The quality of chronic disease care under the GP pay for performance system is poorer for residents of care homes than those living in the community, according to a study published on bmj today.
The Quality and Outcomes Framework (QOF) for general practice is a voluntary system of financial incentives, which has been in place since 2004. Part of the programme includes specific targets for GPs to demonstrate high quality care for patients with chronic diseases.
The study found that, although pay for performance systems do not invariably disadvantage residents of care homes, GPs are much more likely to exclude them from quality targets, which may compromise their care.
The authors, led by Dr Sunil Shah from St George's, University of London, say that pay for performance systems should include measures relevant to care home residents to improve chronic disease care in this often vulnerable group.
Dr Shah and his team studied data from The Health Improvement Network (THIN), a large database of primary care records from 326 UK general practices, to assess the quality of chronic disease care for care home and community residents.
They identified 10,387 care home and 403,259 community residents aged 65 to 104 years who were registered for 90 or more days with their general practitioner.
Even after adjusting for age, sex and dementia diagnosis, they found that attainment of quality targets was significantly lower for residents of care homes than for those in the community for 14 of 16 indicators suitable for older people in care homes.
The largest differences were for prescribing in heart disease and monitoring of diabetes. Smaller differences were seen for use of antiplatelet therapy and monitoring of blood pressure.
Residents of care homes were also more likely to be excluded from all QOF targets for a condition. For example, 34% of patients with stroke in care homes were excluded compared with 17% in the community, and 35% compared with 9% for diabetes.
This difference persisted even after taking account of patients with dementia or with limited life expectancy.
This is the first study to examine quality of care for residents in care home since the introduction of pay for performance in the primary care contract and shows a need to improve care for chronic diseases among older people in care homes, say the authors.
They acknowledge that, for some interventions, lower attainment of quality indicators may be appropriate, but argue that "high disease wide exceptions suggest a less individualised approach and may act as a disincentive to good disease management."
They conclude: "Our current findings support enhancement of pay for performance systems to include measures that are particularly relevant to residents of care homes and vulnerable older people in the community, such as pain management, falls and continence care."
Link to paper
Source
British Medical Journal
воскресенье, 26 июня 2011 г.
суббота, 25 июня 2011 г.
Study Reveals Cultural Differences In Attitudes Towards Caring For People With Dementia
People of south Asian or Black Caribbean origin are far more likely to hold a 'traditional' view of caregiving than White British people, new research shows.
The study, published in the September issue of the British Journal of Psychiatry, found that south Asian and Black Caribbean carers of people with dementia are more likely to perceive their caring role as natural, expected and virtuous.
In contrast, White British people are more likely to hold a 'non-traditional' caregiving ideology, deriving little or no reward from such a relationship and believing their own lives are put 'on hold' while they perform caring duties.
In the UK, around two-thirds of older people with dementia are supported in the community, and family members are the most important source of dementia care. This is particularly true among ethnic minority populations, who are less likely to access specialist healthcare of social care services.
Researchers at the Institute of Psychiatry, King's College London carried out in-depth qualitative interviews with 32 carers of people with dementia: 10 were Black Caribbean (9 women, 1 man), 10 south Asian (5 women, 5 men) and 12 White British (11 women, 1 man). The participants were recruited from four socially and ethnically diverse south London boroughs - Lambeth, Southwark, Lewisham and Croydon.
Carers fell into one of two groups (traditional and non-traditional) according to whether they held three core interrelated beliefs: that caregiving is natural, expected and virtuous. The majority of the south Asian, half of the Black Caribbean and only a minority of White British participants were found to possess a traditional ideology.
Most south Asian and Black Caribbean carers with traditional ideologies possessed strong religious values. For them, providing care was consistent with being a 'good' Hindu or Christian and was therefore the normal thing to do.
Others felt a natural inclination towards caregiving. For example, a high proportion of Black Caribbean carers had experience in the nursing profession, and felt this equipped them to deal with the caregiving role.
Many traditional caregivers viewed their role as a natural part of their life course, either as the spouse or the child of someone with dementia. One south Asian son said: "You know, as Indians, we always look after our parents??¦my father looked after me when I was young and he has done lots and lots of things for me so it's my turn to look after him."
Sons and daughters of south Asian and Black Caribbean origin with traditional ideologies viewed caring less as a necessity and more as an opportunity to reciprocate parental support. One daughter, born in the Caribbean, reflected on how her attitude towards caregiving differed from that of her British-born siblings: "It's something I want to do and I'm glad I can do it. It's almost a privilege to do, but then, you know, I??¦as I said I grow up in Jamaica and it's probably a cultural thing. Whereas my younger siblings don't have quite the same dedication, they'll do it because it's Dad but it's not their duty."
