The design of caring environments and the quality of life of older people

There has been little systematic research into the design of care environments for older people. This article reviews empirical studies from both the architectural and the psychological literature. It outlines the instruments that are currently available for measuring both the environment and the quality of life of older people, and it summarises the evidence on the layout of buildings, the sensory environment and the privacy of residents. The conclusion is drawn that all evidence-based design must be a compromise or dynamic and, as demands on the caring environment change over time, this compromise must be re-visited in the form of post-occupancy evaluation

EFFECTS OF CARBOFURAN ON THE REPRODUCTIVE CAPACITY OF A FRESHWATER SNAIL, RADIX QUADRASI, UNDER LABORATORY CONDITIONS

The  effects  of  4  sublethal  concentrations  of  carbofuran  (250,  500,  1000  and  2000  ppm)  on  the reproductive  capacity of R. quadrasi was determined. Results showed  that  incubation period  is delayed  and inhibited by 1000 and 2000 ppm carbofuran but not by lower concentrations. The hatching period is longer in treated snails and not  all  eggs hatch  in  the 1000 and 2000  ppm  treatment. The  percentage  of hatching  is inversely proportional to the carbofuran concentration. Oviposition  was  delayed  in  all  the  treated  stages  and  at  all  dosages.  The  higher  the  carbofuran concentration,  the  later  the onset of oviposition. The  reproductive period  is shortened. Fecundity was decreased in snails treated at EMB and SM. However, only the 2000 ppm carbofuran concentration showed an adverse effect on the snails exposure at PSM

Effects of Carbofuran on the Reproductive Capacity of a Freshwater Snail, Radix Quadrasi, Under Laboratory Conditions

The effects of 4 sublethal concentrations of carbofuran (250, 500, 1000 and 2000 ppm) on the reproductive capacity of R. quadrasi was determined. Results showed that incubation period is delayed and inhibited by 1000 and 2000 ppm carbofuran but not by lower concentrations. The hatching period is longer in treated snails and not all eggs hatch in the 1000 and 2000 ppm treatment. The percentage of hatching is inversely proportional to the carbofuran concentration. Oviposition was delayed in all the treated stages and at all dosages. The higher the carbofuran concentration, the later the onset of oviposition. The reproductive period is shortened. Fecundity was decreased in snails treated at EMB and SM. However, only the 2000 ppm carbofuran concentration showed an adverse effect on the snails exposure at PSM

Older parents of people who have a learning disability : perceptions of future accomodation needs

The aim of this qualitative study was to provide an insight into the perceptions of older parents of learning disabled people on the future accommodation needs of their adult children. Semi-structured interviews were used to seek parental awareness of residential options available, concerns in relation to future accommodation and the preferred accommodation options for their offspring. Four couples who shared the family home with an adult who has a learning disability took part in the study and data was analysed using a step by step form of content analysis as described by Burnard (1991). Emergent themes from transcripts were then organised into main categories The results of this study suggest that older parents are dissatisfied with both statutory and private services, that they have concerns for their non-disabled children and their own ageing. Being a parent to a person who has a learning disability is seen to be a difficult task and yet parents may want to provide support at home for as long a possible. Of the parents who participated in this study, three couples wanted to maintain their adult child at home for as long as possible and the parents who were actively seeking accommodation outside the family home expected to be involved in all aspects of their daughter�s care for the long term future

Choice in the context of informal care-giving

Extending choice and control for social care service users is a central feature of current English policies. However, these have comparatively little to say about choice in relation to the informal carers of relatives, friends or older people who are disabled or sick. To explore the realities of choice as experienced by carers, the present paper reviews research published in English since 1985 about three situations in which carers are likely to face choices: receiving social services; the entry of an older person to long-term care; and combining paid work and care. Thirteen electronic databases were searched, covering both the health and social care fields. Databases included: ASSIA; IBSS; Social Care Online; ISI Web of Knowledge; Medline; HMIC Sociological Abstracts; INGENTA; ZETOC; and the National Research Register. The search strategy combined terms that: (1) identified individuals with care-giving responsibilities; (2) identified people receiving help and support; and (3) described the process of interest (e.g. choice, decision-making and self-determination). The search identified comparatively few relevant studies, and so was supplemented by the findings from another recent review of empirical research on carers' choices about combining work and care. The research evidence suggests that carers' choices are shaped by two sets of factors: one relates to the nature of the care-giving relationship; and the second consists of wider organisational factors. A number of reasons may explain the invisibility of choice for carers in current policy proposals for increasing choice. In particular, it is suggested that underpinning conceptual models of the relationship between carers and formal service providers shape the extent to which carers can be offered choice and control on similar terms to service users. In particular, the exercise of choice by carers is likely to be highly problematic if it involves relinquishing some unpaid care-giving activities

Measurements of daily energy intake and total energy expenditure in people with dementia in care homes: the use of wearable technology.

