, are available from the NICHD Web site, nichd.nih, or from the NICHD Information Resource Center, 1-800-370-2943; e-mail NICHInformationResourceCentermail.nih.
вторник, 7 июня 2011 г.
понедельник, 6 июня 2011 г.
Rubber Gloves: "Born" And Now Banished
William Stewart Halsted, The Johns Hopkins Hospital's first surgeon in chief, is widely credited as the first to develop and introduce rubber surgical gloves in the United States. That was in 1894, five years after the institution opened.
Now, in an effort to make medical care safer for patients and health care workers, The Johns Hopkins Hospital has become the first major medical institution to become "latex safe" by ending all use of latex gloves and almost all medical latex products.
"Latex hospital gloves were invented here, so it's only fitting that Johns Hopkins takes the initiative to promoting alternatives," says Johns Hopkins anesthesiologist Robert H. Brown, M.D., M.P.H., the chair of the John Hopkins Hospital Latex Task Force and one of many Hopkins faculty and staff members who have contributed to making the hospital latex-safe.
It was at Hopkins that immunologists Robert Hamilton, Ph.D., and Franklin Adkinson, M.D., conducted early key research related to the problems of natural rubber latex as an allergen. Furthermore, Brown points out, the nurses and other frontline hospital workers have been instrumental in implementing the latex-safe policy and educating the staff. Studies show that roughly 6 percent of the general population and up to 15 percent of health care works are allergic to latex, with the higher rate among medical personnel due to longer periods of contact with natural rubber. In addition to surgical gloves, latex is used in numerous medical devices such as tourniquets, blood pressure cuffs and stethoscope tubes. The anaphylactic reactions, similar to those caused by foods such as peanuts or by bee sting allergies, can include a drop in blood pressure, an irregular heartbeat, swelling in the hands and feet and constriction of the airways. In extreme cases, anaphylactic shock, which can occur minutes after the exposure, can lead to death.
Allergic reactions generally result from exposure to natural proteins, in this case proteins specific to natural rubber latex, a product from rubber trees.
Currently available replacement gloves are made of one of three synthetic products -- neoprene, polyisoprene or vinyl, none of which contain natural plant proteins.
Johns Hopkins is now using sterile neoprene and polyisoprene gloves in the operating room because they have a more sensitive feel.
"The sensitivity and fit of the new gloves are the same as what you get with latex gloves," says Julie Freischlag, M.D., professor and chair of surgery. "Unless someone told you, you wouldn't know the difference. The only down side is that they are a little more expensive."
Sterile neoprene and polyisoprene gloves cost 30 percent to 50 percent more than latex gloves. Nonsterile neoprene and vinyl examine gloves cost approximately the same as those made from latex. Johns Hopkins uses mostly neoprene gloves for all nonsterile procedures that require glove protection.
Dr. Brown says the risk of developing an allergic reaction to latex is higher if contact is made with broken skin or mucous membranes such as when hands are raw from multiple scrubbings or when health care workers breathe in the powder that makes the gloves easier to put on. Patients for whom latex medical products are commonly used for treatment such as children with conditions such as bladder exstrophy or spinal bifida can have as high as an 80 percent chance of developing an allergic reaction to the natural rubber latex.
Halsted is reported to have developed the latex glove to protect the hands of his scrub nurse from the harsh antiseptics in widespread use as disinfectants. By 1966, disposable latex gloves were the norm in operating rooms nationwide, and in the 1980s, the need for "universal precautions," prompted by the AIDS epidemic, increased their use outside the operating room and among health care workers everywhere. As glove use proliferated, so did the rate of allergic reactions, and by the mid-1990s, latex allergies were considered a major health issue. Dr. Brown says he prefers the term "latex safe" to "latex free" because removing all sources of natural rubber remains a bit of a challenge.
"We are still searching the hospital for the few remaining medical latex products that we might have overlooked, although we can safely say that all major latex products that are a clear risk to health care workers and patients have been eliminated," he says.
Johns Hopkins Medicine
901 S. Bond St., Ste 550
Baltimore, MD 21231
United States
hopkinsmedicine
Now, in an effort to make medical care safer for patients and health care workers, The Johns Hopkins Hospital has become the first major medical institution to become "latex safe" by ending all use of latex gloves and almost all medical latex products.