Having a traditional caregiving ideology was found to help carers derive rewards from the relationship and feel that their lives, although changed, were ongoing. This contrasts sharply with those with non-traditional ideologies, for whom caregiving often signified the end of their relationship and, to a large extent, their lives.
For example, one White British woman with a non-traditional ideology caring for her mother said: "In a way she's not my Mum anymore, that's the hard bit, she's just sometimes??¦she can be a difficult old lady that you have to keep your eye on."
The researchers found that caregiving had a negative impact on carer health across all participants - both traditional and non-traditional. Many felt that they were constantly battling exhaustion and were sleep-deprived.
Overall, caregivers with a traditional ideology were more likely to be satisfied with the support they received from professional health and social care services. Conversely, some carers with non-traditional ideologies were eager to relinquish their caregiving responsibility, were more demanding of services and more likely to feel their needs were not being met.
The study's authors make recommendations of ways in which carers with both traditional and non-traditional ideologies can be better supported.
For those with traditional ideologies, professional care staff should reassure carers that it is both natural and necessary to take time for themselves. Significantly, some south Asian carers saw asking for professional help as a failure to fulfil their responsibilities. Therefore, services might be considered more acceptable if they communicated their commitment to supporting - rather than substituting - family members in the caregiving role.
Carers with non-traditional ideologies may benefit from a change in governmental policy and the benefits system to directly support and promote the role of family carers. Specific grants or targeted benefits would help legitimise the caregiving role as well as directly help those who care.
Reference:
"Attitudes and support needs of Black Caribbean, south Asian and White British carers of people with dementia in the UK."
Lawrence V, Murray J, Samsi K and Banerjee S (2008)
British Journal of Psychiatry, 193: 240-246
Royal College of Psychiatrists
The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland. We promote mental health by:
- Setting standards and promoting excellence in mental health care
- Improving understanding through research and education
- Leading, representing, training and supporting psychiatrists
- Working with patients, carers and their organisations
Royal College of Psychiatrists
The study, published in the September issue of the British Journal of Psychiatry, found that south Asian and Black Caribbean carers of people with dementia are more likely to perceive their caring role as natural, expected and virtuous.
In contrast, White British people are more likely to hold a 'non-traditional' caregiving ideology, deriving little or no reward from such a relationship and believing their own lives are put 'on hold' while they perform caring duties.
In the UK, around two-thirds of older people with dementia are supported in the community, and family members are the most important source of dementia care. This is particularly true among ethnic minority populations, who are less likely to access specialist healthcare of social care services.
Researchers at the Institute of Psychiatry, King's College London carried out in-depth qualitative interviews with 32 carers of people with dementia: 10 were Black Caribbean (9 women, 1 man), 10 south Asian (5 women, 5 men) and 12 White British (11 women, 1 man). The participants were recruited from four socially and ethnically diverse south London boroughs - Lambeth, Southwark, Lewisham and Croydon.
Carers fell into one of two groups (traditional and non-traditional) according to whether they held three core interrelated beliefs: that caregiving is natural, expected and virtuous. The majority of the south Asian, half of the Black Caribbean and only a minority of White British participants were found to possess a traditional ideology.
Most south Asian and Black Caribbean carers with traditional ideologies possessed strong religious values. For them, providing care was consistent with being a 'good' Hindu or Christian and was therefore the normal thing to do.
Others felt a natural inclination towards caregiving. For example, a high proportion of Black Caribbean carers had experience in the nursing profession, and felt this equipped them to deal with the caregiving role.
Many traditional caregivers viewed their role as a natural part of their life course, either as the spouse or the child of someone with dementia. One south Asian son said: "You know, as Indians, we always look after our parents??¦my father looked after me when I was young and he has done lots and lots of things for me so it's my turn to look after him."
Sons and daughters of south Asian and Black Caribbean origin with traditional ideologies viewed caring less as a necessity and more as an opportunity to reciprocate parental support. One daughter, born in the Caribbean, reflected on how her attitude towards caregiving differed from that of her British-born siblings: "It's something I want to do and I'm glad I can do it. It's almost a privilege to do, but then, you know, I??¦as I said I grow up in Jamaica and it's probably a cultural thing. Whereas my younger siblings don't have quite the same dedication, they'll do it because it's Dad but it's not their duty."
Having a traditional caregiving ideology was found to help carers derive rewards from the relationship and feel that their lives, although changed, were ongoing. This contrasts sharply with those with non-traditional ideologies, for whom caregiving often signified the end of their relationship and, to a large extent, their lives.
