A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

The Pattern of Women’s Reliance on Family Planning Providers in Egypt

Understanding choice of family planning provider is fundamental for policy makers and program managers as they seek ways to both improve the coverage and increase the sustainability and efficiency of family planning services for Egypt to achieve its population objectives. This study focuses first on providing a descriptive profile of the patterns of reliance on sources of family planning services during the early 2000s. Binomial logit models are then estimated to obtain a more in depth understanding of the determinants of the choice of family planning providers in Egypt using the 2000 Egypt Demographic and Health Survey. The study offers insights into a number of aspects of family planning service provision about which there has been less previous investigation. There are marked differences in the extent to which Egyptian women rely on public or private providers for family planning services depending on the type of method they are seeking. Among the more important findings is the consistency women display in the choice of provider among women reporting multiple segments of use. With regard to the determinants of the choice of provider for family planning services, perhaps the most interesting finding is that household wealth was not a significant determinant of the choice of provider. This may reflect that private sources met the demand for family planning services of significant proportions of women in rural areas and among those in the low income groups.

Healthcare Providers' Perceptions of the Sexual and Reproductive Health Needs (Including Family Planning) of Elderly Women from Selected Sites in Botswana

Much of the sexual and reproductive health services and service delivery including family planning target women of child bearing ages (15 - 49 years) and sometimes men. Hardly are there programmes/interventions that specifically target the needs of the elderly women (50 years and above), yet this group has serious sexual and reproductive health needs as many of them are still sexually active. This cross-sectional study obtained the views of a stratified random sample of 169 healthcare providers (doctors, nurses and pharmacists) from four selected sites, Gaborone, Selibe Phikwe, Barolong and Kweneng East health districts in Botswana on how the healthcare system in the selected sites is meeting the SRH/FP needs of the elderly women. The study found out that while overwhelming majority of the healthcare providers feltthat the healthcare system has no programme that specifically target the SRH/FP needs of this significant others and their SRH/FP needs are not being met ,less than 15% indicated that Pap smear screening as well as screening of cervical cancer were on-going. Although there are SRH/FP services available in the healthcare system, the elderly women are minimally accessing these services. Only condom, combined oral contraceptives, progestogen-only pills, treatment of STIs, screening for HIV/AIDS and screening for cervical cancer are accessed and information is also limited to these services. Reasons given by the healthcare providers for the non-accessibility of these services were cultural diversity (80%), people's sexual behavior and perceptions about sex (79%), lack of knowledge about the desired SRH/FP services (76%), religion (73%) and gender issues (62%). The study, advocates as part of policy options to mitigate the obstacles to accessing SRH/FP services, the expansion of counseling programmes, screening and treatment for breast cancer, public awareness campaigns, production and circulation of appropriate educational materials, effective training of healthcare providers and the establishment of separate clinic days for the elderly women' SRH/FP services.

Mutual Experiences of Japanese Parents and Their Children When Late School-Age Children Engage in Meal-Related Family Routines: A Qualitative Analysis of Parent and Child Dyads

Purpose: The objective of the present study was to identify the type of experiences that parents and their children have with each other when late-school age children take on roles in family routines related to daily meals. Methods: A grounded theory approach was used. The participants were children in the 4th, 5th, and 6th grades of elementary school and their main caregivers. First, 10 parent and child dyads were interviewed using a semi-structured schedule. Next, online group interviews were conducted for 17 parent and child dyads to deductively confirm the categories. Results: The average age of the subjects was 41.9 years for parents and 10.4 years for children in parent-child interviews, and 41.1 years for parents and 9.6 years for children in group interviews. Six categories emerged with nineteen subcategories. Conclusions: Experiences mutually nurtured by parents and their children included experiences in which children used negotiation and conversation skills to consensually engage in family routines related to meals. It also included experiences that socialized the children in family life and fostered good communication. The six categories will be useful for healthcare professionals and school authorities in providing health guidance that addresses health functions of late school-age children and their families.

Older Migrants： Finding Strategies for Sustaining Family Relationships

Issues specific to older migrants moving country are not yet fully understood as there are few studies on this age group. These migrants are most likely to be caught in attending to the needs of their children or their elderly parents, both requiring support. Over a period of two years, 35 older Polish migrants were interviewed and they told their stories of the migration experience. It was found that they had to make choices and were faced with quite difficult decisions on whether they were going to leave children or parents in Poland while they were forced into a position where they had to find work outside their own country due to age discrimination. Both men and women expressed feelings of guilt at leaving sick parents, and at not being able to afford to travel back to Poland more regularly to be with their families. Without effective cost or free digital technology, these families would not be able to sustain communication channels and relationships would break down. Consequently both the economic and emotional costs to these families and the communities in which they live could be very high.

