Reminiscence groups for people with dementia and their family carers: pragmatic eight-centre randomised trial of joint reminiscence and maintenance versus usual treatment: a protocol

The growing number of people with dementia, and the increasing cost of care, provides a major incentive to develop and test methods of supporting them in the community for longer. Most attention has been given to pharmacological interventions, but there is increasing recognition that psychosocial interventions may be equally effective, even preferable where medication has negative side-effects. Reminiscence groups, run by professionals and volunteers, which use photographs, recordings and other objects to trigger personal memories are probably the most popular therapeutic approach to working with people with dementia, but there is little evidence for their effectiveness and cost-effectiveness. The recent inclusion of family carers in groups with people with dementia, notably in our own pilot studies, has generated informal evidence that this joint approach improves relationships between people with dementia and their carers, and benefits both

Repurposing NGO data for better research outcomes: A scoping review of the use and secondary analysis of NGO data in health policy and systems research

Background Non-government organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytic approach provided a comprehensive overview and descriptive analyses of the studies which: 1) used data produced or collected by or about NGOs; 2) performed secondary analysis of the NGO data (beyond use of an NGO report as a supporting reference); 3) used NGO-collected clinical data. Results Of the 156 studies which performed secondary analysis of NGO-produced or collected data, 64% (n=100) used NGO-produced reports (e.g. to critique NGO activities and as a contextual reference) and 8% (n=13) analysed NGO-collected clinical data.. Of the studies, 55% investigated service delivery research topics, with 48% undertaken in developing countries and 17% in both developing and developed. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), with some limitations such as inconsistencies and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics, such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. Their use could enable relevant and timely research in the areas of health policy, programme evaluation and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries

Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan

BACKGROUND: Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan. METHODS: Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007–December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models. RESULTS: Of 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 % confidence interval (CI) 67.9–125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3–44.6) and 1.5/100 p-y (95 % CI 0.6–3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR) = 0.53, 95 % CI 0.31–0.92), while duration of injecting (AHR = 1.09, 95 % CI 1.01–1.18/year) and sharing syringes (AHR = 10.09, 95 % CI 1.01–100.3) independently predicted HIV infection. CONCLUSION: There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support

Bilateral health aid: lessons from Europe

Objective: The objective of this study is to document current issues in policy and planning for development assistance in health from the perspective of key bilateral aid donors in Europe, and to explore its relevance for Australia. Methodology: This study is based on seventy-seven interviews and documentary analysis undertaken between July and December 1999 with policy, technical and field staff of major European bilateral aid donors. the World Health Organisation (WHO), and key academic institutions. Notes were taken of interviews. and relevant documentation collected. Forty-five key interviews were tape recorded and transcribed for analysis. Results: The shift towards program and Sector Wide Approaches in development assistance reflects broader political changes in Europe since the collapse of the Communist block. increasingly, achieving an impact on poverty is seen as linked to better governance, improved policy frameworks. and collaboration between donors and partner governments, and between donors themselves, reflected in the broad support for Sector Wide Approaches to development assistance. Conclusions: These perspectives bring new demands to donors such as Australia: structural changes. procedural changes, collaborative approaches to programs, closer relationships with counterparts. Implications: The uncertainty in which health sector reform operates necessitates a reflective and adaptive approach to management of aid, and responsiveness to monitoring and evaluation and the development of new knowledge. Given Australia's strategic positioning in its sphere of influence, the experience from Europe should inform the development of our own future directions

Thinking disability orientation : practicing affirmation

Introduction: Occupational therapy’s theoretical base is informed by beliefs in empowerment, partnership, choice and hope — all key components in client-centred practice (Sumsion and Law 2006). In order to be client-centred, it is important to appreciate an individual’s perception of their own disability, known as their disability orientation. Disability orientation, as described by Darling and Heckert (2010), includes three aspects: disability identity; adherence to a particular model of disability, and involvement in disability rights activism. Each type of disability orientation will affect the disabled person’s beliefs and feelings about themselves, their impaired bodies and their disabled lives. This, in turn, is likely to influence their expectations of and satisfaction with occupational therapy services. Therefore, occupational therapists aiming to work within a client-centred approach should be cognisant of this concept and consider its possible impact on their therapeutic approach. This seminar will: – Explore the concept of disability orientation and discuss examples of different orientations; – Examine the affirmative disability orientation as it relates to occupational therapy; – Enable participants to analyse and understand their clients’ disability orientation; – Discuss strategies to provide intervention informed by a client’s disability orientation. Case studies will be used to promote discussion and explore practical ways to ascertain an individual’s disability orientation. The affirmative disability orientation will be discussed in particular. Impact on service users: Understanding disability orientation could lead to enhanced client-centred and culturally sensitive practice. Implications for occupational therapy: Contribution to the improvement of practice through the development of culturally sensitive therapeutic strategies