For example, one White British woman with a non-traditional ideology caring for her mother said: "In a way she's not my Mum anymore, that's the hard bit, she's just sometimes??¦she can be a difficult old lady that you have to keep your eye on."
The researchers found that caregiving had a negative impact on carer health across all participants - both traditional and non-traditional. Many felt that they were constantly battling exhaustion and were sleep-deprived.
Overall, caregivers with a traditional ideology were more likely to be satisfied with the support they received from professional health and social care services. Conversely, some carers with non-traditional ideologies were eager to relinquish their caregiving responsibility, were more demanding of services and more likely to feel their needs were not being met.
The study's authors make recommendations of ways in which carers with both traditional and non-traditional ideologies can be better supported.
For those with traditional ideologies, professional care staff should reassure carers that it is both natural and necessary to take time for themselves. Significantly, some south Asian carers saw asking for professional help as a failure to fulfil their responsibilities. Therefore, services might be considered more acceptable if they communicated their commitment to supporting - rather than substituting - family members in the caregiving role.
Carers with non-traditional ideologies may benefit from a change in governmental policy and the benefits system to directly support and promote the role of family carers. Specific grants or targeted benefits would help legitimise the caregiving role as well as directly help those who care.
Reference:
"Attitudes and support needs of Black Caribbean, south Asian and White British carers of people with dementia in the UK."
Lawrence V, Murray J, Samsi K and Banerjee S (2008)
British Journal of Psychiatry, 193: 240-246
Royal College of Psychiatrists
The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom and the Republic of Ireland. We promote mental health by:
- Setting standards and promoting excellence in mental health care
- Improving understanding through research and education
- Leading, representing, training and supporting psychiatrists
- Working with patients, carers and their organisations
Royal College of Psychiatrists
пятница, 24 июня 2011 г.
Death At Home Less Distressing For Cancer Patients And Families
Cancer patients who die in the hospital or an intensive care unit have worse quality of life at the end-of-life, compared to patients who die at home with hospice services, and their caregivers are at higher risk for developing psychiatric illnesses during bereavement, according to a study by researchers at Dana-Farber Cancer Institute.
One striking finding of the study, reported in the September 13th issue of the Journal of Clinical Oncology, was that bereaved caregivers of patients who died in an intensive care unit (ICU) were five times more likely to be diagnosed with Posttraumatic Stress Disorder (PTSD), compared with caregivers of patients who died at home with hospice services.
"This is the first study to show that caregivers of patients who die in ICUs are at a heightened risk for developing PTSD," wrote the authors, led by Alexi Wright, MD, a medical oncologist and outcomes researcher at Dana-Farber. The American Medical Association Glossary defines PTSD as "feelings of anxiety experienced after a particularly frightening or stressful event, which include recurring dreams, difficulty sleeping, and a feeling of isolation."
In addition, families and loved ones of patients who died in the hospital, though not in an ICU, were at higher risk of developing Prolonged Grief Disorder (PGD), an intense and disabling form of grief which lasts more than 6 months.
The report comes at a time of growing concern over the appropriateness of aggressive, hospital-based end-of-life care for terminal cancer patients. The authors noted that although most cancer patients would prefer to spend their last days at home, 36 percent die in a hospital and 8 percent in an ICU and may be subjected to invasive and painful procedures at the end of life.
In contrast to home or hospice care that emphasizes alleviating pain and discomfort and providing a peaceful death, ICU care can be traumatic for patients and their family and caregivers, said Wright.
The report, whose senior author is Holly Prigerson, PhD, director of Dana-Farber's Center for Psycho-oncology & Palliative Care Research, contains findings from a prospective, longitudinal study of advanced cancer patients recruited at seven cancer centers from 2002 to 2008. Patients and caregivers mainly family members were interviewed at the beginning of the study. Their medical charts were reviewed at that point and after the patients died, on average 4.5 months later. Within two weeks of the death, researchers interviewed the caregiver most closely involved with the patient's care during the last week of life; they interviewed the caregiver again six months later.
In the interviews, the researchers asked the caregivers to assess the patients' quality of life and physical and psychological stress during the last week of life. The researchers also evaluated the caregivers' own mental health at the beginning of the study to uncover any pre-existing psychiatric illnesses and again six months after the patient's death.
After analyzing the data on 342 patient-caregiver pairs, the investigators found that patients who had died in the hospital or an ICU experienced more physical and emotional distress and worse quality of life than those dying at home. Among the caregivers, they determined that 4 of 19 caregivers (21 percent) of patients dying in an ICU developed PTSD, compared with 6 of 137 (4.4 percent) when death occurred in the home/hospice setting. A similar elevated risk of prolonged grief disorder was found in caregivers when patients died in the hospital, but not in an ICU.
