'He just gave up': an exploratory study into the perspectives of paid carers on supporting older people living in care homes with depression, self-harm, and suicide ideation and behaviours

This study explored the concept of ‘giving up’ from the perspective of care staff working in care homes, and their everyday communication and hidden knowledge concerning what they think about this taboo topic and the context it reflects. Moving to a care home is a major transition where cumulative losses can pose risks to mental health in later life. If not recognised, this vulnerability can lead to depression which extends to suicide ideation and behaviours in the form of self-harm and self-neglect. Care homes are a significant place of care until death, yet a discourse of silence means that self-harm and suicide is under-reported or not attended to with specialist expertise. The layperson’s concept of an older person ‘giving up’ on life is hardly discussed in the literature. This co-produced qualitative study used an inductive approach to explore this phenomenon through focus groups with 33 care staff across four care homes in South-East England. Findings paint a complex picture, highlighting tensions in providing the right support and creating spaces to respond to such challenging situations. ‘Giving up’ requires skilled detailed assessment to respond to risks alongside improved training and support for paid carers, to achieve a more holistic strategy which capitalises on significant relationships within a wider context

Association of Autoimmunity to Autonomic Nervous Structures With Nerve Function in Patients With Type 1 Diabetes: A 16-Year Prospective Study

OBJECTIVE We prospectively evaluate the association between autoimmunity to autonomic nervous structures and autonomic neuropathy in type 1 diabetes in relation to clinical variables. RESEARCH DESIGN AND METHODS A cohort of 112 patients with type 1 diabetes was prospectively followed from adolescence (T0) to approximately 4 (T4) and 16 (T16) years later. Standard cardiovascular (CV) tests and neurological examination were performed and related to the presence of circulating antibodies (Ab) to autonomic nervous structures detected at T0 and T4. Quality of life was assessed by a diabetes-specific questionnaire. RESULTS Sixty-six patients (59% of the cohort) were re-examined at T16 (age 31.4 ± 2 years; disease duration 23.4 ± 3.7 years). Nineteen had circulating Ab to autonomic structures. Prevalence of abnormal tests and autonomic symptoms were higher in Ab-positive (68 and 26%, respectively) than Ab-negative (32 and 4%) patients ( P 1c increase). Presence of Ab carried over a 68% probability of developing an altered CV test; absence of Ab carried a 91% probability of not having an altered DB test and an 89% probability of not having an altered Valsalva ratio. Autonomic neuropathy was independently associated with worse quality of life. CONCLUSIONS Circulating Ab to autonomic structures are associated with the development of autonomic dysfunction in young diabetic patients independent of glycemic control

Needs, expectations and consequences for the child growing up in a family with a parent with mental illness

Parental mental illness is considered one of the strongest risk-factors for development of offspring psychopathology. The lack of pan-European guidelines for empowering children of parents with mental illness led to EU project CAMILLE - Empowerment of Children and Adolescents of Mentally Ill Parents through Training of Professionals working with children and adolescents. The first task in this project, was to analyse needs, expectations and consequences for children, with respect to living with a parent with mental illness. The aim this paper is to report results of these analyses. The qualitative research was conducted in England, Finland, Germany, Italy, Norway, Poland and Scotland (N=96). There were 3 types of focus groups: (1) professionals (doctors, nurses, psychologists, social workers), (2) adult children and partners of a person with mental illness, (3) parents who have experienced mental illness during their parenthood. Framework analysis method was used. Results of the study highlighted that the main consequences for children of parental mental illness were role reversal, emotional and behavioural problems, lack of parent’s attention and stigma. The main needs of these children were emotional support, security and multidisciplinary help. Implications for practice are: (1) professionals working with parents with mental illness should be aware of the specific consequences for the children; (2) to empower children they should focus on them, but not excluding parents from the parental roles; (3) the multi-agency collaboration is necessary; (4) schools should provide counselling and teach staff and students about mental health problems to reduce stigm

Peripheral neuropathy after viral eradication with direct-acting antivirals in chronic HCV hepatitis: A prospective study