"Latex hospital gloves were invented here, so it's only fitting that Johns Hopkins takes the initiative to promoting alternatives," says Johns Hopkins anesthesiologist Robert H. Brown, M.D., M.P.H., the chair of the John Hopkins Hospital Latex Task Force and one of many Hopkins faculty and staff members who have contributed to making the hospital latex-safe.
It was at Hopkins that immunologists Robert Hamilton, Ph.D., and Franklin Adkinson, M.D., conducted early key research related to the problems of natural rubber latex as an allergen. Furthermore, Brown points out, the nurses and other frontline hospital workers have been instrumental in implementing the latex-safe policy and educating the staff. Studies show that roughly 6 percent of the general population and up to 15 percent of health care works are allergic to latex, with the higher rate among medical personnel due to longer periods of contact with natural rubber. In addition to surgical gloves, latex is used in numerous medical devices such as tourniquets, blood pressure cuffs and stethoscope tubes. The anaphylactic reactions, similar to those caused by foods such as peanuts or by bee sting allergies, can include a drop in blood pressure, an irregular heartbeat, swelling in the hands and feet and constriction of the airways. In extreme cases, anaphylactic shock, which can occur minutes after the exposure, can lead to death.
Allergic reactions generally result from exposure to natural proteins, in this case proteins specific to natural rubber latex, a product from rubber trees.
Currently available replacement gloves are made of one of three synthetic products -- neoprene, polyisoprene or vinyl, none of which contain natural plant proteins.
Johns Hopkins is now using sterile neoprene and polyisoprene gloves in the operating room because they have a more sensitive feel.
"The sensitivity and fit of the new gloves are the same as what you get with latex gloves," says Julie Freischlag, M.D., professor and chair of surgery. "Unless someone told you, you wouldn't know the difference. The only down side is that they are a little more expensive."
Sterile neoprene and polyisoprene gloves cost 30 percent to 50 percent more than latex gloves. Nonsterile neoprene and vinyl examine gloves cost approximately the same as those made from latex. Johns Hopkins uses mostly neoprene gloves for all nonsterile procedures that require glove protection.
Dr. Brown says the risk of developing an allergic reaction to latex is higher if contact is made with broken skin or mucous membranes such as when hands are raw from multiple scrubbings or when health care workers breathe in the powder that makes the gloves easier to put on. Patients for whom latex medical products are commonly used for treatment such as children with conditions such as bladder exstrophy or spinal bifida can have as high as an 80 percent chance of developing an allergic reaction to the natural rubber latex.
Halsted is reported to have developed the latex glove to protect the hands of his scrub nurse from the harsh antiseptics in widespread use as disinfectants. By 1966, disposable latex gloves were the norm in operating rooms nationwide, and in the 1980s, the need for "universal precautions," prompted by the AIDS epidemic, increased their use outside the operating room and among health care workers everywhere. As glove use proliferated, so did the rate of allergic reactions, and by the mid-1990s, latex allergies were considered a major health issue. Dr. Brown says he prefers the term "latex safe" to "latex free" because removing all sources of natural rubber remains a bit of a challenge.
"We are still searching the hospital for the few remaining medical latex products that we might have overlooked, although we can safely say that all major latex products that are a clear risk to health care workers and patients have been eliminated," he says.
Johns Hopkins Medicine
901 S. Bond St., Ste 550
Baltimore, MD 21231
United States
hopkinsmedicine
воскресенье, 5 июня 2011 г.
Intel Launches Online Community To Connect Family Carers And Nurses In The UK
With a goal to assist carers in the United Kingdom, Intel Corporation unveiled ConnectingForCare.co.uk, the first online community of its kind for family carers, community and district nurses, healthcare assistants, social care workers and others to share information and provide emotional support to one another, filling a void in today's healthcare system.
Developed by Intel, in collaboration with Counsel and Care, The Princess Royal Trust for Carers and The Queen's Nursing Institute, ConnectingForCare.co.uk uses the Internet to build a sense of community among carers through interactive forums, personal profiles and links to the latest research or treatments. The forums will allow carers to engage with one another at any time, ultimately leading to better coordination of care between the various groups.