These findings are important for both patients and physicians, said Wright. "If patients are aware that more-aggressive care may affect not only their quality of life, but also their loved ones after their death, they may make different choices."
In addition to Wright and Prigerson, the paper's other authors are Tracy Balboni, MD, Ursula Matulonis, MD, and Susan Block, MD, of Dana-Farber, and Nancy L. Keating, MD, of Harvard Medical School.
The research was supported by grants from the National Institute of Mental Health and the National Cancer Institute.
One striking finding of the study, reported in the September 13th issue of the Journal of Clinical Oncology, was that bereaved caregivers of patients who died in an intensive care unit (ICU) were five times more likely to be diagnosed with Posttraumatic Stress Disorder (PTSD), compared with caregivers of patients who died at home with hospice services.
"This is the first study to show that caregivers of patients who die in ICUs are at a heightened risk for developing PTSD," wrote the authors, led by Alexi Wright, MD, a medical oncologist and outcomes researcher at Dana-Farber. The American Medical Association Glossary defines PTSD as "feelings of anxiety experienced after a particularly frightening or stressful event, which include recurring dreams, difficulty sleeping, and a feeling of isolation."
In addition, families and loved ones of patients who died in the hospital, though not in an ICU, were at higher risk of developing Prolonged Grief Disorder (PGD), an intense and disabling form of grief which lasts more than 6 months.
The report comes at a time of growing concern over the appropriateness of aggressive, hospital-based end-of-life care for terminal cancer patients. The authors noted that although most cancer patients would prefer to spend their last days at home, 36 percent die in a hospital and 8 percent in an ICU and may be subjected to invasive and painful procedures at the end of life.
In contrast to home or hospice care that emphasizes alleviating pain and discomfort and providing a peaceful death, ICU care can be traumatic for patients and their family and caregivers, said Wright.
The report, whose senior author is Holly Prigerson, PhD, director of Dana-Farber's Center for Psycho-oncology & Palliative Care Research, contains findings from a prospective, longitudinal study of advanced cancer patients recruited at seven cancer centers from 2002 to 2008. Patients and caregivers mainly family members were interviewed at the beginning of the study. Their medical charts were reviewed at that point and after the patients died, on average 4.5 months later. Within two weeks of the death, researchers interviewed the caregiver most closely involved with the patient's care during the last week of life; they interviewed the caregiver again six months later.
In the interviews, the researchers asked the caregivers to assess the patients' quality of life and physical and psychological stress during the last week of life. The researchers also evaluated the caregivers' own mental health at the beginning of the study to uncover any pre-existing psychiatric illnesses and again six months after the patient's death.
After analyzing the data on 342 patient-caregiver pairs, the investigators found that patients who had died in the hospital or an ICU experienced more physical and emotional distress and worse quality of life than those dying at home. Among the caregivers, they determined that 4 of 19 caregivers (21 percent) of patients dying in an ICU developed PTSD, compared with 6 of 137 (4.4 percent) when death occurred in the home/hospice setting. A similar elevated risk of prolonged grief disorder was found in caregivers when patients died in the hospital, but not in an ICU.
These findings are important for both patients and physicians, said Wright. "If patients are aware that more-aggressive care may affect not only their quality of life, but also their loved ones after their death, they may make different choices."
In addition to Wright and Prigerson, the paper's other authors are Tracy Balboni, MD, Ursula Matulonis, MD, and Susan Block, MD, of Dana-Farber, and Nancy L. Keating, MD, of Harvard Medical School.
The research was supported by grants from the National Institute of Mental Health and the National Cancer Institute.
четверг, 23 июня 2011 г.
Medicare Reimbursement for Home Inhalation Drug Therapies Must Rise Dramatically
A study of inhalation drug therapy services provided to Medicare beneficiaries in their homes found the new 2005 Medicare reimbursement formula based on average sales price (ASP formula) would under-reimburse the actual cost of providing two key drug therapies by $68.10 per monthly supply.
The study, the largest of its kind, conducted for the American Association for Homecare (AAHomecare) by Muse and Associates, surveyed 109 pharmacies that represent 2,448 branch locations providing inhalation drug therapy services to 337,348 Medicare beneficiaries per month - or 61 percent of all Medicare inhalation drug therapy patients. AAHomecare is sharing the study with the Centers for Medicare and Medicaid Services (CMS) and the Government Accountability Office.
"This objective assessment of the cost of inhalation therapies in the home reveals a serious gap between what will be paid under the new 2005 reimbursement formula and the reality of what it costs to deliver these therapies to Medicare beneficiaries," said Kay Cox, president and CEO of the American Association for Homecare. "The ability to provide these therapies and patient access to these therapies will both suffer if we don't close this reimbursement gap."