Survey on hospice care attitude of family members of advanced cancer patients at different ages

BACKGROUND Hospice care plays an important role in improving the quality of life of advanced cancer patients,but controversy remains over whether age affects the attitudes of family members toward hospice care.AIM To investigate the attitudes of family members of advanced cancer patients of different ages toward hospice care.METHODS The study participants were 175 family members of patients with advanced cancer from January 2020 and October 2022.The participants were divided into youth(<40 years,n=65),middle-aged(40–60 years,n=59),and elderly(>60 years,n=51)groups.Researchers investigated and compared the degree of awareness regarding hospice care,attitudes,and whether the family members of patients would choose hospice care.RESULTS Among the family members of 175 patients,approximately 28%(49/175)were aware of hospice care.Awareness of hospice care,the proportion of hospice care acceptance and adaptation attitudes,and the proportion of those who chose hospice care in the youth group were higher in the middle-aged and elderly groups(P<0.05).No statistically significant difference was found in these three indicators between the middle-aged and elderly groups(P>0.05).Hospice care was chosen mainly to relieve pain and reduce unnecessary treatment,whereas the reasons for not choosing hospice care were mainly distrust and ethical concerns.CONCLUSION The family members of patients with advanced cancer had relatively low awareness of hospice care,while youth had a higher awareness of hospice care,acceptance,and adaptation attitudes,and were more willing to choose hospice care.

Social differentiation by age group and resource difficulties encountered in the rural system of family support for the elderly

This paper focuses on social equity issues among different age groups and generations in rural society and rural families in China. The researchers describe the material and social living condition of the elderly in rural areas, pointing out their relative poverty and the structural contradiction between the deterioration in their quality of life and socioeconomic position and the gradual improvement overall in rural living standards. They see this as evidence of social differentiation based on age and generation. The paper further provides an analysis of the resource difficulties encountered by the system of family support for the elderly that illustrates how economic, social and cultural developments affect the lives, power and rights of the elderly through changes in the rural family system and intergenerational familial relations.

Early Age of Onset, Multiple Primary Malignancies and Poor Prognosis Are Indicative of an Inherited Predisposition to Esophageal Squamous Cell Carcinoma in Familial Rather Than Sporadic Disease- An Update Based on 14- to 23-year Follow-up

OBJECTIVE To demonstrate the effects of an inherited predisposition to familial esophageal squamous cell carcinoma （ESCC） through the comparison and analysis of the clinicopathologic differences between familial and sporadic ESCC cases. METHODS Differences in age of onset, prevalence rates of double primary ESCC, and survival rates between familial ESCC （n = 476） and sporadic ESCC cases （n = 1226） were analyzed. RESULTS Overall, familial ESCC cases showed a significantly younger age of onset （51.9±8.2 vs. 53.4 ±8.0, Pt.test = 0.00）, a significantly higher prevalence rate for double ESCC （2.73 % vs. 1.22%, adjusted with TNM：χMH2 = 4.029, P = 0.045）, and a lower survival rate than in sporadic cases （Pwald = 0.04）. The familial cases showed both a younger age of onset and poorer survival in most subgroups, and the differences were more marked in early-stage rather than in the .late-stage disease groups. CONCLUSION Theses findings confirm the existence of familial as opposed to sporadic ESCC. By the theory of the ＂two-hit＂ origin of cancer, these findings also suggest that the ＂first hit＂, a genetic predisposition, can affect the age of onset, number of primary carcinomas, and the prognosis for familial ESCC patients.

Who should be checked for hepatitis C virus infection in endemic areas?

Objective: To find additional factors suggestive of hepatitis C virus(HCV) infection in the general population by using data from a hepatitis virus survey. Methods: This study collected data of HCV infection from a hepatitis virus survey. The survey was conducted in 13 provinces in the northeast Thailand in 2014 and 2015. During the survey, a blood test was performed to screen for HCV. A questionnaire was also distributed to all participants asking about baseline characteristics, risk factors for HCV infection, and daily life activities. Risk factors for HCV infection were executed. Results: There were 2 112 participants for the survey. Of those, 110 participants(5.21%) tested positive for HCV infection. After adjustment by multivariate logistic regression, three factors were significantly associated with HCV infection, namely male gender, age, and family history of liver cancer. The adjusted ORs and 95% CI of these factors were 3.14(1.50, 6.56), 3.78(1.12, 12.76), and 2.28(1.08, 4.80), respectively. Conclusions: Male gender, increasing age, and family history of liver cancer are predictors of HCV infection in endemic areas. Males with a family history of liver cancer in their firstdegree relatives should be tested for HCV infection regardless of symptoms.