Stephen Burke, Chief Executive of Counsel and Care said: "The growing number of carers in the UK need more support, guidance, information and resources to help them continue in their caring role. Too many carers go without the support they are entitled to, or risk their own health because they cannot access the essential support they need. ConnectingforCare.co.uk links unpaid carers with professional carers, giving them an opportunity to develop new coping skills, and helping them to become more effective in their role."
"Community nurses have always considered patients, their families and informal carers to be essential partners in their work," Rosemary Cook, Director of The Queen's Nursing Institute said. "Without this shared endeavour, many patients would find it much harder, and sometimes impossible, to cope. So we are very pleased to support this initiative to enable everyone involved in care in the community to share experience, expertise and support."
The Princess Royal Trust for Carers estimates that there are 6 million carers in the UK and that 13 million people can expect to become carers in the next decade.
British actress Pam Ferris (best known for her roles as Ma Larkin from the TV series "The Darling Buds of May" and more recently Aunt Marge in the Harry Potter films), Vice President of The Princess Royal Trust for Carers, knows from personal experience the challenges faced by carers. "Most caring experiences are borne out of crisis. You find yourself thrust into a whole new world which can be very demanding, draining and isolating," she said. "Being able to connect with not only other family carers but also healthcare professionals for advice and support during those difficult moments is invaluable. The Connecting for Care website offers a place for the exchange of experiences, expertise and knowledge and is a welcomed addition to the carer community."
The Carers Week survey results announced this week revealed that 77 percent feel their health is worse as a result of the strain of caring, and well over half have not had a chance to discuss their concerns about their mental or physical health with someone else, either a friend or healthcare professional. ConnectingForCare.co.uk offers a gateway for communication with other carers which may help alleviate the isolation that many carers experience on a daily basis.
ConnectingForCare.co.uk is part of Intel's commitment to finding new and innovative ways to apply technology to support today's carer population and improve health outcomes. Since 1999, Intel has focused on research-driven solutions for improving the care of aging and chronically ill individuals in home and clinical settings. This research continues to drive a variety of product offerings, aimed to assist those with various conditions as well as members of the care team. For example, the Intel Mobile Clinical Assistant (MCA) platform was designed to enable nurses to access patient records at the point of care, helping them spend more time with patients, remain connected while on the move and manage the administration of medications.
Intel shares a vision with healthcare leaders of using technology to enhance the healthcare experience, increase quality of care and reduce the burden on the healthcare system. This campaign is a natural outgrowth of Intel's focus on people-centred innovation, providing a way to not only improve the quality of healthcare and reduce the burden of caring, but also a way to connect people and build a sense of community.
"Intel respects and honours the important work of carers around the world," said Louis Burns, vice president and general manager of Intel's Digital Health Group. "By developing ConnectingForCare.co.uk we hope to not only celebrate this dedication, but also to use our expertise in technology as a tool to support and encourage the community to share information and ultimately improve the quality of life for both the patients and the carers."
ConnectingForCare.co.uk provides various ways for carers to interact with one another. Highlights include:
- My Connections: a page where carers can create a personal profile and join a variety of networks based on their specific needs and interests. Carers can directly connect with others within their networks to share stories, tips and support.
- Forums and message boards where carers can discuss issues or concerns and pose questions to the community - linking carers to each other in an active dialogue 24 hours a day.
- Information centres on a range of chronic diseases and conditions where carers can search for information and connect on health-specific topics. Within these centres, users can add comments and link to the latest research and resources on caring for individuals with specific conditions, including Alzheimer's, Parkinson's, diabetes, COPD and heart failure.
- Spotlight on: a section where users can publicly honour carers who have touched their lives. Patients, loved ones and fellow carers can use this feature to recognise carers and share their stories.
About Intel
Intel, the world leader in silicon innovation, develops technologies, products and initiatives to continually advance how people work and live.
intel
Developed by Intel, in collaboration with Counsel and Care, The Princess Royal Trust for Carers and The Queen's Nursing Institute, ConnectingForCare.co.uk uses the Internet to build a sense of community among carers through interactive forums, personal profiles and links to the latest research or treatments. The forums will allow carers to engage with one another at any time, ultimately leading to better coordination of care between the various groups.
