Predictors of satisfaction with life in family carers: evidence from the third European quality of life survey

This research aimed to identify predictors of satisfaction with life in family carers. Evidence from the literature and from the Third European Quality of Life Survey (years 2011–2012) led to the construction of a model which was tested through linear regression analysis. The results corroborate findings from previous studies identified in the literature, showing that married and employed carers with higher education, those with fewer difficulties making ends meet with their household income and those who are healthier have higher levels of satisfaction with life. Carers that participate in physical and social activities and have larger informal social support networks also have higher levels of satisfaction with life. Those reporting difficulties finding time to see a doctor for their own health due to their caregiving role and those experiencing difficulties in accessing formal long-term care have lower satisfaction with life. Policies aiming at balancing care and other activities, such as work, respite and activities in other life spheres, may have an important influence on informal carers’ quality of life

Improving health-promoting self-care in family carers of people with dementia: a review of interventions

Background: Providing care for a family member with dementia can leave little time for carers to look after their own health needs, which makes them more susceptible to mental and physical health problems. This scoping review aimed to explore potential health benefits of interventions aimed at improving health-promoting self-care in family carers of people with dementia.Methods: A scoping review was carried out using Arksey and O’Malley’s methodological framework. EMBASE, MEDLINE, PsycINFO, Google Scholar databases. Original and peer-reviewed research published in English up to April 2017 were included. Publications were selected by two reviewers independently. Eight experts from several countries provided extra relevant information, which was triangulated with the review results. A narrative approach was used to describe and discuss the review findings.Results: Seven interventions were identified. These were highly heterogeneous in content, method of delivery and outcome measures. None was specifically focused on improving and evaluating health-promoting self-care, instead they often focused on health promotion and healthy lifestyle (e.g. physical activity). Some of the multi-component interventions included ‘self-care’ as a domain, but as none used a specific measure of health-promoting self-care, so we are unable to affirm that the improvements found in the interventions were due to an improvement in this area. Interventions helped reduce carer depression and burden and increased quality of life, positive affect and physical activity. The expert panel recommended to consider carers’ preparedness and capacity to adhere to self-care practices, as well as carers’ age and culture. Future interventions should be context specific, flexible and person-centered.Conclusions: Psychosocial interventions may improve health-promoting self-care behavior, but more research is needed to establish efficacy. Interventions should be flexible, use a person-centered approach, be implemented with fidelity and use the right dosage

Development of metformin HCl granules using brown flaxseed mucilage as a retardant polymer: effects of polymer and drug ratio

Flaxseed (Linum usitatissimum L.) is the seed of a multipurpose plant of pharmaceutical interest, as its mucilage can be used as a natural matrix to develop extended-release dosage forms and potentially replace synthetic polymers. In this study, a 3² factorial design with two replicates of the central point was applied to optimize the development of extended-release granules of metformin HCl. The total fiber content of the mucilage as well as the friability and dissolution of the formulations were evaluated. The lyophilized mucilage presented a high total fiber content (42.63%), which suggests a high efficiency extraction process. Higher concentrations of the mucilage and metformin HCl yielded less friable granules. In addition, lower concentrations of metformin HCl and higher concentrations of the mucilage resulted in slower drug release during the dissolution assays. The release kinetics for most formulations were better represented by the Hixson-Crowell model, while formulations containing a higher concentration of the mucilage were represented by the Korsmeyer-Peppas model. Nonetheless, five formulations showed a longer release than the reference HPMC formulation. More desirable results were obtained with a higher concentration of the mucilage (13-18%) and a lower concentration of metformin (40%)

Ageing and quality of life in family carers of people with dementia being cared for at home: a literature review

Background: Despite the increasing older population providing care for family members with dementia at home, there is no consensus in the literature in terms of how caring impacts on their quality of life (QoL) and the association of the family carer's age with QoL outcomes. Aims: To explore the available literature investigating the QoL of older family carers (family carers aged > 60) and the association of family carers' age and QoL outcomes in a dementia context. Methods: A review of the literature to December 2013 was conducted using Embase-O VID, CINAL, Medline-OVID, Psyc INFO-OVID, Grey literature and the references of the included studies. Cross-sectional or prospective longitudinal studies published in English were eligible. The selection and appraisal processes were performed by two reviewers independently and the methodological quality was assessed by STROBE statement. Results: From the 12 selected studies, 4 were carried out with older family carers' samples and 8 associated the variable 'age' with QoL outcomes. Eight different instruments were used to assess family carers' QoL, however none were designed specifically for older people or older family carers. The mean age of the carers' samples ranged from 55.2 to 76.0 years old. Older family carers showed low levels of QoL and were often below the age-matched standard population. Carers' age was negatively correlated with QoL outcomes in most of the studies. Conclusion: Older people are increasingly involved with dementia care and family carer's advanced age was shown to be associated with low levels of QoL. Future research should investigate the QoL of older family carers separately and use QoL instruments containing older family carers' specific needs and perspectives of QoL. In planning care and support, primary health care practitioners should consider family carer's age group and their specific needs