In a notice of proposed rule making for the 2005 Medicare physician fee schedule issued last month, CMS proposed 89 percent reimbursement cuts, using the ASP formula, for albuterol sulfate and ipratropium bromide. The two drugs, covered under Medicare Part B, are commonly prescribed to treat diseases such as chronic obstructive pulmonary disease (COPD), which afflicts more than 14 million Americans. However, because of the numerous patient-management, pharmacy, compounding, delivery, and administrative costs, these drug therapies cannot be provided to Medicare patients at the ASP mandated formula without a substantial service or dispensing fee, says AAHomecare.
Among suppliers responding to the survey, nearly nine out of ten (89 percent) said that they would discontinue providing inhalation drugs to Medicare beneficiaries under the ASP formula if no other Medicare reimbursement were available to offset their substantial, additional costs. The study was supervised by Don Muse, Ph.D., president of Muse and Associates which specializes in analysis of Medicare and Medicaid statutes and regulations.
"We will file the study as part of our comments to CMS and look forward to cooperating closely with CMS to ensure that beneficiaries continue to have access to critical inhalation therapies," said Cox.
To see the executive summary of the study, visit aahomecare and click on Newsroom.
Homecare provides tremendous value for Americans' healthcare dollar. AAHomecare is the only national association that represents every line of service in the homecare community, including home health and home medical equipment providers, respiratory and infusion therapy, telemedicine, and re/hab and assistive technology. Representing more than 3,000 member locations nationwide, AAHomecare is dedicated to advancing the value and practice of quality, cost-effective health care services where consumers prefer them - at home.
Michael Reinemer
Director, Communications
American Association for Homecare
625 Slaters Lane, Suite 200
Alexandria, VA 22314-1171
703-535-1881
aahomecare
The study, the largest of its kind, conducted for the American Association for Homecare (AAHomecare) by Muse and Associates, surveyed 109 pharmacies that represent 2,448 branch locations providing inhalation drug therapy services to 337,348 Medicare beneficiaries per month - or 61 percent of all Medicare inhalation drug therapy patients. AAHomecare is sharing the study with the Centers for Medicare and Medicaid Services (CMS) and the Government Accountability Office.
"This objective assessment of the cost of inhalation therapies in the home reveals a serious gap between what will be paid under the new 2005 reimbursement formula and the reality of what it costs to deliver these therapies to Medicare beneficiaries," said Kay Cox, president and CEO of the American Association for Homecare. "The ability to provide these therapies and patient access to these therapies will both suffer if we don't close this reimbursement gap."
In a notice of proposed rule making for the 2005 Medicare physician fee schedule issued last month, CMS proposed 89 percent reimbursement cuts, using the ASP formula, for albuterol sulfate and ipratropium bromide. The two drugs, covered under Medicare Part B, are commonly prescribed to treat diseases such as chronic obstructive pulmonary disease (COPD), which afflicts more than 14 million Americans. However, because of the numerous patient-management, pharmacy, compounding, delivery, and administrative costs, these drug therapies cannot be provided to Medicare patients at the ASP mandated formula without a substantial service or dispensing fee, says AAHomecare.
Among suppliers responding to the survey, nearly nine out of ten (89 percent) said that they would discontinue providing inhalation drugs to Medicare beneficiaries under the ASP formula if no other Medicare reimbursement were available to offset their substantial, additional costs. The study was supervised by Don Muse, Ph.D., president of Muse and Associates which specializes in analysis of Medicare and Medicaid statutes and regulations.
"We will file the study as part of our comments to CMS and look forward to cooperating closely with CMS to ensure that beneficiaries continue to have access to critical inhalation therapies," said Cox.
To see the executive summary of the study, visit aahomecare and click on Newsroom.
Homecare provides tremendous value for Americans' healthcare dollar. AAHomecare is the only national association that represents every line of service in the homecare community, including home health and home medical equipment providers, respiratory and infusion therapy, telemedicine, and re/hab and assistive technology. Representing more than 3,000 member locations nationwide, AAHomecare is dedicated to advancing the value and practice of quality, cost-effective health care services where consumers prefer them - at home.
Michael Reinemer
Director, Communications
American Association for Homecare
625 Slaters Lane, Suite 200
Alexandria, VA 22314-1171
703-535-1881
aahomecare
среда, 22 июня 2011 г.
Mental Health Therapy For Children Traumatized By Hurricane Katrina
After a successful pilot run, the LSU School of Social Work received $100,000 from the AmeriCares Mental Health Grant Program to continue its study, "Weathering the Storm: Wellness Groups for Children and Caregivers."