Stephen Burke, Chief Executive of Counsel and Care said: "The growing number of carers in the UK need more support, guidance, information and resources to help them continue in their caring role. Too many carers go without the support they are entitled to, or risk their own health because they cannot access the essential support they need. ConnectingforCare.co.uk links unpaid carers with professional carers, giving them an opportunity to develop new coping skills, and helping them to become more effective in their role."
"Community nurses have always considered patients, their families and informal carers to be essential partners in their work," Rosemary Cook, Director of The Queen's Nursing Institute said. "Without this shared endeavour, many patients would find it much harder, and sometimes impossible, to cope. So we are very pleased to support this initiative to enable everyone involved in care in the community to share experience, expertise and support."
The Princess Royal Trust for Carers estimates that there are 6 million carers in the UK and that 13 million people can expect to become carers in the next decade.
British actress Pam Ferris (best known for her roles as Ma Larkin from the TV series "The Darling Buds of May" and more recently Aunt Marge in the Harry Potter films), Vice President of The Princess Royal Trust for Carers, knows from personal experience the challenges faced by carers. "Most caring experiences are borne out of crisis. You find yourself thrust into a whole new world which can be very demanding, draining and isolating," she said. "Being able to connect with not only other family carers but also healthcare professionals for advice and support during those difficult moments is invaluable. The Connecting for Care website offers a place for the exchange of experiences, expertise and knowledge and is a welcomed addition to the carer community."
The Carers Week survey results announced this week revealed that 77 percent feel their health is worse as a result of the strain of caring, and well over half have not had a chance to discuss their concerns about their mental or physical health with someone else, either a friend or healthcare professional. ConnectingForCare.co.uk offers a gateway for communication with other carers which may help alleviate the isolation that many carers experience on a daily basis.
ConnectingForCare.co.uk is part of Intel's commitment to finding new and innovative ways to apply technology to support today's carer population and improve health outcomes. Since 1999, Intel has focused on research-driven solutions for improving the care of aging and chronically ill individuals in home and clinical settings. This research continues to drive a variety of product offerings, aimed to assist those with various conditions as well as members of the care team. For example, the Intel Mobile Clinical Assistant (MCA) platform was designed to enable nurses to access patient records at the point of care, helping them spend more time with patients, remain connected while on the move and manage the administration of medications.
Intel shares a vision with healthcare leaders of using technology to enhance the healthcare experience, increase quality of care and reduce the burden on the healthcare system. This campaign is a natural outgrowth of Intel's focus on people-centred innovation, providing a way to not only improve the quality of healthcare and reduce the burden of caring, but also a way to connect people and build a sense of community.
"Intel respects and honours the important work of carers around the world," said Louis Burns, vice president and general manager of Intel's Digital Health Group. "By developing ConnectingForCare.co.uk we hope to not only celebrate this dedication, but also to use our expertise in technology as a tool to support and encourage the community to share information and ultimately improve the quality of life for both the patients and the carers."
ConnectingForCare.co.uk provides various ways for carers to interact with one another. Highlights include:
- My Connections: a page where carers can create a personal profile and join a variety of networks based on their specific needs and interests. Carers can directly connect with others within their networks to share stories, tips and support.
- Forums and message boards where carers can discuss issues or concerns and pose questions to the community - linking carers to each other in an active dialogue 24 hours a day.
- Information centres on a range of chronic diseases and conditions where carers can search for information and connect on health-specific topics. Within these centres, users can add comments and link to the latest research and resources on caring for individuals with specific conditions, including Alzheimer's, Parkinson's, diabetes, COPD and heart failure.
- Spotlight on: a section where users can publicly honour carers who have touched their lives. Patients, loved ones and fellow carers can use this feature to recognise carers and share their stories.
About Intel
Intel, the world leader in silicon innovation, develops technologies, products and initiatives to continually advance how people work and live.
intel
суббота, 4 июня 2011 г.
UNISON Appeals For Urgent Action Over Care Worker Deportations, UK
UNISON, the UK's largest public sector union, is calling for urgent Government action, to stop the wholesale deportation of much needed, highly skilled senior care workers. The union is making representations to the government as a result of a growing number of pleas for help from care workers across the UK. The complaints come from workers who currently care for the elderly in residential care homes and in the community but face deportation because of unfair changes to the immigration rules.