Objectives: To estimate daily total energy expenditure (TEE) using a physical activity monitor, combined with dietary assessment of energy intake to assess the relationship between daily energy expenditure and patterns of activity with energy intake in people with dementia living in care homes. Design and setting: A cross-sectional study in care homes in the UK. Participants: Twenty residents with confirmed dementia diagnosis were recruited from two care homes that specialised in dementia care. Measurements: A physical activity monitor (Sensewear TM Armband , Body Media, Pittsburgh, PA) was employed to objectively determine total energy expenditure, sleep duration and physical activity. The armband was placed around the left upper triceps for up to 7 days. Energy intake was determined by weighing all food and drink items over 4 days (3 weekdays and 1 weekend day) including measurements of food wastage. Results: The mean age was 78.7 (SD ± 11.8) years, Body Mass Index (BMI) 23.0 (SD ± 4.2) kg/m2 ; 50% were women. Energy intake (mean 7.4; SD ± 2.6) MJ/d) was correlated with TEE (mean 7.6; SD ± 1.8 MJ/d; r=0.49, p<0.05). Duration of sleeping ranged from 0.4-12.5 (mean 6.1) hrs/d and time spent lying down was 1.3-16.0 (8.3) hrs/d. On average residents spent 17.9 (6.3-23.4) hrs/d undertaking sedentary activity. TEE was correlated with BMI (r=0.52, p<0.05) and body weight (r=0.81, p<0.001) but inversely related to sleep duration (r=-0.59, p<0.01) and time lying down (r=-0.62, p<0.01). Multiple linear regression analysis revealed that after taking BMI, sleep duration and time spent lying down into account, TEE was no longer correlated with energy intake. Conclusions: The results show the extent to which body mass, variable activity and sleep patterns may be contributing to TEE and together with reduced energy intake, energy requirements were not satisfied. Thus wearable technology has the potential to offer real-time monitoring to provide appropriate nutrition management that is more person-centred to prevent weight loss in dementi

在宅失語症者の家族の介護負担感 : アンケート調査報告

失語症は言語によるコミュニケーションを阻害し, 生活基盤を脅かす重大な障害であるにもかかわらず, 要介護度認定にはほとんど反映されない。また, 失語症者を介護する家族の介護負担感には, コミュニケーションの問題が影響すると思われるが, こうした側面を考慮した評価法や質問紙は未だ開発されていない。我々は失語症者の家族の介護負担感を評価する評価法作成の基礎データを得ることを目的に, 失語症友の会全国大会参加者を対象に失語症によるコミュニケーションの困難さが日常生活に及ぼす影響についてアンケート調査を行った。アンケートの方法は自己記入式で, 266名より回答があった。介護者の特性についての検討から, 見守り時間の長さと介護者の年齢の間には関連があることが示唆された。一方, 失語症者のコミュニケーションの困難度は, 誰かに相談したい思い, 見守り時間の長さなどと関連することが示唆された。見守り理由としては, 身体介助の問題とコミュニケーション困難に関連する本人の不安が挙げられた。Aphasia brings about difficulties in all aspects of communication. Persons with aphasia not only have difficulties expressing their problems, and understanding what others say, but have difficulty obtaining information through various media including printed media. Although communication problems tend to leave persons with aphasia isolated from all kinds of social interaction and threaten the foundations of their lives, care-giver burden assessment tools developed thus far have not included the unique needs of persons with aphasia. As a part of the process of developing a care-giver burden scale for family members caring for persons with aphasia, we asked care-givers attending the 20th National Aphasia Peer Group Meeting to fill in questionnaires regarding communication difficulties and their influence on daily life. Consequently, 266 family care-givers self-administered the questionnaire. The results indicated statistically significant relationships between care-givers' age and the length of time family care-givers look after persons with aphasia. As for persons with aphasia, statistically significant relationships were indicated between the degree of communication difficulty, care-givers' needs for consulting with somebody and the length of time family care-givers look after persons with aphasia. The main reasons for the length of time spent looking after persons with aphasia fell into two categories : one was the need for physical care and the other was the anxiety of persons with aphasia about being left alone without effective methods of communication.報告Report国立情報学研究所で電子

