Search Results (37)

Background: After an older person moves into a nursing home, the next of kin often continues to participate in the care provided there. This participation in care may contribute valuable knowledge of the preferences and wishes of the older person, thereby helping nursing staff deliver personalised care. Objectives: The aim of this study was to explore how next of kin experience their participation in the care of older persons residing in nursing homes after educating nursing staff about participation in palliative care. Methods: This follow-up study used a qualitative design based on semi-structured interviews with 37 next of kin. A thematic analysis was applied. Results: Participation of the next of kin involved active communication and collaboration with nursing staff, expressed in three themes: striving to achieve co-created care, navigating involvement through presence, and building commitment through communication and information. The dual role of being an emotionally close next of kin and a participant in the relative’s care was challenging and became increasingly burdensome and often overwhelming when the older person’s health deteriorated. Conclusions: This study reveals the need to develop and implement a policy for the participation of next of kin in the care of older people living in nursing homes. In addition, support groups can increase well-being through dialogue with other next of kin, thereby alleviating emotional strain. Increased implementation of life stories and the use of digital communication would keep the next of kin informed about the older person’s condition, especially when they cannot be present in person. Life story is a valuable tool for person-centred care and strengthens the relationships between the next of kin, the older person, and the nursing staff. Full article

Background/Objectives: Egg consumption in adults has been linked with a modestly increased risk of all-cause and CVD mortality. However, evidence on adults aged 65 y+ is limited. The objective of this study was to investigate the association between egg intake and mortality in community-dwelling older adults. Methods: In this prospective cohort study, 8756 adults aged 70+ years, participants in the ASPirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons, self-reported the frequency of their total egg intake: never/infrequently (rarely/never, 1–2 times/month), weekly (1–6 times/week), and daily (daily/several times per day). All-cause and cause-specific (cardiovascular disease [CVD] and cancer) mortality was established from at least two sources: medical records, death notices, next of kin, or death registry linkage. The association between egg intake and mortality was assessed using Cox proportional hazards regression analysis, adjusted for socio-demographic, health-related, and clinical factors and overall dietary quality. Results: Over the median 5.9-year follow-up period, a total of 1034 all-cause deaths (11.8%) were documented. A 29% lower risk of CVD mortality (HR (95% CI): 0.71 [0.54–0.92]) and a 17% (HR (95% CI): 0.83 [0.71–0.96]) lower risk of all-cause mortality were observed among those who consumed eggs weekly, compared to those who consumed eggs never/infrequently; no statistically significant association was observed for weekly consumption and cancer mortality. In contrast, compared to those that never or infrequently consumed eggs, daily consumption had slightly higher odds of mortality, though these results did not reach statistical significance. Conclusions: The consumption of eggs 1–6 times per week was associated with a lower risk of all-cause mortality and CVD mortality in community-dwelling adults aged 70 years and over. These findings may be important to inform the development of evidence-based guidelines for egg consumption. Full article

Post-injury confusional state is a common phenomenon following acquired brain injury. A multi-faceted approach for decreasing confusion is recommended, but there is a paucity of research related to non-pharmacological management. The main objective was to present a conceptual model of multi-faceted approaches for confusion, and secondly to investigate the rehabilitation outcome following these approaches. The setting is a specialized ward for rehabilitation of patients with severe cognitive difficulties following acquired brain injury. The conceptual model encompasses neurobehavioral strategies, pharmacological treatment, engagement in meaningful occupations, next of kin involvement, organizational demands, the physical environment, along with differential diagnostics. Patient cases are provided to illustrate the impact of each approach. A total of 141 of 281 patients were in a confusional state at admission. At discharge, 62% had emerged from the confusional state. Patients in a confusional state due to traumatic brain injury and subarachnoid hemorrhage had clinically important differences of >22 points in the functional independence measure from admission to discharge, following rehabilitation efforts based on the conceptual model. No clinically important difference was seen in patients with non-SAH stroke and patients with other types of brain injuries. The proposed conceptual model should be further evaluated in complex intervention studies. Full article