Activities of some defense proteins associated with age or plant family in larch needles of Larix olgensis and L. kaempferi× L. gmelinii

Defence proteins are a kind of chemical defence compounds. They play a key role in plant restraining biotic and abiotic harm. To illuminate activities of some defense proteins associated with age or plant family of larch, the larch needles were collected from two different families of Korean larch, Larix olgensis and a hybrid larch, L. kaempferi × L. gmelinii, respectively, and then the activities of defence proteins in those were tested using a UV spectrophotometry. The results showed that the activities of protective enzymes at thel6-/17- and 19-year-age groups were higher than those at the other age groups in the both larch species. While the activities of polyphenol oxidase （PPO） at the 16-/17-year-age group and phenylalanine ammonia-lyase （PAL） and protease inhibitors at the 19-year-age group were the highest among all age groups. Then, compared with L. olgensis, the hybrid larch had significant effects on the activities of protective enzymes. The effects of plant family on the activities of PAL and chymotrypsin inhibitor were significantly different, and then those on the activities of PPO were not significantly different. The effects of the two families in L. olgensis on the activities of trypsin inhibitor （TI） were significantly different, while those in the hybrid larch on the activities of TI were contrary. To conclusions showed that the different age and plant family significantly affected the activities of defence proteins in the needles of two larch species, and then enhanced the larch resistance to pests. These could play a key function in forestry tree genetic improvement and management in future.

Key Elements of “Family” Life Style of Old-age Residential Facilities

The problem of old-age care in China is more and more serious. Under the background of continuous promotion of community old-age, the importance of research on the"family" life style of oldage residential facilities has become increasingly prominent. Through field survey of different types of oldage residential facilities and questionnaire interviews, the shortcomings of the old-age residential facilities in Xi’an were compared and summarized, and the key elements of "family" life style of the old-age residential facilities were concluded, which mainly include urban community embeddedness, family structure elements, indoor furnishings and accompanying care system. The "family" life style of the old-age residential facilities can not only maintain the "kinship" living needs, but also conform to the new direction of promoting the "community" of the old-age residential facilities in China.

Sleep Disturbance in Parkinson’s Disease Varies with Age of Onset and Family History

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disease more common in those over the age of 60. PD is classically characterized by motor features, although patients may also experience non-motor symptoms. Sleep disturbances, such as rapid eye movement (REM) behavior disorder (RBD), are common in patients with PD and may precede onset of PD. Methods: Data was collected on patients with PD (358 subjects)in a movement disorders clinic at a safety net hospital. In this retrospective database analysis, the association of PD complications with age of onset was evaluated using chi-square tests and logistic regression. Results: Of the PD complications analyzed, there was a significant difference in sleep disturbances by age. Among the 358 PD patients, 120 individuals (33.5%) had information regarding the presence or absence of sleep disturbances. There was a significant difference between the early (onset < 50) and later onset (≥50) groups (p = 0.03) with the odds of having a sleep disorder for the early group 1.6 times that of the late group. Those subjects with siblings who also had PD had 2.0 times the odds of having a sleep disorder compared those without (p = 0.02). Conclusion: Non-motor symptoms such as sleep disorders are a useful predictor of early onset PD. Genetic components of PD impact both motor and non-motor aspects of the disease.

Clothing Expenditures of Different Aged Families

This study was undertaken to investigate clothing expen-diture patterns of families in Shanghai, and especially the relationship between age of the family and the expendi-tures . Interview data from 292 families in Shanghai were used in analysis. Families were divided into three groups, including the young, middle - aged, and old families. Descriptive analysis and regression were em-ployed. Major findings concern total expenditures of family members as well as the entire family, and expen-ditures on different categories of clothing. Factors which had impacts on clothing expenditures were also investi-gated. It was concluded that age of the families had an impact on expenditures, and the three groups of families had different patterns of clothing consumption.