The union is also exploring the possibility of mounting a legal challenge to the Home Office's revised policy decision not to issue any more new or renew any existing work permits for senior care workers.
Heather Wakefield, UNISON's Head of Local Government, said:
"These senior care workers are a tried and tested workforce who, day in day out, deliver high quality care to the elderly. This is a real vocation and we simply cannot afford to lose this skilled and dedicated workforce.
"These are the people who make such a difference to the comfort and security of elderly residents in care homes across the country. They also provide home care services that give the support needed to elderly people, to allow them to stay in their own homes, instead of being forced into residential care.
"UNISON will be doing all it can and adding its weight to the growing number of voices protesting at this unfair change in policy."
UNISON is also sending out urgent guidelines to staff in its regions to help them respond to the growing number of requests for help from members threatened with deportation.
Heather Wakefield went on to say: "We have to move quickly or it may be too late for some members who have already been refused new work permits. We are also working with employers on this issue and issuing advice about steps to take if their staff are refused permits."
unison.uk
The union is also exploring the possibility of mounting a legal challenge to the Home Office's revised policy decision not to issue any more new or renew any existing work permits for senior care workers.
Heather Wakefield, UNISON's Head of Local Government, said:
"These senior care workers are a tried and tested workforce who, day in day out, deliver high quality care to the elderly. This is a real vocation and we simply cannot afford to lose this skilled and dedicated workforce.
"These are the people who make such a difference to the comfort and security of elderly residents in care homes across the country. They also provide home care services that give the support needed to elderly people, to allow them to stay in their own homes, instead of being forced into residential care.
"UNISON will be doing all it can and adding its weight to the growing number of voices protesting at this unfair change in policy."
UNISON is also sending out urgent guidelines to staff in its regions to help them respond to the growing number of requests for help from members threatened with deportation.
Heather Wakefield went on to say: "We have to move quickly or it may be too late for some members who have already been refused new work permits. We are also working with employers on this issue and issuing advice about steps to take if their staff are refused permits."
unison.uk
пятница, 3 июня 2011 г.
Antipsychotics In Older Adults With Dementia Associated With Serious Adverse Events And Death
Short term courses of antipsychotic medications, when given to older
adults with dimentia, are associated with a greater risk of
hospitalization and death, according to a report released on May 26,
2008 in the Archives of Internal Medicine, one of
the JAMA/Archives journals.
Antipsychotic drugs are used to treat various psychotic disorders --
some conventional examples include haloperidol or loxaprine. The
authors point out that a new generation of these drugs has been
released, but the effects of short term prescription have not yet been
ascertained. "Newer antipsychotic drugs (olanzapine, quetiapine
fumarate and
risperidone) have been on the market for more than a decade and are
commonly used to treat the behavioral and psychological symptoms of
dementia," they say. "Antipsychotic drugs are often used for short
periods to treat agitation
in clinical practice. They are frequently prescribed around the time of
nursing home admission." Approximately 17% of nursing home admission
begin a regimen of antipsychotic medications, with only 10% on a single
prescription. Given this information, they say, it is important to
evaluate the effects of short term regimens on patients.
To investigate this issue, Paula A. Rochon, M.D., M.P.H., F.R.C.P.C.,
of the Institute for Clinical Evaluative Sciences (ICES), Ontario, and
colleagues examined older adults living with dementia in the community
and in nursing homes between 1997 and 2004. In each setting, three
separate groups of equal size were identified, each differing only in
their exposure to antipsychotic medications. One group had not received
antipsychcotics, one group had been prescribed atypical or newer
antipsychotics, and the last group was prescribed conventional
psychotics. For older adults in the community, 6,894 were in each group
for a total or 20,682 patients. In the older adults with dementia
living in nursing homes, each group had 6,853 for a total of 20,559
subjects.