Psychosocial risk factors, such as socioeconomic disadvantage and having close relatives with severe health conditions (RSHCs), may negatively impact an adolescent’s life. This study aimed to investigate the associations between adolescent experiences with RSHCs (no, one or several RSHCs), parental working status (PWS) (both parents working (both PW) or having ≥1 parent not working (≥1 PNW)) and the composite variable of RSCHs/PWS in relation to self-reported poor mental health. In 2020, population-based data on 15–18-year-olds (n = 3509) were collected from schools in Sörmland, Sweden. Relationships between the composite variable of RSCHs/PW and poor mental health were determined through logistic regression analyses in three different models. Odds ratios (ORs) are separately reported for girls and boys. Girls reporting several RSHCs/≥1 PNW displayed an OR of 5.05 (95% CI 2.82–9.04) in comparison with the reference group with no RSCHs/both PW when adjusting for grade and ethnicity. The corresponding OR for boys was 2.26 (95% CI 1.46–3.49). Further adjustments for protective factors for mental health attenuated the associations with poor mental health. In conclusion, adolescents with RSHC experiences in combination with parental unemployment are at increased risk of developing their own poor mental health, making this group particularly vulnerable. Full article

Exposure to persistent organic pollutants (POPs) is suspected to play a role in the occurrence of estrogen receptor-positive breast cancer (ER-positive BC). Our objective was to investigate the association between patterns of dietary exposure to POPs and ER-positive BC risk in the E3N cohort. The study included 67,879 women. The intake of 81 POPs, including dioxins, polychlorinated biphenyls (PCBs), per- and polyfluoroalkyl substances (PFASs), brominated flame retardants (BFRs) and polycyclic aromatic hydrocarbons (PAHs), was estimated using food consumption data, collected through a validated semi-quantitative food frequency questionnaire, and food contamination data, as measured in the second French Total Diet Study. ER-positive BC cases were identified through self-administered questionnaires, from next-of-kin spontaneous reports, or through information from the national cause-of-death registry. Partial least square–Cox regression (PLS–Cox), a supervised dimension reduction method, was used to identify POPs patterns associated with ER-positive BC occurrence. Cox proportional hazard models were then used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for the associations between the PLS–Cox patterns retained and the risk of ER-positive BC, adjusted on potential confounders identified using a directed acyclic graph. The women were followed for a maximum of 21.4 years, and 5,686 developed incident ER-positive BC. Based on POP intake estimates, five patterns were retained. The first pattern was characterized by positive weights for almost all POPs, especially PAHs and some dioxins. The other principal components were characterized by both positive and negative weights. A significant non-linear and non-monotonic association was highlighted between exposure to the first pattern and ER-positive BC risk, and significant positive linear associations were highlighted between exposure to the second, fourth and fifth patterns and ER-positive BC risk. The use of the PLS–Cox method allowed the identification of relevant patterns in POPs explaining, as far as possible, the covariance between the exposures and the outcomes. Identifying such patterns can help to better clarify the pollutants involved in BC occurrence and to estimate their cumulative effect. Full article

Adolescents’ lives are negatively influenced by experiences of close relatives having severe health conditions. This study aimed to investigate the associations between adolescents’ experiences of close relatives with severe health conditions (RSHCs) and poor mental health and non-suicidal self-injury (NSSI). Cross-sectional population-based data on 15–18-year-olds (n = 3483) in Sörmland, Sweden, were used to analyse the associations between RSHC experiences, such as physical illness, mental illness, addiction/gambling disorders, or death, and poor mental health and NSSI. Logistic regression models (odds ratios) were generated for having one or multiple types of RSHC experiences in different combinations, adjusting for background factors and protective factors for mental health, and stratifying by gender. Adolescents reporting multiple types of RSHC experiences had significantly increased odds ratios for poor mental health (1.74–3.07) or NSSI (1.83–3.02) compared with peers without such experiences. Adjustments for mental health protective factors attenuated the associations with poor mental health or NSSI. These associations remained significant among girls with multiple types of RSHC experiences, while boys’ vulnerabilities included having a relative who had died or had an addiction/gambling disorder. In conclusion, adolescents with RSHC experiences are at increased risk of poor mental health and NSSI. This vulnerability is most pronounced among girls with multiple RSHC experiences and especially for NSSI. Full article

