The National Home and Hospice Care Survey: 1996 summary.
(33/1663)
OBJECTIVE: This report presents data about agencies providing home and hospice care, their current patients, and their discharges. The data are presented in 159 tables according to standard sets of descriptive variables. The tables are grouped into five categories: agencies, home health care current patients, home health care discharges, hospice care current patients, and hospice care discharges. Data are presented on agency characteristics, demographic characteristics, utilization measures, and health and functional status of current patients and discharges. METHODS: The data used for this report are from the National Center for Health Statistics' 1996 National Home and Hospice Care Survey. This is a sample survey through which data are collected on the use of home health and hospice care agencies in the United States. The data were collected by personal interview using three questionnaires and two sampling lists. (+info)
Failure to maintain the benefits of home-based intervention in adolescents with poorly controlled type 1 diabetes.
(34/1663)
OBJECTIVE: To determine whether a 6-month home-based intervention program in adolescents with poorly controlled diabetes improves metabolic control and whether benefits are maintained after the intervention. RESEARCH DESIGN AND METHODS: Adolescents with a mean HbA1c of > 9.0% over the preceding 12 months received either routine care in a diabetes clinic and an ambulatory intervention for 6 months (n = 37) or routine care only (n = 32). A diabetes educator provided monthly home visits and weekly phone contact to educate and support the adolescents in setting goals for insulin adjustment, blood glucose monitoring, and target blood glucose range. There was no systematic change in the frequency of insulin injections. After the intervention, there was a 12-month follow-up when the intervention and control groups both received only routine care. Outcome measures were HbA1c and Diabetes Knowledge Assessment (DKN). RESULTS: During the intervention, mean HbA1c fell (baseline: 11.1 +/- 1.3%, 6 months: 9.7 +/- 1.6%; P = 0.0001) and mean knowledge scores increased (P = 0.0001) in the intervention group but not in control subjects. However, this improvement in HbA1c and increase in knowledge was not maintained in the intervention group at 12- and 18-month follow-up assessments. Parents' knowledge scores also improved significantly from baseline levels in the intervention group at 6 and 12 months (P = 0.001, P = 0.005, respectively). CONCLUSIONS: An ambulatory program improves metabolic control and knowledge in adolescents with poorly controlled type 1 diabetes; however, it is effective only while the intervention is maintained. (+info)
Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial.
(35/1663)
OBJECTIVES: This study examined differences between nurses and paraprofessionals in implementation of a home visiting program for low-income, first-time parents during pregnancy and the first 2 years of the child's life. METHODS: Mothers were randomly assigned to either a nurse-visited (n = 236) or a paraprofessional-visited (n = 244) condition. Nurse- and paraprofessional-visited families were compared on number and length of visits, topics covered, number of program dropouts, and relationship with home visitor. RESULTS: On average, nurses completed more visits than paraprofessionals (28 vs 23; P < .001) and spent a greater proportion of time on physical health issues during pregnancy (38% vs 27%; P < .001) and on parenting issues during infancy (46% vs 32%; P < .001). Paraprofessionals conducted visits that lasted longer and spent a greater proportion of time on environmental health and safety issues (15% vs 7% pregnancy; 15% vs 8% infancy; P < .001). While home visitors were viewed equally positively by mothers, nurses had fewer dropouts than did paraprofessionals (38% vs 48%; P = .04). More paraprofessional-visited families than nurse-visited families experienced staff turnover. CONCLUSIONS: Nurses and paraprofessionals, even when using the same model, provide home visiting services in different ways. (+info)
Falls prevention over 2 years: a randomized controlled trial in women 80 years and older.
(36/1663)
BACKGROUND: after 1 year, a home-based programme of strength and balance retraining exercises was effective in reducing falls and injuries in women aged 80 years and older. The exercise programme had been individually prescribed by a physiotherapist during the first 2 months of a randomized controlled trial. OBJECTIVE: we aimed to assess the effectiveness of the programme over 2 years. SUBJECTS: women from both the control group and the exercise group completing a 1-year trial (213 out of the original 233) were invited to continue for a further year. METHODS: falls and compliance to the exercise programme were monitored for 2 years. RESULTS: 81 (74%) in the control group and 71 (69%) in the exercise group agreed to continue in the study. After 2 years, the rate of falls remained significantly lower in the exercise group than in the control group. The relative hazard for all falls for the exercise group was 0.69 (95% confidence interval 0.49-0.97). The relative hazard for a fall resulting in a moderate or severe injury was 0.63 (95% confidence interval 0.42-0.95). Those complying with the exercise programme at 2 years had a higher level of physical activity at baseline, were more likely to have reported falling in the year before the study and had remained more confident in the first year about not falling compared with the rest of the exercise group. CONCLUSIONS: falls and injuries can be reduced by an individually tailored exercise programme in the home. For those who keep exercising, the benefit continues over a 2-year period. (+info)
Health care consequences of falls for seniors.
