Limited availability of cardiac rehabilitation for heart failure patients in the United Kingdom: findings from a national survey

Background: Participation of patients with heart failure in cardiac rehabilitation in the UK is low. This study investigated the availability of cardiac rehabilitation services for patients with heart failure in the UK and the views of service coordinators on ideal service models. Design: Our study was a cross-sectional national postal survey that was mailed to 342 service coordinators in the UK between April and June 2009. Methods: We developed a 38-item questionnaire to survey all cardiac rehabilitation service coordinators on theNational Audit of Cardiac Rehabilitation register in the UK in 2009. Results: The survey response rate was 71% (244/342). Forty three per cent (105/244) of coordinators did not accept patients with heart failure to their cardiac rehabilitation services. Most coordinators who did accept patients with heart failure offered their services to patients with a variety of cardiac conditions, though referral criteria and models of care varied widely. Services inconsistently used New York Heart Association classes and left ventricular ejection fraction measures to select patients. Few offered separate dedicated heart failure programmes (14%; 33/244) but where these existed they ran for longer than programmes which included patients with heart failure alongside other cardiac patients (10.9 vs 8.5 weeks; F=4.04; p=0.019). Few offered home-based options for patients with heart failure (11%; 27/244). Coordinators accepting patients with heart failure to their cardiac rehabilitation services tended to agree that patients with heart failure should be included in services alongside other cardiac patients (X2=6.2; p=0.013). Conclusions: There is limited access for patients with heart failure to cardiac rehabilitation in the UK. Local policies on referral and selection criteria differ and reflect coordinators views rather than clinical guidance. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav

Female emigres from the \u27shtetl\u27 and their interpretations of the past: An oral history.

Within this study, I present some of the experiences that occurred in the lives of fifteen Jewish women who grew-up in pre-World War Two Eastern Europe. Using oral history as my methodology, I show how they either embraced or shunned learning about and/or practicing traditional customs and rituals at a time when traditional society was facing many modern changes. Moreover, I show their past experiences with and interpretations of their education, male/female interaction and female dress, the marriage process, a married woman\u27s responsibilities and a married woman\u27s commandments. (Abstract shortened by UMI.) Source: Masters Abstracts International, Volume: 30-03, page: 0571. Chairperson: Seymour Faber. Thesis (M.A.)--University of Windsor (Canada), 1990

Revisiting convergence and divergence: support for older people in Europe

Recent commentators have distinguished ‘weak’ from ‘strong’ family societies, arguing that older people in less family-oriented societies receive less support from family members than those in countries with strong family ties (e.g. Southern Europe). This study explored the north-south divide in various dimensions associated with support for older people among selected European countries participating in a European Scientific Foundation network, ‘Family Support for Older People: Determinants and Consequences’ (FAMSUP). Employing data from a wide variety of sources (e.g. nationally representative surveys, censuses, and official publications) we used principal components and cluster analysis to investigate patterns across countries in four dimensions designed to be indicative of the balance between family and formally provided resources for older people and the socio-economic, demographic and policy contexts in which these are provided. Rather than a clear-cut north-south division European countries reflect a more complex classification in terms of support for older individuals when a wide range of measures associated with different dimensions of support for older people are used. Future research requires comparable cross-national data on key indicators of family support

Relationships between scores on the Jefferson Scale of physician empathy, patient perceptions of physician empathy, and humanistic approaches to patient care: a validity study.

BACKGROUND: Empathy is the backbone of a positive physician-patient relationship. Physician empathy and the patient\u27s awareness of the physician\u27s empathic concern can lead to a more positive clinical outcome. MATERIAL/METHODS: The Jefferson Scale of Physician Empathy (JSPE) was completed by 36 physicians in the Family Medicine residency program at Thomas Jefferson University Hospital, and 90 patients evaluated these physicians by completing the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a survey about physicians\u27 humanistic approaches to patient care. RESULTS: A statistically significant correlation was found between scores of the JSPE and JSPPPE (r=0.48, p CONCLUSIONS: These findings provide further support for the validity of the JSPE. Implications for the assessments of empathy in the physician-patient relationship as related to clinical outcomes are discussed

The impact of caring for grandchildren on the health of grandparents in Europe: a lifecourse approach

