What can local authorities do to improve the social care-related quality of life of older adults living at home? Evidence from the Adult Social Care Survey

Local authorities spend considerable resources on social care at home for older adults. Given the expected growth in the population of older adults and budget cuts on local government, it is important to find efficient ways of maintaining and improving the quality of life of older adults. The ageing in place literature suggests that policies in other functions of local authorities may have a significant role to play. This study aims to examine the associations between social care-related quality of life (SCRQoL) in older adults and three potential policy targets for local authorities: (i) accessibility of information and advice, (ii) design of the home and (iii) accessibility of the local area. We used cross-sectional data from the English national Adult Social Care Survey (ASCS) 2010/2011 on service users aged 65 years and older and living at home (N=29,935). To examine the association between SCRQoL, as measured by the ASCOT, and three single-item questions about accessibility of information, design of the home and accessibility of the local area, we estimate linear and quantile regression models. After adjusting for physical and mental health factors and other confounders our findings indicate that SCRQoL is significantly lower for older adults who find it more difficult to find information and advice, for those who report that their home design is inappropriate for their needs and for those who find it more difficult to get around their local area. In addition, these three variables are as strongly associated with SCRQoL as physical and mental health factors. We conclude that in seeking to find ways to maintain and improve the quality of life of social care users living at home, local authorities could look more broadly across their responsibilities. Further research is required to explore the cost-effectiveness of these options compared to standard social care services

Impact of COVID-19 Pandemic on TAVR Activity: A Worldwide Registry

Background: The COVID-19 pandemic had a considerable impact on the provision of structural heart intervention worldwide. Our objectives were: 1) to assess the impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity globally; and 2) to determine the differences in the impact according to geographic region and the demographic, development, and economic status of diverse international health care systems. Methods: We developed a multinational registry of global TAVR activity and invited individual TAVR sites to submit TAVR implant data before and during the COVID-19 pandemic. Specifically, the number of TAVR procedures performed monthly from January 2019 to December 2021 was collected. The adaptive measures to maintain TAVR activity by each site were recorded, as was a variety of indices relating to type of health care system and national economic indices. The primary subject of interest was the impact on TAVR activity during each of the pandemic waves (2020 and 2021) compared with the same period pre–COVID-19 (2019). Results: Data were received from 130 centers from 61 countries, with 14 subcontinents and 5 continents participating in the study. Overall, TAVR activity increased by 16.7% (2,337 procedures) between 2018 and 2019 (ie, before the pandemic), but between 2019 and 2020 (ie, first year of the pandemic), there was no significant growth (–0.1%; –10 procedures). In contrast, activity again increased by 18.9% (3,085 procedures) between 2020 and 2021 (ie, second year of the pandemic). During the first pandemic wave, there was a reduction of 18.9% (945 procedures) in TAVR activity among participating sites, while during the second and third waves, there was an increase of 6.7% (489 procedures) and 15.9% (1,042 procedures), respectively. Further analysis and results of this study are ongoing and will be available at the time of the congress. Conclusion: The COVID-19 pandemic initially led to a reduction in the number of patients undergoing TAVR worldwide, although health care systems subsequently adapted, and the number of TAVR recipients continued to grow in subsequent COVID-19 pandemic waves. Categories: STRUCTURAL: Valvular Disease: Aorti

Myocardial tagging by Cardiovascular Magnetic Resonance: evolution of techniques--pulse sequences, analysis algorithms, and applications

Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging

Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

Aim To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Methods and results Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). Conclusion A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957

Empowering Domestic Workers: A Critical Analysis of the Belgian Service Voucher System

Domestic cleaners lack bargaining power, which can prevent them from being in control of their work quality. The ‘service voucher system’ is expected to change the power position of domestics. This is expected because the system is formalized by the Belgian government and organized through a triangular employment relationship between the domestic, the service voucher company (the employer), and the customers. This study draws on 42 interviews with immigrant and native service voucher cleaners. It probes into how the employment relationship with the company affects the domestics’ perceived power to bargain with customers about determinants of the work quality. Based on the results, policy recommendations are made to further empower domestic cleaners in the relationship with their customers and to help them safeguard their work quality

The Role of Attachment and Maladaptive Emotion Regulation Strategies in the Development of Bulimic Symptoms in Adolescents