制约农村养老社会化发展的因素分析

我国农村养老社会化既是养老制度发展的客观规律,也是我国农村经济和社会发展的客观要求。但是,事实上,我国农村养老社会化程度偏低,其原因在于我国农村存在着种种制约养老社会化发展的因素。加快农村养老社会化发展的措施主要是转变传统的家庭养老观念,健全社会养老法律制度,社会养老与农业政策紧密结合,加大国家经济支持力度,理顺社会养老管理体制,分层次、循序渐进地完善农村社会养老制度。

日本居家护理服务的发展与启示

日本自20世纪70年代进入人口老龄化社会,老人的养老护理成为社会问题,为应对人口老龄化的挑战,日本建立护理保险制度,护理保险由居家护理服务和设施护理服务两部分组成,主要为居家护理服务。日本的居家护理服务很好地解决了日本养老服务问题,呈现出自己的鲜明特点,对我国养老服务提供了有益的借鉴。

中国传统家庭养老的演进:文化伦理观念的转变结果

中国家庭养老功能的变化从现象上看是由于家庭构成的变化导致了养老功能的变化,而本质原因是文化伦理观念转变导致的家庭养老的协调费用变化。针对这种变化,从历史发展和中西比较两个角度进行文化伦理分析。部分养老职能虽然已从家庭组织中分离出来,但家庭作为养老职能的最主要承担者的作用并未降低,在某些方面还有所加强。家庭养老有着很高的财政贡献度、传统伦理支持度和社会和谐贡献度。

规范化培训乡(镇)节育技术人员提高IUD避孕效果

中国农村放置宫内节育器(IUD)的主要技术力量是乡(镇)节育技术人员。在安徽省全省范围内,选择房屋设备、人员情况等基本相同的34个乡(镇)计划生育服务所,随机分配成规范化培训组和对照组;每组随机放置TCu220C和带铜宫型IUD共3073例。填写统一表格,按期随访。生命表法分析随访一年的结果。两种IUD的妊娠率、脱落率、因出血或疼痛取出率等,规范化培训组明显低于对照组,揭示加强乡(镇)节育技术人员的规范化培训,有助于提高IUD的避孕效果。

计划生育门诊医务人员主动提供HIV检测咨询(PITC)服务的探讨

目的:探讨在计划生育门诊中开展医务人员主动提供HIV检测咨询(provider-initiated testing and counse-ling,PITC)服务的必要性和可行性及影响因素。方法:随机抽取计划生育门诊就诊者800人进行问卷凋查。结果:就诊者艾滋病总知识知晓率为85.27%,各知识点知晓率差距较大,12个知识点中有7项正确回答率90%以上,有3项正确回答率在70%以下;年轻、初中文化程度和无业人员、工人等人群知晓率偏低。对艾滋病病毒感染者态度有30.0%持"同情并帮助"态度,有38.00%持"同情并疏远"态度。76.75%认为HIV检测咨询可以控制艾滋病的流行和传播。"认为HIV检测的负面影响"的选择中,害怕被歧视29.73%、家庭破裂24.62%、失去工作24.44%、暴露隐私21.21%。在不愿接受HIV检测的就诊者中,81.90%认为没必要。25.62%(人.项)的就诊者知道计生门诊可以提供艾滋病检测咨询服务;35.22%的就诊者会首选到计生门诊检测。分别有86.88%和94.63%的人表示,在计生门诊就诊时,愿意接受医务人员提供HIV检测和HIV方面的知识信息咨询。开展PITC服务1年,门诊检测率从11.64%提高到23.15%,有显著性差异(P<0.01)。结论:计划生育门诊医务人员开展PITC服务是必要的和可行的,能明显提高就诊者的HIV检测率。艾滋病综合知识知晓率低、HIV检测重要性认识不足、社会歧视是阻碍就诊者接受PITC服务的重要影响因素。

早产儿照护者家庭护理知识及技能掌握情况的调查

目的了解早产儿照护者对早产儿相关家庭护理知识及技能的掌握情况,为完善早产儿出院后的家庭延伸护理提供依据。方法便利选取2012年6-12月入住北京协和医院新生儿监护病房的50位早产儿照护者进行问卷调查,调查内容包括照护者基本资料、早产儿相关护理知识及技能、获得现有知识及技能的途径,以及希望出院后进一步获得相关知识及技能的途径。结果在早产儿护理知识及技能方面,得分最高的是早产儿的日常护理[(2.97±0.31)分],得分最低的是常见异常情况的识别与处理[(1.98±0.22)分];早产儿照护者的现有知识及技能主要来源于媒体(80.0%)和孕妇学校(62.0%);照护者希望出院后进一步获得相关知识及技能的主要途径依次为医院设立咨询电话(100%)、医院提供教育光盘或手册(78.0%)及医院提供专人访视(66.0%)。结论照护者对早产儿的家庭护理知识及技能掌握水平较低。医院应扩大护理服务范围,为照护者提供家庭护理健康教育,以保障早产儿的延伸护理质量、降低早产儿的再就诊率、提高早产儿的生活质量。