The grant enables clinically licensed social workers to offer psycho-educational help by using group interventions in Baton Rouge area schools. The groups are expected to reduce the long-term consequences of post-hurricane trauma and relocation of elementary school-aged children.
Officials estimate that more than 46,000 public school elementary students relocated to Baton Rouge following Hurricane Katrina. Many of these children and their caregivers not only lost their physical homes, they also lost their communities and their sense of normalcy. With priorities focused on regaining basic needs, children's mental and emotional health can easily become neglected.
In response to the need for counseling, Daphne Cain, LSU social work professor, requested her co-workers' help in providing a program to teach parents the normal reactions to disaster regression behavior. This approach enables parents to help their own children to cope with the traumatic loss.
Cain, who has research experience in parenting interventions, is the study's primary investigator. Carol Plummer, assistant professor in LSU's School of Social Work, has research experience with trauma and children's studies. Toni Bankston, LSU adjunct professor, and Tangela Colson, a local social work practitioner, are also participating in the study.
Bankston developed a six-week program based on a one-hour session each week to go with the book, "After Hurricane Katrina: Helping Children Cope with Traumatic Loss" by Marge Heegaard. The book helps child trauma victims to understand and express their emotions in the form of drawings. Heegaard is a registered art therapist and social worker in Minneapolis.
The team provides caregivers with information about the group therapy provided for the children, including handouts with explanations of the differences between common and severe reactions. The term caregivers refers to parents or other legal guardians. The team can provide caregivers with referrals for additional services for children showing severe reactions. Caregivers can also receive more information, ask questions and participate with their children during the drop-in sessions, which occur during two of the six therapy sessions.
Group leaders help children to cope better with their emotions and reactions to the trauma caused by Hurricane Katrina, making the children less likely to have behavior problems at school. Group leaders will use positive channels including art, dialogue and play activities to release anxiety and other negative feelings associated with the disaster.
Cain said that the best assistance she can offer is to employ interventions known to be effective in offsetting trauma exposure in other disaster situations. Many post-disaster studies of children have documented elevated levels of post-traumatic stress disorder. The long-term effects and mental health consequences for children who survived Katrina are still unknown. The LSU Health Sciences Center screened children affected by Katrina and found several common symptoms. These include medical symptoms, nightmares, flashbacks, increased anxiety, bed-wetting, behavior problems and depression.
Topics covered in the groups include: change as a part of life, learning about feelings and difficult feelings about Katrina. Other topics are: soothing painful feelings, changing negative thoughts, and moving on and getting stronger.
The groups are being offered through area schools, which are able to distribute informed consent forms for parents to enroll their children. The team is currently working in Glen Oaks Park Elementary and Scottlandville Middle schools. All school-age children displaced by Hurricane Katrina who have relocated to the Baton Rouge and Baker areas are invited to participate in the groups. The groups meet for one hour each week. Participation is free.
LSU's School of Social Work is working with the Big Buddy Program, East Baton Rouge Truancy Assessment and Services Center and a number of health-care facilities. The grant is through the AmeriCares Foundation in collaboration with the Baton Rouge Area Foundation.
AmeriCares is a non-profit disaster relief and humanitarian aid organization that provides immediate response to emergency medical needs and supports long-term humanitarian assistance programs.
"After being in the Gulf region early on in the disaster, we recognized that the long-term efforts were going to be just as important as the immediate relief needs," said Trish Tweedley, vice president of the AmeriCares Hurricane Relief Program.
As part of AmeriCares longer-term recovery effort, the organization has partnered with the Baton Rouge Area Foundation to develop a funding mechanism to support local mental health providers in recovery efforts in their own communities.
"Funding from AmeriCares will not only provide relief for the people in the affected areas but also for the agencies that have been stretched by the shift in population to Baton Rouge and other communities," said John Davies, president and CEO of the Baton Rouge Area Foundation.
Contact: Melissa Prescott
Louisiana State University
The grant enables clinically licensed social workers to offer psycho-educational help by using group interventions in Baton Rouge area schools. The groups are expected to reduce the long-term consequences of post-hurricane trauma and relocation of elementary school-aged children.
Officials estimate that more than 46,000 public school elementary students relocated to Baton Rouge following Hurricane Katrina. Many of these children and their caregivers not only lost their physical homes, they also lost their communities and their sense of normalcy. With priorities focused on regaining basic needs, children's mental and emotional health can easily become neglected.
In response to the need for counseling, Daphne Cain, LSU social work professor, requested her co-workers' help in providing a program to teach parents the normal reactions to disaster regression behavior. This approach enables parents to help their own children to cope with the traumatic loss.