Following the theoretical propositions of the Emotion Regulation model of attachment, the current study investigated whether attachment anxiety and attachment avoidance might play a differential contributing role in the development of bulimic symptoms, through assumed differences in adopting specific maladaptive emotion regulation strategies in a sample of adolescents. Developmentally appropriate self-report questionnaires were administered to a community sample of 397 adolescents (Mean age: 14.02; 62.7% female) and this at 2 time points with a 1-year time lag. Results provided longitudinal evidence for the Emotion Regulation model of attachment in confirming the differential contributing role of the attachment dimensions on the development of bulimic symptoms in a sample of adolescents. More specifically, attachment anxiety seemed to be related to bulimic symptoms through rumination, while attachment avoidance through emotional control. These results may have clinical implications for assessment and treatment of bulimic symptoms in adolescents.status: publishe

Explaining the relation between precarious employment and mental well-being. A qualitative study among temporary agency workers

BACKGROUND: From an employee-perspective, temporary agency employment can be considered in two ways. According to the first perspective, agency jobs are associated with job characteristics that adversely affect mental well-being: job insecurity, low wages, a lack of benefits, little training, poorer prospects for the future, high working time flexibility, minimal trade union representation and problematic triadic employment relations. The other perspective underlines that flexibility, learning opportunities and freedom in agency employment enable workers to build the career of their choice, which may positively affect mental well-being. OBJECTIVE: This article aims at interpreting and explaining these conflicting perspectives. In particular, we discuss the role of coping resources (control, support, trust and equity) in the stress pathway between characteristics of temporary agency employment and mental well-being. METHODS: Semi-structured interviews with 12 Belgian temporary agency workers were conducted and analysed from a phenomenological perspective. RESULTS: The results reveal mainly how a lack of coping resources plays a key role in how (precarious) characteristics of temporary agency employment affect employees' mental well-being. CONCLUSIONS: This study illustrates the earlier assumed stress pathway between precarious employment and mental well-being, in which coping resources play an intermediary as well as a moderating role.status: publishe

Model observer detectability as a substitute for contrast detail analysis in routine digital mammography quality control

This work investigated the substitution of CDMAM contrast detail (c-d) analysis with detectability (d’) from a non- prewhitening eye filter model observer (NPWE) for routine quality control (QC). Routinely acquired QC data for 53 systems were analyzed: 13 computed radiography (CR) and 40 integrated detector (DR) systems. For a given system, threshold gold thickness from the c-d analysis (T) was calculated from 16 images and compared against d’ calculated for 0.1 and 0.25 mm diameter discs. The d’ data were calculated from the routine 50 mm PMMA AEC image and the measured pre-sampling detector modulation transfer function (MTF). Threshold gold thickness T and d’ were plotted as function of MGD and compared. The Fuji CR and the Agfa CR systems had the highest T values compared to the other systems. The Hologic systems were found to have a low value of T, compared to the other systems, for both disc diameters. The NPWE results reflected the performance seen for T data for the majority of the systems with the exception of the Fuji CR and Konica CR systems. The Hologic systems gave unexpectedly low d’ results or unexpectedly low T values. The correspondence between the two quality indices was examined with the Pearson correlation statistical test. This test was not applicable to the GE Essential systems because all systems are grouped together at the same working point so the result of r is about 0. For all other groups of systems the test gave good results (larger than -0.65).status: publishe

Dirty work, dirty worker? Stigmatization and coping strategies among domestic workers

© 2015 Elsevier Inc. Domestic work can be perceived to be 'dirty work' in several ways: it is associated with dirt handling, low occupational prestige, and domestic workers have a servile relationship to their clients/employers. This stigma may negatively affect domestic workers' sense of self, and thus coping strategies appear to be critical. In this article, we explore the coping strategies that moderate the relation between the stigma of dirty work and domestic workers' sense of self, based on the analyses of 43 interviews with domestic workers in Belgium. By using a social stress approach in which stigma is considered a stressor, our results reveal a range of maladaptive and adaptive coping strategies that contribute to a negative or a more positive sense of self. Four main categories of coping strategies are discussed: confronting or countering perceptions and behaviours, occupational ideologies, social weighting and defensive tactics. The first two categories are adaptive coping strategies; the last two can be adaptive or maladaptive. We also reveal that workers used adaptive and maladaptive coping strategies simultaneously, leading to mixed implications for their sense of self.publisher: Elsevier articletitle: Dirty work, dirty worker? Stigmatisation and coping strategies among domestic workers journaltitle: Journal of Vocational Behavior articlelink: http://dx.doi.org/10.1016/j.jvb.2015.11.008 content_type: article copyright: Copyright © 2015 Elsevier Inc. All rights reserved.status: publishe