High Performing Hospital Enterprise Architecture: Insights from a Multi-method Exploratory Case

The US healthcare system is a critical infrastructure grappling with as much as 16% of the GDP in its expenditures and unsatisfactory outcomes, and undergoing considerable public scrutiny. High ranking officials have both singled out the US healthcare system as the most expensive and among the least effective in the developed world. Hospitals hoping to find “The Toyota Way” so as to rid themselves of waste through lean and six sigma improvement initiatives, have mostly focused in applying tools at a process level, rather than adopting an enterprise perspective and understanding the full breadth of their socio-technical complexity. This paper adopts a systems thinking approach in describing a leading Boston hospital’s enterprise architecture through a multi-method exploratory case. The initial exploratory question proposed by hospital senior leadership was “How to speed patient flow in the Emergency Department?”, however as results became available, the scope was expanded to include the whole hospital enterprise. Both qualitative and quantitative data evidence were collected through a variety of methods, namely observation, archival records, documentation, and interviews. Analysis includes techniques consistent with the grounded theory approach, as well as more traditional quantitative data analysis. Hospital enterprise performance is hypothesized to be related to hospital enterprise architecture, and an alternative hospital enterprise architecture is proposed as well as future work

NATURE-BASED SOLUTION AS FLOOD PROTECTION STRATEGIES: THE CASE OF CARAHÁ RIVER PARK, BRAZIL

Following the road paradigm, many cities, at the beginning of the 20th century, experienced a reckless increase in the number of vehicles on the road causing an unsustainable urban and environmental situation. The origin of the problem surely lies in the occupation of the preserved areas. In many South American states, for example, highways generally ignore the presence of environmental obstacles (such as rivers) as they may cause a “delay in modernization”. As a result, riparian forests are invaded and turned into highways, water beds are channeled and most rivers are contaminated with wastewater. Due to the occupation of green and riparian areas, urban floods have become more and more and consequently urban spaces have been disqualified. This situation also involved the Carahá River that crosses the city of Lages in southern Brazil, in fact the river embankment has become completely impermeable due to the construction of an urban road. Proposing urban spaces with an emphasis on improving environmental quality and integrating forms of public transport are basic points that could lead to the sustainable development of our cities. In this context, the aim of this research is to propose a sustainable river project for the Carahá River, with the aim of presenting nature-based solutions to prevent floods and improve the environmental, functional and aesthetic quality of the city. To develop this research, first theoretical studies were carried out on the relationship between rivers and cities, secondly three international case studies and related literature were analyzed with the aim of deepening the knowledge of the connection between rivers and population. Finally, an intensive study of the territory was carried out and a social analysis was conducted through a semi-structured interview in which the population of Lages participated. The result of this study contributed to effectively defining the intervention guidelines for the Carahá river park project considering, as an added value, also the main needs of citizens

Nature Based Solution As Flood Protection Strategies: The Case Of Caraha River Park, Brazil

Following the road paradigm, many cities, at the beginning of the 20th century, experienced a reckless increase in the number of vehicles on the road causing an unsustainable urban and environmental situation. The origin of the problem surely lies in the occupation of the preserved areas. In many South American states, for example, highways generally ignore the presence of environmental obstacles (such as rivers) as they may cause a “delay in modernization”. As a result, riparian forests are invaded and turned into highways, water beds are channeled and most rivers are contaminated with wastewater. Due to the occupation of green and riparian areas, urban floods have become more and more and consequently urban spaces have been disqualified. This situation also involved the Carahá River that crosses the city of Lages in southern Brazil, in fact the river embankment has become completely impermeable due to the construction of an urban road. Proposing urban spaces with an emphasis on improving environmental quality and integrating forms of public transport are basic points that could lead to the sustainable development of our cities. In this context, the aim of this research is to propose a sustainable river project for the Carahá River, with the aim of presenting nature-based solutions to prevent floods and improve the environmental, functional and aesthetic quality of the city. To develop this research, first theoretical studies were carried out on the relationship between rivers and cities, secondly three international case studies and related literature were analyzed with the aim of deepening the knowledge of the connection between rivers and population. Finally, an intensive study of the territory was carried out and a social analysis was conducted through a semi-structured interview in which the population of Lages participated. The result of this study contributed to effectively defining the intervention guidelines for the Carahá river park project considering, as an added value, also the main needs of citizens