Psychosocial and economic problems of parents of children with epilepsy.
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The parents of children with epilepsy (PCE) face multiple psychosocial and economic problems that are often neglected. We undertook this study to ascertain these problems among the patients attending a tertiary referral center for epilepsy in India. A structured questionnaire was administrated to parents of 50 children aged between 5-10 years and having epilepsy for more than 1 year's duration. Some 52% of the children had partial epilepsy whilst the remaining had generalized epilepsy. The median seizure frequency was one per 6 months. The majority of the patients (86%) were living in villages. The family income was less than 1000 Rs per month (1 USD = 42 INR) for 66% of the patients. A decline in social activities, after the onset of epilepsy in their children, was reported by 80% of the parents. Daily routines were significantly affected in over 75% of the parents. Parents had been experiencing frustration (52%) and hopelessness (76%), whilst 60% were in financial difficulties. The most important item of expenditure was cost of drugs or cost of travel to hospital for 54% and 36% parents respectively. Impaired emotional status and poor social adaptation were co-related with the severity of epilepsy (frequent seizures/generalized seizures/attention disorder) and low economic status of the parents. These observations need to be borne in mind while organizing rehabilitation programs for epilepsy. (+info)
Systematic review of day hospital care for elderly people. The Day Hospital Group.
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OBJECTIVE: To examine the effectiveness of day hospital attendance in prolonging independent living for elderly people. DESIGN: Systematic review of 12 controlled clinical trials (available by January 1997) comparing day hospital care with comprehensive care (five trials), domiciliary care (four trials), or no comprehensive care (three trials). SUBJECTS: 2867 elderly people. MAIN OUTCOME MEASURES: Death, institutionalisation, disability, global "poor outcome," and use of resources. RESULTS: Overall, there was no significant difference between day hospitals and alternative services for death, disability, or use of resources. However, compared with subjects receiving no comprehensive care, patients attending day hospitals had a lower odds of death or "poor" outcome (0.72, 95% confidence interval 0.53 to 0.99; P<0.05) and functional deterioration (0.61, 0.38 to 0.97; P<0.05). The day hospital group showed trends towards reductions in hospital bed use and placement in institutional care. Eight trials reported treatment costs, six of which reported that day hospital attendance was more expensive than other care, although only two analyses took into account cost of long term care. CONCLUSIONS: Day hospital care seems to be an effective service for elderly people who need rehabilitation but may have no clear advantage over other comprehensive care. Methodological problems limit these conclusions, and further randomised trials are justifiable. (+info)
Cost-effective treatment for severely malnourished children: what is the best approach?
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In urban Bangladesh, 437 children with severe malnutrition aged 12-60 months were sequentially allocated to treat either as i) inpatients, ii) day care, or iii) domiciliary care after one week of day care. Average institutional cost (US$) to achieve 80% weight-for-height were respectively $156, $59 and $29/child. As a proportion of the overall costs, staff salaries were the largest component, followed by laboratory tests. Parental costs were highest for domiciliary care, as no food supplements were provided. Nevertheless it was the option most preferred by parents and when the institutional and parental costs were combined, domiciliary care was 1.6 times more cost-effective than day care, and 4.1 times more cost-effective than inpatient care. CONCLUSION: With careful training and an efficient referral system, domiciliary care preceded by one week of day care is the most cost-effective treatment option for severe malnutrition in this setting. (+info)
Goal attainment scaling in a geriatric day hospital. Team and program benefits.
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PROBLEM BEING ADDRESSED: The Geriatric Day Program (GDP) of the Capital Health Region in Victoria, BC, is concerned with effective team processes, accountability for health service outcomes, and improving the quality of programs. The GDP identified a need to improve its interdisciplinary processes and generate useful patient outcome data. OBJECTIVE OF PROGRAM: To determine whether Goal Attainment Scaling (GAS) could be introduced to facilitate interdisciplinary processes and to generate useful health outcome data. MAIN COMPONENTS OF PROGRAM: The GAS procedures were incorporated into clinical routines based on published guidelines. The authors determined GAS outcome scores for patients who completed the program and developed outcome scores for specific geriatric problem areas requiring intervention. Outcome scores were made available to the clinical care team and to program managers for continuous quality improvement purposes. CONCLUSIONS: The GAS process was successfully implemented and was acceptable to clinicians and managers at the GDP. Team processes were thought to be improved by focusing on patient goals in a structured way. The GAS provided data on both patient outcomes and outcomes of interventions in specific problem areas. Accountability for patient care increased. Goal Attainment Scaling provided indicators of care for which clinicians could develop program quality improvements. (+info)
Psychosocial changes associated with participation in a pediatric summer camp.