(37/1663)
OBJECTIVES: This article examines falls that caused a serious injury among people aged 65 or older living in private households. Based on an analysis of people followed over a two-year period, it focuses on the association of a fall in 1994/95 with subsequent health care. DATA SOURCE: The data are from the household component of the 1994/95 and 1996/97 cycles of the National Population Health Survey conducted by Statistics Canada. Longitudinal and cross-sectional data are from a sample of 2,081 people aged 65 or older in 1994/95 for whom data were available and who were still alive in 1996/97. An additional 11,282 elderly people in this age group provided cross-sectional data in 1996/97, yielding a total sample of 13,363. ANALYTICAL TECHNIQUES: In addition to descriptive statistics, multivariate analyses were used to study the associations between injurious falls and subsequent entry into care, controlling for selected factors. MAIN RESULTS: After controlling for age, decline in ability to perform activities of daily living, and other factors, the odds of entry into care were three times as high for seniors who reported an injurious fall in 1994/95 as for those who did not. (+info)
Factors predicting completion of a home visitation program by high-risk pregnant women: the North Carolina Maternal Outreach Worker Program.
(38/1663)
OBJECTIVES: This study sought to identify characteristics of high-risk pregnant women that predicted long-term participation in a home visitation program. METHODS: Data regarding sociodemographic characteristics, perceived needs, psychological functioning, substance use, and informal social support were collected prospectively from 152 short-term and 221 long-term program participants. RESULTS: In comparison with short-term participants, long-term participants were more likely to have been African American, married, nonsmokers, and enrolled in the program during their second trimester of pregnancy, and they were more likely to have had emotional and instrumental support needs. CONCLUSIONS: Women with greater social support needs and healthier behaviors were more receptive to long-term home visitation than other women. (+info)
Evaluation of antecedent stimulus parameters for the treatment of escape-maintained aberrant behavior.
(39/1663)
We evaluated a methodology for identifying the range of stimulus features of antecedent stimuli associated with aberrant behavior in demand contexts in natural settings. For each participant, an experimental analysis of antecedents (Phase 1) was conducted to confirm the hypothesis that task instructions occasioned increases in aberrant behavior. During Phase 2, specific stimulus features associated with the presentation of task instructions were assessed by evaluating the child's behavior across two distinct settings, therapists, and types of tasks in a sequential fashion. Aberrant behavior occurred immediately across settings and therapists, presumably because the presence of a discriminative stimulus for escape-maintained behavior (the delivery of a task instruction) occasioned aberrant behavior. However, aberrant behavior decreased initially across tasks, suggesting that familiarity with the task might be a variable. During Phase 3, an experimental (functional) analysis of consequences was conducted with 2 participants to verify that aberrant behavior was maintained by negative reinforcement. During Phase 4, a treatment package that interspersed play with task instructions was conducted to disrupt the ongoing occurrence of aberrant behavior. Immediate and durable treatment effects occurred for 2 of the 3 participants. (+info)
Representing nursing activities within a concept-oriented terminological system: evaluation of a type definition.
(40/1663)
OBJECTIVE: A type definition, as a component of the categorical structures of a concept-oriented terminology, must support nonambiguous concept representations and, consequently, comparisons of data that are represented using different terminologies. The purpose of the study was to evaluate the adequacy and utility of a proposed type definition for nursing activity concepts. DESIGN: Nursing activity terms (n = 1039) from patient charts and intervention terms from two nursing terminologies (Home Health Care Classification and Omaha System) were decomposed into the attributes of the proposed type definition-Delivery Mode, Activity Focus, and Recipient. MEASUREMENTS: Attributes of the type definition were coded as present or absent for each term by multiple raters. In addition, Delivery Mode was rated as Explicit or Implicit and Recipient was rated as Explicit, Implicit, or Ambiguous. The data were summarized using descriptive statistics. Inter-rater reliabilities were calculated for each attribute of the type definition. RESULTS: All attributes of the type definition were present in 73.9 percent of the chart terms, 91.3 percent of Home Health Care Classification intervention terms, and 63.5 percent of Omaha System intervention terms. While Delivery Mode and Activity Focus were almost universally present, Recipient was problematic. It was rated as ambiguous in 4.8 percent of the chart terms, 8.7 percent of Home Health Care Classification intervention terms, and 36.5 percent of Omaha System intervention terms. CONCLUSIONS: The study findings supported the adequacy and utility of the type definition. Further research is needed to refine the type definition and its use for representing nursing activity concepts within a concept-oriented terminological system. (+info)