Cain, who has research experience in parenting interventions, is the study's primary investigator. Carol Plummer, assistant professor in LSU's School of Social Work, has research experience with trauma and children's studies. Toni Bankston, LSU adjunct professor, and Tangela Colson, a local social work practitioner, are also participating in the study.
Bankston developed a six-week program based on a one-hour session each week to go with the book, "After Hurricane Katrina: Helping Children Cope with Traumatic Loss" by Marge Heegaard. The book helps child trauma victims to understand and express their emotions in the form of drawings. Heegaard is a registered art therapist and social worker in Minneapolis.
The team provides caregivers with information about the group therapy provided for the children, including handouts with explanations of the differences between common and severe reactions. The term caregivers refers to parents or other legal guardians. The team can provide caregivers with referrals for additional services for children showing severe reactions. Caregivers can also receive more information, ask questions and participate with their children during the drop-in sessions, which occur during two of the six therapy sessions.
Group leaders help children to cope better with their emotions and reactions to the trauma caused by Hurricane Katrina, making the children less likely to have behavior problems at school. Group leaders will use positive channels including art, dialogue and play activities to release anxiety and other negative feelings associated with the disaster.
Cain said that the best assistance she can offer is to employ interventions known to be effective in offsetting trauma exposure in other disaster situations. Many post-disaster studies of children have documented elevated levels of post-traumatic stress disorder. The long-term effects and mental health consequences for children who survived Katrina are still unknown. The LSU Health Sciences Center screened children affected by Katrina and found several common symptoms. These include medical symptoms, nightmares, flashbacks, increased anxiety, bed-wetting, behavior problems and depression.
Topics covered in the groups include: change as a part of life, learning about feelings and difficult feelings about Katrina. Other topics are: soothing painful feelings, changing negative thoughts, and moving on and getting stronger.
The groups are being offered through area schools, which are able to distribute informed consent forms for parents to enroll their children. The team is currently working in Glen Oaks Park Elementary and Scottlandville Middle schools. All school-age children displaced by Hurricane Katrina who have relocated to the Baton Rouge and Baker areas are invited to participate in the groups. The groups meet for one hour each week. Participation is free.
LSU's School of Social Work is working with the Big Buddy Program, East Baton Rouge Truancy Assessment and Services Center and a number of health-care facilities. The grant is through the AmeriCares Foundation in collaboration with the Baton Rouge Area Foundation.
AmeriCares is a non-profit disaster relief and humanitarian aid organization that provides immediate response to emergency medical needs and supports long-term humanitarian assistance programs.
"After being in the Gulf region early on in the disaster, we recognized that the long-term efforts were going to be just as important as the immediate relief needs," said Trish Tweedley, vice president of the AmeriCares Hurricane Relief Program.
As part of AmeriCares longer-term recovery effort, the organization has partnered with the Baton Rouge Area Foundation to develop a funding mechanism to support local mental health providers in recovery efforts in their own communities.
"Funding from AmeriCares will not only provide relief for the people in the affected areas but also for the agencies that have been stretched by the shift in population to Baton Rouge and other communities," said John Davies, president and CEO of the Baton Rouge Area Foundation.
Contact: Melissa Prescott
Louisiana State University
вторник, 21 июня 2011 г.
Strategies Evolving As Retractable Safety Syringe Suppliers Strive For Traction
Following the lead of the Needlestick Safety and Prevention Act in the U.S., government regulations regarding syringe needle handling and disposal continue to proliferate worldwide, fostering increased demand in the use of safety syringes. Retractable syringes represent the most elegant approach to addressing the caregiver sharps risk issue by lowering the risk of user error and de-emphasizing the need for a separate sharps disposal step.
New retractable designs address caregiver preferences while reducing part counts and manufacturing steps. These refinements are helping to close the price gap with naked disposable syringes and non-retractable safety devices, and this development will help retractable syringe manufacturers and their distribution partners make a stronger sales case with the healthcare buying groups that account for the vast majority of syringe purchases.
Historical retractable syringe unit growth continues to be modest, hovering in the single digits. While price points remain the single most important factor limiting market penetration, several unrelated issues are slowing the market acceptance of retractable syringes. Many participants in this sector are undercapitalized and unprepared for the lengthy development, approval and sales cycle steps required to establish a foothold against entrenched devices, user habits, buying cycles and competitors. Patent and IP challenges are another risk area that has impacted and in some cases derailed the product plans of aspiring market entrants, while draining the financial resources of others.