The medical records of each participant were examined, and hospital
admissions and death within 30 days of the initiation of therapy were
noted as serious adverse events. The team found that, in the general
community, those prescribed with nonconventional antipsychotic drugs
were more likely to experience adverse events, while those on
conventional antipsychotic drugs were even more likely. "Relative to
community-dwelling older adults with dementia who did not
receive a prescription for antipsychotic drugs, similar older adults
who did receive atypical antipsychotic drugs were three times more
likely and those who received a conventional antipsychotic drug were
almost four times more likely to experience a serious adverse event
within 30 days of starting therapy." The authors continue, noting a
similar but less pronounced trend in the nursing room group: "Relative
to nursing home residents in the control group, individuals in
the conventional antipsychotic therapy group were 2.4 times more likely
to experience a serious adverse event leading to an acute care hospital
admission or death. Those in the atypical antipsychotic group were 1.9
times more likely to experience a serious adverse event during 30 days
of follow-up."
The precise number of adverse events may be underestimated in this
study, because the length of follow-up was so short, according to the
authors. Also, often, the serious events experienced by nursing home
residents are taken care of within the facility, without hospital
admission. Additionally, when physicians notice signs of a problem
early, they may take patients off of antipsychotics. This could avoid
more serious consequences. The authors indicate that this only cements
the need for further research to this end. "Our results exploring
serious adverse events likely identify only the 'tip of the iceberg',"
they say. "Antipsychotic drugs should be prescribed with caution even
for short-term therapy."
Antipsychotic Therapy and Short-term Serious Events in Older Adults
With Dementia
Paula A. Rochon; Sharon-Lise Normand; Tara Gomes; Sudeep S. Gill;
Geoffrey M. Anderson; Magda Melo; Kathy Sykora; Lorraine Lipscombe;
Chaim M. Bell; Jerry H. Gurwitz
Arch Intern Med. 2008;168(10):1090-1096.
Click Here For
Journal
Written by Anna Sophia McKenney
adults with dimentia, are associated with a greater risk of
hospitalization and death, according to a report released on May 26,
2008 in the Archives of Internal Medicine, one of
the JAMA/Archives journals.
Antipsychotic drugs are used to treat various psychotic disorders --
some conventional examples include haloperidol or loxaprine. The
authors point out that a new generation of these drugs has been
released, but the effects of short term prescription have not yet been
ascertained. "Newer antipsychotic drugs (olanzapine, quetiapine
fumarate and
risperidone) have been on the market for more than a decade and are
commonly used to treat the behavioral and psychological symptoms of
dementia," they say. "Antipsychotic drugs are often used for short
periods to treat agitation
in clinical practice. They are frequently prescribed around the time of
nursing home admission." Approximately 17% of nursing home admission
begin a regimen of antipsychotic medications, with only 10% on a single
prescription. Given this information, they say, it is important to
evaluate the effects of short term regimens on patients.
To investigate this issue, Paula A. Rochon, M.D., M.P.H., F.R.C.P.C.,
of the Institute for Clinical Evaluative Sciences (ICES), Ontario, and
colleagues examined older adults living with dementia in the community
and in nursing homes between 1997 and 2004. In each setting, three
separate groups of equal size were identified, each differing only in
their exposure to antipsychotic medications. One group had not received
antipsychcotics, one group had been prescribed atypical or newer
antipsychotics, and the last group was prescribed conventional
psychotics. For older adults in the community, 6,894 were in each group
for a total or 20,682 patients. In the older adults with dementia
living in nursing homes, each group had 6,853 for a total of 20,559
subjects.
The medical records of each participant were examined, and hospital
admissions and death within 30 days of the initiation of therapy were
noted as serious adverse events. The team found that, in the general
community, those prescribed with nonconventional antipsychotic drugs
were more likely to experience adverse events, while those on
conventional antipsychotic drugs were even more likely. "Relative to
community-dwelling older adults with dementia who did not
receive a prescription for antipsychotic drugs, similar older adults
who did receive atypical antipsychotic drugs were three times more
likely and those who received a conventional antipsychotic drug were
almost four times more likely to experience a serious adverse event
within 30 days of starting therapy." The authors continue, noting a
similar but less pronounced trend in the nursing room group: "Relative
to nursing home residents in the control group, individuals in
the conventional antipsychotic therapy group were 2.4 times more likely
to experience a serious adverse event leading to an acute care hospital
admission or death. Those in the atypical antipsychotic group were 1.9
times more likely to experience a serious adverse event during 30 days
of follow-up."