In the past years the number of hospital autopsies have declined steadily, becoming almost excluded from medical training. Medicolegal (forensic) autopsies account for almost all autopsies, whereas hospital autopsies are becoming increasingly rare. Minimally invasive tissue sampling (MITS) using post mortem ultrasound offers the opportunity to increase the number of post mortem examinations in a clinical and even forensic context. MITS is a needle-based post mortem procedure that uses (radiological) imaging techniques to examine major organs of the body, acquire tissue samples and aspirate fluid from the body cavities or hollow organs. In this study, MITS was used to determine the presence of other co-existing diseases in a deceased infected 97-year-old woman with severe acute respiratory syndrome coronavirus 2. The examination of her body was carried out using ultrasound as an imaging tool and to gather ultrasound-guided biopsies as conventional autopsy was rejected by the next of kin. Ultrasound and histology identified an intravesical mass leading to an obstruction of the urinary outlet resulting in bilateral hydronephrosis and purulent pyelonephritis, which was unknown during her lifetime. Histopathological examination revealed the tumor mass to be a squamous cell carcinoma. This study has shown that MITS can be used to determine the cause of death and the presence of concomitant diseases in the infectious deceased. Full article

Objective: To obtain and evaluate detailed descriptions of potential value propositions as seen by adults undergoing hearing rehabilitation with hearing aids. Design: Semi-structured interviews with patients and audiologists, a literature search, and the inclusion of domain knowledge from experts and scientists were used to derive value propositions. A two-alternative forced-choice paradigm and probabilistic choice models were used to investigate hearing aid users’ preferences for the value propositions through an online platform. Study sample: Twelve hearing aid users (mean age 70, range 59–70) and eleven clinicians were interviewed. A total of 173 experienced hearing aid users evaluated the value propositions. Results: Twenty-nine value propositions as described by patients, clinicians, and hearing care experts where identified, from which twenty-one value propositions were evaluated. Results of the pair-wise evaluation method show that the value propositions judged to be the most important for the hearing aid users were: “13. To solve the hearing problem you have”, “09. Thorough diagnosis of the hearing”, and “16. The hearing aid solution is adapted to individual needs”, which are related to finding the correct hearing solution and to be considered in the process. The value propositions judged to be least important were: “04 Next of kin and others involved in the process”, “26. To be in the same room as the practitioner”, and “29. The practitioner’s human characteristics”, related to the involvement of others in the process and the proximity and personal manner of the practitioners. Full article

Many older adults with complex illnesses are today cared for by their next of kin in their own homes and are often sent between different caregivers in public healthcare. Mobile Geriatric Teams (MGTs) are a healthcare initiative for older adults with extensive care needs living at home, coordinated between hospital, primary, and municipal care. The study aims to describe how next of kin experience care efforts from an MGT for their older adult family members. The study has a descriptive qualitative design and uses a phenomenographic approach. Fourteen next of kin to older adult family members who receive efforts from an MGT were interviewed. Two descriptive categories reflecting their experiences emerged: Professional care and No longer having the main responsibility. The study shows that the participants valued that the staff was very competent, that the physician made home visits and could make quick decisions, and that treatments were given at home. They feel that they receive support and experience security and that a burden is lifted from them. Our study shows that through the MGT, next of kin become involved in the care and are relieved of the burden of responsibility of caring for their older family member. Full article

Social diversification in microbes is an evolutionary process where lineages bifurcate into distinct populations that cooperate with themselves but not with other groups. In bacteria, this is frequently driven by horizontal transfer of mobile genetic elements (MGEs). Here, the resulting acquisition of new genes changes the recipient’s social traits and consequently how they interact with kin. These changes include discriminating behaviors mediated by newly acquired effectors. Since the producing cell is protected by cognate immunity factors, these selfish elements benefit from selective discrimination against recent ancestors, thus facilitating their proliferation and benefiting the host. Whether social diversification benefits the population at large is less obvious. The widespread use of next-generation sequencing has recently provided new insights into population dynamics in natural habitats and the roles MGEs play. MGEs belong to accessory genomes, which often constitute the majority of the pangenome of a taxon, and contain most of the kin-discriminating loci that fuel rapid social diversification. We further discuss mechanisms of diversification and its consequences to populations and conclude with a case study involving myxobacteria. Full article

Background: Exploring the experience and impact of aneurysmal subarachnoid hemorrhage (aSAH) from three perspectives, that of those directly affected (AFs), their next of kin (NoK), and treating clinicians, is a way to support and empower others to make informed medical decisions. Methods: In a Swiss neurosurgical intensive care unit (ICU), eleven semi-structured interviews were conducted as part of a Database of Individual Patient Experiences (DIPEx) pilot project and thematically analyzed. Interviews were held with two clinicians, five people experiencing aSAH, and four NoK 14–21 months after the bleeding event. Results: Qualitative analysis revealed five main themes from the perspective of clinicians: emergency care, diagnosis and treatment, outcomes, everyday life in the ICU, and decision-making; seven main themes were identified for AFs and NoK: the experience of the aSAH, diagnosis and treatment, outcomes, impact on loved ones, identity, faith, religion and spirituality, and decision-making. Perspectives on decision-making were compared, and, whereas clinicians tended to focus their attention on determining treatment, AFs and NoK valued participation in shared decision-making processes. Conclusions: Overall, aSAH was perceived as a life-threatening event with various challenges depending on severity. The results suggest the need for tools that aid decision-making and better prepare AFs and NoK using accessible means and at an early stage. Full article

