Caregivers’ interactions with health care services: mediator of stress or added strain? Experiences and perceptions of informal caregivers of people with dementia: a qualitative study

Background: There are an estimated 46.8 million people worldwide living with dementia in 2015, being cared for usually by family members or friends (informal caregivers). The challenges faced by informal caregivers often lead to increased levels of stress, burden and risk of care-recipient institutionalisation. Aim: The overarching aim of this study was to explore the experiences and perceptions of informal caregivers of people with dementia when interacting with the health care system, and whether the support received acted as a mediator of caregiver stress. The secondary aim was to investigate healthcare professionals’ views and current practice regarding people with dementia and their interactions with informal caregivers. Method: We employed a qualitative research design, using focus groups and one face-to-face interview with a purposive sample of informal caregivers and healthcare professionals (HCPs) in Lincolnshire, UK. Data were collected between March and July 2015. We used the stress-process model of stress in caregivers as a theoretical framework. Results: We interviewed 18 caregivers and 17 HCPs. Five themes, mapped to the stress-process in caregivers’ model, captured the main challenges faced by caregivers and the type of support they wanted from health care services. Primary stressors included the challenge of diagnosing dementia; caregivers’ needs and expectations of an in-depth knowledge and understanding of dementia from HCPs; and need for carer education. Secondary role strain included lack of support and mismatch of communication and expectations. Caregiver involvement in monitoring care and disease was a potential mediator tool. Conclusions: Fragmentation of dementia care services, lack of training for HCPs and the dearth of information for caregivers means health care services are only partially fulfilling a support role. In turn, lack of support may be intensifying caregiver stress leading to worsening in their health and well-being; thus, potentially increasing the risk of institutionalisation of their care-recipient

Exploring the experiences of having Guillain‐Barré Syndrome: A qualitative interview study

Background: Guillain-Barré syndrome (GBS) is a rare inflammatory disorder affecting the peripheral nerves. Although typically there is full neurological recovery, some people continue to experience residual physical, psychological or social problems longer term. Evidence describing the experiences of people with GBS is limited. Objective: We aimed to explore the experiences of people with GBS in the UK. Design: We used qualitative (face-to-face and telephone) interviews to explore experiences of people with GBS. Audio-recorded data were transcribed verbatim and analysed using the Framework Method supported by NVivo 11. Setting and Participants: We purposively recruited a sample of 16 volunteers with a prior diagnosis of GBS of varying age, sex, ethnicity, location, marital status, time since diagnosis and length of hospital stay to maximize differences in experience. Interviewees were required to have been discharged from hospital, able to give informed consent, able to speak and understand English and currently resident in the United Kingdom. Results: The key themes arising from the analysis were as follows: the importance of early diagnosis; the experiences of inpatient care; the importance of active support for recovery; the need for communication throughout the course of the illness; the need for greater awareness, knowledge and provision of information by health-care staff; and path to achieving function. Conclusion: This is the first qualitative study exploring experiences of people with GBS in the UK through their whole illness journey from onset to recovery. The findings contribute to our understanding of the experiences and support needs of people recovering from GBS

BESTFACT Best Practice Handbook 3

The Best Practice Handbook (BPH) gives an overview about current concepts, strategies and actions in freight transport all over Europe. It is disseminating information on successful projects and practices to increase awareness and share experiences. It is enabling knowledge transfer and supporting transferability for best practices. The third and last Best Practice Handbook focuses on the work done over the entire project, with 157 inventory cases and 60 in-depth analyses. After four years of case collection a wide field of solutions is available. The main findings of the BESTFACT cases are cross-checked and summarised for each of the cluster topics. The consistent form of collection and information provision broadens the structural understanding of best practice cases. The synthesis of cases per topic shows that under consideration of barriers and framework conditions replicable impacts are achievable. Main editors are Martin Ruesch & Simon Bohne (Rapptrans) and Jacques Leonardi (UoW). Project leader is Marcel Huschebeck (PTV)