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OBJECTIVE: To examine the relationship between a 1-week pediatric summer camping program and children's attitudes toward their physical disabilities and/or medical conditions and levels of trait anxiety. METHOD: The Child Attitude Toward Illness Scale (CATIS; Austin & Huberty, 1993) and the trait scale of the State-Trait Anxiety Inventory for Children (STAIC; Spielberger, 1973) were given to 90 children as pretests to determine baseline attitudes toward their illnesses and their overall levels of trait anxiety. At the end of the 1-week camp sessions, the CATIS and STAIC A-Trait Form were completed once more as posttest measures. RESULTS: Pretest and posttest scores for all camp groups were compared to assess changes in the children's attitudes toward their illnesses and levels of trait anxiety. Overall, participants had better attitudes toward their illnesses and lower levels of trait anxiety at the end of camp. CONCLUSIONS: Participation in a pediatric summer camp was related to changes in psychosocial functioning, with changes evident across diagnostic groups and gender. The consistency of the findings underscores the need for further investigation. (+info)
Effects of the Medicare Alzheimer's Disease Demonstration on the use of community-based services.
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STUDY QUESTION: Did the Medicare Alzheimer's Disease Demonstration with its case management and community service waivers affect the use of community-based long-term care services among people with dementia and their primary caregivers? DATA SOURCES: Baseline and periodic caregiver interviews. Measures include client and caregiver attributes and self-reported service use. STUDY DESIGN: The demonstration randomly assigned voluntary applicants into treatment and control groups. Treatment group cases were eligible for case management and for up to $699 per month in community care benefits. The actual monthly entitlement varied among the eight demonstration communities due to regional cost and inflation adjustments over time. Analyses are for the year after enrollment. DATA COLLECTION: Analyses are of cases surviving six months or more in the community after enrollment (n = 5,209). Cases received baseline and semi-annual assessments. PRINCIPAL FINDINGS: The intervention of case management and community service reimbursement had a strong, consistent, and positive effect on the likelihood of using home care (including homemaker/chore services, personal care services, companion services) and adult day care. Treatment group clients were at least twice as likely as control group clients to be using any of the four community-based services. A similar, but less pervasive effect was achieved with caregiver training and support group participation. Reimbursement provided by the demonstration's Medicare waiver was generally not sufficient to exceed the level of control group service acquired through private payment. CONCLUSIONS: Reimbursement levels within the demonstration may have enabled more individuals to purchase some services, but they were not sufficient to increase the average level of use over those in the control group. No consistent differences between demonstration models were found in service use likelihood or average use among users. (+info)
Alcohol-Use Disorders Identification Test: a comparison between paper and pencil and computerized versions.
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The use of screening questionnaires to detect early problem drinking has been stimulated by the development of the AUDIT (Alcohol-Use Disorders Identification Test). A comparison of a computerized version of the test and its paper and pencil original was conducted on 110 consecutive attenders at an alcoholism day-treatment facility. The findings suggest that the computer version is as acceptable as the paper and pencil one and that scores on the two formats are comparable. (+info)
Response acquisition under direct and indirect contingencies of reinforcement.
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We compared the effects of direct and indirect reinforcement contingencies on the performance of 6 individuals with profound developmental disabilities. Under both contingencies, completion of identical tasks (opening one of several types of containers) produced access to identical reinforcers. Under the direct contingency, the reinforcer was placed inside the container to be opened; under the indirect contingency, the therapist held the reinforcer and delivered it to the participant upon task completion. One participant immediately performed the task at 100% accuracy under both contingencies. Three participants showed either more immediate or larger improvements in performance under the direct contingency. The remaining 2 participants showed improved performance only under the direct reinforcement contingency. Data taken on the occurrence of "irrelevant" behaviors under the indirect contingency (e.g., reaching for the reinforcer instead of performing the task) provided some evidence that these behaviors may have interfered with task performance and that their occurrence was a function of differential stimulus control. (+info)