Several sector companies are evolving their business strategies to focus on niche opportunities for which retractable safety syringes present strong business and use cases. These developments, long overdue, signify a willingness on the part of syringe developers to accept the role of retractable syringes as a specialty device.
Source
Greystone Associates
New retractable designs address caregiver preferences while reducing part counts and manufacturing steps. These refinements are helping to close the price gap with naked disposable syringes and non-retractable safety devices, and this development will help retractable syringe manufacturers and their distribution partners make a stronger sales case with the healthcare buying groups that account for the vast majority of syringe purchases.
Historical retractable syringe unit growth continues to be modest, hovering in the single digits. While price points remain the single most important factor limiting market penetration, several unrelated issues are slowing the market acceptance of retractable syringes. Many participants in this sector are undercapitalized and unprepared for the lengthy development, approval and sales cycle steps required to establish a foothold against entrenched devices, user habits, buying cycles and competitors. Patent and IP challenges are another risk area that has impacted and in some cases derailed the product plans of aspiring market entrants, while draining the financial resources of others.
Several sector companies are evolving their business strategies to focus on niche opportunities for which retractable safety syringes present strong business and use cases. These developments, long overdue, signify a willingness on the part of syringe developers to accept the role of retractable syringes as a specialty device.
Source
Greystone Associates
понедельник, 20 июня 2011 г.
Children's Stress Affected By Child Care Providers' Behavior
A new study on preschoolers attending full-day child care in licensed day care homes has found increases in cortisol, a stress hormone, when the children are in child care that exceeds their levels at home. The increases were larger in day care homes where providers were intrusive or overcontrolling.
The study, in the May/June 2010 issue of the journal Child Development, was conducted by researchers at the University of Minnesota, Georgetown University, and the Oregon Social Learning Center.
The researchers looked at about 150 mostly White, largely middle-class 3- and 4-year-olds in 110 different family child care homes, observing the children's behavior at child care as well as the behavior of their care providers, and sampling saliva to measure cortisol levels. Cortisol is a hormone that helps individuals adapt to challenges and stretches their coping skills.
The study found that about 40 percent of the children showed elevations in cortisol that were large enough to indicate that their bodies were stressed. It also found that cortisol increases over the day were larger in settings where care providers were intrusive or overcontrolling. In such settings, children moved frequently between activities, were given relatively little time for free play, and spent long periods of time in structured activities led by the providers. While many of these structured activities seemed designed to help the preschoolers learn letters, numbers, and colors, the activities weren't carried out in a way that allowed the children to learn actively through play, but rather in a rote fashion that required the little ones to sit quietly and respond when called on.
The larger elevations in cortisol meant different things for girls and boys in terms of behavior. Girls with larger increases in the hormone acted more anxious and vigilant at child care, while boys acted more angry and aggressive.
"These findings indicate that the behavior of the care provider is associated with both how well children function at child care, and how much their cortisol is elevated," according to Megan R. Gunnar, Regents Professor of Child Development at the University of Minnesota, who led the study. "They add to our understanding of how children process stressors in child care, highlighting differences between boys and girls in how they express being more physiologically stressed."
The study was supported by the National Institute of Mental Health.
The study, in the May/June 2010 issue of the journal Child Development, was conducted by researchers at the University of Minnesota, Georgetown University, and the Oregon Social Learning Center.
The researchers looked at about 150 mostly White, largely middle-class 3- and 4-year-olds in 110 different family child care homes, observing the children's behavior at child care as well as the behavior of their care providers, and sampling saliva to measure cortisol levels. Cortisol is a hormone that helps individuals adapt to challenges and stretches their coping skills.
The study found that about 40 percent of the children showed elevations in cortisol that were large enough to indicate that their bodies were stressed. It also found that cortisol increases over the day were larger in settings where care providers were intrusive or overcontrolling. In such settings, children moved frequently between activities, were given relatively little time for free play, and spent long periods of time in structured activities led by the providers. While many of these structured activities seemed designed to help the preschoolers learn letters, numbers, and colors, the activities weren't carried out in a way that allowed the children to learn actively through play, but rather in a rote fashion that required the little ones to sit quietly and respond when called on.
The larger elevations in cortisol meant different things for girls and boys in terms of behavior. Girls with larger increases in the hormone acted more anxious and vigilant at child care, while boys acted more angry and aggressive.
"These findings indicate that the behavior of the care provider is associated with both how well children function at child care, and how much their cortisol is elevated," according to Megan R. Gunnar, Regents Professor of Child Development at the University of Minnesota, who led the study. "They add to our understanding of how children process stressors in child care, highlighting differences between boys and girls in how they express being more physiologically stressed."
The study was supported by the National Institute of Mental Health.
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