チイキ ホウカツ イリョウ ジッシュウ ノ ジュコウセイ ノ トクセイ ト ソノ キョウイク コウカ ニ カンスル ケンキュウ

全国的に地域枠入学者による医学部定員増加が行われている.それに伴い医学部では,より良い地域医療教育の導入が求められている.そこで本研究は,地域医療を目指す学生の特性を知るとともに地域医療教育の効果を学生の自己評価点とSOC (Sense of Coherence) 得点の地域教育導入前後比較により検討することを目的とした.調査対象は,獨協医科大学医学部第1学年おける地域包括医療実習受講生の16名( 男子9名,女子7名:平均年齢18.9±1.0歳) と非受講生の1年生98名( 男子66名,女子32名:平均年齢19.9±1.7歳) である.平成22 年7 月15 日に対象者全員に対して研究の説明を行い,文書による研究参加への同意を得た後,行動規範26項目の自己評価 (7 点満点) とSense of Coherence (SOC) 29 項目及び生活習慣に関する質問12 項目に回答する自記式アンケート調査を行った.さらに,平成22 年12 月11 日に,受講生のみを対象に7 月15 日に施行したものと同一のアンケート調査を行った.地域包括医療実習I 受講生は,非受講生に比較して,家族と同居しているもの,現在運動をしていないものが多かった.また,学習態度の自己評価点とSOC 処理可能感の得点が有意に高かった.地域包括医療実習I の実習前後の変化を検討したところ,生活態度の自己評価が終了時には有意に上昇していた.しかしSOC 把握可能感の得点が有意に低下していた.地域医療教育導入前後でほとんどの項目で大きな変化はなかったが,生活態度の行動変容に良い効果が得られた.また,把握可能感が低下していたため,面接などで適切な支援が必要である.The quotas of students who wish to be involved in communitymedicine have increased in medical schools in Japan.Accordingly, programs focused on community medicineare required in medical education. In this study weaimed to identify the characteristics of medical studentswho pursue community medicine. We also aimed to evaluatethe effects of the local community medical educationcourse for medical students by examining changes in thescores of self-evaluation of standards of conduct and in thescores of sense of coherence (SOC) before and after thecourse.Participants were 16 first-year students (9 men, 7 women;mean age, 18.9±1.0 years) at Dokkyo Medical Universitywho took the comprehensive community medicinepractice course( community medicine course students) and98 students (66 men, 32 women;mean age, 19.9±1.7years) who did not take the course( non-community medicinecourse students).Information on the study was provided on July 15, 2010,and written informed consent was obtained from all participants.A self-evaluation questionnaire comprising 26 itemsregarding standards of conduct, each to be rated on a seven-point scale, and a questionnaire comprising 29 items ofSOC and 12 items of lifestyle were used. Both questionnaireswere completed by all participants on July 15, 2010and by the community medicine course students on DecemberThe percentage of students who lived with their familiesand the percentage of students who did not regularly exerciseat the time of the questionnaire survey were higher inthe community medicine course students than in the noncommunitymedicine course students. In addition, the selfevaluationscore for attitude toward leaning and the SOCscore for sense of manageability were significantly higher inthe community medicine course students than in the noncommunitymedicine course students. In the communitymedicine course students, the self-evaluation score for attitudetoward life was significantly increased, while the SOCscore for sense of comprehensibility significantly decreasedby the end of the course.The comprehensive community medicine practice coursehad a positive effect on student attitude toward life, andpreferable behavioral modifications were observed, althoughscores for most items remained unchanged by the end ofthe course. Our findings revealed a decrease in sense ofcomprehensibility, indicating that appropriate student support,such as consultation, is necessary

イガクセイ トシテ テキセツ ナ コウドウ ヤ タイド オ ジコ ヒョウカ スル トキニ エイキョウ スル セイカツ シュウカン カンレン インシ ノ ケントウ : ダイ1ガクネン カラ ダイ2ガクネン エノ ジコ ヒョウカ テン ノ ヘンカ オ チュウシン ニ