The precise number of adverse events may be underestimated in this
study, because the length of follow-up was so short, according to the
authors. Also, often, the serious events experienced by nursing home
residents are taken care of within the facility, without hospital
admission. Additionally, when physicians notice signs of a problem
early, they may take patients off of antipsychotics. This could avoid
more serious consequences. The authors indicate that this only cements
the need for further research to this end. "Our results exploring
serious adverse events likely identify only the 'tip of the iceberg',"
they say. "Antipsychotic drugs should be prescribed with caution even
for short-term therapy."
Antipsychotic Therapy and Short-term Serious Events in Older Adults
With Dementia
Paula A. Rochon; Sharon-Lise Normand; Tara Gomes; Sudeep S. Gill;
Geoffrey M. Anderson; Magda Melo; Kathy Sykora; Lorraine Lipscombe;
Chaim M. Bell; Jerry H. Gurwitz
Arch Intern Med. 2008;168(10):1090-1096.
Click Here For
Journal
Written by Anna Sophia McKenney
четверг, 2 июня 2011 г.
The Effects Of Caregiving Examined By USC Study
A new study from the USC Davis School of Gerontology found that caregivers of different ethnicities showed few negative mental or physical health effects as a result of tending to a family member with dementia.
The findings, which appeared the journal Aging & Mental Health, analyzed mental health and physical health differences between African-American and white caregivers.
A population-based sample of 102 caregivers compared with 102 non-caregivers matched participants on ethnicity, gender and age. The study, funded by the National Institute on Aging, is the first to use a population-based or community sampling strategy, to focus specifically on ethnic differences among caregivers tending to people with dementia.
"Community samples show a wider range of responses to family caregiving than those surveyed from clinics and service agencies, where most show clinical levels of distress," said lead author Bob Knight, holder of the Merle H. Bensinger Professorship in Gerontology. "Some caregivers are coping well; others are clearly over-stressed and in need of help."
Well-known ethnic differences in health rather than a specific response to caregiving explain the findings that both African-American caregivers and non-caregivers had worse physical health than white caregivers and non-caregivers. Analysis was based upon self-reported diseases of the circulatory system and measures of blood pressure.
One exception was that diastolic blood pressure was uniquely elevated in African-American caregivers.
"If confirmed by future research, this finding is especially important since it points to a specific health risk for African-American caregivers and one not reflected in self-reported health," Knight said.
Another NIA funded study led by Knight examined the role of familism, or prioritizing the good of the family over one's self, on stress and coping between white and African-American caregivers.
The results, which appeared in the journal Health Psychology, found putting the needs of the family over personal well-being is related to lower educational levels rather than ethnic or cultural differences. These self-sacrificing caregivers were found to avoid coping with problems and as a result to be in poor physical and mental health.
Knight's team determined behavioral problems of the person with dementia to be the source of increased burden for less educated caregivers, which led to the use of unhealthy coping mechanisms, known as avoidant coping. These detrimental habits include denying a problem exists, substance abuse, drinking and simply giving up -- ultimately resulting in poor physical and mental health outcomes.
Diastolic blood pressure indicators were affected differently through the use active coping styles, which are a healthy way of dealing with the problems that come with caregiving. Active coping styles include planning, positive reappraisal of problems and choosing the best time to address problems. Researchers found these techniques provide some protection for the high levels of diastolic blood pressure in African-American caregivers.
"The results could serve as a basis for improving services for caregivers and to understanding when the services can cross cultural lines and when they need to be more culture specific," Knight said.
Contributing authors of the first study include C.V. Flynn Longmire of Medical University of South Carolina, J.H. Kim of Sejong Cyber University, South Korea, Steve David of the UCLA Semel Institute for Neuroscience and Human Behavior and Jennifer Dave of the Clinical Psychology Department at USC. Flynn and Kim also co-wrote the second article along with Knight.
The findings, which appeared the journal Aging & Mental Health, analyzed mental health and physical health differences between African-American and white caregivers.
A population-based sample of 102 caregivers compared with 102 non-caregivers matched participants on ethnicity, gender and age. The study, funded by the National Institute on Aging, is the first to use a population-based or community sampling strategy, to focus specifically on ethnic differences among caregivers tending to people with dementia.
"Community samples show a wider range of responses to family caregiving than those surveyed from clinics and service agencies, where most show clinical levels of distress," said lead author Bob Knight, holder of the Merle H. Bensinger Professorship in Gerontology. "Some caregivers are coping well; others are clearly over-stressed and in need of help."