Linkages between environmental innovation and policy measures in the EU15

In March 2007, the European Commission presented the “Renewable Energy Roadmap”, a document establishing a binding target for all European Union’s Member States to increase their renewable energy consumption rates from sources such as wind, solar, hydro or biomass. The overall value (for all EU Members) was set at 20 percent and should be reached by the year 2020. The renewable energy production was introduced in the energy production sector just after the energy crises of the 1970s as private attempts of few countries to deal with prospective energy security issues. In addition, renewable energy technologies contributed in pollution abatement, which has been a challenging issue for the European Commission ever since, due to their non-depletable nature and the decreased amount of greenhouse gas emissions compared to the ones produced by fossil fuels. In December 2008 the European Union adopted the proposal of the Commission (2008), which stated each Member country’s target share of renewable energy consumption, calculated on the basis of per capita gross domestic product. The Directive included in-between targets (such as 25 percent of the overall target between 2011 and 2012) but no binding constraints on their implementation. Besides the increase of the Renewables share, another solution which has been proposed by the European Commission has been the concept of “energy efficiency”. This idea is defined as decreasing the energy consumption by 20% by the year 2020. In contrast to the renewable concept, energy efficiency has been implemented following regulations suggested by the European Commission. The general policy instruments which have been used remain the same with those of Renewables but they have been more clearly defined for all sectors (households, industries, transports and services). Despite the fact that the Renewables have proceeded as a concept, energy efficiency has been adopted widely and faster. These two trends have been the most representative concerning the energy changes which the European Union started promoting the last decades. Their effect is multi-oriented: prevention from energy depletion and dependence on foreign countries and pollution abatement, according to the directions of the Kyoto protocol. The success of the implementation of environmental friendly technologies has been related to the technological change in the energy field. Many researchers tried to connect environmental innovation with various characteristics, such as R&D expenditures or policy instruments, in order to suggest effective means for their promotion. Characteristic researches have been these of Popp (2005) with “lessons” over environmental innovation and connection of innovation to energy prices, Brunnermeier and Cohen (2003) who modeled, for the US industrial sector, the determinants of environmental innovation, Vries and Withagen (2005) who connected environmental innovation to stringency policies and Johnstone et al. (2008) who modelled the environmental innovation determinants and specified their research in policy instruments. Johnstone et al. (2008) tried to define a relation between environmental innovation and energy policies for the Renewables using an empirical model. The model included some general variables, such as electricity prices or energy consumption, and then defined binary variables to operationalise the policy measures. The environmental innovation was defined as the number of patent counts for specific classes of the International Patent Classification. The present study’s model is based on Johnstone’s et al (2008) model. It follows the main lines of their research by using the same innovation output, i.e. the patent counts, and by having two sets of variables: the general ones and the policy-related ones. The patent counts were considered to be the most appropriate output indicator for this empirical study, as well, as they provided the necessary information to modelling (such as priority date and country of application) and were widely available (from the European Patent Office - EPO). Johnstone et al. (2008) defined a simple “input-output” model for six renewable energy sources. For each one of the sources, they used a specific classification in order to gather all patent counts relevant to each source. They also included seven policy types which were implemented for the renewable energies for a specific time period. Finally, they included a set of “explanatory” variables, which were considered as input innovation indicators. This study based on their model also used patent counts as innovation output. The main “modelling” differences are the introduction of more explanatory variables, such as R&D personnel, international trade indicator or R&D intensity, the different policy instrument operationalisation (from binary to semi-quantitative) and the empirical analysis methods. Also, Johnstone’s model is implemented for a different set of countries and a different time period than the one we examine. Our focus is on the effects of policies on environmental innovation for the EU15. The reason for that is that it is interesting to measure the effects of policies within the borders of the European Union (for policy recommendations) and that the data collected are from the EPO. Johnstone et al (2008) mention that, when coming from non-European country it is less likely to patent at the EPO. Also, our information is set for a shorter period of time for practical reasons (there was no available information before 1990 for the renewable sector and, by definition the European Commission has not started yet promoting the Renewables). The new framework has been yet once modified in order to include the effects on energy efficiency energy trend. Using the same variables, we created a new output set in order to incorporate the policy measures implemented for this second energy trend. Using a logarithmic scale, we performed two types of regression analysis to model our data, the linear regression using the ordinal least squares, which provides a linear relationship between the dependent variable (our output) and the independent variables (our input) and gives the best-fitting relation by minimising the least squares error and the general linear regression, which takes into account possible attributes of the dataset, such as heteroscedasticity or correlation, and, is also more efficient in analysing datasets with cross sectional data (such as time series) included in our model. The model used for both energy trends several explanatory variables, determinants of patenting activities. From these we extracted valuable information concerning the R&D input, the energy consumption and the electricity prices. R&D was measured in two separate ways: the R&D intensity, which reflects the R&D expenditures ratio, spent on each energy trend and R&D personnel. Both of these variables showed a positive linkage to the output. Positive impact also came from energy consumption. As for the electricity ratio, a subsidy for the electricity prices for households and industries, the results diverged, depending on the energy sector. For the renewable energy, the electricity ratio had a negative impact denoting the importance of the industry electricity price as innovation determinant and for energy efficiency; the electricity ratio had a positive impact denoting the importance of household prices as innovation determinants. At the same time, we should mention the fact that policy instruments follow this observation: for energy efficiency, most measures are implemented in the household sector, while on renewable energy most measures affect the industry sector. The regression analyses showed interesting results concerning the policy instruments for both energy trends. While the renewables favour price based instruments, such as taxes and tariffs, the energy efficiency favours legislative (like quotas) and financial (like grants and subsidies). This observation is very important as it shows the tendencies of the last 17 years to promote different energy trends. For renewables, which were boosted right after the energy crises, the measures have a more obligatory character in order to succeed. This information combined with the fact that renewables were mostly promoted in the industry sector (which by definition consumes the largest amount of energy) links renewable innovation to stringency policies. On the contrary, energy efficiency has a more liberate character. This is also connected to the fact that it is mostly implemented in households. After the conclusions, the policy measures provide a clearer picture of how environmental innovation is linked to them. In conclusion, the environmental innovation is strongly related to existing policy measures, and, in fact, different policy instruments have greater effect on different environmental friendly energy trends than others. Price based measures are most effective in inducing innovation for renewable energy technologies, while legislative and financial measures are most effective on energy saving innovation. During the study, there were found no significant results on voluntary measures. In general, public policies are linked directly to these two energy trends. This conclusion could urge the promotion of the two trends in parallel so that the targets (pollution abatement and security of supply) of the European Commission are achieved as scheduled.Engineering and Policy AnalysisInnovation SystemsTechnology, Policy and Managemen