Grandparents are becoming an increasingly important source of childcare. However, caring for grandchildren may have negative health consequences particularly for grandparents with intensive commitments such as those with primary care responsibilities. To date most studies on this issue are based on cross-sectional data and do not take earlier life circumstances into account. Thus, it is not known whether (or to what extent) the relationship between grandparental childcare and health is due to cumulative advantage or disadvantage throughout the lifecourse or to the impact of grandchild care per se. Employing data from waves 1–3 of the Survey of Health, Ageing and Retirement in Europe we investigated the longitudinal relationship between grandparental childcare (i.e. intensive and non-intensive) and health once cumulative histories of advantage or disadvantage are taken into account. We used latent class analysis to categorise respondents according to childhood socio-economic and health conditions drawing on life history information. Experiences in adulthood (e.g. periods of ill health) were also captured. We created a latent continuous physical health variable based on self- and observer-measured indicators. OLS regression was used to explore the association between physical health at wave 2 and grandparental childcare at baseline, controlling for conditions in childhood and adulthood, and for health and socio-economic characteristics. We found a positive longitudinal association between grandchild care and health even after earlier life health and socio-economic conditions were taken into account. However, this significant association was found only for grandmothers, and not grandfathers. Our results suggesting the health benefits of grandchild care are important given the widespread provision of grandparental childcare in Europe. However, further research on underlying mechanisms and causal pathways between grandchild care and grandparent health, as well as on gender differences in the pattern of association, is needed

Enhancing the role of pragmatics in primary English teacher training

Teaching EFL in primary school is no longer a novelty but firmly established in the education landscape throughout Europe and many countries worldwide. Primary English language teaching (PELT) is a unique branch of ELT insofar as it entails both the teaching of children and beginners. While PELT teachers and PELT teacher educators largely agree that this concurrence of ‘young plus beginning’ requires a focus on vocabulary, speaking and listening, introduced and practiced through songs, games, stories, roleplaying and embodiment techniques such as Total Physical Response, pragmatic aspects often take a backseat in PELT teacher training and by extension in the PELT classroom, even though it has been established that pragmatics instruction is necessary and feasible on all proficiency levels, right from the beginning. This article discusses possible reasons for this omission and illustrates with authentic examples why pragmatics should play a bigger role in the training of primary English teacher

The Development of a Remote Sensor System and Decision Support Systems Architecture to Monitor Resistance Development in Transgenic Crops

The United States Environmental Protection Agency (EPA) has declared that "significant benefits accrue to growers, the public, and the environment" from the use of transgenic pesticidal crops due to reductions in pesticide usage for crop pest management. Large increases in the global use of transgenic pesticidal crops has reduced the amounts of broad spectrum pesticides used to manage pest populations, improved yield and reduced the environmental impact of crop management. A significant threat to the continued use of this technology is the evolution of resistance in insect pest populations to the insecticidal Bt toxins expressed by the plants. Management of transgenic pesticidal crops with an emphasis on conservation of Bt toxicity in field populations of insect pests is important to the future of sustainable agriculture. A vital component of this transgenic pesticidal crop management is establishing the proof of concept basic understanding, situational awareness, and monitoring and decision support system tools for more than 133650 square kilometers (33 million acres) of bio-engineered corn and cotton for development of insect resistance . Early and recent joint NASA, US EPA and ITD remote imagery flights and ground based field experiments have provided very promising research results that will potentially address future requirements for crop management capabilities

Sex Differences in Medication and Primary Healthcare Use before and after Spousal Bereavement at Older Ages in Denmark: Nationwide Register Study of over 6000 Bereavements

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark

Parents’ Perceptions of the Physical Health Outcomes of Young People Diagnosed with First Episode Psychosis

This study explores parents’ perceptions of their son/daughter’s physical health needs following a first episode psychosis diagnosis and commencement on antipsychotic medication. The research process was guided by grounded theory methodology and data were collected using semi-structure interviews with 16 parents. Four categories were identified. Participants described the importance, challenges and strategies for their son/daughter to maintain their physical health, and the need to improve young people’s health literacy, particularly in areas of physical health, diet and lifestyle. These findings will assist health professionals to provide parents with information to better support their son/daughter to maintain their physical health