Formal caregivers’ perceptions of quality of care for older people: associating factors

Background Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers’ perspective. The aim was to describe formal caregivers’ perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient’s Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431). Results In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience. Conclusions The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers’ working conditions are of great importance for quality of care

HHV-6B Induces IFN-Lambda1 Responses in Cord Plasmacytoid Dendritic Cells through TLR9

Human herpesvirus type 6B (HHV-6B) is a strong inducer of IFN-alpha and has the capacity to promote Th1 responses and block Th2 responses in vitro. In this study we addressed whether inactivated HHV-6B can also induce IFN lambda responses and to what extent interferons alpha and lambda affect Th1/Th2 polarization. We show that inactivated HHV-6B induced IFN-lambda1 (IL-29) but not IFN-lambda2 (IL-28A) responses in plasmacytoid DC and that this induction was mediated through TLR9. We have previously shown that HHV-6B promotes Th1 responses and blocks Th2 responses in both humans and mice. We now show that neutralization of IFN-alpha but not IFN-lambda1 blocked the HHV-6B-induced enhancement of Th1 responses in MLR, but did not affect the HHV-6-induced dampening of Th2 responses. Similarly, blockage of TLR9 counteracted HHV-6Bs effects on the Th1/Th2 balance. In addition, IFN-alpha but not IFN-lambda1 promoted IFN-gamma production and blocked IL-5 and IL-13 production in purified CD4+ T-cells. The lack of effect of IFN-lambda1 correlated with the absence of the IFN-lambda receptor IL-28Ralfa chain on the cell surface of both resting and activated CD4+ T-cells. We conclude that inactivated HHV-6B is a strong inducer of IFN-lambda1 in plasmacytoid DC and that this induction is TLR9-dependent. However, human CD4+ T-cells do not express the IFN-lambda receptor and are refractory to IFN-lambda1 treatment. The HHV-6B-induced alterations in the Th1/Th2 balance are instead mediated mainly through TLR9 and IFN-alpha

Needs of young children with cancer during their initial hospitalization: an observational study.

The aim of this study was to describe young (under the age of 7) children’s needs as expressed by their behavior, body language and verbal expression through observations during their initial hospitalization after being diagnosed with cancer. Twelve children under the age of seven were followed during 26 hours with nonparticipant unstructured observations. Field notes were written after each observation and transcribed into a narrative text, which was analyzed by content analysis at both manifest and latent level. Five themes were identified, of which “need to have the parent close by” was the most prominent. The other themes were “need to play and feel joy,” “need for participation in care and treatment,” “need for a good relationship with the staff,” and “need for physical and emotional satisfaction.” The results indicate that the children needed their parents and the parents’presence helped the children to express other needs. Professionals need to support the child and his or her parents so that the parents in their turn can support and alleviate their child’s hospitalization and cancer treatment

Neutralization of IFN-alpha but not IFN-lambda1 blocks the HHV-6B-induced promotion of IFN-gamma responses in cord mixed lymphocyte reactions.

<p>Cord blood pDC were incubated with allogeneic cord-blood CD4+ T-cells in the presence or absence of inactivated HHV-6B and neutralizing antibodies to IFN-alpha or IFN-lambda1. Supernatants were collected after 48 h and analyzed for IFN-gamma (A), IL-5 (B) and IL-13 (C) content. Data are expressed as medians and the 25% and 75% percentile (the boxes) with the minimum and maximum responses for n = 9. *  =  p<0.05 using ANOVA with Bonferronís multiple comparison test.</p

HHV-6B induces the production of IFN-alpha, IFN-lambda1 but not IFN-lambda2 in pDC in a TLR9-dependent fashion.

<p>Purified cord pDC were exposed to inactivated HHV-6B in the presence or absence of G-ODN, a TLR9-specific inhibitor. The levels of IFN-alpha (A; n = 20), IFN-lambda1 (B; n = 15) and IFN-lambda2 (C; n = 5) were analyzed in 24h culture supernatants. Data are expressed as mean + SEM. **  =  p<0.01, ***  =  p<0.001 using ANOVA with Bonferroni's multiple comparison test. The levels of IFN-lambda1 and IFN-lambda2 were also assessed over a 72 h time-period (D; n = 3).</p

CD4+ T-cells do not express IL-28Ralpha.

<p>Resting or activated cord blood mononuclear cells were analyzed for IL-28Ralpha expression using FACS. IL-28Ralpha expression (histograms) on pDC (A) or CD4+ T-cells obtained directly upon isolation (B) or after 24 h incubation with anti-CD3 (C) or recombinant human IFN-alpha (D). Filled red areas represent isotype-PE control and blue lines represent IL-28Ralpha-PE.</p

HHV-6B affects the IFN-gamma and IL-13 responses in cord mixed lymphocyte reactions via TLR9 signaling.

<p>Cord blood pDC were incubated with allogeneic cord-blood CD4+ T-cells and inactivated HHV-6B in the presence or absence of G-ODN. Supernatants were collected after 48 h and analyzed for IFN-gamma (A), IL-5 (B) and IL-13 (C) content. Data are expressed as medians and the 25% and 75% percentile (the boxes) with the minimum and maximum responses for n = 5. *  =  p<0.05 using student's t-test.</p

IFN-alpha but not IFN-lambda1 promote Th1 responses and block Th2 responses in activated cord CD4+ T-cells.

<p>Cord blood CD4+ T-cells were activated with anti-CD3 (A–B) or anti-CD3 and anti-CD28 (C) in the presence or absence of recombinant human IFN-alpha or IFN-lambda1. Supernatants were collected after 48 h and analyzed for IFN-gamma (A), IL-5 (B) and IL-13 (C) content. Data are expressed as medians and the 25% and 75% percentile (the boxes) with the minimum and maximum responses for n = 5. *  =  p<0.05 using ANOVA with Bonferroni's multiple comparison test.</p