Well-known ethnic differences in health rather than a specific response to caregiving explain the findings that both African-American caregivers and non-caregivers had worse physical health than white caregivers and non-caregivers. Analysis was based upon self-reported diseases of the circulatory system and measures of blood pressure.
One exception was that diastolic blood pressure was uniquely elevated in African-American caregivers.
"If confirmed by future research, this finding is especially important since it points to a specific health risk for African-American caregivers and one not reflected in self-reported health," Knight said.
Another NIA funded study led by Knight examined the role of familism, or prioritizing the good of the family over one's self, on stress and coping between white and African-American caregivers.
The results, which appeared in the journal Health Psychology, found putting the needs of the family over personal well-being is related to lower educational levels rather than ethnic or cultural differences. These self-sacrificing caregivers were found to avoid coping with problems and as a result to be in poor physical and mental health.
Knight's team determined behavioral problems of the person with dementia to be the source of increased burden for less educated caregivers, which led to the use of unhealthy coping mechanisms, known as avoidant coping. These detrimental habits include denying a problem exists, substance abuse, drinking and simply giving up -- ultimately resulting in poor physical and mental health outcomes.
Diastolic blood pressure indicators were affected differently through the use active coping styles, which are a healthy way of dealing with the problems that come with caregiving. Active coping styles include planning, positive reappraisal of problems and choosing the best time to address problems. Researchers found these techniques provide some protection for the high levels of diastolic blood pressure in African-American caregivers.
"The results could serve as a basis for improving services for caregivers and to understanding when the services can cross cultural lines and when they need to be more culture specific," Knight said.
Contributing authors of the first study include C.V. Flynn Longmire of Medical University of South Carolina, J.H. Kim of Sejong Cyber University, South Korea, Steve David of the UCLA Semel Institute for Neuroscience and Human Behavior and Jennifer Dave of the Clinical Psychology Department at USC. Flynn and Kim also co-wrote the second article along with Knight.
среда, 1 июня 2011 г.
Alliance Between Disability Advocates, Bush Administration Officials Helped Develop Program To Encourage Home Care For Medicaid Beneficiaries
NPR's "Morning Edition" on Friday examined how an "unlikely alliance" between a group of disability advocates and Bush administration officials resulted in a major change to federal funding for long-term care of Medicaid beneficiaries (Shapiro, "Morning Edition," NPR, 9/15). HHS in July announced plans to award $1.75 billion in grants to states under a five-year program that would allow Medicaid beneficiaries to reside in their homes or in their communities, rather than in nursing homes. Under the program, states for one year will receive a higher rate of federal Medicaid matching funds for beneficiaries whom states move from nursing homes into their own homes or communities. States also can use the funds to make modifications to the homes of Medicaid beneficiaries to allow their continued residence and to provide respites for family caregivers. States must agree to continue to provide Medicaid beneficiaries with home or community care for at least one year after the higher rate of federal Medicaid matching funds ends. HHS said that the program could reduce costs because nursing home care is more expensive than home or community care (Kaiser Daily Health Policy Report, 7/27). According to NPR, the relationship began in 2002 when 200 protestors in wheelchairs blocked traffic at an intersection near the White House and started discussions with Mark McClellan, current CMS administrator and a member of the president's Council of Economic Advisers at the time. Since his appointment to CMS, McClellan met four times annually with Bob Kafka, executive director of the American Disabled for Attendant Programs Today. Although some health care and disability advocates criticize some of the program's provisions, such as one allowing states to change benefits and charge copayments, McClellan said the Money Follows the Person program is the "biggest change in long-term financing in decades" and that his work with ADAPT is one of his proudest accomplishments from his tenure. According to NPR, 30 states have told McClellan that they would like to participate in the program, which began accepting grant applications two weeks ago. The NPR segment includes comments from Kafka and McClellan ("Morning Edition," NPR, 9/15).
The complete segment is available online in RealPlayer. Expanded NPR coverage, including a transcript of the segment, additional audio from ADAPT members and photos, is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The complete segment is available online in RealPlayer. Expanded NPR coverage, including a transcript of the segment, additional audio from ADAPT members and photos, is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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