Electron temperature is reconsidered for weakly-ionized oxygen and nitrogen plasmas with its discharge pressure of a few hundred Pa, with its electron density of the order of ${10}^{17}{\mathrm{m}}^{-3}$ and in a state of non-equilibrium, based on thermodynamics and statistical physics. The relationship between entropy and electron mean energy is focused on based on the electron energy distribution function (EEDF) calculated with the integro-differential Boltzmann equation for a given reduced electric field $E/N$. When the Boltzmann equation is solved, chemical kinetic equations are also simultaneously solved to determine essential excited species for the oxygen plasma, while vibrationally excited populations are solved for the nitrogen plasma, since the EEDF should be self-consistently found with the densities of collision counterparts of electrons. Next, the electron mean energy U and entropy S are calculated with the self-consistent EEDF obtained, where the entropy is calculated with the Gibbs’s formula. Then, the “statistical” electron temperature $T_{\mathrm{e}}^{\mathrm{st}}$ is calculated as $T_{\mathrm{e}}^{\mathrm{st}}={[\partial S/\partial U]}^{-1}$. The difference between $T_{\mathrm{e}}^{\mathrm{st}}$ and the electron kinetic temperature $T_{\mathrm{e}}^{\mathrm{kin}}$ is discussed, which is defined as $[2/(3k\left)\right]$ times of the mean electron energy $U=⟨ϵ⟩$, as well as the temperature given as a slope of the EEDF for each value of $E/N$ from the viewpoint of statistical physics as well as of elementary processes in the oxygen or nitrogen plasma. Full article

Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies. Full article

Collaboration in interprofessional collaboration (IPC) teams is a part of working in welfare services. Unlike uniprofessional supervision, interprofessional supervision involves supervisors and students with different educational backgrounds. This study explores 105 supervisors’ responses after synchronous supervision of 15,700 students from teaching, health, and social work education programs who participated in an annual preservice interprofessional learning (IPL) course from 2018 to 2022. The purpose was to explore supervisors’ experience of the online IPL supervisor role and of the student’s learning outcomes through a longitudinal mixed-methods repeated design. Response rates: 61%, 45%, 82% and 40%, respectively. The students worked in IPL groups with limited interaction with supervisors, using a case-based learning approach. The supervisors were supportive of IPL but suggested changes to increase relevance. The imbalance in the knowledge base on child-related topics and IPL preparedness among the student groups was challenging. Some questioned the need for supervision, whereas others were concerned about the limited time allocated for supervision. We conclude that online supervision is forward-looking because candidates must prepare for helping users, such as children and their next-of-kin, online. We deduce that online supervision is relevant for the future and less complicated than IPL supervision Full article

The role and responsibilities of next-of-kin carers are significant, filling several years of their lives and causing them to experience a burden of care. This study was conducted to investigate the burden of next-of-kin carers for dementia sufferers in Slovakia. Data were compiled via the Relatives’ Stress Scale (RSS) screening instrument through a survey of 112 primary next-of-kin carers and analysed using the statistical tests of descriptive statistics, means, scores and significance differences (Wilcoxon test). This is one of the few scales which provides: (a) specific measures of caregiver stress, and (b) is standardised for a population of informal carers in the home environment. The profiles of Slovak next-of-kin carers were identified with statistically significant characteristics (gender, age of carers). The study identified a high level of caregiving stress (82.15%), and selected factors were found to be significant in all burden dimensions: emotional stress (p = 0.001), social stress (p = 0.003), and negative feelings (p = 0.002). The results emphasise the need for coordination of healthcare and social services, possibly by expanding the network of social support groups, operating a counselling hotline/chat, and introducing national educational programmes for the next-of-kin carers of dementia sufferers. The results are also a source of reference for the umbrella organisation ‘the Slovak Alzheimer’s Society’ to access when implementing changes at a national level. Full article