目的:プロフェッショナリズムの育成を医学教育に導入することを前提に医学生の低学年時の行動に対する自己評価の変化とそれに影響する因子を検討した.調査対象:2010 年の獨協医科大学医学部第1 学年の学生92 名(男子57 名,女子35 名)調査方法:2010 年7 月の1 年次と2011 年8 月に2 年次の2 回にわたって行動規範に関する自己評価表および国民健康・栄養調査に基づき作成した生活習慣調査アンケート調査を施行したその得点に影響する生活習慣関連因子を検討した.結果:1 年次から2 年次で自己評価が有意に向上したのは,「他者の人権や人格を尊重し,積極的かつ友好的にコミュニケーションをとり,分かりやすく説明する技術や態度の習得」「常に予習・復習を欠かさないなど学習習慣」「積極的に新しい知識や技能を吸収しようとする能動的な学習態度」であった.一方,2 年次で有意に自己評価が低下していたのは「講義や実習を欠席しない」「他人のものを盗用したり,データをねつ造したりしてレポートを作成しない」「与えられた課題や宿題等の提出期限を守っている」などであった.1 年次の低い自己評価に影響した項目は,男子,喫煙経験,朝食欠食,睡眠で休養がとれていないこと,睡眠補助剤の使用であった.さらに,1 年次の喫煙経験は2 年次の低い自己評価にも影響した.結論:不健康なライフスタイルが行動や態度の自己評価に影響することが判明したことより,生活習慣の変容は,行動の自己評価を向上させる可能性が示唆された.ObjectiveThe purpose of this study was to investigate factors associatedwith the professionalism of medical students, andspecifically their fitness to practice.SubjectsSubjects were 92 first-year students (57 men, 35 women)at Dokkyo Medical University School of Medicine.MethodsA 26-item self-report questionnaire on fitness to practiceand a 12-item self-report questionnaire on lifestyle werecompleted by the medical students at Dokkyo Medical University,once in their first year in July 2010 and again intheir second year in August 2011.ResultsFitness to practice scores were significantly higheramong second-year than first-year students regarding"friendly and positive communication with others while respectingtheir individual differences and human rights","learning earnestly through preparation and review beforeand after lectures", and "willingness to learn". Conversely,fitness to practice scores were significantly lower amongthe second-year than first-year students regarding "unexcusedabsence from lectures or clinical practice"," submissionof plagiarized or falsified reports", and" missed submissiondeadlines". The factors associated with lower selfassessmentscores among first-year students were beingmale, smoking experience, skipping breakfast, poor qualityof sleeping and sleeping pill usage. Furthermore, smokingexperience among first-year students was associated withlower self-assessment scores of fitness to practice in thesecond year.ConclusionThe results suggest that the early adoption of healthybehaviors had a positive influence on fostering educationalprofessionalism among medical student

The development and psychometric testing of three instruments that measure person‐centred caring as three concepts – Personalization, participation and responsiveness

AimTo develop and test the psychometric properties of three instruments that measure Person?centred Caring: as Personalization, Participation and Responsiveness.DesignA three?phase mixed methods design used two frameworks: content validity determination and quantification; consensus?based standards for selection of health measurement instruments.MethodsA narrative literature review identified the domain definition. A systematic review of instruments provided the basis for item pools, which were refined by focus groups (N = 4) of multidisciplinary staff and service users (N = 25) and cognitive interviews (N = 11) with service users. Scale content validity indexes were calculated. Three cross?sectional surveys were conducted between April 2015 and June 2016. The instruments' psychometric properties tested included factor structure, internal consistency and construct validity. Convergent validity was tested, hypothesizing that: Personalization related to relational empathy; Participation related to empowerment; and Responsiveness related to trust.ResultsScale content validity indexes were ?0.96 in all instruments. Response rates were 24% (N = 191), 15% (N = 108) and 19% (N = 124). Two factors were revealed for the Personalization and Responsiveness instruments and one factor for the Participation instrument. All had acceptable: reliability (Cronbach's Alpha > 0.7); construct validity (> 50%); and convergent validity (Spearman's correlation coefficient > 0.25, p < 0.05).ConclusionThis study composed definitions and instruments that reflect the multidisciplinary teams' caring behaviours, which have acceptable reliability and validity in the community population. Further psychometric testing of Participation and Responsiveness instruments should be undertaken with a larger sample.ImpactThe instruments can be used to monitor the variability of multidisciplinary teams' caring behaviours; research effective interventions to improve caring behaviours; and increase understanding of the impact of caring on health outcomes