BACKGROUND: HCV‐related extra‐hepatic complications include peripheral neuropathies, with important prevalence and impact. A recent metanalysis of previous intervention trials concluded for insufficient data to support evidence‐based treatments for this complication. In this longitudinal study, we assessed for the first time prevalence and outcome of neuropathy in a cohort of patients with chronic HCV, before and after direct‐acting antiviral agent (DAA) treatment. METHOD: Ninety‐four patients (mean age 58.5 ± 9.9, infection duration 22.2 ± 6.3 years) without systemic and metabolic diseases, underwent neurological examination and electroneurography studies before (T0) and 10.4 ± 1.7 months after the end of DAA therapy (T1), and cryoglobulins (CG) assessment. Muscle strength was evaluated by Medical Research Council (MRC) score; neuropathic pain, sensory function, disability, quality of life were assessed by validated questionnaires (DN4, NPSI, SSS, INCAT and Euro‐QoL). RESULTS: At T0, sensory‐motor neuropathy was detected in 22 patients (23%), reflexes were depressed in 32 (34%) with no association with infection duration, viral load, age, CG. Neuropathic pain (DN4 ≥4) was present in 37 patients (39%). At T1, out of the 22 patients with altered electroneurography, 3 had died or developed HCC, 4 showed normal electroneurography, and nerve amplitude parameters tended to improve in the whole group. Only 11 patients (12%) had depressed reflexes and 10 (11%) DN4 ≥4 (P < .05 compared to T0). Scores for MRC, questionnaires and Euro‐QoL improved significantly (P < .05). CONCLUSION: Our study confirms the high prevalence of clinical and subclinical peripheral sensory‐motor neuropathy in patients with HCV infection and indicates improvement after eradication by DAA. These results support the need for larger intervention studies

Eficiencia energética en vivienda: aplicación de norma IRAM 11900 y uso del evaluador energético en prototipos aislados para Buenos Aires

Teniendo en cuenta el contexto energético local y el creciente interés del gobierno nacional en la implementación de medidas para el ahorro y la disminución de la demanda de energía, se han producido recientes avances en el desarrollo de normas para la promoción de la eficiencia energética en edificios. En este contexto, el presente trabajo tiene por objetivo la aplicación práctica de la Norma IRAM 11.900 en prototipos de vivienda aisladas para el área metropolitana de Buenos Aires y de la Planilla Evaluador Energético, a fin de evaluar su implementación en este tipo de edificios. Las conclusiones obtenidas han permitido demostrar que toda herramienta de evaluación o calificación tendiente a la disminución de la demanda debe considerar el edificio como un sistema de energía integral, evaluando tanto los aspectos morfológicos y tecnológicos de la envolvente como los factores de uso e instalaciones que inciden en el consumo.Considering the local energy context and the increasing government interest in reducing energy consumption, recent advances in the normalization promoting energy efficiency in buildings were produced. Taking this into account the aim of this paper is to apply the IRAM 11.900 norm and the Evaluador Energético in prototypes of isolated houses in the metropolitan area of Buenos Aires and to evaluate its implementation in this kind of building. The results obtained prove that every evaluation-qualification method, aimed to promote envelope energy efficiency, must consider buildings like an energy system where morphology and technology aspects are integrated with use factors and conditioning systems that affects energy consumption.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Eficiencia energética en vivienda: aplicación de norma IRAM 11900 y uso del evaluador energético en prototipos aislados para Buenos Aires

Teniendo en cuenta el contexto energético local y el creciente interés del gobierno nacional en la implementación de medidas para el ahorro y la disminución de la demanda de energía, se han producido recientes avances en el desarrollo de normas para la promoción de la eficiencia energética en edificios. En este contexto, el presente trabajo tiene por objetivo la aplicación práctica de la Norma IRAM 11.900 en prototipos de vivienda aisladas para el área metropolitana de Buenos Aires y de la Planilla Evaluador Energético, a fin de evaluar su implementación en este tipo de edificios. Las conclusiones obtenidas han permitido demostrar que toda herramienta de evaluación o calificación tendiente a la disminución de la demanda debe considerar el edificio como un sistema de energía integral, evaluando tanto los aspectos morfológicos y tecnológicos de la envolvente como los factores de uso e instalaciones que inciden en el consumo.Considering the local energy context and the increasing government interest in reducing energy consumption, recent advances in the normalization promoting energy efficiency in buildings were produced. Taking this into account the aim of this paper is to apply the IRAM 11.900 norm and the Evaluador Energético in prototypes of isolated houses in the metropolitan area of Buenos Aires and to evaluate its implementation in this kind of building. The results obtained prove that every evaluation-qualification method, aimed to promote envelope energy efficiency, must consider buildings like an energy system where morphology and technology aspects are integrated with use factors and conditioning systems that affects energy consumption.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES