NCHS Data on Drug-poisoning Deaths
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Vascular access for home haemodialysis.
Al Shakarchi, Julien; Day, C; Inston, N
2018-03-01
Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.
75 FR 55333 - Board of Scientific Counselors, National Center for Health Statistics, (BSC, NCHS)
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Velásquez, Claudia; Bermúdez, Juliana; Echeverri, Claudia; Estrada, Alejandro
2011-12-01
A descriptive study was conducted to evaluate the concordance of National Center for Health Statistics reference (NCHS) used to classify undernourished children from Colombia with the WHO Child Growth Standards. We used data from children aged 6 to 59 months with acute malnutrition (Z <-2) and severe (Z <-3) who were admitted to the "Unidad Vida Infantil" nutrition program in Colombia. Indicators height-for-age, weight for-height were analyzed when they were admitted to the hospital and weight for-height leaving the hospital. A statistical method used to compare means was T-student. Correlation coefficient intraclass (CCI) and Kappa index evaluated the concordance between NCHS and OMS; McNemar method evaluated the changes on the nutritional classification for children according to growth devices used. Of the total number of children classified as normal by NCHS, 10.4% were classified as stunted by WHO. 64% of the children admitted to the hospital presented acute malnutrition according to NCHS, of these 44,8% presented severe emaciation according to OMS, indeed severe emaciation increased of 36,0% to 63,3% using OMS. 5% of children leaving the hospital could need to stay more days if they had been evaluated with OMS. Growth devices shown high concordance in height-for-age (CCI = 0,988; k= 0,866) and weight for-height (CCI = 0,901; k = 0,578). Concluded that OMS growth standards classified more malnourished children and more severe states, in addition more malnourished children could be hospitalized and they could stay more days.
Development of an integrated staircase lift for home access.
Mattie, Johanne L; Borisoff, Jaimie F; Leland, Danny; Miller, William C
2015-12-01
Stairways into buildings present a significant environmental barrier for those with mobility impairments, including older adults. A number of home access solutions that allow users to safely enter and exit the home exist, however these all have some limitations. The purpose of this work was to develop a novel, inclusive home access solution that integrates a staircase and a lift into one device. The development of an integrated staircase lift followed a structured protocol with stakeholders providing feedback at various stages in the design process, consistent with rehabilitation engineering design methods. A novel home access device was developed. The integrated staircase-lift has the following features: inclusivity, by a universal design that provides an option for either use of stairs or a lift; constant availability, with a lift platform always ready for use on either level; and potential aesthetic advantages when integrating the device into an existing home. The potential also exists for emergency descent during a power outage, and self-powered versions. By engaging stakeholders in a user centred design process, insight on the limitations of existing home access solutions and specific feedback on our design guided development of a novel home access device.
Catalog of electronic data products
NASA Astrophysics Data System (ADS)
1990-07-01
The catalog lists and describes the public-use data files produced by the National Center for Health Statistics (NCHS). More than 500 public-use data files, representing most of the NCHS data collection programs, are available for purchase and use. Public-use data files are prepared and disseminated to speed and enhance access to the full scope of data. NCHS data systems include a national vital registration program; household interview and health examination surveys; surveys of hospitals, nursing homes, physicians, and other health care providers; and other periodic or occasional data collection activities to produce a wide spectrum of health and health-related data. NCHS data users encompass all levels of government, the academic and research communities, and business. The majority of the data files released by NCHS contain microdata to allow researchers to aggregate findings in whatever format appropriate for their analyses.
77 FR 31359 - Board of Scientific Counselors, National Center for Health Statistics (BSC, NCHS)
Federal Register 2010, 2011, 2012, 2013, 2014
2012-05-25
...., Director of Extramural Research, NCHS/CDC, 3311 Toledo Road, Room 7208, Hyattsville, Maryland 20782... Services Office, has been delegated the authority to sign Federal Register notices pertaining to...
47 CFR 76.806 - Pre-termination access to cable home wiring.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 47 Telecommunication 4 2011-10-01 2011-10-01 false Pre-termination access to cable home wiring. 76... access to cable home wiring. (a) Prior to termination of service, a customer may: install or provide for the installation of their own cable home wiring; or connect additional home wiring, splitters or other...
47 CFR 76.806 - Pre-termination access to cable home wiring.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 47 Telecommunication 4 2014-10-01 2014-10-01 false Pre-termination access to cable home wiring. 76... access to cable home wiring. (a) Prior to termination of service, a customer may: install or provide for the installation of their own cable home wiring; or connect additional home wiring, splitters or other...
47 CFR 76.806 - Pre-termination access to cable home wiring.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 47 Telecommunication 4 2013-10-01 2013-10-01 false Pre-termination access to cable home wiring. 76... access to cable home wiring. (a) Prior to termination of service, a customer may: install or provide for the installation of their own cable home wiring; or connect additional home wiring, splitters or other...
Access Control for Home Data Sharing: Attitudes, Needs and Practices
2009-10-01
cameras, mobile phones and portable music players make creating and interacting with this content easy. Home users are increasingly interested in...messages, photos, home videos, journal files and home musical recordings. Many participants considered unauthorized access by strangers, acquaintances...configuration does not allow users to share different subsets of music with different people. Facebook supplies rich, customizable access controls for
Comparison of NCHS, CDC, and WHO curves in children with cardiovascular risk.
Oliveira, Grasiela Junges de; Barbiero, Sandra Mari; Cesa, Claudia Ciceri; Pellanda, Lucia Campos
2013-01-01
The study aimed to compare the prevalence of overweight and obesity according to three growth curves, created by the World Health Organization (WHO/2006), by the National Center for Health Statistics (NCHS/1977), and by the Centers for Disease Control and Prevention (CDC/2000) in children with cardiovascular risk factors. Data from 118 children and adolescents, aged between 2 and 19 years, treated between the years 2001 to 2009 at the Pediatric Preventive Cardiology Outpatient Clinic of the Instituto de Cardiologia de Porto Alegre were evaluated. The variables analyzed were: weight, height, age, and gender. Variables were classified according to the following criteria: weight/age, height/age, and body mass index (BMI). The cutoff points used were obtained from the three growth curves: WHO/2006, NCHS/1977, and CDC/2000. Regarding the criterion weight/age by the NCHS curve, 18% of the children were classified as having normal weight, and 82% had excess weight; by the CDC curve, 28% had normal and 72% had excess weight; by the WHO curve, 16.0% had normal weight and 84% had excess weight. According to the BMI, 0.8% of the population was underweight. According to the CDC and WHO curves, 7.6% and 6.8% had normal weight; 26.3% and 11.9% were overweight; and 65.3% and 80.5% were obese, respectively. Regarding the height/age criterion, there was no significant difference between the references and, on average, 98.3% of the population showed adequate height for age. The new WHO curves are more sensitive to identify obesity in a population at risk, which has important implications for preventive and therapeutic management. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
Orellana, Jesem D Y; Santos, Ricardo V; Coimbra, Carlos E A; Leite, Maurício S
2009-01-01
To perform a comparative analysis of anthropometric data from Suruí, Xavánte and Wari' indigenous children under 60 months of age using the NCHS/1977 and the WHO/2005 growth curves. Anthropometric measurements followed standard procedures and the data obtained were converted into z scores using the Epi-Info (Version 3.4) and WHO-Anthro (Version Beta) softwares. The indices height/age (H/A), weight/age (W/A) and weight/height (W/H) were descriptors of nutritional status for all children under 60 months of age, as well as the body mass index (BMI) for children 24-59 months old. The frequencies of Suruí children < -2 z scores for H/A were 31.4 (NCHS/1977) and 38.6% (WHO/2005); Xavánte 30.9 and 42.3%; Wari' 61.7 and 68.3%. The frequencies of Suruí children < -2 z scores for W/A were 12.4 (NCHS/1977) and 8.5% (WHO/2005); Xavánte 16.5 and 11.6%; Wari' 51.7 and 45.0%. None of the Suruí children were < -2 z scores for W/H (NCHS/1977 and WHO/2005); the frequencies of Xavánte children were 1.7 and 3.3% and Wari' 1.7 and 0.0%. The frequencies of Suruí children > 2 z scores for W/H were 3.9 (NCHS/1977) and 3.9% (WHO/2005); Xavánte 0.0 and 0.8%; Wari' 0.0 and 0.0%. The frequency of Suruí children aged 24-59 months > 2 z scores for BMI was 5.4% (WHO/2005); Xavánte 9.5%; and Wari' 0.0%. Our findings revealed important differences in the results from nutritional assessment, according to the set of growth curves used; however, the use of both growth curves revealed a high prevalence of malnutrition. Therefore, future studies with indigenous populations should present their results using two sets of growth curves to allow consistent comparison.
Access to palliative care and hospice in nursing homes.
Zerzan, J; Stearns, S; Hanson, L
2000-11-15
Nursing homes are the site of death for many elderly patients with incurable chronic illness, yet dying nursing home residents have limited access to palliative care and hospice. The probability that a nursing home will be the site of death increased from 18.7% in 1986 to 20.0% by 1993. Dying residents experience high rates of untreated pain and other symptoms. They and their family members are isolated from social and spiritual support. Hospice improves end-of-life care for dying nursing home residents by improving pain control, reducing hospitalization, and reducing use of tube feeding, but it is rarely used. For example, in 1997 only 13% of hospice enrollees were in nursing homes while 87% were in private homes, and 70% of nursing homes had no hospice patients. Hospice use varies by region, and rates of use are associated with nursing home administrators' attitudes toward hospice and contractual obligations. Current health policy discourages use of palliative care and hospice for dying nursing home residents. Quality standards and reimbursement rules provide incentives for restorative care and technologically intensive treatments rather than labor-intensive palliative care. Reimbursement incentives, contractual requirements, and concerns about health care fraud also limit its use. Changes in health policy, quality standards, and reimbursement incentives are essential to improve access to palliative care and hospice for dying nursing home residents. JAMA. 2000;284:2489-2494.
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... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards Staff, Announces the... Prevention, Classifications and Public Health Data Standards, 3311 Toledo Road, Room 2337, Hyattsville, MD...
Selamat, Rusidah; Zain, Fuziah; Raib, Junidah; Zakaria, Rosini; Marzuki, Mohd Shaffari; Ibrahim, Taziah Fatimah
2011-12-01
To study the validity of the visual clinical assessment of weight relative to length and length relative to age as compared to the World Health Organization (WHO) 2006 standard and National Center for Health Statistics (NCHS) 1977 reference in asssessing the physical growth of children younger than 1 year. A prospective cohort study was carried out among 684 infants attending goverment health clinics in 2 states in Malaysia. Body weight, length, and clinical assessment were measured on the same day for 9 visits, scheduled every month until 6 months of age and every 2 months until 12 months of age. All of the 3 z-scores for weight for age (WAZ), length for age (HAZ), and weight for length (WHZ) were calculated using WHO Anthro for Personal Computers software. The average sensitivity and specificity for the visual clinical assessment for the detection of thinness were higher using the WHO 2006 standard as compared with using NCHS 1977. However, the overall sensitivity of the visual clinical assessment for the detection of thin and lean children was lower from 1 month of age until a year as compared with the WHO 2006 standard and NCHS 1977 reference. The positive predictive value (PPV) for the visual clinical assessment versus the WHO 2006 standard was almost doubled as compared with the PPV of visual clinical assessment versus the NCHS 1977 reference. The overall average sensitivity, specificity, PPV, and negative predictive value for the detection of stunting was higher for visual clinical assessment versus the WHO 2006 standard as compared with visual clinical assessment versus the NCHS 1977 reference. The sensitivity and specificity of visual clinical assessment for the detection of wasting and stunting among infants are better for the WHO 2006 standard than the NCHS 1977 reference.
75 FR 82030 - Board of Scientific Counselors, National Center for Health Statistics (BSC, NCHS)
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76 FR 53137 - Board of Scientific Counselors, National Center for Health Statistics, (BSC, NCHS)
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... Regulation, Subpart 101-20.301, all persons entering in or on Federal controlled property and their packages... Discussed: The agenda will include welcome remarks by the Director, NCHS; update on the Health Indicators Warehouse; update on program reviews; discussion of the NHANES program, plans for the NHIS for 2012 and...
Spatial access to restaurants and grocery stores in relation to frequency of home cooking.
Pinho, Maria Gabriela M; Mackenbach, Joreintje D; Charreire, Hélène; Oppert, Jean-Michel; Bárdos, Helga; Rutter, Harry; Compernolle, Sofie; Beulens, Joline W J; Brug, Johannes; Lakerveld, Jeroen
2018-01-16
Little is known about the relation between the neighbourhood food environment and home cooking. We explored the independent and combined associations between residential neighbourhood spatial access to restaurants and grocery stores with home cooking in European adults. Data of 5076 participants of the SPOTLIGHT study were collected across five European countries in 2014. Food retailers were classified into grocery stores (supermarkets and local food shops) and restaurants (full-service restaurants, fast food and take-away restaurants, café/bars). We used multinomial logistic regression models to test the associations between tertiles of spatial access to restaurants and spatial to access grocery stores and the outcome 'frequency of home cooking' categorized into 0-3; 4-5; and 6-7 days/week. Additive interaction analysis was used to test the combined association between access to grocery stores and to restaurants with home cooking. Mean age was 52.3 years; most participants were women (55.5%) and completed higher education (53.8%). Residents with highest access to restaurants had a reduced likelihood of home cooking 6-7 days/week (vs. 0-3 days/week) (relative risk ratio (RRR) 0.42; 95%CI = 0.23-0.76) when compared with lowest access to restaurants. No association was found for spatial access to grocery stores. Additive interaction analysis showed that individuals with medium access to grocery stores and highest access to restaurants had the lowest likelihood (RRR = 0.29, 95%CI = 0.10-0.84) of cooking 6-7 days/week when compared to individuals with lowest access to restaurants and highest access to grocery stores. Greater neighbourhood spatial access to restaurants was associated with lower frequency of home cooking, largely independent of access to grocery stores.
ERIC Educational Resources Information Center
Access Group, Atlanta, GA.
Two brief fact sheets for people with disabilities provide information on: (1) modifying a trailer to make it accessible for persons with mobility impairments, especially those in wheelchairs, and (2) accessibility considerations for home buyers or home owners with mobility impairments. The first fact sheet identifies inherent problems in…
A remote data access architecture for home-monitoring health-care applications.
Lin, Chao-Hung; Young, Shuenn-Tsong; Kuo, Te-Son
2007-03-01
With the aging of the population and the increasing patient preference for receiving care in their own homes, remote home care is one of the fastest growing areas of health care in Taiwan and many other countries. Many remote home-monitoring applications have been developed and implemented to enable both formal and informal caregivers to have remote access to patient data so that they can respond instantly to any abnormalities of in-home patients. The aim of this technology is to give both patients and relatives better control of the health care, reduce the burden on informal caregivers and reduce visits to hospitals and thus result in a better quality of life for both the patient and his/her family. To facilitate their widespread adoption, remote home-monitoring systems take advantage of the low-cost features and popularity of the Internet and PCs, but are inherently exposed to several security risks, such as virus and denial-of-service (DoS) attacks. These security threats exist as long as the in-home PC is directly accessible by remote-monitoring users over the Internet. The purpose of the study reported in this paper was to improve the security of such systems, with the proposed architecture aimed at increasing the system availability and confidentiality of patient information. A broker server is introduced between the remote-monitoring devices and the in-home PCs. This topology removes direct access to the in-home PC, and a firewall can be configured to deny all inbound connections while the remote home-monitoring application is operating. This architecture helps to transfer the security risks from the in-home PC to the managed broker server, on which more advanced security measures can be implemented. The pros and cons of this novel architecture design are also discussed and summarized.
A survey of access to medical services in nursing and residential homes in England.
Glendinning, Caroline; Jacobs, Sally; Alborz, Alison; Hann, Mark
2002-07-01
Residential and nursing homes make major demands on NHS services. To investigate patterns of access to medical services for residents in homes for older people. Telephone survey. All nursing and dual registered homes and one in four residential homes located in a stratified random sample of 72 English primary care group/trust (PCG/T) areas. A structured questionnaire investigating home characteristics, numbers of general practitioners (GPs) or practices per home, homes' policies for registering new residents with GPs, existence of payments to GPs, GP services provided to homes, and access to specialist medical care. There were wide variations in the numbers of GPs providing services to individual homes; this was not entirely dependent on home size. Eight percent of homes paid local GPs for their services to residents; these were more likely to be nursing homes (33%) than residential homes (odds ratio [OR] = 10.82, [95% CI = 4.48 to 26.13], P<0.001) and larger homes (OR for a ten-bed increase = 1.51 [95% CI = 1.28 to 1.79], P<0.001). Larger homes were more likely to encourage residents to register with a 'home' GP (OR for a ten-bed increase = 1.16 [95% CI = 1.04 to 1.31], P = 0.009). Homes paying local GPs were more likely to receive one or more additional services, over and above GPs' core contractual obligations. Few homes had direct access to specialist clinicians. Extensive variations in homes' policies and local GP services raise serious questions about patient choice, levels of GP services and, above all, about equity between residents within homes, between homes and between those in homes and in the community.
Nutrition accesses among patients receiving enteral treatment in the home environment.
Sznajder, Janusz; Ślefarska-Wasilewska, Marta; Wójcik, Piotr
2017-10-31
Enteral feeding in the home environment is connected with creating access to digestive tract, and thanks to that, this kind of treatment is possible. The gold standard in enteral nutrition is PEG, other types of access are: nasogastric tube, gastronomy and jejunostomy. In the article 851 patients who were treated nutritionally in the home environment, in the nutrition clinic, Nutrimed Górny Śląsk, were analyzed. It was described how, in practice, the schedule of nutrition access looks like in the nutrition clinic at a time of qualifying patients to the treatment (PEG 47,35%, gastronomy 18,91%, nasogastric tube 17,39%,jejunostomy 16,33%) and how it changes among patients treated in the nutrition clinic during specific period of time - to the treatment there were qualified patients with at least three-month period of therapy ( second evaluation: PEG 37,01%, gastrostomy 31,13%, nasogastric tube 16,98%, jejunostomy 15,86%). The structure of changes was described, also the routine and the place in what exchanging or changing nutrition access was analyzed. The biggest changes in quantity, among all groups of ill people concerned patients with PEG and gastronomy. In most cases the intervention connected with exchanging access to the digestive tract could be implemented at patient's home.
A universal data access and protocol integration mechanism for smart home
NASA Astrophysics Data System (ADS)
Shao, Pengfei; Yang, Qi; Zhang, Xuan
2013-03-01
With the lack of standardized or completely missing communication interfaces in home electronics, there is no perfect solution to address every aspect in smart homes based on existing protocols and technologies. In addition, the central control unit (CCU) of smart home system working point-to-point between the multiple application interfaces and the underlying hardware interfaces leads to its complicated architecture and unpleasant performance. A flexible data access and protocol integration mechanism is required. The current paper offers a universal, comprehensive data access and protocol integration mechanism for a smart home. The universal mechanism works as a middleware adapter with unified agreements of the communication interfaces and protocols, offers an abstraction of the application level from the hardware specific and decoupling the hardware interface modules from the application level. Further abstraction for the application interfaces and the underlying hardware interfaces are executed based on adaption layer to provide unified interfaces for more flexible user applications and hardware protocol integration. This new universal mechanism fundamentally changes the architecture of the smart home and in some way meets the practical requirement of smart homes more flexible and desirable.
A survey of access to medical services in nursing and residential homes in England.
Glendinning, Caroline; Jacobs, Sally; Alborz, Alison; Hann, Mark
2002-01-01
BACKGROUND: Residential and nursing homes make major demands on NHS services. AIM: To investigate patterns of access to medical services for residents in homes for older people. DESIGN OF STUDY: Telephone survey. SETTING: All nursing and dual registered homes and one in four residential homes located in a stratified random sample of 72 English primary care group/trust (PCG/T) areas. METHOD: A structured questionnaire investigating home characteristics, numbers of general practitioners (GPs) or practices per home, homes' policies for registering new residents with GPs, existence of payments to GPs, GP services provided to homes, and access to specialist medical care. RESULTS: There were wide variations in the numbers of GPs providing services to individual homes; this was not entirely dependent on home size. Eight percent of homes paid local GPs for their services to residents; these were more likely to be nursing homes (33%) than residential homes (odds ratio [OR] = 10.82, [95% CI = 4.48 to 26.13], P<0.001) and larger homes (OR for a ten-bed increase = 1.51 [95% CI = 1.28 to 1.79], P<0.001). Larger homes were more likely to encourage residents to register with a 'home' GP (OR for a ten-bed increase = 1.16 [95% CI = 1.04 to 1.31], P = 0.009). Homes paying local GPs were more likely to receive one or more additional services, over and above GPs' core contractual obligations. Few homes had direct access to specialist clinicians. CONCLUSION: Extensive variations in homes' policies and local GP services raise serious questions about patient choice, levels of GP services and, above all, about equity between residents within homes, between homes and between those in homes and in the community. PMID:12120725
Accessible Home Environments for People with Functional Limitations: A Systematic Review
Cho, Hea Young; MacLachlan, Malcolm; Clarke, Michael; Mannan, Hasheem
2016-01-01
The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home. PMID:27548194
Accessible Home Environments for People with Functional Limitations: A Systematic Review.
Cho, Hea Young; MacLachlan, Malcolm; Clarke, Michael; Mannan, Hasheem
2016-08-17
The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.
Suurmond, Jeanine; Rosenmöller, Doenja L; El Mesbahi, Hakima; Lamkaddem, Majda; Essink-Bot, Marie-Louise
2016-02-01
Ethnic minority elderly have a high prevalence of functional limitations and chronic conditions compared to Dutch elderly. However, their use of home care services is low compared to Dutch elderly. Explore the barriers to access to home care services for Turkish, Moroccan Surinamese and ethnic Dutch elderly. Qualitative semi-structured group interviews and individual interviews. The Netherlands. Seven group interviews (n=50) followed by individual interviews (n=5) were conducted, in the preferred language of the participants. Results were ordered and reported according to a framework of access to health care services. This framework describes five dimensions of accessibility to generate access to health care services, from the perspective of the users: ability to perceive health needs, ability to seek health care, ability to reach, ability to pay and ability to engage. This study shows that while barriers are common among all groups, several specific barriers in access to home care services exist for ethnic minority elderly. Language and communication barriers as well as limited networks and a preference for informal care seem to mutually enforce each other, resulting in many barriers during the navigation process to home care. In order to provide equal access to home care for all who need it, the language and communication barriers should be tackled by home care services and home care nurses. Copyright © 2015 Elsevier Ltd. All rights reserved.
Socioeconomic disparities in home health care service access and utilization: a scoping review.
Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie
2012-10-01
Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage
Howard, Larry L
2014-01-01
Gains in life expectancy around the world have increasingly placed pressure on governments to ensure that the elderly receive assistance with activities of daily living. This research examines the impact of government oversight of Medicaid payment policies on access to nursing home care services in the United States. Variation in price levels induced by a federal policy shift in 1997 is used to identify the effect of Medicaid reimbursements on the number of nursing homes and beds available. Court rulings prior to the policy change are used to categorically define a range of oversight treatments at the state level. Difference-in-differences estimates indicate a significant decline in access to nursing home care services for individuals living in states in which courts consistently ruled that Medicaid reimbursements did not meet the minimum standard implied by federal law. The findings suggest that nursing home care services were made more accessible through a combination of legislative and judicial oversight of Medicaid payment policies. © The Author(s) 2014.
2014-01-01
Gains in life expectancy around the world have increasingly placed pressure on governments to ensure that the elderly receive assistance with activities of daily living. This research examines the impact of government oversight of Medicaid payment policies on access to nursing home care services in the United States. Variation in price levels induced by a federal policy shift in 1997 is used to identify the effect of Medicaid reimbursements on the number of nursing homes and beds available. Court rulings prior to the policy change are used to categorically define a range of oversight treatments at the state level. Difference-in-differences estimates indicate a significant decline in access to nursing home care services for individuals living in states in which courts consistently ruled that Medicaid reimbursements did not meet the minimum standard implied by federal law. The findings suggest that nursing home care services were made more accessible through a combination of legislative and judicial oversight of Medicaid payment policies. PMID:25526725
Technology and Learning at Home: Findings from the Evaluation of the Home Access Programme Pilot
ERIC Educational Resources Information Center
Jewitt, C.; Parashar, U.
2011-01-01
This paper examines the impact of a UK government initiative, introduced in late 2008 and closed in 2011, to provide a computer and 1 year of Internet connectivity to low-income households with children aged 5-19 years. This paper presents and discusses the findings from the evaluation of the initiative, the Home Access Programme (HAP) pilot study…
DOE Office of Scientific and Technical Information (OSTI.GOV)
Stukel, Laura; Hoen, Ben; Adomatis, Sandra
Capturing the Sun: A Roadmap for Navigating Data-Access Challenges and Auto-Populating Solar Home Sales Listings supports a vision of solar photovoltaic (PV) advocates and real estate advocates evolving together to make information about solar homes more accessible to home buyers and sellers and to simplify the process when these homes are resold. The Roadmap is based on a concept in the real estate industry known as automatic population of fields. Auto-population (also called auto-pop in the industry) is the technology that allows data aggregated by an outside industry to be matched automatically with home sale listings in a multiple listingmore » service (MLS).« less
Accessibility of Home Blood Pressure Monitors for Blind and Visually Impaired People
Uslan, Mark M.; Burton, Darren M.; Wilson, Thomas E.; Taylor, Steven; Chertow, Bruce S.; Terry, Jack E.
2007-01-01
Background The prevalence of hypertension comorbid with diabetes is a significant health care issue. Use of the home blood pressure monitor (HBPM) for aiding in the control of hypertension is noteworthy because of benefits that accrue from following a home measurement regimen. To be usable by blind and visually impaired patients, HBPMs must have speech output to convey all screen information, an easily readable visual display, identifiable controls that are easy to use, and an accessible user manual. Methods Data on the physical aspects and the features and functions of nine Food and Drug Administration-approved HBPMs (eight of which were recommended by the British Hypertension Society) were tabulated and analyzed for usability by blind and visually impaired individuals. Video Electronics Standards Association standards were used to measure contrast modulation in the displays of the HBPMs. Ten persons who are blind or visually impaired and who have diabetes were surveyed to determine how they monitor their blood pressure and to learn their ideas for improvements in usability. Results Physical controls were found to be easy to identify, and operating procedures were found to be relatively simple on all of the HBPMs, but user manuals were either inaccessible or minimally accessible to blind persons. The two HBPMs that have speech output do not voice all of the information that is displayed on the screen. Some functions that are standard in the HBPMs without speech output, such as the feature for automatically setting cuff inflation volume and memory, were lacking in the HBPMs with speech output. These features were mentioned as desirable in interviews with legally blind persons who are diabetic and who monitor their blood pressure at home. Visual display output was large and adequate in all of the HBPMs. Michelson contrast for numeric digits in the HBPM displays was also measured, ranging from 55 to 75% for characters with dominant spatial frequency components lying
Kim, Jinho
2018-04-01
The high prevalence of household firearms in the U.S. has ignited a growing body of research seeking to understand its health consequences. While a large number of studies examine the impact of firearm availability on health risks of gun owners in the household, relatively little attention is given to whether and how in-home firearm access may shape psychological outcomes among children of gun owners. This study examined whether and how in-home firearm access is associated with adolescents' depressive symptoms. Given a strong social/cultural association between masculinity and gun possession as well as stark gender differences in perceptions of safety and attitudes toward firearms, this study also investigated whether this association differs for male and female adolescents. Participants were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (n = 14,013). This study used random- and fixed-effects regression analyses as well as propensity-score matching models in order to reduce the chances of bias due to individual-level heterogeneity. The present study showed that gaining access to guns at home was significantly related to increased depressive symptoms among children of gun owners, even after accounting for both observed and unobserved individual characteristics. Both fixed-effects and propensity-score matching models yielded consistent results. In addition, the observed association between in-home firearm access and depression was more pronounced for female adolescents. Finally, this study found suggestive evidence that the perceptions of safety, especially about school (but not neighborhood), are an important mechanism linking in-home firearm access to adolescent depression. As a substantial proportion of U.S. adolescents reported in-home firearm access, the findings of this study suggest that scholars and policymakers must seriously consider mental as well as physical health consequences related to household access to
47 CFR 76.806 - Pre-termination access to cable home wiring.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 47 Telecommunication 4 2010-10-01 2010-10-01 false Pre-termination access to cable home wiring. 76.806 Section 76.806 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Cable Inside Wiring § 76.806 Pre-termination...
Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R
2015-12-01
Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.
Rosati, Robert J; Russell, David; Peng, Timothy; Brickner, Carlin; Kurowski, Daniel; Christopher, Mary Ann; Sheehan, Kathleen M
2014-06-01
The Affordable Care Act directed Medicare to update its home health prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce home health payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using home health care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit home health agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for home health agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's home health services when planning rebasing and future adjustments to the prospective payment system. Project HOPE—The People-to-People Health Foundation, Inc.
Trends in characteristics of women choosing contraindicated home births.
Zafman, Kelly B; Stone, Joanne L; Factor, Stephanie H
2018-04-12
To characterize the American College of Obstetricians and Gynecologists (ACOG) contraindicated home births and the women who are receiving these births in hopes of identifying venues for intervention. The National Center for Health Statistics (NCHS) birth certificate records from 1990 to 2015 were used. "Planned home births" were defined as those births in which birthplace was coded as "residence" and birth attendant was coded as "certified nurse midwife (CNM)" or "other midwife". Contraindicated home births were defined as "planned home births" from 1990 to 2015 that had one or more of the ACOG risk factors for home births, which include vaginal birth after prior cesarean delivery (VBAC), breech presentation and multiple gestations. A review of trends in contraindicated home births from 1990 to 2015 suggests that they are increasing in number (481-1396) and as a percentage of total births (0.01%-0.04%, P<0.001). There has been an increase in the proportion of college-educated women (31%-51%, P<0.001). Most women receive prenatal care (>95%), which is most frequently initiated in the first trimester. The majority of home births were paid out-of-pocket (65%-69%). The increasing number of contraindicated home births in the United States requires public health action. Home births are likely a matter of choice rather than a lack of resources. It is unclear if women choose home births while knowing the risk or due to a lack of information. Prenatal education about contraindicated home births is possible, as almost all women receive prenatal care.
Wojnicki, F.H.E.; Babbs, R.K.; Corwin, R.L.W
2013-01-01
When non-food-deprived rats are given brief access to vegetable shortening (a semi-solid fat used in baked products) on an intermittent basis (Monday, Wednesday, Friday), they consume significantly more and emit more operant responses for shortening than a separate group of rats given brief access to shortening every day. Since both groups are traditionally housed in the same room, it is possible that the environmental cues associated with placing shortening in the cages (e.g., investigator in room, cages opening and closing, etc.) provide predictable cues to the daily group, but unpredictable cues to the intermittent group. The present study examined the effects of providing predictable environmental cues to an isolated intermittent group in order to examine the independent contributions of intermittency and predictability on intake and operant performance. Two groups of rats were housed in the same room, with one group provided 30-min intermittent (INT) access and the second group provided 30-min daily access (D) to shortening. A third group (ISO) of rats was housed in a room by themselves in which all environmental cues associated with intermittent shortening availability were highly predictable. After five weeks of home cage shortening access, all rats were then exposed to several different operant schedules of reinforcement. The INT and ISO groups consumed significantly more shortening in the home cage than the D group. In contrast, the INT group earned significantly more reinforcers than both the ISO and D groups under all but one of the reinforcement schedules, while ISO and D did not differ. These data indicate that intermittent access will generate binge-type eating in the home cage independent of cue predictability. However, predictable cues in the home cage reduce operant responding independent of intermittent access. PMID:23535243
[Correlation of size and age in Colombian indigenous children based on WHO and NCHS references].
Benjumea-Rincón, María V; Parra-Sánchez, José H; Ocampo-Téllez, Paul R
2016-08-01
Objective To evaluate the correlation of size, according to age, of the anthropometric growth references of Colombian indigenous children studied in Encuesta Nacional de la Situación Nutricional de Colombia 2010 -ENSIN 2010 (National Survey of Nutrition in Colombia - 2010). Method A secondary analysis of 2598 data of indigenous Colombian children under five years of age, evaluated by ENSIN in 2010, was performed. The considered variables were size according to age, gender, height, place of residence, department and socioeconomic position. The classification of the deficit in size, based on the references of the National Center for Health Statistics (NCHS) and the World Health Organization (WHO), was made by using the Z <-2 score and the Anthro software. The Kappa coefficient was estimated to assess the correlation between anthropometric categories and was classified taking into account the proposal of Altman DG. Results One in four children had a deficit in size in the light of both anthropometric references. The prevalence of the deficit was higher when using the WHO standard, increased with age and was higher in children who resided in low altitude (m). The correlation between the two references was good (kappa ≥0,688, p=0,000) for children of both genders and all ages; the exception corresponded to children of age two, since it was moderate (kappa=0,601, p=0,000). The greatest disagreement in the classification was observed in the category "tall". Conclusion According to the statistical correlation found between the two anthropometric references (WHO vs. NCHS), any reference could be used for assessment of size according to for age.
Yang, Dan; Xu, Bin; Rao, Kaiyou; Sheng, Weihua
2018-01-24
Indoor occupants' positions are significant for smart home service systems, which usually consist of robot service(s), appliance control and other intelligent applications. In this paper, an innovative localization method is proposed for tracking humans' position in indoor environments based on passive infrared (PIR) sensors using an accessibility map and an A-star algorithm, aiming at providing intelligent services. First the accessibility map reflecting the visiting habits of the occupants is established through the integral training with indoor environments and other prior knowledge. Then the PIR sensors, which placement depends on the training results in the accessibility map, get the rough location information. For more precise positioning, the A-start algorithm is used to refine the localization, fused with the accessibility map and the PIR sensor data. Experiments were conducted in a mock apartment testbed. The ground truth data was obtained from an Opti-track system. The results demonstrate that the proposed method is able to track persons in a smart home environment and provide a solution for home robot localization.
Yang, Dan; Xu, Bin; Rao, Kaiyou; Sheng, Weihua
2018-01-01
Indoor occupants’ positions are significant for smart home service systems, which usually consist of robot service(s), appliance control and other intelligent applications. In this paper, an innovative localization method is proposed for tracking humans’ position in indoor environments based on passive infrared (PIR) sensors using an accessibility map and an A-star algorithm, aiming at providing intelligent services. First the accessibility map reflecting the visiting habits of the occupants is established through the integral training with indoor environments and other prior knowledge. Then the PIR sensors, which placement depends on the training results in the accessibility map, get the rough location information. For more precise positioning, the A-start algorithm is used to refine the localization, fused with the accessibility map and the PIR sensor data. Experiments were conducted in a mock apartment testbed. The ground truth data was obtained from an Opti-track system. The results demonstrate that the proposed method is able to track persons in a smart home environment and provide a solution for home robot localization. PMID:29364188
Stroope, Samuel; Tom, Joshua C
2017-09-01
Religious participation is linked to numerous positive safety outcomes for adolescents. Scant attention, however, has been paid to associations between religious participation and safety risks among adolescents. Using data from Add Health (N = 18,449), a nationally representative school-based sample of US adolescents, this study examines the relationship between adolescents' religious affiliation and easy access to firearms at home. Regression analyses adjust for complex sampling design and compare easy firearm access at home among conservative Protestant adolescents to adolescent firearm access in other religious traditions. Conservative Protestant adolescents have a substantially greater likelihood of easy access to a gun at home compared to adolescents of all other major religious traditions in the United States. Recognizing differences in adolescent firearm access between subcultural groups can help public health interventions more effectively identify and address the needs of vulnerable populations. The paper's conclusion considers suggestions for effective policy and programmatic initiatives. Copyright © 2017 Elsevier Inc. All rights reserved.
Thompson, Terrill; Burgstahler, Sheryl; Moore, Elizabeth J
2010-01-01
This article reports on a follow-up assessment to Thompson et al. (Proceedings of The First International Conference on Technology-based Learning with Disability, July 19-20, Dayton, Ohio, USA; 2007. pp 127-136), in which higher education home pages were evaluated over a 5-year period on their accessibility to individuals with disabilities. The purpose of this article is to identify trends in web accessibility and long-term impact of outreach and education. Home pages from 127 higher education institutions in the Northwest were evaluated for accessibility three times over a 6-month period in 2004-2005 (Phase I), and again in 2009 (Phase II). Schools in the study were offered varying degrees of training and/or support on web accessibility during Phase I. Pages were evaluated for accessibility using a set of manual checkpoints developed by the researchers. Over the 5-year period reported in this article, significant positive gains in accessibility were revealed on some measures, but accessibility declined on other measures. The areas of improvement are arguably the more basic, easy-to-implement accessibility features, while the area of decline is keyboard accessibility, which is likely associated with the emergence of dynamic new technologies on web pages. Even on those measures where accessibility is improving, it is still strikingly low. In Phase I of the study, institutions that received extensive training and support were more likely than other institutions to show improved accessibility on the measures where institutions improved overall, but were equally or more likely than others to show a decline on measures where institutions showed an overall decline. In Phase II, there was no significant difference between institutions who had received support earlier in the study, and those who had not. Results suggest that growing numbers of higher education institutions in the Northwest are motivated to add basic accessibility features to their home pages, and that
Open access in the patient-centered medical home: lessons from the Veterans Health Administration.
True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M
2013-04-01
The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.
Dressing remedies: a concept for improving access to and use of dressings in nursing homes.
Clarkson, A
2007-01-01
Delays in accessing dressings prescribed by general practitioners can result in the inappropriate use of dressings on more than one resident in nursing homes. The dressing remedies concept was developed to overcomes this problem.
Lear, Scott A; Araki, Yuriko; Maric, Biljana; Kaan, Annemarie; Horvat, Dan
2009-01-01
BACKGROUND: Patients living outside of urban centres do not have access to the same level of care as patients in cities. The use of the Internet has been suggested as a possible resolution to this geographic inequity. OBJECTIVE: To identify the determinants of Internet use in patients with cardiovascular disease and the patterns of use. METHODS: Cardiac inpatients of an urban tertiary and a northern regional hospital in British Columbia were invited to participate. Patients who could not speak English or who had mental impairment were excluded. Consenting patients were interviewed regarding demographics and home Internet use. RESULTS: A total of 294 patients participated. The mean (± SD) age was 64.0±12.7 years. Most participants were men (68%) of European ancestry (77%) with some postsecondary education (57%). All geographical regions of British Columbia were represented. A total of 66% of patients had home Internet access. In rural areas, 47% of patients had access to the Internet (P=0.020 compared with nonrural areas). Eighty-four per cent of patients with Internet access had a high-speed connection, 55% reported using the Internet daily and 23% used it more than once per week. Accessing health information from the Internet was reported by 70% of patients. CONCLUSION: These data indicate a high prevalence of Internet use among English-speaking cardiac patients and a strong desire to obtain health information using the Internet. Health care organizations can take advantage of the Internet to develop and evaluate the delivery of cardiac services to patients in their homes, particularly to patients in rural and remote communities. PMID:19812805
Casado, Banghwa Lee; Lee, Sang E
2012-01-01
This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.
Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.
2015-01-01
Objectives To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. PMID:25687930
Goodman, Claire; Davies, Sue L; Gordon, Adam L; Meyer, Julienne; Dening, Tom; Gladman, John R F; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C
2015-05-01
To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All
ERIC Educational Resources Information Center
Preyde, Michele; Watkins, Hanna; Ashbourne, Graham; Lazure, Kelly; Carter, Jeff; Penney, Randy; White, Sara; Frensch, Karen; Cameron, Gary
2013-01-01
The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental…
Nijp, Hylco H; Beckers, Debby G J; Kompier, Michiel A J; van den Bossche, Seth N J; Geurts, Sabine A E
2015-07-01
Worktime control (WTC) has been suggested as a tool to reduce employees' work-home interference and fatigue and improve job motivation. The purpose of this study was twofold: (i) to examine the prevalence of employees' need for, access to, and use of WTC, as well as the incongruence between need for and access to WTC (ie, mismatch); and (ii) to examine the associations of this mismatch and the use of WTC with employees' work-home interference (WHI), fatigue and job motivation. Questionnaire data were collected among a large (N=2420) quasi-representative sample of Dutch employees. The prevalence of WTC need, access, use, and mismatch was assessed by means of descriptive statistics. Associations with employees' outcomes were assessed by analyses of covariance. The need for WTC was highly prevalent. For many employees, we observed a negative mismatch between access to and need for WTC (ie, access
NASA Astrophysics Data System (ADS)
Coffman, Mitchell Ward
The purpose of this dissertation was to examine the relationship between student access to a computer at home and academic achievement. The 2009 National Assessment of Educational Progress (NAEP) dataset was probed using the National Data Explorer (NDE) to investigate correlations in the subsets of SES, Parental Education, Race, and Gender as it relates to access of a home computer and improved performance scores for U.S. public school grade 12 science students. A causal-comparative approach was employed seeking clarity on the relationship between home access and performance scores. The influence of home access cannot overcome the challenges students of lower SES face. The achievement gap, or a second digital divide, for underprivileged classes of students, including minorities does not appear to contract via student access to a home computer. Nonetheless, in tests for significance, statistically significant improvement in science performance scores was reported for those having access to a computer at home compared to those not having access. Additionally, regression models reported evidence of correlations between and among subsets of controls for the demographic factors gender, race, and socioeconomic status. Variability in these correlations was high; suggesting influence from unobserved factors may have more impact upon the dependent variable. Having access to a computer at home increases performance scores for grade 12 general science students of all races, genders and socioeconomic levels. However, the performance gap is roughly equivalent to the existing performance gap of the national average for science scores, suggesting little influence from access to a computer on academic achievement. The variability of scores reported in the regression analysis models reflects a moderate to low effect, suggesting an absence of causation. These statistical results are accurate and confirm the literature review, whereby having access to a computer at home and the
Futrell Dunaway, Lauren; Carton, Thomas; Ma, Ping; Mundorf, Adrienne R; Keel, Kelsey; Theall, Katherine P
2017-06-20
Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children's diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children ( n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children's diets. We observed a negligible impact of the neighborhood food environment on children's diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.
van der Vaart, Rosalie; Drossaert, Constance H C; Taal, Erik; van de Laar, Mart A F J
2013-09-01
Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted. First, interviews were performed with nurses/nurse practitioners (n = 9) and rheumatologists (n = 13). Subsequently, collected responses were quantified, using a questionnaire among the interviewees. The following advantages of patient home access to the EMR were reported: (1) enhancement of patient participation in treatment, (2) increased knowledge and self-management, (3) improved patient-provider interaction, (4) increased patient safety, and (5) better communication with others. Foreseen disadvantages of the service included: (1) problems with interpretation of data, (2) extra workload, (3) a change in consultation content, and (4) disturbing the patient-provider interaction. Also, the following preconditions emerged from the data: (1) optimal security, (2) no extra record, but a patient-accessible section, (3) no access to clinical notes, and (4) a lag time on the release of lab data. Most respondents reported that data on diagnosis, medication, treatment plan and consultations could be released to patients. On releasing more complex data, such as bodily examinations, lab results and radiological images the opinions differed considerably. Providing patients home access to their medical record might be a valuable next step into patient empowerment and in service towards the patient, provided that security is optimal and content and presentation of data are carefully considered.
Boosting a Low-Cost Smart Home Environment with Usage and Access Control Rules.
Barsocchi, Paolo; Calabrò, Antonello; Ferro, Erina; Gennaro, Claudio; Marchetti, Eda; Vairo, Claudio
2018-06-08
Smart Home has gained widespread attention due to its flexible integration into everyday life. Pervasive sensing technologies are used to recognize and track the activities that people perform during the day, and to allow communication and cooperation of physical objects. Usually, the available infrastructures and applications leveraging these smart environments have a critical impact on the overall cost of the Smart Home construction, require to be preferably installed during the home construction and are still not user-centric. In this paper, we propose a low cost, easy to install, user-friendly, dynamic and flexible infrastructure able to perform runtime resources management by decoupling the different levels of control rules. The basic idea relies on the usage of off-the-shelf sensors and technologies to guarantee the regular exchange of critical information, without the necessity from the user to develop accurate models for managing resources or regulating their access/usage. This allows us to simplify the continuous updating and improvement, to reduce the maintenance effort and to improve residents’ living and security. A first validation of the proposed infrastructure on a case study is also presented.
The Impact of the Medical Home on Access to Care for Children with Autism Spectrum Disorders
ERIC Educational Resources Information Center
Cheak-Zamora, Nancy C.; Farmer, Janet E.
2015-01-01
Children with autism spectrum disorders (ASD) experience difficulty accessing health care services. Using parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs, we examined whether having a medical home reduces unmet need for specialty care services for children with ASD (n = 3,055). Descriptive…
Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children’s Diets
Futrell Dunaway, Lauren; Carton, Thomas; Ma, Ping; Mundorf, Adrienne R.; Keel, Kelsey; Theall, Katherine P.
2017-01-01
Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity. PMID:28632162
Abbott, Rebecca A; Smith, Anne J; Howie, Erin K; Pollock, Clare; Straker, Leon
2014-08-01
Active-input videogames could provide a useful conduit for increasing physical activity by improving a child's self-confidence, physical activity enjoyment, and reducing anxiety. Therefore this study evaluated the impact of (a) the removal of home access to traditional electronic games or (b) their replacement with active-input videogames, on child self-perception, enjoyment of physical activity, and electronic game use anxiety. This was a crossover, randomized controlled trial, conducted over a 6-month period in participants' family homes in metropolitan Perth, Australia, from 2007 to 2010. Children 10-12 years old were recruited through school and community media. Of 210 children who were eligible, 74 met inclusion criteria, and 8 withdrew, leaving 66 children (33 girls) for analysis. A counterbalanced randomized order of three conditions sustained for 8 weeks each: No home access to electronic games, home access to traditional electronic games, and home access to active-input electronic games. Perception of self-esteem (Harter's Self Perception Profile for Children), enjoyment of physical activity (Physical Activity Enjoyment Scale questionnaire), and anxiety toward electronic game use (modified Loyd and Gressard Computer Anxiety Subscale) were assessed. Compared with home access to traditional electronic games, neither removal of all electronic games nor replacement with active-input games resulted in any significant change to child self-esteem, enjoyment of physical activity, or anxiety related to electronic games. Although active-input videogames have been shown to be enjoyable in the short term, their ability to impact on psychological outcomes is yet to be established.
Information Access Policy & Compliance Branch
Information Access Policy & Compliance Branch Join the Air Force Home Offices By Command By Base Library Handbook Annual Reports Resources Privacy Act Search Information Access Policy & Compliance BranchMeasuring patient-centered medical home access and continuity in clinics with part-time clinicians.
Rosland, Ann-Marie; Krein, Sarah L; Kim, Hyunglin Myra; Greenstone, Clinton L; Tremblay, Adam; Ratz, David; Saffar, Darcy; Kerr, Eve A
2015-05-01
Common patient-centered medical home (PCMH) performance measures value access to a single primary care provider (PCP), which may have unintended consequences for clinics that rely on part-time PCPs and team-based care. Retrospective analysis of 110,454 primary care visits from 2 Veterans Health Administration clinics from 2010 to 2012. Multi-level models examined associations between PCP availability in clinic, and performance on access and continuity measures. Patient experiences with access and continuity were compared using 2012 patient survey data (N = 2881). Patients of PCPs with fewer half-day clinic sessions per week were significantly less likely to get a requested same-day appointment with their usual PCP (predicted probability 17% for PCPs with 2 sessions/week, 20% for 5 sessions/week, and 26% for 10 sessions/week). Among requests that did not result in a same-day appointment with the usual PCP, there were no significant differences in same-day access to a different PCP, or access within 2 to 7 days with patients' usual PCP. Overall, patients had >92% continuity with their usual PCP at the hospital-based site regardless of PCP sessions/week. Patients of full-time PCPs reported timely appointments for urgent needs more often than patients of part-time PCPs (82% vs 71%; P < .01), but reported similar experiences with routine access and continuity. Part-time PCP performance appeared worse when using measures focused on same-day access to patients' usual PCP. However, clinic-level same-day access, same-week access to the usual PCP, and overall continuity were similar for patients of part-time and full-time PCPs. Measures of in-person access to a usual PCP do not capture alternate access approaches encouraged by PCMH, and often used by part-time providers, such as team-based or non-face-to-face care.
NASA Astrophysics Data System (ADS)
Tiwari, Samrat Vikramaditya; Sewaiwar, Atul; Chung, Yeon-Ho
2015-10-01
In optical wireless communications, multiple channel transmission is an attractive solution to enhancing capacity and system performance. A new modulation scheme called color coded multiple access (CCMA) for bidirectional multiuser visible light communications (VLC) is presented for smart home applications. The proposed scheme uses red, green and blue (RGB) light emitting diodes (LED) for downlink and phosphor based white LED (P-LED) for uplink to establish a bidirectional VLC and also employs orthogonal codes to support multiple users and devices. The downlink transmission for data user devices and smart home devices is provided using red and green colors from the RGB LEDs, respectively, while uplink transmission from both types of devices is performed using the blue color from P-LEDs. Simulations are conducted to verify the performance of the proposed scheme. It is found that the proposed bidirectional multiuser scheme is efficient in terms of data rate and performance. In addition, since the proposed scheme uses RGB signals for downlink data transmission, it provides flicker-free illumination that would lend itself to multiuser VLC system for smart home applications.
Faststats: Attention Deficit Hyperactivity Disorder (ADHD)
... this? Submit What's this? Submit Button NCHS Home Attention Deficit Hyperactivity Disorder (ADHD)* Recommend on Facebook Tweet ... visits Number of visits to physician offices with attention deficit disorder as the primary diagnosis: 10.9 ...
FastStats: Anemia or Iron Deficiency
... this? Submit What's this? Submit Button NCHS Home Anemia or Iron Deficiency Recommend on Facebook Tweet Share ... visits Number of visits to emergency departments with anemia as the primary hospital discharge diagnosis: 188,000 ...
FastStats: Obesity and Overweight
... this? Submit What's this? Submit Button NCHS Home Obesity and Overweight Recommend on Facebook Tweet Share Compartir ... Percent of adults aged 20 and over with obesity: 37.9% (2013-2014) Percent of adults aged ...
... Submit What's this? Submit Button NCHS Home Viral Hepatitis Recommend on Facebook Tweet Share Compartir Data are for the U.S. Morbidity Number of new hepatitis A cases: 1,239 (2014) Number of new ...
Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry
2011-01-01
Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993
FastStats: Self-Inflicted Injury/Suicide
... this? Submit What's this? Submit Button NCHS Home Suicide and Self-Inflicted Injury Recommend on Facebook Tweet ... Tables, table 17 [PDF – 676 KB] Mortality All suicides Number of deaths: 44,193 Deaths per 100, ...
FastStats: Oral and Dental Health
... What's this? Submit Button NCHS Home Oral and Dental Health Recommend on Facebook Tweet Share Compartir Data ... States, 2016, table 60 [PDF – 9.8 MB] Dental visits Percent of children aged 2-17 years ...
FastStats: Exercise or Physical Activity
... What's this? Submit Button NCHS Home Exercise or Physical Activity Recommend on Facebook Tweet Share Compartir Data are ... adults aged 18 and over who met the Physical Activity Guidelines for aerobic physical activity: 51.7% Percent ...
How access to long-term care affects home health transfers.
Kenney, G M
1993-01-01
This study examines the determinants of home health use after hospitalization for acute illness for eleven diagnosis-related groups (DRGs) in 1985, drawing on data from four primary sources: Medicare hospital bills, Medicare home health bills, the Medicare and Medicaid Automated Certification System files, and the American Hospital Association Survey. Separate Tobit models are estimated for each DRG. The analysis shows that transfers to home health care are heavily influenced by the hospital's long-term care arrangement and by conditions in local nursing home and home health care markets. Especially important is whether a hospital has its own long-term care unit, swing beds, or both, and whether nursing home beds are available in the local area. Patients discharged from hospitals are more likely to use home health care in areas with a low supply of nursing home beds and low Medicaid reimbursement levels for skilled nursing facilities. The results of this study have implications for proposals to extend Medicare's Prospective Payment System for hospital services to include postacute care. Proponents of a "bundled payment" that encompasses both acute and postacute services argue that the current system leads to inefficiencies and inequities. This analysis points to systematic relationships between home health and nursing home services, which should be factored into the development of a bundled payment policy.
... this? Submit What's this? Submit Button NCHS Home Heart Disease Recommend on Facebook Tweet Share Compartir Data are ... the U.S. Morbidity Number of adults with diagnosed heart disease: 28.1 million Percent of adults with diagnosed ...
ERIC Educational Resources Information Center
Johnson-Staub, Christine; Schmit, Stephanie
2012-01-01
Home visiting is one tool used to prevent child abuse and improve child well-being by providing education and services in families' homes through parent education and connection to community resources. This toolkit provides state policymakers and advocates with strategies for extending and expanding access to state- or federally-funded home…
This document presents the results of completed work using existing geographic information system (GIS) data to map existing water and sewer infrastructure and homes without access to safe drinking water and basic sanitation on the Navajo Nation.
Ethical conflicts over access to services: patient effects and worker influence in home health.
Egan, Marcia; Kadushin, Goldie
2002-01-01
A survey of home health social workers (N = 51) explored the effects on patients of ethical conflicts over access to services. The findings suggest that patients were as likely to be discharged or not receive services as they were to receive the services without paying a fee. Social workers rated themselves as moderately influential in the resolution of the conflict. Their influence was significantly correlated with patients more often receiving services and less often being discharged. Social work influence was enhanced by recognition of professional expertise and/or through informal networking within the agency. Implications for practice and education are discussed.
Editorial: Next Generation Access Networks
NASA Astrophysics Data System (ADS)
Ruffini, Marco; Cincotti, Gabriella; Pizzinat, Anna; Vetter, Peter
2015-12-01
Over the past decade we have seen an increasing number of operators deploying Fibre-to-the-home (FTTH) solutions in access networks, in order to provide home users with a much needed network access upgrade, to support higher peak rates, higher sustained rates and a better and more uniform broadband coverage of the territory.
Paid sick days and stay-at-home behavior for influenza
Piper, Kaitlin; Youk, Ada; James, A. Everette
2017-01-01
Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees’ decisions to stay home from work for their own or a child’s illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee’s own or a child’s illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee’s own illness/injury, ILI, or influenza, and for a child’s illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee’s own or a child’s illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child’s illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and
Paid sick days and stay-at-home behavior for influenza.
Piper, Kaitlin; Youk, Ada; James, A Everette; Kumar, Supriya
2017-01-01
Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees' decisions to stay home from work for their own or a child's illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee's own or a child's illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee's own illness/injury, ILI, or influenza, and for a child's illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee's own or a child's illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child's illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and families.
Akamigbo, Adaeze B; Wolinsky, Fredric D
2007-07-01
Historical disparities in rates of nursing home placement between blacks and whites have been well documented, and are thought to result from more extensive and supportive social networks, cultural aversion, and poorer geographic access among African Americans. A few recent studies, however, suggest that these racial disparities may no longer exist. We used comprehensive data to assess whether racial differences in nursing home placement remain, and if so, to identify the reasons for them. Data on 6242 black and white self-respondents to the Survey of Assets and Health Dynamics Among the Oldest Old cohort who were 70 years old or older at baseline (1993) were used. Placement status was ascertained at each biennial follow-up through 2004, and discrete-time hazards models were estimated. After adjusting for baseline covariates, it was found that blacks were 26% (lambda = 0.74, P < 0.001) less likely to use a nursing home over an 11-year period than whites. Moreover, the supply of skilled nursing beds was more salient for nursing home placement for blacks than whites, as was the increasing supply of assisted living beds. The racial gap in nursing home placement remains, despite the increased supply of nursing home beds and the emergence of assisted living facilities as the preferred alternative. As the supply of skilled nursing beds increases, in part due to whites choosing assisted living facilities, the racial gap in the risks of nursing home placement may be lessening. Blacks, however, remain less likely to be placed in a nursing home than whites.
ERIC Educational Resources Information Center
Baker, Nick, Ed.
1995-01-01
This issue of the quarterly newsletter "Rural Exchange" provides information and resources on accessible rural housing for the disabled. "Accessible Manufactured Housing Could Increase Rural Home Supply" (Nick Baker) suggests that incorporation of access features such as lever door handles and no-step entries into manufactured housing could help…
7 CFR 1755.509 - Mobile homes.
Code of Federal Regulations, 2014 CFR
2014-01-01
... 7 Agriculture 11 2014-01-01 2014-01-01 false Mobile homes. 1755.509 Section 1755.509 Agriculture... homes. (a) Customer access location installations at mobile homes shall be treated the same whether the homes are mounted on permanent foundations or temporary foundations and shall be installed as specified...
7 CFR 1755.509 - Mobile homes.
Code of Federal Regulations, 2012 CFR
2012-01-01
... 7 Agriculture 11 2012-01-01 2012-01-01 false Mobile homes. 1755.509 Section 1755.509 Agriculture... homes. (a) Customer access location installations at mobile homes shall be treated the same whether the homes are mounted on permanent foundations or temporary foundations and shall be installed as specified...
7 CFR 1755.509 - Mobile homes.
Code of Federal Regulations, 2013 CFR
2013-01-01
... 7 Agriculture 11 2013-01-01 2013-01-01 false Mobile homes. 1755.509 Section 1755.509 Agriculture... homes. (a) Customer access location installations at mobile homes shall be treated the same whether the homes are mounted on permanent foundations or temporary foundations and shall be installed as specified...
7 CFR 1755.509 - Mobile homes.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 11 2011-01-01 2011-01-01 false Mobile homes. 1755.509 Section 1755.509 Agriculture... homes. (a) Customer access location installations at mobile homes shall be treated the same whether the homes are mounted on permanent foundations or temporary foundations and shall be installed as specified...
7 CFR 1755.509 - Mobile homes.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 7 Agriculture 11 2010-01-01 2010-01-01 false Mobile homes. 1755.509 Section 1755.509 Agriculture... homes. (a) Customer access location installations at mobile homes shall be treated the same whether the homes are mounted on permanent foundations or temporary foundations and shall be installed as specified...
Latest Trends in Home Networking Technologies
NASA Astrophysics Data System (ADS)
Tsutsui, Akihiro
Broadband access service, including FTTH, is now in widespread use in Japan. More than half of the households that have broadband Internet access construct local area networks (home networks) in their homes. In addition, information appliances such as personal computers, networked audio, and visual devices and game machines are connected to home networks, and many novel service applications are provided via the Internet. However, it is still difficult to install and incorporate these devices and services because networked devices have been developed in different communities. I briefly explain the current status of information appliances and home networking technologies and services and discuss some of the problems in this and their solutions.
Johnson, Clifford L; Dohrmann, Sylvia M; Kerckove, Van de; Diallo, Mamadou S; Clark, Jason; Mohadjer, Leyla K; Burt, Vicki L
2014-11-01
The National Health and Nutrition Examination Survey's (NHANES) National Youth Fitness Survey (NNYFS) was conducted in 2012 by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). NNYFS collected data on physical activity and fitness levels to evaluate the health and fitness of children aged 3-15 in the United States. The survey comprised three levels of data collection: a household screening interview (or screener), an in-home personal interview, and a physical examination. The screener's primary objective was to determine whether any children in the household were eligible for the interview and examination. Eligibility was determined by preset selection probabilities for desired sex-age subdomains. After selection, the in-home personal interview collected demographic, health, physical activity, and nutrition information about the child as well as information about the household. The examination included physical measurements and fitness tests. This report provides background on the NNYFS program and summarizes the survey's sample design specifications. The report presents NNYFS estimation procedures, including the methods used to calculate survey weights for the full sample as well as a combined NHANES/NNYFS sample for 2012 (accessible only through the NCHS Research Data Center). The report also describes appropriate variance estimation methods. Documentation of the sample selection methods, survey content, data collection procedures, and methods to assess nonsampling errors are reported elsewhere. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John
2017-01-01
We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. PMID:28277206
Poss, Jeffrey W; Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John
2017-02-01
We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. Copyright © 2017 Longwoods Publishing.
Patterns in Home Care Use in Manitoba
ERIC Educational Resources Information Center
Mitchell, Lori; Roos, Noralou, P.; Shapiro, Evelyn
2005-01-01
Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were…
Dauz, Emily; Moore, Jan; Smith, Carol E; Puno, Florence; Schaag, Helen
2004-01-01
This article describes the experiences of nurses who, as part of a large clinical trial, brought the Internet into older adults' homes by installing a computer, if needed, and connecting to a patient education Web site. Most of these patients had not previously used the Internet and were taught even basic computer skills when necessary. Because of increasing use of the Internet in patient education, assessment, and home monitoring, nurses in various roles currently connect with patients to monitor their progress, teach about medications, and answer questions about appointments and treatments. Thus, nurses find themselves playing the role of technology managers for patients with home-based Internet connections. This article provides step-by-step procedures for computer installation and training in the form of protocols, checklists, and patient user guides. By following these procedures, nurses can install computers, arrange Internet access, teach and connect to their patients, and prepare themselves to install future generations of technological devices.
Survey of home hemodialysis patients and nursing staff regarding vascular access use and care.
Spry, Leslie A; Burkart, John M; Holcroft, Christina; Mortier, Leigh; Glickman, Joel D
2015-04-01
Vascular access infections are of concern to hemodialysis patients and nurses. Best demonstrated practices (BDPs) have not been developed for home hemodialysis (HHD) access use, but there have been generally accepted practices (GAPs) endorsed by dialysis professionals. We developed a survey to gather information about training provided and actual practices of HHD patients using the NxStage System One HHD machine. We used GAP to assess training used by nurses to teach HHD access care and then assess actual practice (adherence) by HHD patients. We also assessed training and adherence where GAPs do not exist. We received a 43% response rate from patients and 76% response from nurses representing 19 randomly selected HHD training centers. We found that nurses were not uniformly instructing HHD patients according to GAP, patients were not performing access cannulation according to GAP, nor were they adherent to their training procedures. Identification of signs and symptoms of infection was commonly trained appropriately, but we observed a reluctance to report some signs and symptoms of infection by patients. Of particular concern, when aggregating all steps surveyed, not a single nurse or patient reported training or performing all steps in accordance with GAP. We also identified practices for which there are no GAPs that require further study and may or may not impact outcomes such as infection. Further research is needed to develop strategies to implement and expand GAP, measure outcomes, and ultimately develop BDP for HHD to improve infectious complications. © 2014 The Authors. Hemodialysis International published by Wiley Periodicals, Inc. on behalf of International Society for Hemodialysis.
Kawagoe, Koh; Matsuura, Shinobu
2008-12-01
This is a case of a 50s male with cecal cancer suffering from severe pain caused by osteolytic metastasis to the lumbar vertebra, right iliac bone, and the head of the right femur. The pain was palliated by continuous infusion of morphine using a subarachnoid catheter that had access to the subcutaneous "Port". The maximum dose of morphine used a day was 384 mg, which corresponded to 57,600 mg/day of oral morphine. Sixty eight days after the start of home hospice care, the patient died at home because of diffuse peritonitis caused by intestinal rupture.
Improving access to care through the patient-centered medical home.
North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda
2014-02-01
School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.
Adverse Childhood Experiences, the Medical Home, and Child Well-Being.
Balistreri, Kelly Stamper
2015-11-01
To examine the relationship between adverse childhood experiences (ACE), access to a medical home and a global measure of well-being among children ages 6-17 using the 2011-2012 National Survey of Children's Health. Multivariate linear regressions assessed the associations between each adverse experience and an index of child well-being with and without the impact of other events. The number of ACE was summed for each respondent and the analyses were repeated with the cumulative score as a continuous variable. The cumulative model was repeated with the addition of an interaction term between ACE score and medical home access. All analyses were conducted separately for children ages 6-11 and adolescents 12-17. Over half (53 %) of US children ages 6-17 have experienced some adverse experience during childhood. Over a quarter (28 %) has experienced at least two adverse experiences, while 15 % have experienced three or more hardships. Results suggest that the accumulation of ACE reduces well-being in children. The associations remained significant after controlling for gender, race/ethnicity, age, parental education, special health condition, and medical home access. Medical home access was consistently associated with higher levels of child well-being and was a significant moderator of the relationship between the total ACE and child well-being among children ages 6-11. Children with ACE exposure and access to a medical home have higher levels of well-being than comparable children without access to a medical home. Children exposed to adverse experiences have measurably lower levels of well-being, although younger children with access to a medical home are protected at increasing exposure.
Ritchie, Christine S; Leff, Bruce
2018-03-01
With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Perl, Jeffrey; Nessim, Sharon J; Moist, Louise M; Wald, Ron; Na, Yingbo; Tennankore, Karthik K; Chan, Christopher T
2016-02-01
While central venous catheter (CVC) use has expanded home hemodialysis (HHD) eligibility to many patients who may be unable to self-cannulate an arteriovenous (AV) access, the association between CVC use and mortality has not been directly examined among HHD patients. Registry-based retrospective observational cohort study. Incident HHD patients in The Canadian Organ Replacement Register who had information for vascular access type (CVC vs AV access) within the first year of HHD therapy initiation. Use of a CVC versus an AV access (AV fistula or graft) within the first year of HHD therapy initiation. The composite of all-cause mortality and technique failure (long-term transfer to an alternate dialysis modality). A Cox proportional hazards model was used to evaluate the adjusted composite outcome and each outcome separately. 1,869 patients initiated HHD therapy in Canada in 1996 to 2012, of whom 1,217 had an access type recorded within the first year of HHD therapy initiation. Compared to CVC use (n=523) and during a median follow-up of 513 and 427 days for AV access and CVC patients, respectively, AV access use (n=694) was associated with lower risk for the composite event of death and technique failure (490 events; adjusted HR, 0.78; 95% CI, 0.64-0.94) and lower adjusted all-cause mortality (129 deaths; adjusted HR, 0.63; 95% CI, 0.43-0.91); the risk for technique failure was nominally lower, but this result was not statistically significant (361 events; adjusted HR, 0.84; 95% CI, 0.67-1.05). Results were robust to sensitivity analyses and after missing data imputation. Missing information for vascular access type (n=659[35% of patients]) and lack of information for longitudinal changes in vascular access type. Compared to CVC use, AV access use was associated with superior survival. Minimizing CVC use and maximizing AV access use while addressing barriers to their placement and self-cannulation may improve HHD outcomes. Copyright © 2016 National Kidney
SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.
Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson
2016-01-01
The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.
Partridge, Roland W; Hughes, Mark A; Brennan, Paul M; Hennessey, Iain A M
2014-08-01
Objective performance feedback has potential to maximize the training benefit of laparoscopic simulators. Instrument movement metrics are, however, currently the preserve of complex and expensive systems. We aimed to develop and validate affordable, user-ready software that provides objective feedback by tracking instrument movement in a "take-home" laparoscopic simulator. Computer-vision processing tracks the movement of colored bands placed around the distal instrument shafts. The position of each instrument is logged from the simulator camera feed and movement metrics calculated in real time. Ten novices (junior doctors) and 13 general surgery trainees (StR) (training years 3-7) performed a standardized task (threading string through hoops) on the eoSim (eoSurgical™ Ltd., Edinburgh, Scotland, United Kingdom) take-home laparoscopic simulator. Statistical analysis was performed using unpaired t tests with Welch's correction. The software was able to track the instrument tips reliably and effectively. Significant differences between the two groups were observed in time to complete task (StR versus novice, 2 minutes 33 seconds versus 9 minutes 53 seconds; P=.01), total distance traveled by instruments (3.29 m versus 11.38 m, respectively; P=.01), average instrument motion smoothness (0.15 mm/second(3) versus 0.06 mm/second(3), respectively; P<.01), and handedness (mean difference between dominant and nondominant hand) (0.55 m versus 2.43 m, respectively; P=.03). There was no significant difference seen in the distance between instrument tips, acceleration, speed of instruments, or time off-screen. We have developed software that brings objective performance feedback to the portable laparoscopic box simulator. Construct validity has been demonstrated. Removing the need for additional motion-tracking hardware makes it affordable and accessible. It is user-ready and has the potential to enhance the training benefit of portable simulators both in the
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The Role of Hospice Care in the Nursing Home Setting
Miller, Susan C.; Mor, Vince N.T.
2013-01-01
The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the “added value” of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration. PMID:12006229
2006-08-01
In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.
Medical home services for children with behavioral health conditions.
Sheldrick, Radley C; Perrin, Ellen C
2010-01-01
Whether medical services received by children and youth with behavioral health conditions are consistent with a Medical Home has not been systematically studied. The objectives of this study were to examine the variation among four behavioral health conditions in regard to services related to the Medical Home. Cross-sectional analyses of the 2003 National Survey of Children's Health were conducted. Multiple logistic regression analyses tested the impact of behavioral health conditions on medical needs, on Medical Home components, and on likelihood of having a Medical Home overall. Autism, Depression/Anxiety, and Behavior/Conduct problems were associated with reduced likelihood of having a Medical Home, whereas Attention-Deficit Hyperactivity Disorder was associated with increased likelihood. All health conditions predicted increased access to a primary care physician (PCP) and a preventive visit in the past year. However, all were also associated with higher needs for specialty care and all behavioral health conditions except Attention-Deficit Hyperactivity Disorder were associated with difficulties accessing this care. A detailed examination of the receipt of services among children and youth with behavioral health conditions reveals two primary reasons why such care is less likely to be consistent with a Medical Home model: (1) parents are more likely to report needing specialty care; and (2) these needs are less likely to be met. These data suggest that the reason why services received by children and youth with behavioral health conditions are not consistent with the Medical Home has more to do with difficulty accessing specialty care than with problems accessing quality primary care.
Simple Remodeling for Tomorrow's Needs: Cost-Effective Green Solutions for Your Home
ERIC Educational Resources Information Center
Purpora, Megan
2009-01-01
People normally do not think about the future of their home in terms of accessibility. But, since Americans spend approximately 90 percent of their time indoors, shouldn't their home be as accessible as possible? By doing a few simple home upgrades on overlooked items, it will lessen the burden later. To live safer and healthier use natural…
NEEDS AND CHALLENGES OF HOME VISITORS CONDUCTING PERINATAL DEPRESSION SCREENING.
Doering, Jennifer J; Maletta, Kristyn; Laszewski, Audrey; Wichman, Christina L; Hammel, Jennifer
2017-07-01
This article describes the needs and challenges faced by home visitors, supervisors, and clients when conducting perinatal depression screening. Home visitors (n = 11), supervisors (n = 5), and clients (n = 9) representing rural and urban practice settings in Wisconsin were recruited into three separate focus groups. Themes were identified from the transcribed audio-recorded interviews using content analysis. Results indicate that a trusting relationship was leveraged to facilitate depression screening and referral. Home visitors personalized care to a client's context and to protect confidentiality. Home-visiting practice demanded flexibility and negotiation in decision-making with clients and families. Coordinating access to mental health evaluation in areas of limited access was a common challenge. Participants reported a need for further training on safety management. With adequate training and support, home visitors are well-positioned to promote access to mental health services in vulnerable families to support infant mental health. © 2017 Michigan Association for Infant Mental Health.
Bringing healthcare closer to home: one province's approach to home care.
Witmer, E
2000-01-01
Ontario is implementing a number of steps to address the growing need for home care and continuing care. One of these steps is the establishment of Ontario's network of 43 Community Care Access Centres (CCACs). Responsible for aiding Ontario residents who seek community-based long-term healthcare, CCACs coordinate access to home services such as nursing and homemaking, manage placement to long-term care facilities and provide information and referral services. In 2000/01 the Ontario government announced 92.5 million Canadian dollars in new funding for long-term community services. This new funding includes 70.1 million Canadian dollars for CCACs. During this time, the provincial government will spend more than 1.6 billion Canadian dollars for long-term-care community-based services. Of this amount, 1.1 Canadian dollars billion will go to CCACs. Community Care Access Centres served more than 400,000 people in 1998/99 and are estimated to serve more than 420,000 in 2000/01. The administrative funds saved by this province-wide system are reinvested in front-line health services.
Effect of prospective reimbursement on nursing home costs.
Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P
1993-04-01
This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.
Walz, Helena; Bohn, Barbara; Sander, Jessica; Eberle, Claudia; Alisch, Monika; Oswald, Bernhard; Kroke, Anja
2015-01-01
Health and social inequality are tightly linked and still pose an important public health problem. However, vulnerable and disadvantaged populations are difficult to reach for health-related interventions. Given the long-lasting effects of an adverse, particular nutrition-related, intrauterine and neonatal environment on health development (perinatal programming), an early and easy access is essential for sustainable interventions. The goal of this explorative study was therefore to elucidate whether an existing access of family midwives (FMs) to families in need of support could be an option to implement effective public health and nutrition interventions. To that end three research objectives were formulated: (1) to determine whether a discernible impact of home visits by FMs can be described; (2) to identify subgroups among these families in need of more specific interventions; (3) to determine how relevant nutrition-related topics are for both FMs and the supported families. For addressing these objectives a mixed methods design was used: Routine documentation data from 295 families visited by a family midwife (FM) were analyzed (secondary analysis), and structured expert interviews with FMs were conducted and analyzed. Study reporting followed the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) statement. Based on the FMs reports, a significant improvement (p < 0.001) regarding psycho-social variables could be determined after the home visits. Single mothers, however, seemed to benefit less from the FMs service compared to their counterparts (p = 0.015). Nutritional counseling was demanded by 89% of the families during the home visits. In addition, nutrition-related topics were reported in the interviews to be of high interest to both families and the FMs. Based on the obtained results it is concluded that FMs home visits offer a promising access to vulnerable and disadvantaged families for implementing nutrition
Development and validation of a remote home safety protocol.
Romero, Sergio; Lee, Mi Jung; Simic, Ivana; Levy, Charles; Sanford, Jon
2018-02-01
Environmental assessments and subsequent modifications conducted by healthcare professionals can enhance home safety and promote independent living. However, travel time, expense and the availability of qualified professionals can limit the broad application of this intervention. Remote technology has the potential to increase access to home safety evaluations. This study describes the development and validation of a remote home safety protocol that can be used by a caregiver of an elderly person to video-record their home environment for later viewing and evaluation by a trained professional. The protocol was developed based on literature reviews and evaluations from clinical and content experts. Cognitive interviews were conducted with a group of six caregivers to validate the protocol. The final protocol included step-by-step directions to record indoor and outdoor areas of the home. The validation process resulted in modifications related to safety, clarity of the protocol, readability, visual appearance, technical descriptions and usability. Our final protocol includes detailed instructions that a caregiver should be able to follow to record a home environment for subsequent evaluation by a home safety professional. Implications for Rehabilitation The results of this study have several implications for rehabilitation practice The remote home safety evaluation protocol can potentially improve access to rehabilitation services for clients in remote areas and prevent unnecessary delays for needed care. Using our protocol, a patient's caregiver can partner with therapists to quickly and efficiently evaluate a patient's home before they are released from the hospital. Caregiver narration, which reflects a caregiver's own perspective, is critical to evaluating home safety. In-home safety evaluations, currently not available to all who need them due to access barriers, can enhance a patient's independence and provide a safer home environment.
Nelson, Karin; Sun, Haili; Dolan, Emily; Maynard, Charles; Beste, Laruen; Bryson, Christopher; Schectman, Gordon; Fihn, Stephan D
2014-01-01
Care continuity, access, and coordination are important features of the patient-centered medical home model and have been emphasized in the Veterans Health Administration patient-centered medical home implementation, called the Patient Aligned Care Team. Data from more than 4.3 million Veterans were used to assess the relationship between these attributes of Patient Aligned Care Team and Veterans Health Administration hospitalization and mortality. Controlling for demographics and comorbidity, we found that continuity with a primary care provider was associated with a lower likelihood of hospitalization and mortality among a large population of Veterans receiving VA primary care.
The virtual dental home: a critique.
Friedman, Jay W; Nash, David A; Mathu-Muju, Kavita R
2017-09-01
The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a "cloud" dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations. © 2017 American Association of Public Health Dentistry.
The Traveler's Guide to E-mail Access.
ERIC Educational Resources Information Center
Clyde, Anne
1999-01-01
Presents options that travelers can use to keep in e-mail contact. Discusses equipment/access issues related to traveling with a laptop; Internet cafes; free e-mail services; accessing home mail via a Web page; and new options e-mail access for travelers. Includes Internet resources on Internet access providers. (AEF)
Home is Private…Do Not Enter! Introversion and Sensitivity to Work-Home Conflict.
Baer, Stacy M; Jenkins, Jade S; Barber, Larissa K
2016-10-01
This study examined extraversion as a moderator of the relationship between negative work-home conflict and stress-related outcomes among US employees using conservation of resources theory and privacy regulation theory. Introverts only experienced stronger negative effects of negative work-home conflict on work-related resource depletion (job burnout, low engagement, low satisfaction with balance) rather than general resource depletion (personal burnout) and strain (physical and psychological). This finding suggests that introverts selectively withdraw from the work domain to conserve resources when privacy at home is threatened. Employers may want to consider ways to help introverts increase work-home segmentation, such as reducing workplace norms that encourage employees to be continuously accessible. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.
Effect of prospective reimbursement on nursing home costs.
Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P
1993-01-01
OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems. PMID:8463109
Easy access to firearms: juveniles' risks for violent offending and violent victimization.
Ruback, R Barry; Shaffer, Jennifer N; Clark, Valerie A
2011-07-01
Keeping firearms at home may increase personal safety but it may also increase the risk of injury. This study uses data from three waves of the National Longitudinal Study of Adolescent Health to assess the extent to which adolescents' easy access to firearms at home increases the risk of violent offending and violent victimization. Access to firearms was higher for males, Whites, and adolescents having two parents, especially fathers. Current access to firearms at home significantly increased the odds of both violent offending and violent victimization, even after controlling for prior access, prior offending, and prior victimization. This relationship persisted into early adulthood; access to firearms still significantly increased the odds of violent offending and violent victimization.
Calhoun, Patrick S; Wilson, Sarah M; Hicks, Terrell A; Thomas, Shaun P; Dedert, Eric A; Hair, Lauren P; Bastian, Lori A; Beckham, Jean C
2016-09-15
Access to the internet at home may be an important barrier to electronic health (eHealth) smoking cessation interventions. The current study explored possible sociodemographic disparities in access to the internet at home among veteran smokers. Data from participants proactively recruited and enrolled in a randomized smoking cessation effectiveness trial (N = 408) that compared a web-based smoking cessation intervention to Veterans Affairs (VA) usual care were used to examine the demographic attributes of smokers with and without internet access at home. Multivariable logistic regression was used to examine associations between demographic factors and home internet access. Data from patients randomized to the internet arm of the study (N = 205) were used to ascertain correlates of utilization of the intervention website. While the majority of the sample (82 %) endorsed access to the internet at home, veterans who were African-American, older, and not married were significantly less likely to have home internet access. Veterans who were African-American, older, less educated, had longer travel times to the nearest VA facility, and increased nicotine dependence were less likely to access the internet on a daily basis. While several sociodemographic variables (e.g., age, race, education, employment) were related to utilization of a free membership to a commercial, web-based smoking cessation intervention in bivariate analyses, only access to the internet at home was related to use of the smoking cessation site in adjusted results. These results highlight gaps in internet access and use among veterans and additionally underscore the importance of improving accessibility of eHealth interventions for low-income, minority, and socially disadvantaged veteran populations.
Case mix reimbursement for nursing homes.
Schlenker, R E
1986-01-01
Nursing home care is growing in importance as the population ages and as Medicare's prospective payment system encourages earlier discharges from acute care settings to nursing homes. Nursing home reimbursement policy is primarily a Medicaid issue, since Medicaid pays for about half the nation's nursing home care. The research reviewed in this article suggests a strong association between case mix and cost, and a weaker but still positive association between quality and cost. The research also implies that traditional nursing home reimbursement methodologies may impede access and may lower quality for Medicaid (and Medicare) recipients. To offset these problems, several states have recently begun to incorporate case mix directly into the reimbursement process. These systems deserve careful policy consideration.
Home e-health system integration in the Smart Home through a common media server.
Pau, I; Seoane, F; Lindecrantz, K; Valero, M A; Carracedo, J
2009-01-01
Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.
Accessibility issues with long-term disabilities.
Sebring-Cale, Nancy J
2008-06-01
Home modifications for barrier-free accessibility will assist the physically challenged populations by increasing their independence. By providing an accessible environment, an individual can become more independent and require less assistance for functional activities, such as kitchen appliance access, door widening, open floor plan, elevated electric outlets, roll-under sinks, roll-in showers and MobiLife elevating wheelchair.
HomeBank: An Online Repository of Daylong Child-Centered Audio Recordings
VanDam, Mark; Warlaumont, Anne S.; Bergelson, Elika; Cristia, Alejandrina; Soderstrom, Melanie; De Palma, Paul; MacWhinney, Brian
2017-01-01
HomeBank is introduced here. It is a public, permanent, extensible, online database of daylong audio recorded in naturalistic environments. HomeBank serves two primary purposes. First, it is a repository for raw audio and associated files: one database requires special permissions, and another redacted database allows unrestricted public access. Associated files include metadata such as participant demographics and clinical diagnostics, automated annotations, and human-generated transcriptions and annotations. Many recordings use the child-perspective LENA recorders (LENA Research Foundation, Boulder, Colorado, United States), but various recordings and metadata can be accommodated. The HomeBank database can have both vetted and unvetted recordings, with different levels of accessibility. Additionally, HomeBank is an open repository for processing and analysis tools for HomeBank or similar data sets. HomeBank is flexible for users and contributors, making primary data available to researchers, especially those in child development, linguistics, and audio engineering. HomeBank facilitates researchers’ access to large-scale data and tools, linking the acoustic, auditory, and linguistic characteristics of children’s environments with a variety of variables including socioeconomic status, family characteristics, language trajectories, and disorders. Automated processing applied to daylong home audio recordings is now becoming widely used in early intervention initiatives, helping parents to provide richer speech input to at-risk children. PMID:27111272
Pediatric Home Sleep Apnea Testing
Tan, Hui-Leng; Kheirandish-Gozal, Leila
2015-01-01
Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel. PMID:26270608
Household computer and Internet access: The digital divide in a pediatric clinic population
Carroll, Aaron E.; Rivara, Frederick P.; Ebel, Beth; Zimmerman, Frederick J.; Christakis, Dimitri A.
2005-01-01
Past studies have noted a digital divide, or inequality in computer and Internet access related to socioeconomic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access to computers and the Internet, and whether this access differed by socio-economic status or other demographic information. We conducted a phone survey of a population-based sample of parents with children ages 0 to 11 years old. Analyses assessed predictors of having home access to a computer, the Internet, and high-speed Internet service. Overall, 88.9% of all households owned a personal computer, and 81.4% of all households had Internet access. Among households with Internet access, 48.3% had high speed Internet at home. There were statistically significant associations between parental income or education and home computer ownership and Internet access. However, the impact of this difference was lessened by the fact that over 60% of families with annual household income of $10,000–$25,000, and nearly 70% of families with only a high-school education had Internet access at home. While income and education remain significant predictors of household computer and internet access, many patients and families at all economic levels have access, and might benefit from health promotion interventions using these modalities. PMID:16779012
Simulation of Smart Home Activity Datasets
Synnott, Jonathan; Nugent, Chris; Jeffers, Paul
2015-01-01
A globally ageing population is resulting in an increased prevalence of chronic conditions which affect older adults. Such conditions require long-term care and management to maximize quality of life, placing an increasing strain on healthcare resources. Intelligent environments such as smart homes facilitate long-term monitoring of activities in the home through the use of sensor technology. Access to sensor datasets is necessary for the development of novel activity monitoring and recognition approaches. Access to such datasets is limited due to issues such as sensor cost, availability and deployment time. The use of simulated environments and sensors may address these issues and facilitate the generation of comprehensive datasets. This paper provides a review of existing approaches for the generation of simulated smart home activity datasets, including model-based approaches and interactive approaches which implement virtual sensors, environments and avatars. The paper also provides recommendation for future work in intelligent environment simulation. PMID:26087371
Simulation of Smart Home Activity Datasets.
Synnott, Jonathan; Nugent, Chris; Jeffers, Paul
2015-06-16
A globally ageing population is resulting in an increased prevalence of chronic conditions which affect older adults. Such conditions require long-term care and management to maximize quality of life, placing an increasing strain on healthcare resources. Intelligent environments such as smart homes facilitate long-term monitoring of activities in the home through the use of sensor technology. Access to sensor datasets is necessary for the development of novel activity monitoring and recognition approaches. Access to such datasets is limited due to issues such as sensor cost, availability and deployment time. The use of simulated environments and sensors may address these issues and facilitate the generation of comprehensive datasets. This paper provides a review of existing approaches for the generation of simulated smart home activity datasets, including model-based approaches and interactive approaches which implement virtual sensors, environments and avatars. The paper also provides recommendation for future work in intelligent environment simulation.
Healthcare Benefits for Veterans: What Home Care Clinicians Need to Know.
Erickson-Hurt, Carma; McGuirk, Dianne; Long, Carol O
2017-05-01
As the world prepares for an increasingly aging population with chronic debilitating diseases, the demand for home healthcare services is increasing. As such, home healthcare clinicians face increased pressure to find resources and continuing support for patients. One area that may be underutilized is accessing Veteran benefits. Home healthcare clinicians care for Veterans every day, and knowing what benefits are available and how to access those benefits can help some Veterans who may be struggling with healthcare needs. Home healthcare clinicians may find understanding Veteran's health benefits intimidating and may falsely assume that a Veteran is aware of his or her benefits. Staying current on home healthcare benefits can be challenging and this article is intended to provide an overview of current and relevant information regarding Veteran health benefits.
Competition, information, and quality: Evidence from nursing homes.
Zhao, Xin
2016-09-01
Economic theory suggests that competition and information can both be important for product quality, and yet evidence on how they may interact to affect quality is sparse. This paper estimates the impact of competition between nursing homes on their quality, and how this impact varies when consumers have better access to information. The effect of competition is identified using exogenous variation in the geographical proximity of nursing homes to their potential consumers. The change in information transparency is captured by the launch of the Five-Star Quality Rating System in 2009, which improved access to the quality information of nursing homes. We find that while the effect of competition on nursing home quality is generally rather limited, this effect becomes significantly stronger with increased information transparency. The results suggest that regulations on public quality reporting and on market structure are policy complements, and should be considered jointly to best improve quality. Copyright © 2016 Elsevier B.V. All rights reserved.
Home-School Links: Networking the Learning Community.
ERIC Educational Resources Information Center
1996
The topic of networking the learning community with home-school links is addressed in four papers: "Internet Access via School: Expectations of Students and Parents" (Roy Crotty); "The School Library as Community Information Gateway" (Megan Perry); "Rural Access to the Internet" (Ken Eustace); and "NetDay '96:…
Design of smart home gateway based on Wi-Fi and ZigBee
NASA Astrophysics Data System (ADS)
Li, Yang
2018-04-01
With the increasing demand for home lifestyle, the traditional smart home products have been unable to meet the needs of users. Aim at the complex wiring, high cost and difficult operation problems of traditional smart home system, this paper designs a home gateway for smart home system based on Wi-Fi and ZigBee. This paper first gives a smart home system architecture base on cloud server, Wi-Fi and ZigBee. This architecture enables users to access the smart home system remotely from Internet through the cloud server or through Wi-Fi at home. It also offers the flexibility and low cost of ZigBee wireless networking for home equipment. This paper analyzes the functional requirements of the home gateway, and designs a modular hardware architecture based on the RT5350 wireless gateway module and the CC2530 ZigBee coordinator module. Also designs the software of the home gateway, including the gateway master program and the ZigBee coordinator program. Finally, the smart home system and home gateway are tested in two kinds of network environments, internal network and external network. The test results show that the designed home gateway can meet the requirements, support remote and local access, support multi-user, support information security technology, and can timely report equipment status information.
Straker, Leon M; Abbott, Rebecca A; Smith, Anne J
2013-01-01
Objective To evaluate the impact of (1) the removal of home access to traditional electronic games or (2) their replacement with active input electronic games, on daily physical activity and sedentary behaviour in children aged 10–12 years. Design Crossover randomised controlled trial, over 6 months. Setting Family homes in metropolitan Perth, Australia from 2007 to 2010. Participants 10-year-old to 12-year-old children were recruited through school and community media. From 210 children who were eligible, 74 met inclusion criteria, 8 withdrew and 10 had insufficient primary outcome measures, leaving 56 children (29 female) for analysis. Intervention A counterbalanced randomised order of three conditions sustained for 8 weeks each: no home access to electronic games, home access to traditional electronic games and home access to active input electronic games. Main outcome measures Primary outcome was accelerometer assessed moderate/vigorous physical activity (MVPA). Secondary outcomes included sedentary time and diary assessed physical activity and sedentary behaviours. Results Daily MVPA across the whole week was not significantly different between conditions. However, compared with home access to traditional electronic games, removal of all electronic games resulted in a significant increase in MVPA (mean 3.8 min/day, 95% CI 1.5 to 6.1) and a decrease in sedentary time (4.7 min/day, 0.0 to 9.5) in the after-school period. Similarly, replacing traditional games with active input games resulted in a significant increase in MVPA (3.2 min/day, 0.9 to 5.5) and a decrease in sedentary time (6.2 min/day, 1.4 to 11.4) in the after-school period. Diary reports supported an increase in physical activity and a decrease in screen-based sedentary behaviours with both interventions. Conclusions Removal of sedentary electronic games from the child's home and replacing these with active electronic games both resulted in small, objectively measured improvements in
Predictors of home healthcare nurse retention.
Ellenbecker, Carol Hall; Porell, Frank W; Samia, Linda; Byleckie, James J; Milburn, Michael
2008-01-01
To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. A descriptive correlation study of home healthcare nurses in six New England states. Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future.
Maternity waiting homes in Ethiopia--three decades experience.
Gaym, Asheber; Pearson, Luwei; Soe, Khynn Win Win
2012-07-01
Access to comprehensive emergency obstetric care is limited in Ethiopia. Maternity waiting homes are part of the strategies utilized to improve access to hard to reach rural populations. Despite long years of existence of this service in Ethiopia, the practice has not been adequately assessed so far. Describe the current status of maternity waiting home services in Ethiopia All facilities in Ethiopia that have a maternity waiting home were identified from FMOH data as well as personal contacts with focal persons at Regional Health Bureaus in the nine regions and UNICEF regional offices. A standardized data collection tool for facility assessment was developed by the quality referral team, Health Section, UNICEF. Data collection included site visits and documentation of infrastructural related issues through a facility checklist. Service related issues were also collected from log books and other documents as well as through interview with relevant staff Focus group discussions were held with all MWHs attendants who were found admitted at the time of the review at Attat, Wolisso and Gidole hospital maternity waiting homes on major thematic areas identified by the review team regarding MWH care The practice of maternity waiting homes in Ethiopia spans more than three decades. Nine facilities located in five Regional States had maternity waiting home services. All except one were located in hospitals. Admission capacity ranged from 4 up to 44 mothers at a time. Seven of the maternity waiting homes required the clients to cater for their own food, firewood and clothing supply providing only kitchen space and few kitchen utensils. Clients came from as far as 400 kms away to obtain services. Medical care and documentation of services were not standardized Duration of stay varied from 3-90 days. Monthly admission rates varied from 0-84 mothers at different institutions. Major indications for admission were previous caesarean section 34%; previous fistula repair 12
Dementia Home Care Resources: How Are We Managing?
Ward-Griffin, Catherine; Hall, Jodi; DeForge, Ryan; St-Amant, Oona; McWilliam, Carol; Oudshoorn, Abram; Forbes, Dorothy; Klosek, Marita
2012-01-01
With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future. PMID:22132332
Webcasting in home and hospice care services: virtual communication in home care.
Smith-Stoner, Marilyn
2011-06-01
The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.
Home Modification Basics: Tips from a Professional Contractor
ERIC Educational Resources Information Center
Apel, Ryan K.
2008-01-01
Accessibility for individuals with disabilities is paramount to successful mobility. No matter where a person with physical disabilities goes, there must be a plan for considering any physical barriers. In a home setting, however, these issues can be easily resolved--allowing for the comforts that all homes should provide. Ryan K. Apel is a…
Transforming home health nursing with telehealth technology.
Farrar, Francisca Cisneros
2015-06-01
Telehealth technology is an evidence-based delivery model tool that can be integrated into the plan of care for mental health patients. Telehealth technology empowers access to health care, can help decrease or prevent hospital readmissions, assist home health nurses provide shared decision making, and focuses on collaborative care. Telehealth and the recovery model have transformed the role of the home health nurse. Nurses need to be proactive and respond to rapidly emerging technologies that are transforming their role in home care. Copyright © 2015 Elsevier Inc. All rights reserved.
Incremental short daily home hemodialysis: a case series.
Toth-Manikowski, Stephanie M; Mullangi, Surekha; Hwang, Seungyoung; Shafi, Tariq
2017-07-05
Patients starting dialysis often have substantial residual kidney function. Incremental hemodialysis provides a hemodialysis prescription that supplements patients' residual kidney function while maintaining total (residual + dialysis) urea clearance (standard Kt/Vurea) targets. We describe our experience with incremental hemodialysis in patients using NxStage System One for home hemodialysis. From 2011 to 2015, we initiated 5 incident hemodialysis patients on an incremental home hemodialysis regimen. The biochemical parameters of all patients remained stable on the incremental hemodialysis regimen and they consistently achieved standard Kt/Vurea targets. Of the two patients with follow-up >6 months, residual kidney function was preserved for ≥2 years. Importantly, the patients were able to transition to home hemodialysis without automatically requiring 5 sessions per week at the outset and gradually increased the number of treatments and/or dialysate volume as the residual kidney function declined. An incremental home hemodialysis regimen can be safely prescribed and may improve acceptability of home hemodialysis. Reducing hemodialysis frequency by even one treatment per week can reduce the number of fistula or graft cannulations or catheter connections by >100 per year, an important consideration for patient well-being, access longevity, and access-related infections. The incremental hemodialysis approach, supported by national guidelines, can be considered for all home hemodialysis patients with residual kidney function.
The National Home Visiting Coalition: A History of Collaboration
ERIC Educational Resources Information Center
Callahan, Jane; Gavaghan, Bridget; Howard, Karen; Kelley, Melissa L.; Schwartz, Marvin; Walzer, Sarah
2010-01-01
The Home Visiting Coalition represents more than 75 organizations working together to articulate the effectiveness of home visiting to a range of policymakers and stakeholders in the early childhood field. Despite varying program goals and service delivery strategies, the Coalition participants share a commitment to expanding access to…
ERIC Educational Resources Information Center
Olalere, Abiodun; Lazar, Jonathan
2011-01-01
U.S. federal websites are required to be accessible for people with impairments. However, despite the existing regulations and guidelines, many federal websites continue to be inaccessible, and accessibility policy statements available on federal websites often do not provide any useful information. This paper provides three contributions to the…
Deutsch, Arielle R; Steinley, Douglas; Sher, Kenneth J; Slutske, Wendy S
2017-09-01
The findings of previous research that examined relationships between popularity and alcohol use in adolescents have been mixed, and few hypotheses have proposed mechanisms for this relationship. The current study expands on previous literature (a) by examining a possible mechanism that can explain the relation between popularity and alcohol use (home access to alcohol) and (b) by using another sociometric measure ("betweenness"), beyond popularity, that may relate more to home alcohol access. Using network-level data from adolescents in 9th-11th grades in eight schools within two in-home waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined two sociometric measures of social status: popularity (number of schoolmates who nominated participants as a friend) and betweenness (level of ties participants have to multiple social subgroups within a network). Betweenness, but not popularity, related to later alcohol use. Having home access to alcohol positively related to later alcohol use, and having friends with home access to alcohol negatively related to later alcohol use. Alcohol access was also related to later sociometric status. Friends' alcohol access negatively related to later betweenness, and personal alcohol access moderated other pathways predicting betweenness. Betweenness appears to play a unique role in the association between social status and alcohol use in adolescent social networks. This is potentially tied to specific ways in which adolescents may be able to access alcohol (through home or through friends with access at home). More research is necessary to examine the ways in which multiple sociometric statuses relate to the contexts in which adolescents access and use alcohol.
Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care
ERIC Educational Resources Information Center
Davitt, Joan K.
2014-01-01
Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…
Home-ownership in Europe: How did it happen?
Angelini, Viola; Laferrère, Anne; Weber, Guglielmo
2013-03-01
We use data from the third wave of the Survey of Health, Ageing and Retirement in Europe (SHARELIFE)(1) to document the different ways individuals first became home-owners across countries and over cohorts over the second half of the 20th century. Focusing on first-time home owners we find that younger cohorts became home-owners earlier and were more likely to do it through credit, less likely to inherit their home directly. Having higher human capital, being employed, married, having children and living in an urban area, all make it more likely to purchase a home with a mortgage. The persistence of family help in accessing home-ownership in many countries demonstrates the interrelation between family, market and the state in most of continental Europe. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Care for the chronically ill: Nursing home incentive payment experiment
Weissert, William G.; Scanlon, William J.; Wan, Thomas T. H.; Skinner, Douglas E.
1983-01-01
Nursing home reinbursement systems which do not adjust payment levels to patient care needs lead to access problems for heavy-care patients. Unnecessarily long and costly hospital stays may result. A patient-based nursing home incentive reimbursement system has been designed and is being evaluated in a controlled field experiment in 36 California skilled nursing facilities. Incentives are paid for admitting heavy-care patients, meeting outcome goals on some patients, and discharging and maintaining some patients in the community. This article describes a nursing home reimbursement system which is intended to simultaneously mitigate problems of restricted access, inefficient use of beds, and nonoptimal care. It also discusses the approach to evaluating this broad social intervention by application of a controlled experimental design. PMID:10310528
Unbundling in Current Broadband and Next-Generation Ultra-Broadband Access Networks
NASA Astrophysics Data System (ADS)
Gaudino, Roberto; Giuliano, Romeo; Mazzenga, Franco; Valcarenghi, Luca; Vatalaro, Francesco
2014-05-01
This article overviews the methods that are currently under investigation for implementing multi-operator open-access/shared-access techniques in next-generation access ultra-broadband architectures, starting from the traditional "unbundling-of-the-local-loop" techniques implemented in legacy twisted-pair digital subscriber line access networks. A straightforward replication of these copper-based unbundling-of-the-local-loop techniques is usually not feasible on next-generation access networks, including fiber-to-the-home point-to-multipoint passive optical networks. To investigate this issue, the article first gives a concise description of traditional copper-based unbundling-of-the-local-loop solutions, then focalizes on both next-generation access hybrid fiber-copper digital subscriber line fiber-to-the-cabinet scenarios and on fiber to the home by accounting for the mix of regulatory and technological reasons driving the next-generation access migration path, focusing mostly on the European situation.
Hospital information technology in home care.
Zhang, Xiao-Ying; Zhang, Pei-Ying
2016-10-01
The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.
Designing of smart home automation system based on Raspberry Pi
NASA Astrophysics Data System (ADS)
Saini, Ravi Prakash; Singh, Bhanu Pratap; Sharma, Mahesh Kumar; Wattanawisuth, Nattapol; Leeprechanon, Nopbhorn
2016-03-01
Locally networked or remotely controlled home automation system becomes a popular paradigm because of the numerous advantages and is suitable for academic research. This paper proposes a method for an implementation of Raspberry Pi based home automation system presented with an android phone access interface. The power consumption profile across the connected load is measured accurately through programming. Users can access the graph of total power consumption with respect to time worldwide using their Dropbox account. An android application has been developed to channelize the monitoring and controlling operation of home appliances remotely. This application facilitates controlling of operating pins of Raspberry Pi by pressing the corresponding key for turning "on" and "off" of any desired appliance. Systems can range from the simple room lighting control to smart microcontroller based hybrid systems incorporating several other additional features. Smart home automation systems are being adopted to achieve flexibility, scalability, security in the sense of data protection through the cloud-based data storage protocol, reliability, energy efficiency, etc.
On Using Home Networks and Cloud Computing for a Future Internet of Things
NASA Astrophysics Data System (ADS)
Niedermayer, Heiko; Holz, Ralph; Pahl, Marc-Oliver; Carle, Georg
In this position paper we state four requirements for a Future Internet and sketch our initial concept. The requirements: (1) more comfort, (2) integration of home networks, (3) resources like service clouds in the network, and (4) access anywhere on any machine. Future Internet needs future quality and future comfort. There need to be new possiblities for everyone. Our focus is on higher layers and related to the many overlay proposals. We consider them to run on top of a basic Future Internet core. A new user experience means to include all user devices. Home networks and services should be a fundamental part of the Future Internet. Home networks extend access and allow interaction with the environment. Cloud Computing can provide reliable resources beyond local boundaries. For access anywhere, we also need secure storage for data and profiles in the network, in particular for access with non-personal devices (Internet terminal, ticket machine, ...).
NASA Astrophysics Data System (ADS)
Quigley, Mark Declan
The purpose of this researcher was to examine specific environmental, educational, and demographic factors and their influence on mathematics and science achievement. In particular, the researcher ascertained the interconnections of home computer access and social capital, with Asian American students and the effect on mathematics and science achievement. Coleman's theory on social capital and parental influence was used as a basis for the analysis of data. Subjects for this study were the base year students from the National Education Longitudinal Study of 1988 (NELS:88) and the subsequent follow-up survey data in 1990, 1992, and 1994. The approximate sample size for this study is 640 ethnic Asians from the NELS:88 database. The analysis was a longitudinal study based on the Student and Parent Base Year responses and the Second Follow-up survey of 1992, when the subjects were in 12th grade. Achievement test results from the NELS:88 data were used to measure achievement in mathematics and science. The NELS:88 test battery was developed to measure both individual status and a student's growth in a number of achievement areas. The subject's responses were analyzed by principal components factor analysis, weights, effect sizes, hierarchial regression analysis, and PLSPath Analysis. The results of this study were that prior ability in mathematics and science is a major influence in the student's educational achievement. Findings from the study support the view that home computer access has a negative direct effect on mathematics and science achievement for both Asian American males and females. None of the social capital factors in the study had either a negative or positive direct effect on mathematics and science achievement although some indirect effects were found. Suggestions were made toward increasing parental involvement in their children's academic endeavors. Computer access in the home should be considered related to television viewing and should be closely
Models of Educational Computing @ Home: New Frontiers for Research on Technology in Learning.
ERIC Educational Resources Information Center
Kafai, Yasmin B.; Fishman, Barry J.; Bruckman, Amy S.; Rockman, Saul
2002-01-01
Discusses models of home educational computing that are linked to learning in school and recommends the need for research that addresses the home as a computer-based learning environment. Topics include a history of research on educational computing at home; technological infrastructure, including software and compatibility; Internet access;…
Potter, Rachel; Sheehan, Bart; Cain, Rebecca; Griffin, James; Jennings, Paul A
2018-05-08
Forty percent of residents living in care homes in the United Kingdom have significant depressive symptoms. Care homes can appear to be depressing places, but whether the physical environment of homes directly affects depression in care home residents is unknown. This study explores the relationship between the physical environment and depressive symptoms of older people living in care homes. In a prospective cohort study the physical environment of 50 care homes were measured using the Sheffield Care Environment Assessment Matrix (SCEAM) and depressive symptoms of 510 residents measured using the Geriatric Depression Scale (GDS-15). The study was supplemented with semi-structured interviews with residents living in the care homes. Quantitative data were analyzed using multi-level modeling, and qualitative data analyzed using a thematic framework approach. The overall physical environment of care homes (overall SCEAM score) did not predict depressive symptoms. Controlling for dependency, social engagement, and home type, having access to outdoor space was the only environmental variable to significantly predict depressive symptoms. Residents interviewed reported that access to outdoor space was restricted in many ways: locked doors, uneven foot paths, steep steps, and needing permission or assistance to go outside. We provide new evidence to suggest that access to outdoor space predicts depressive symptoms in older people living in care home. Interventions aimed at increasing access to outdoor spaces could positively affect depressive symptoms in older people.
Food Away from Home and Childhood Obesity.
Mancino, Lisa; Todd, Jessica E; Guthrie, Joanne; Lin, Biing-Hwan
2014-12-01
Childhood obesity is associated with a number of serious health risks that can persist into adulthood. While trends in food away from home and fast-food consumption have paralleled trends in childhood obesity, it is important to identify whether this is a causal relationship. This paper reviews recent literature in this area to summarize if there is a consensus in research findings. We group the literature into two areas - consumption of and access to food away from home (FAFH). While no consensus findings have been reached in either area, the evidence of an association between FAFH consumption and childhood obesity has gained strength. Further, there is evidence that FAFH meals add calories to children's diets. The literature on the role of FAFH access and childhood obesity has continued producing mixed results.
Potential Market Demand for Two-Way Information Services to the Home, 1970-1990.
ERIC Educational Resources Information Center
Baran, Paul
Two-way information services to the home may become a $20 billion per year industry by the end of the next decade; this report presents some market forecasts for thirty such home information services. The thirty possible home information services are grouped into six major categories: education, business, general information access, shopping…
World Wide Web home page for the South Platte NAWQA
Qi, Sharon L.; Dennehy, Kevin F.
1997-01-01
A World Wide Web home page for the U.S. Geological Survey's (USGS) National Water-Quality Assessment (NAWQA) Program, South Platte River Basin study is now online. The home page includes information about the basinwide investigation and provides viewing and downloading access to physical, chemical, and biological data collected by the study team.
Birchley, Giles; Huxtable, Richard; Murtagh, Madeleine; Ter Meulen, Ruud; Flach, Peter; Gooberman-Hill, Rachael
2017-04-04
Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology's potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engineers themselves. By exploring the views of engineering researchers in a large smart-home project, we sought to contribute to dialogue between ethics and the engineering community. Either face-to-face or using Skype, we conducted in-depth qualitative interviews with 20 early- and mid-career smart-home researchers from a multi-centre smart-home project, who were asked to describe their own experience and to reflect more broadly about ethical considerations that relate to smart-home design. With participants' consent, interviews were audio-recorded, transcribed and analysed using a thematic approach. Two overarching themes emerged: in 'Privacy', researchers indicated that they paid close attention to negative consequences of potential unauthorised information sharing in their current work. However, when discussing broader issues in smart-home design beyond the confines of their immediate project, researchers considered physical privacy to a lesser extent, even though physical privacy may manifest in emotive concerns about being watched or monitored. In 'Choice', researchers indicated they often saw provision of choice to end-users as a solution to ethical dilemmas. While researchers indicated that choices of end-users may need to be restricted for technological reasons, ethical standpoints that restrict choice were usually assumed and embedded in design. The tractability of informational privacy may explain the greater attention that is paid to it. However, concerns about physical privacy may
Nutritional status, psychosocial development and the home environment of Indian rural children.
Vazir, S; Naidu, A N; Vidyasagar, P
1998-10-01
To assess the psychosocial development of well nourished and malnourished children aged 0-6 years and to identify the microenvironmental factors influencing their growth and development. Multicentric cross-sectional. Rural Communities. Total of 3668 children of whom 2212 were well nourished and 1456 were malnourished. Weight for age index to assess nutritional status. Cut-off < 75% NCHS standards used based on Gomez grades II and III being malnourished and Normal and grade I being well nourished. ICMR Developmental Screening Test to assess psychosocial development and modified WHO parental interview schedule to assess family and micro-environmental factors. Malnourished children attained developmental milestones at a later age. Developmental delay among the malnourished was especially observed in areas like vision and fine motor, language and comprehension and personal social. The delay was to the extent of 7-11 months in these areas in different age groups. Paternal involvement with child care especially, father spending time, telling stories and taking child for outing was found to be important for positive psychosocial development. Other significant factors included parents teaching child, small family size and paternal occupation. Child's appetite, absence of health problems, parental age and family having own house and electricity were the factors significantly related to better nutritional status of children. Factors identified in the study are important for the development of relevant intervention at the home level. Appropriate multifaceted community based programmes such as the ICDS are also required for stimulating growth and development of backward rural children.
Care home manager attitudes to balancing risk and autonomy for residents with dementia.
Evans, Elizabeth A; Perkins, Elizabeth; Clarke, Pam; Haines, Alina; Baldwin, Ashley; Whittington, Richard
2018-02-01
To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach. There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home. There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.
Medical Home Transformation in Pediatric Primary Care—What Drives Change?
McAllister, Jeanne W.; Cooley, W. Carl; Van Cleave, Jeanne; Boudreau, Alexy Arauz; Kuhlthau, Karen
2013-01-01
PURPOSE The aim of this study was to characterize essential factors to the medical home transformation of high-performing pediatric primary care practices 6 to 7 years after their participation in a national medical home learning collaborative. METHODS We evaluated the 12 primary care practice teams having the highest Medical Home Index (MHI) scores after participation in a national medical home learning collaborative with current MHI scores, a clinician staff questionnaire (assessing adaptive reserve), and semistructured interviews. We reviewed factors that emerged from interviews and analyzed domains and subdomains for their agreement with MHI and adaptive reserve domains and subthemes using a process of triangulation. RESULTS At 6 to 7 years after learning collaborative participation, 4 essential medical home attributes emerged as drivers of transformation: (1) a culture of quality improvement, (2) family-centered care with parents as improvement partners, (3) team-based care, and (4) care coordination. These high-performing practices developed comprehensive, family-centered, planned care processes including flexible access options, population approaches, and shared care plans. Eleven practices evolved to employ care coordinators. Family satisfaction appeared to stem from better access, care, and safety, and having a strong relationship with their health care team. Physician and staff satisfaction was high even while leadership activities strained personal time. CONCLUSIONS Participation in a medical home learning collaborative stimulated, but did not complete, medical home changes in 12 pediatric practices. Medical home transformation required continuous development, ongoing quality improvement, family partnership skills, an attitude of teamwork, and strong care coordination functions. PMID:23690392
Designing of smart home automation system based on Raspberry Pi
DOE Office of Scientific and Technical Information (OSTI.GOV)
Saini, Ravi Prakash; Singh, Bhanu Pratap; Sharma, Mahesh Kumar
Locally networked or remotely controlled home automation system becomes a popular paradigm because of the numerous advantages and is suitable for academic research. This paper proposes a method for an implementation of Raspberry Pi based home automation system presented with an android phone access interface. The power consumption profile across the connected load is measured accurately through programming. Users can access the graph of total power consumption with respect to time worldwide using their Dropbox account. An android application has been developed to channelize the monitoring and controlling operation of home appliances remotely. This application facilitates controlling of operating pinsmore » of Raspberry Pi by pressing the corresponding key for turning “on” and “off” of any desired appliance. Systems can range from the simple room lighting control to smart microcontroller based hybrid systems incorporating several other additional features. Smart home automation systems are being adopted to achieve flexibility, scalability, security in the sense of data protection through the cloud-based data storage protocol, reliability, energy efficiency, etc.« less
The validation of a home food inventory.
Fulkerson, Jayne A; Nelson, Melissa C; Lytle, Leslie; Moe, Stacey; Heitzler, Carrie; Pasch, Keryn E
2008-11-04
Home food inventories provide an efficient method for assessing home food availability; however, few are validated. The present study's aim was to develop and validate a home food inventory that is easily completed by research participants in their homes and includes a comprehensive range of both healthful and less healthful foods that are associated with obesity. A home food inventory (HFI) was developed and tested with two samples. Sample 1 included 51 adult participants and six trained research staff who independently completed the HFI in participants' homes. Sample 2 included 342 families in which parents completed the HFI and the Diet History Questionnaire (DHQ) and students completed three 24-hour dietary recall interviews. HFI items assessed 13 major food categories as well as two categories assessing ready-access to foods in the kitchen and the refrigerator. An obesogenic household food availability score was also created. To assess criterion validity, participants' and research staffs' assessment of home food availability were compared (staff = gold standard). Criterion validity was evaluated with kappa, sensitivity, and specificity. Construct validity was assessed with correlations of five HFI major food category scores with servings of the same foods and associated nutrients from the DHQ and dietary recalls. Kappa statistics for all 13 major food categories and the two ready-access categories ranged from 0.61 to 0.83, indicating substantial agreement. Sensitivity ranged from 0.69 to 0.89, and specificity ranged from 0.86 to 0.95. Spearman correlations between staff and participant major food category scores ranged from 0.71 to 0.97. Correlations between the HFI scores and food group servings and nutrients on the DHQ (parents) were all significant (p < .05) while about half of associations between the HFI and dietary recall interviews (adolescents) were significant (p < .05). The obesogenic home food availability score was significantly associated (p
Home Care Nursing via Computer Networks: Justification and Design Specifications
Brennan, Patricia Flatley
1988-01-01
High-tech home care includes the use of information technologies, such as computer networks, to provide direct care to patients in the home. This paper presents the justification and design of a project using a free, public access computer network to deliver home care nursing. The intervention attempts to reduce isolation and improve problem solving among home care patients and their informal caregivers. Three modules comprise the intervention: a decision module, a communications module, and an information data base. This paper describes the experimental evaluation of the project, and discusses issues in the delivery of nursing care via computers.
Return to nursing home investment: Issues for public policy
Baldwin, Carliss Y.; Bishop, Christine E.
1984-01-01
Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how-sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care. PMID:10310945
ERIC Educational Resources Information Center
Bradley, Robert H.; Putnick, Diane L.
2012-01-01
This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were…
Can Home-Based Care Offer High Quality Early Childhood Education?
ERIC Educational Resources Information Center
Smith, Anne B.
2015-01-01
The nature of quality within home-based early childhood education (HBECE) services is important, since all children have the right to access high quality ECE whether it is centre or home-based. HBECE services are increasing more rapidly than other EC services in New Zealand, and their flexible hours, local contexts, and favourable ratios and group…
Home Computer Use and Academic Performance of Nine-Year-Olds
ERIC Educational Resources Information Center
Casey, Alice; Layte, Richard; Lyons, Sean; Silles, Mary
2012-01-01
A recent rise in home computer ownership has seen a growing number of children using computers and accessing the internet from a younger age. This paper examines the link between children's home computing and their academic performance in the areas of reading and mathematics. Data from the nine-year-old cohort of the Growing Up in Ireland survey…
Measures of the home environment related to childhood obesity: a systematic review.
Pinard, Courtney A; Yaroch, Amy L; Hart, Michael H; Serrano, Elena L; McFerren, Mary M; Estabrooks, Paul A
2012-01-01
Due to a proliferation of measures for different components of the home environment related to childhood obesity, the purpose of the present systematic review was to examine these tools and the degree to which they can validly and reliably assess the home environment. Relevant manuscripts published between 1998 and 2010 were obtained through electronic database searches and manual searches of reference lists. Manuscripts were included if the researchers reported on a measure of the home environment related to child eating and physical activity (PA) and childhood obesity and reported on at least one psychometric property. Of the forty papers reviewed, 48 % discussed some aspect of parenting specific to food. Fifty-per cent of the manuscripts measured food availability/accessibility, 18 % measured PA availability/accessibility, 20 % measured media availability/accessibility, 30 % focused on feeding style, 23 % focused on parenting related to PA and 20 % focused on parenting related to screen time. Many researchers chose to design new measures for their studies but often the items employed were brief and there was a lack of transparency in the psychometric properties. Many of the current measures of the home food and PA environment focus on one or two constructs; more comprehensive measures as well as short screeners guided by theoretical models are necessary to capture influences in the home on food and PA behaviours of children. Finally, the current measures of the home environment do not necessarily translate to specific sub-populations. Recommendations were made for future validation of measures in terms of appropriate psychometric testing.
Survey of continuing professional education within nursing homes.
Aoki, Yumie; Davies, Sue
This article reports a survey of qualified nurses employed in nursing homes in a large city in the north of England. The aim of the study was to describe nurses' experiences and perceptions of continuing professional education (CPE), and their views on the development of their knowledge and skills through formal and informal education. Findings revealed that nurses in nursing homes perceived the value of educational programmes but had limited opportunities to attend formal education programmes. They faced a number of barriers and challenges in accessing formal education. Various informal ways of learning were used, including reading professional journals, watching videotapes and television programmes and accessing the Internet. However, respondents appeared not to use fully opportunities for sharing knowledge with colleagues. Although this study is based on a small sample, the findings support those of other studies in this field. Collectively, these studies suggest an urgent need to develop a range of approaches to CPE within care homes, both formal and informal, if the standards outlined within recent policy initiatives are to be achieved.
Old Buildings Broadband Home Networks: Technologies and Services Overview
NASA Astrophysics Data System (ADS)
Fantacci, Romano; Pecorella, Tommaso; Micciullo, Luigia; Viti, Roberto; Pasquini, Vincenzo; Calì, Marco
2014-05-01
Internet broadband access is becoming a reality in many countries. To fully exploit the benefits from high-speed connection, both suitable home network connectivity and advanced services support have to be made available to the user. In this article, issues relative to the upgrade of existing home networks, particularly in old buildings, together with networking and security requirements are addressed, and possible solutions are proposed.
Seniors' need for and use of Medicare home health services.
Hubbert, Ann O; Hays, Bevely J
2002-01-01
This study examined: (a) nature and extent of seniors' need for care both at time of admission to and discharge from Medicare home health services, and (b) relationships among admission need, service utilization, need at discharge, and discharge disposition for one episode of home care services. The sample of 195 was stratified by home health discharge disposition: (a) acute group, (b) chronic group, and (c) stable home group. Two classification systems were used to access the seniors' level of need, the mandated Medicare case-mix system (CMS) and a holistic intensity of need system. Findings show that there were no differences in services received by the three groups, that discharge did not mean seniors' need for home care services had been eliminated or reduced, and that caregiver support impacts seniors' need for home care.
Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.
Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K
2018-01-01
-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.
Starting a Second Chance Home: A Guide for Policymakers and Practitioners.
ERIC Educational Resources Information Center
Reich, Kathy; Kelly, Lisa M.
This guide outlines 10 basic steps for policymakers and practitioners interested in creating Second Chance Homes in their areas. Second Chance Homes provide stable, nurturing environments for teen families with access to child care, education, job training, counseling, and advice on parenting and life skills. The guide is based on interviews with…
Moraitou, Marina; Pateli, Adamantia; Fotiou, Sotiris
2017-01-01
As access to health care is important to people's health especially for vulnerable groups that need nursing for a long period of time, new studies in the human sciences argue that the health of the population depend less on the quality of the health care, or on the amount of spending that goes into health care, and more heavily on the quality of everyday life. Smart home applications are designed to "sense" and monitor the health conditions of its residents through the use of a wide range of technological components (motion sensors, video cameras, wearable devices etc.), and web-based services that support their wish to stay at home. In this work, we provide a review of the main technological, psychosocial/ethical and economic challenges that the implementation of a Smart Health Caring Home raises.
Dental caries in Victorian nursing homes.
Silva, M; Hopcraft, M; Morgan, M
2014-09-01
The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services. © 2014 Australian Dental Association.
Home-Care Use and Expenditures Among Medicaid Beneficiaries with AIDS
Sambamoorthi, Usha; Collins, Sara R.; Crystal, Stephen; Walkup, James
1999-01-01
This article compares the use and cost of home-care services among traditional Medicaid recipients with acquired immunodeficiency syndrome (AIDS) and among participants in a statewide Human Immunodeficiency Virus (HIV)/AIDS-specific home and community-based Medicaid waiver program in New Jersey, using Medicaid claims and AIDS surveillance data. Waiver program participation appears to mitigate racial and risk group differences in the probability of home-care use. However, the program's successes are confined to its enrollees of which subgroups of the AIDS population are underrepresented. Our findings suggest the need to expand access to home-care programs to racial minorities and injection drug users (IDUs) with HIV/AIDS. PMID:11482120
5 CFR 2100.9 - Appeal of denial to grant access or to amend records.
Code of Federal Regulations, 2010 CFR
2010-01-01
... amend records. 2100.9 Section 2100.9 Administrative Personnel ARMED FORCES RETIREMENT HOME ARMED FORCES RETIREMENT HOME PRIVACY ACT PROCEDURES § 2100.9 Appeal of denial to grant access or to amend records. (a) All... the following addresses: Associate Director, Resource Management, U.S. Soldiers' and Airmen's Home...
Studying "exposure" to firearms: household ownership v access
Ikeda, R; Dahlberg, L; Kresnow, M; Sacks, J; Mercy, J
2003-01-01
Background: Firearm ownership has often been used to measure access to weapons. However, persons who own a firearm may not have access to it and conversely, persons who do not own a firearm may be able to access one quickly. Objectives: To examine whether using firearm ownership is a reasonable proxy for access by describing the demographic characteristics associated with ownership and access. Methods: Data are from the 1994 Injury Control and Risk Survey, a national, random digit dial survey. Information about household firearm ownership and ready access to a loaded firearm were collected and weighted to provide national estimates. Adjusted odds ratios for three separate models were calculated using logistic regression. Results: A total of 1353 (27.9%) respondents reported both having a firearm in the household and ready access to one. An additional 313 respondents (8.1%) reported having a firearm, but were not able to access these weapons. Another 421 respondents (7.2%) did not have a firearm in or around their home, yet reported being able to retrieve and fire one within 10 minutes. Based on the logistic regression findings, the demographic characteristics of this latter group are quite different from those who report ownership. Those who do not have a firearm, but report ready access to one, are more likely to be ethnic minorities, single, and living in attached homes. Conclusions: Asking only about the presence of a firearm in a household may miss some respondents with ready access to a loaded firearm. More importantly, those who do not own a firearm, but report ready access to one, appear to be qualitatively different from those who report ownership. Caution should be exercised when using measures of ownership as a proxy for access. PMID:12642560
Integration of multisensor hybrid reasoners to support personal autonomy in the smart home.
Valero, Miguel Ángel; Bravo, José; Chamizo, Juan Manuel García; López-de-Ipiña, Diego
2014-09-17
The deployment of the Ambient Intelligence (AmI) paradigm requires designing and integrating user-centered smart environments to assist people in their daily life activities. This research paper details an integration and validation of multiple heterogeneous sensors with hybrid reasoners that support decision making in order to monitor personal and environmental data at a smart home in a private way. The results innovate on knowledge-based platforms, distributed sensors, connected objects, accessibility and authentication methods to promote independent living for elderly people. TALISMAN+, the AmI framework deployed, integrates four subsystems in the smart home: (i) a mobile biomedical telemonitoring platform to provide elderly patients with continuous disease management; (ii) an integration middleware that allows context capture from heterogeneous sensors to program environment's reaction; (iii) a vision system for intelligent monitoring of daily activities in the home; and (iv) an ontologies-based integrated reasoning platform to trigger local actions and manage private information in the smart home. The framework was integrated in two real running environments, the UPM Accessible Digital Home and MetalTIC house, and successfully validated by five experts in home care, elderly people and personal autonomy.
Integration of Multisensor Hybrid Reasoners to Support Personal Autonomy in the Smart Home
Valero, Miguel Ángel; Bravo, José; Chamizo, Juan Manuel García; López-de-Ipiña, Diego
2014-01-01
The deployment of the Ambient Intelligence (AmI) paradigm requires designing and integrating user-centered smart environments to assist people in their daily life activities. This research paper details an integration and validation of multiple heterogeneous sensors with hybrid reasoners that support decision making in order to monitor personal and environmental data at a smart home in a private way. The results innovate on knowledge-based platforms, distributed sensors, connected objects, accessibility and authentication methods to promote independent living for elderly people. TALISMAN+, the AmI framework deployed, integrates four subsystems in the smart home: (i) a mobile biomedical telemonitoring platform to provide elderly patients with continuous disease management; (ii) an integration middleware that allows context capture from heterogeneous sensors to program environment's reaction; (iii) a vision system for intelligent monitoring of daily activities in the home; and (iv) an ontologies-based integrated reasoning platform to trigger local actions and manage private information in the smart home. The framework was integrated in two real running environments, the UPM Accessible Digital Home and MetalTIC house, and successfully validated by five experts in home care, elderly people and personal autonomy. PMID:25232910
Pilot Evaluation of a Home Visit Parent Training Program in Disadvantaged Families
ERIC Educational Resources Information Center
Leung, Cynthia; Tsang, Sandra; Heung, Kitty
2013-01-01
Objectives: The study reported the pilot evaluation of the Healthy Start Home Visit Program for disadvantaged Chinese parents with preschool children, delivered by trained parent assistants. Home visiting was used to make services more accessible to disadvantaged families. Method: The participants included 21 parent-child dyads. Outcome measures…
Moving Parkinson care to the home.
Dorsey, E Ray; Vlaanderen, Floris P; Engelen, Lucien Jlpg; Kieburtz, Karl; Zhu, William; Biglan, Kevin M; Faber, Marjan J; Bloem, Bastiaan R
2016-09-01
In many ways, the care of individuals with Parkinson disease does not meet their needs. Despite the documented benefits of receiving care from clinicians with Parkinson disease expertise, many patients (if not most) do not. Moreover, current care models frequently require older individuals with impaired mobility, cognition, and driving ability to be driven by overburdened caregivers to large, complex urban medical centers. Moving care to the patient's home would make Parkinson disease care more patient-centered. Demographic factors, including aging populations, and social factors, such as the splintering of the extended family, will increase the need for home-based care. Technological advances, especially the ability to assess and deliver care remotely, will enable the transition of care back to the home. However, despite its promise, this next generation of home-based care will have to overcome barriers, including outdated insurance models and a technological divide. Once these barriers are addressed, home-based care will increase access to high quality care for the growing number of individuals with Parkinson disease. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.
Blubaugh, Morgan V.; Uslan, Mark M.
2012-01-01
The vast majority of diabetes-related self-management technology utilizes small visual displays (SVDs) that often produce a low level of contrast and suffer from high levels of reflection (glare). This is a major accessibility issue for the 3.5 million Americans with diabetes who have reduced vision. The purpose of this article is to gather comparative data on the key display attributes of the SVDs used in blood glucose meters (BGMs) and home blood pressure monitors (HBPMs) on the market today and determine which displays offer the best prospect for being accessible to people with reduced vision. Nine BGMs and eight HBPMs were identified for this study on the basis of amount of devices sold, full-functionality speech output, and advanced display technologies. An optical instrumentation system obtained contrast, reflection (glare), and font height measurements for all 17 displays. The contrast, reflection, and font-height values for the BGMs and HBPMs varied greatly between models. The Michelson contrast values for the BGMs ranged from 11% to 98% and font heights ranged 0.39–1.00 in. for the measurement results. The HBPMs had Michelson contrast values ranging 55–96% and font height ranging 0.28–0.94 in. for the measurement results. Due largely to the lack of display design standards for the technical requirements of SVDs, there is tremendous variability in the quality and readability of BGM and HBPM displays. There were two BGMs and one HBPM that exhibited high-contrast values and large font heights, but most of the devices exhibited either poor contrast or exceptionally high reflection. PMID:22538132
Blubaugh, Morgan V; Uslan, Mark M
2012-03-01
The vast majority of diabetes-related self-management technology utilizes small visual displays (SVDs) that often produce a low level of contrast and suffer from high levels of reflection (glare). This is a major accessibility issue for the 3.5 million Americans with diabetes who have reduced vision. The purpose of this article is to gather comparative data on the key display attributes of the SVDs used in blood glucose meters (BGMs) and home blood pressure monitors (HBPMs) on the market today and determine which displays offer the best prospect for being accessible to people with reduced vision. Nine BGMs and eight HBPMs were identified for this study on the basis of amount of devices sold, fullfunctionality speech output, and advanced display technologies. An optical instrumentation system obtained contrast, reflection (glare), and font height measurements for all 17 displays. The contrast, reflection, and font-height values for the BGMs and HBPMs varied greatly between models. The Michelson contrast values for the BGMs ranged from 11% to 98% and font heights ranged 0.39-1.00 in. for the measurement results. The HBPMs had Michelson contrast values ranging 55-96% and font height ranging 0.28-0.94 in. for the measurement results. Due largely to the lack of display design standards for the technical requirements of SVDs, there is tremendous variability in the quality and readability of BGM and HBPM displays. There were two BGMs and one HBPM that exhibited high-contrast values and large font heights, but most of the devices exhibited either poor contrast or exceptionally high reflection. © 2012 Diabetes Technology Society.
[The quality of the work-home and home-work relationship in the context of personal resources].
Szymańska, Paulina
2014-01-01
The aim of the study was to examine whether gain or loss of personal resources is associated with conflict or facilitation between work and family. The study involved 90 employees (mean age: 34.5 years). The Polish version of COR-Evaluation (Conservation of Resources-Evaluation) questionnaire, developed by Hobfoll and adapted by Dudek et al, was used to assess personal resources. The questionnaire enables to estimate gain and loss of 40 resources and calculate the overall level of gained or lost resources. SWING Questionnaire (Survey Work-Home Interaction, Nijmegen), developed by Geurts et al. and adapted by Mośicka-Teske and Merecz), was used to examine the quality of work-home and home-work relationship. The gain of personal resources positively correlates with both home-work facilitation (HWF) and work-home facilitation (WHF). Improvement of the family relations proved to be the most significant predictor of HWF and WHF. The loss of personal resources coincides with high level of conflict between the investigated areas of life. The main predictor of home-work conflict (HWC) was the variable relating to restrictions of access to medical services. In case of work-home conflict (WHC) the reduction of material security in case of dramatic life events was the major predictor. The results confirmed that the gain of resources is crucial for HWF/WHF, while their loss is an important factor, when the HWC/WHC is considered. The resources, which proved to be the main predictors of work-home and home-work relatiohship were alsoindicated. The obtained information may be beneficial to human resources managers, especially in designing the activities aimed at increasing the satisfaction and effectiveness of employees.
[eLearning service for home palliative care].
Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu
2008-12-01
In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids.
Pearson, Natalie; Griffiths, Paula; Biddle, Stuart J H; Johnston, Julie P; Haycraft, Emma
2017-05-01
This study aimed to examine individual, behavioural and home environmental factors associated with frequency of consumption of fruit, vegetables and energy-dense snacks among adolescents. Adolescents aged 11-12 years (n = 521, 48% boys) completed a paper-based questionnaire during class-time which included a Food Frequency Questionnaire assessing their consumption of fruit, vegetables, and energy-dense (ED) snacks, and items assessing habits, self-efficacy, eating at the television (TV), eating with parents, parenting practices, and home availability and accessibility of foods. Multiple linear regression analyses showed that eating fruit and vegetables while watching TV and home availability and accessibility of fruit and vegetables were positively associated with frequency of fruit consumption and vegetable consumption, while home accessibility of ED snack foods was negatively associated with frequency of fruit consumption. Habit for eating ED snack foods in front the TV, eating ED snack foods while watching TV, and home availability of ED snacks were positively associated with frequency of ED snack consumption. This study has highlighted the importance of a healthy home environment for promoting fruit and vegetable intake in early adolescents and also suggests that, if snacking while TV viewing occurs, this could be a good opportunity for promoting fruit and vegetable intake. These findings are likely to be useful for supporting the development of multi-faceted interventions and aid us in knowing what advice to give to parents to help them to help their young adolescents to develop and maintain healthy eating habits. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
Feasibility of BCI Control in a Realistic Smart Home Environment.
Kosmyna, Nataliya; Tarpin-Bernard, Franck; Bonnefond, Nicolas; Rivet, Bertrand
2016-01-01
Smart homes have been an active area of research, however despite considerable investment, they are not yet a reality for end-users. Moreover, there are still accessibility challenges for the elderly or the disabled, two of the main potential targets for home automation. In this exploratory study we design a control mechanism for smart homes based on Brain Computer Interfaces (BCI) and apply it in the "Domus" smart home platform in order to evaluate the potential interest of users about BCIs at home. We enable users to control lighting, a TV set, a coffee machine and the shutters of the smart home. We evaluate the performance (accuracy, interaction time), usability and feasibility (USE questionnaire) on 12 healthy subjects and 2 disabled subjects. We find that healthy subjects achieve 77% task accuracy. However, disabled subjects achieved a better accuracy (81% compared to 77%).
Provision of NHS generalist and specialist services to care homes in England: review of surveys.
Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire
2016-03-01
The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population
Park, Young Joo; Martin, Erika G
2017-11-12
We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality. Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey. A cross-sectional study design of nursing homes within U.S. metropolitan areas. Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau. Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating. Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. © Health Research and Educational Trust.
Preyde, Michèle; Watkins, Hanna; Csuzdi, Nicklaus; Carter, Jeff; Lazure, Kelly; White, Sara; Penney, Randy; Ashbourne, Graham; Cameron, Gary; Frensch, Karen
2012-01-01
Objective: There is a dearth of Canadian research with clinical samples of youth who self-harm, and no studies could be located on self-harm in children and youth accessing residential or intensive home-based treatment. The purposes of this report were to explore the proportion and characteristics of children and youth identified as self-harming at admission by clinicians compared to youth not identified as self-harming, compare self-harming children to adolescents, and to compare caregiver ratings of self-harm at intake to clinician ratings at admission. Method: This report was developed from a larger longitudinal, observational study involving 210 children and youth accessing residential and home-based treatment and their caregivers in partnership with five mental health treatment centres in southwestern Ontario. Agency data were gleaned from files, and caregivers reported on symptom severity at 12 to 18 months and 36 to 40 months post-discharge. Results: Fifty-seven (34%) children and youth were identified as self-harming at admission. The mean age was 11.57 (SD 2.75). There were statistically significant differences on symptom severity at intake between those identified as self-harming and those not so identified; most of these differences were no longer present at follow up. Children were reported to have higher severity of conduct disorder symptoms than adolescents at intake, and there was some consistency between caregiver-rated and clinician-rated self-harm. Children were reported to engage in a wide range of self-harming behaviours. Conclusion: These findings suggest that youth who were identified as self-harming at admission have elevated scores of symptom severity, self-harm can occur in young children and while many improve, there remains a concern for several children and youth who did not improve by the end of service. Children engage in some of the same types of self-harm behaviours as adolescents, and they also engage in behaviours unique to
Preyde, Michèle; Watkins, Hanna; Csuzdi, Nicklaus; Carter, Jeff; Lazure, Kelly; White, Sara; Penney, Randy; Ashbourne, Graham; Cameron, Gary; Frensch, Karen
2012-11-01
There is a dearth of Canadian research with clinical samples of youth who self-harm, and no studies could be located on self-harm in children and youth accessing residential or intensive home-based treatment. The purposes of this report were to explore the proportion and characteristics of children and youth identified as self-harming at admission by clinicians compared to youth not identified as self-harming, compare self-harming children to adolescents, and to compare caregiver ratings of self-harm at intake to clinician ratings at admission. This report was developed from a larger longitudinal, observational study involving 210 children and youth accessing residential and home-based treatment and their caregivers in partnership with five mental health treatment centres in southwestern Ontario. Agency data were gleaned from files, and caregivers reported on symptom severity at 12 to 18 months and 36 to 40 months post-discharge. Fifty-seven (34%) children and youth were identified as self-harming at admission. The mean age was 11.57 (SD 2.75). There were statistically significant differences on symptom severity at intake between those identified as self-harming and those not so identified; most of these differences were no longer present at follow up. Children were reported to have higher severity of conduct disorder symptoms than adolescents at intake, and there was some consistency between caregiver-rated and clinician-rated self-harm. Children were reported to engage in a wide range of self-harming behaviours. These findings suggest that youth who were identified as self-harming at admission have elevated scores of symptom severity, self-harm can occur in young children and while many improve, there remains a concern for several children and youth who did not improve by the end of service. Children engage in some of the same types of self-harm behaviours as adolescents, and they also engage in behaviours unique to children.
Ethical challenges in home mechanical ventilation: a secondary analysis.
Dybwik, Knut; Nielsen, Erik Waage; Brinchmann, Berit Støre
2012-03-01
The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for patient and family wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family.
The determinants of nursing home costs in Nebraska's proprietary nursing homes.
Palm, D W; Nelson, S
1984-01-01
-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.
The Technological Revolution in the Home.
ERIC Educational Resources Information Center
Rubin, Philip A.
This exploration of possible information and communications developments in the future focuses on the picture of the family or individual depending on access to information as a key to their status in society. The scenario involves the home as the center for conducting business, banking, shopping, and receiving lifelong education, and this paper…
Contextual determinants of US nursing home racial/ethnic diversity.
Davis, Jullet A; Weech-Maldonado, Robert; Lapane, Kate L; Laberge, Alex
2014-03-01
We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medicaid reimbursement, and those in more competitive markets would have greater resident racial/ethnic diversity than nursing homes not meeting these criteria. Using 2004 Online Survey, Certification and Reporting data, Minimum Data Set, Lewis Mumford Center for Comparative Urban and Regional Research data, and the Area Resource File, we included U.S. Medicare/Medicaid certified nursing homes (N = 8950) located in 310 Metropolitan Statistical Areas. The dependent variable quantified facility-level multiracial diversity. Ordinary least squares regression showed support for the hypothesized relationships: for-profit/chain affiliated nursing homes were more diverse than nursing homes in all other ownership/chain member categories, while higher Medicaid per-diem rates, greater residential diversity, and stronger market competition were also positively associated with nursing home racial/ethnic composition. Results suggest there is room for policy changes to achieve equitable access to all levels of nursing home services for minority elders. Copyright © 2013 Elsevier Ltd. All rights reserved.
Making a "Web" for Students: From the Classroom to Their Homes and to the Instructor's Home Page.
ERIC Educational Resources Information Center
Zhang, Will
Community college students are often described as less motivated, or "turned-off," compared to other college students. This stereotype has prevented many writing instructors from trying new ways of reaching these students at a Midwest community college, the majority of whom have access to the Internet either at home or in the local…
Development of HomeSTEAD's physical activity and screen time physical environment inventory.
Hales, Derek; Vaughn, Amber E; Mazzucca, Stephanie; Bryant, Maria J; Tabak, Rachel G; McWilliams, Christina; Stevens, June; Ward, Dianne S
2013-12-05
The home environment has a significant influence on children's physical activity, sedentary behavior, dietary intake, and risk for obesity and chronic disease. Our understanding of the most influential factors and how they interact and impact child behavior is limited by current measurement tools, specifically the lack of a comprehensive instrument. HomeSTEAD (the Home Self-administered Tool for Environmental assessment of Activity and Diet) was designed to address this gap. This new tool contains four sections: home physical activity and media equipment inventory, family physical activity and screen time practices, home food inventory, and family food practices. This paper will describe HomeSTEAD's development and present reliability and validity evidence for the first section. The ANGELO framework guided instrument development, and systematic literature reviews helped identify existing items or scales for possible inclusion. Refinement of items was based on expert review and cognitive interviews. Parents of children ages 3-12 years (n = 125) completed the HomeSTEAD survey on three separate occasions over 12-18 days (Time 1, 2, and 3). The Time 1 survey also collected demographic information and parent report of child behaviors. Between Time 1 and 2, staff conducted an in-home observation and measured parent and child BMI. Kappa and intra-class correlations were used to examine reliability (test-retest) and validity (criterion and construct). Reliability and validity was strong for most items (97% having ICC > 0.60 and 72% having r > 0.50, respectively). Items with lower reliability generally had low variation between people. Lower validity estimates (r < 0.30) were more common for items that assessed usability and accessibility, with observers generally rating usability and accessibility lower than parents. Small to moderate, but meaningful, correlations between physical environment factors and BMI, outside time, and screen time were observed (e.g., amount of
Personal Empowerment in the Study of Home Internet Use by Low-Income Families.
ERIC Educational Resources Information Center
Bier, Melinda; Gallo, Michael; Nucklos, Eddy; Sherblom, Stephen; Pennick, Michael
1997-01-01
Describes a United States Department of Commerce (National Telecommunications and Information Administrations, NTIA, 1995) study of home Internet use by Low-income families. The study investigated the barriers, benefits (empowerment), and perceived worth of the Internet and concluded that home Internet access enabled powerful emotional and…
Home Infotainment Platform - A Ubiquitous Access Device for Masses
NASA Astrophysics Data System (ADS)
Pal, Arpan; Prashant, M.; Ghose, Avik; Bhaumik, Chirabrata
There is tremendous need for a low-cost Internet-Enabled Platform for developing countries like India that uses TV as the display medium and can connect to Internet using various available connectivity solutions. The paper presents how a generic framework middleware can be used to create a Home Infotainment Platform that can support variety of value-added applications. It also talks about the innovative designs employed to bring about the low-cost solution keeping in mind both the limitations of TV as a display and non-availability of high quality-of-service networks. Finally the social, economic and environmental implications of wide-spread deployment of the proposed solution are outlined.
IMPROVING ACCESS TO INFORMATION ABOUT ORD PROJECTS
ORD project information is maintained in, and retrieved from, multiple systems and home pages. Not all sources of project information are Intranet accessible. Descriptive information may be abbreviated and not useful in conveying a comprehensive understanding of a project. The m...
Outdoor motivation moderates the effects of accessibility on mobility in old age.
Kamin, Stefan T; Beyer, Anja; Lang, Frieder R
2016-07-01
Mobility plays a major role in healthy aging and social participation. This study explored whether accessibility problems in the housing environment are negatively associated with mobility in old age and whether this association is moderated by differences in an individual's preference for spending time outside the home (outdoor motivation). This article reports the results of a research project on mobility in old age. The project included a survey study of 120 community-dwelling older adults between 59 and 92 years of age (mean = 71.7 years, SD = 7.3 years) living in the metropolitan region of Nuremberg, Germany. Objective assessments were conducted in the participants' housing environment to evaluate the magnitude of accessibility problems. Accessibility problems were negatively associated with mobility. Interaction analyses suggested a buffering effect of outdoor motivation on this association, i.e. participants who reported a preference for spending time outside the home had a higher mobility in the face of accessibility problems as compared with those who preferred staying at home. Outdoor motivation may have protective effects for older adults when accessibility problems challenge mobility. These findings contribute to improving the understanding of how and under what circumstances older adults stay mobile and active in everyday life. Considering interindividual differences in outdoor motivation may binterventions and public health programs that are aimed at enhancing mobility and social participation in old age.
Feasibility of BCI Control in a Realistic Smart Home Environment
Kosmyna, Nataliya; Tarpin-Bernard, Franck; Bonnefond, Nicolas; Rivet, Bertrand
2016-01-01
Smart homes have been an active area of research, however despite considerable investment, they are not yet a reality for end-users. Moreover, there are still accessibility challenges for the elderly or the disabled, two of the main potential targets for home automation. In this exploratory study we design a control mechanism for smart homes based on Brain Computer Interfaces (BCI) and apply it in the “Domus”1 smart home platform in order to evaluate the potential interest of users about BCIs at home. We enable users to control lighting, a TV set, a coffee machine and the shutters of the smart home. We evaluate the performance (accuracy, interaction time), usability and feasibility (USE questionnaire) on 12 healthy subjects and 2 disabled subjects. We find that healthy subjects achieve 77% task accuracy. However, disabled subjects achieved a better accuracy (81% compared to 77%). PMID:27616986
NASA Astrophysics Data System (ADS)
Liu, Tao; Jiang, Chuanjia; Cheng, Bei; You, Wei; Yu, Jiaguo
2017-08-01
Nickel (II) oxide (NiO) nanosheet grown on N-doped carbon hollow spheres (NiO/NCHS) with hierarchical pore structure are obtained via facile chemical bath deposition followed by calcination at 350 °C under nitrogen atmosphere. Phase structure measurements indicate that the material is composed of NiO and N-doped carbon. The NiO/NCHS composite exhibits a unique flower-like morphology, where ultrathin NiO nanosheets are vertically grown on the surface of NCHS. This hierarchical nanostructure is beneficial for facilitating electron and electrolyte ion transport and accelerating the reversible redox reaction. The specific capacitance of the NiO/NCHS composite (585 F g-1 at 1 A g-1) is higher than that of pure NiO particle (453 F g-1 at 1 A g-1). Meanwhile, the NiO/NCHS composite exhibits excellent rate performance and superior cycling stability over 6000 cycles. The enhanced supercapacitive performance of the NiO/NCHS nanocomposite indicates that it can be an appealing candidate electrode material for supercapacitors.
Identification of inactivity behavior in smart home.
Poujaud, J; Noury, N; Lundy, J-E
2008-01-01
To help elderly people live independently at home, the TIMC-IMAG laboratory developed Health Smart Homes called 'HIS'. These smart Homes are composed of several sensors to monitor the activities of daily living of the patients. Volunteers have accepted to be monitored during 2 years in their own flats. During one year, we carried out our survey on one elderly patient. Thanks to this experimentation, we will access to relevant information like physiological, environmental and activity. This paper focuses on daily living activity. We will introduce an original data splitting method based on the relationship between the frame of time and the location in the flat. Moreover we will present two different methods to determine a threshold of critical inactivity and eventually we will discuss their possible utilities.
Food Access Patterns and Barriers among Midlife and Older Adults with Mobility Disabilities
Huang, Deborah L.; Rosenberg, Dori E.; Simonovich, Shannon D.; Belza, Basia
2012-01-01
We examined where midlife and older adults with a mobility disability accessed food outside the home in King County, Washington, USA, how they travelled to these food destinations, and facilitators and barriers to food access using qualitative interviews. Thirty-five adults aged ≥50 years with a mobility disability (defined as use of an assistive device for mobility) were interviewed. Supplemental objective information was obtained from a Global Positioning System device worn by participants for 3 days. Participants primarily accessed food at grocery stores, restaurants, and coffee shops/cafés. The most common transportation modes were walking, obtaining a ride from friends, motorized chair/scooter, and public transit. Location and proximity of food destinations were factors affecting participants' ability to access these destinations. Adequate space, ease of entry, available amenities such as restrooms, and helpful people were facilitators for participants to access food outside the home. PMID:23056944
Kneale, Laura; Choi, Yong; Demiris, George
2016-01-01
Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.
HIV/AIDS and access to water: A case study of home-based care in Ngamiland, Botswana
NASA Astrophysics Data System (ADS)
Ngwenya, B. N.; Kgathi, D. L.
This case study investigates access to potable water in HIV/AIDS related home-based care households in five rural communities in Ngamiland, Botswana. Primary data collected from five villages consisted of two parts. The first survey collected household data on demographic and rural livelihood features and impacts of HIV/AIDS. A total of 129 households were selected using a two-stage stratified random sampling method. In the second survey, a total of 39 family primary and community care givers of continuously ill, bed-ridden or non-bed-ridden HIV/AIDS patients were interviewed. A detailed questionnaire, with closed and open-ended questions, was used to collect household data. In addition to using the questionnaire, data were also collected through participant observation, informal interviews and secondary sources. The study revealed that there are several sources of water for communities in Ngamiland such as off-plot, outdoor (communal) and on-plot outdoor and/or indoor (private) water connections, as well as other sources such as bowsed water, well-points, boreholes and open perennial/ephemeral water from river channels and pans. There was a serious problem of unreliable water supply caused by, among other things, the breakdown of diesel-powered water pumps, high frequency of HIV/AIDS related absenteeism, and the failure of timely delivery of diesel fuel. Some villages experienced chronic supply disruptions while others experienced seasonal or occasional water shortages. Strategies for coping with unreliability of water supply included economizing on water, reserve storage, buying water, and collection from river/dug wells or other alternative sources such as rain harvesting tanks in government institutions. The unreliability of water supply resulted in an increase in the use of water of poor quality and other practices of poor hygiene as well as a high opportunity cost of water collection. In such instances, bathing of patients was cut from twice daily to once or
The interaction between design and occupier behaviour in the safety of new homes.
McDermott, Hilary; Haslam, Roger; Gibb, Alistair
2007-03-01
The design of new homes includes many safety features intended to protect occupiers from injury or ill health within the home, however the effectiveness of these primary intervention measures is likely to be affected by user behaviour. This study examined the interaction between user activity and dwelling design and how this might affect health and safety. It aimed to identify how people use features within new homes and how this may limit the protection afforded by building design, codes and regulations. Forty, home-based, semi-structured, in-depth interviews and home inspections were conducted with individuals recently inhabiting a new home. A range of behaviours were reported in relation to building features including fire doors, pipes and cables, and loft access, which may lead to increased risk of injury or ill-health. For example, occupiers described interfering with the self-closing mechanisms on fire doors and drilling into walls without considering the location of services. They also reported knowingly engaging in unsafe behaviour when accessing the loft, increasing their risk of falls. The accounts suggest that designers and builders need to give greater consideration to how occupier behaviour interacts with building features so that improvements in both design and occupier education can lead to improved health and safety.
Electronic doors to education: study of high school website accessibility in Iowa.
Klein, David; Myhill, William; Hansen, Linda; Asby, Gary; Michaelson, Susan; Blanck, Peter
2003-01-01
The Americans with Disabilities Act (ADA), and Sections 504 and 508 of the Rehabilitation Act, prohibit discrimination against people with disabilities in all aspects of daily life, including education, work, and access to places of public accommodations. Increasingly, these antidiscrimination laws are used by persons with disabilities to ensure equal access to e-commerce, and to private and public Internet websites. To help assess the impact of the anti-discrimination mandate for educational communities, this study examined 157 website home pages of Iowa public high schools (52% of high schools in Iowa) in terms of their electronic accessibility for persons with disabilities. We predicted that accessibility problems would limit students and others in obtaining information from the web pages as well as limiting ability to navigate to other web pages. Findings show that although many web pages examined included information in accessible formats, none of the home pages met World Wide Web Consortium (W3C) standards for accessibility. The most frequent accessibility problem was lack of alternative text (ALT tags) for graphics. Technical sophistication built into pages was found to reduce accessibility. Implications are discussed for schools and educational institutions, and for laws, policies, and procedures on website accessibility. Copyright 2003 John Wiley & Sons, Ltd.
Broadband Optical Access Technologies to Converge towards a Broadband Society in Europe
NASA Astrophysics Data System (ADS)
Coudreuse, Jean-Pierre; Pautonnier, Sophie; Lavillonnière, Eric; Didierjean, Sylvain; Hilt, Benoît; Kida, Toshimichi; Oshima, Kazuyoshi
This paper provides insights on the status of broadband optical access market and technologies in Europe and on the expected trends for the next generation optical access networks. The final target for most operators, cities or any other player is of course FTTH (Fibre To The Home) deployment although we can expect intermediate steps with copper or wireless technologies. Among the two candidate architectures for FTTH, PON (Passive Optical Network) is by far the most attractive and cost effective solution. We also demonstrate that Ethernet based optical access network is very adequate to all-IP networks without any incidence on the level of quality of service. Finally, we provide feedback from a FTTH pilot network in Colmar (France) based on Gigabit Ethernet PON technology. The interest of this pilot lies on the level of functionality required for broadband optical access networks but also on the development of new home network configurations.
Patient-centered medical homes for patients with disabilities.
Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael
2015-01-01
The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.
Adult BMI and Access to Built Environment Resources in a High-Poverty, Urban Geography.
Tung, Elizabeth L; Peek, Monica E; Makelarski, Jennifer A; Escamilla, Veronica; Lindau, Stacy T
2016-11-01
The purpose of this study is to examine the relationship between BMI and access to built environment resources in a high-poverty, urban geography. Participants (aged ≥35 years) were surveyed between November 2012 and July 2013 to examine access to common health-enabling resources (grocers, outpatient providers, pharmacies, places of worship, and physical activity resources). Survey data were linked to a contemporaneous census of built resources. Associations between BMI and access to resources (potential and realized) were examined using independent t-tests and multiple linear regression. Data analysis was conducted in 2014-2015. Median age was 53.8 years (N=267, 62% cooperation rate). Obesity (BMI ≥30) prevalence was 54.9%. BMI was not associated with potential access to resources located nearest to home. Nearly all participants (98.1%) bypassed at least one nearby resource type; half bypassed nearby grocers (realized access >1 mile from home). Bypassing grocers was associated with a higher BMI (p=0.03). Each additional mile traveled from home to a grocer was associated with a 0.9-higher BMI (95% CI=0.4, 1.3). Quality and affordability were common reasons for bypassing resources. Despite potential access to grocers in a high-poverty, urban region, half of participants bypassed nearby grocers to access food. Bypassing grocers was associated with a higher BMI. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Safety of union home care aides in Washington State.
Schoenfisch, Ashley L; Lipscomb, Hester; Phillips, Leslie E
2017-09-01
A rate-based understanding of home care aides' adverse occupational outcomes related to their work location and care tasks is lacking. Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides' demographic and work characteristics. Injury narratives and focus groups provided contextual detail. Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern. Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides' improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce. © 2017 Wiley Periodicals, Inc.
Paediatric palliative care by video consultation at home: a cost minimisation analysis.
Bradford, Natalie K; Armfield, Nigel R; Young, Jeanine; Smith, Anthony C
2014-07-28
In the vast state of Queensland, Australia, access to specialist paediatric services are only available in the capital city of Brisbane, and are limited in regional and remote locations. During home-based palliative care, it is not always desirable or practical to move a patient to attend appointments, and so access to care may be even further limited. To address these problems, at the Royal Children's Hospital (RCH) in Brisbane, a Home Telehealth Program (HTP) has been successfully established to provide palliative care consultations to families throughout Queensland. A cost minimisation analysis was undertaken to compare the actual costs of the HTP consultations, with the estimated potential costs associated with face-to face-consultations occurring by either i) hospital based consultations in the outpatients department at the RCH, or ii) home visits from the Paediatric Palliative Care Service. The analysis was undertaken from the perspective of the Children's Health Service. The analysis was based on data from 95 home video consultations which occurred over a two year period, and included costs associated with projected: clinician time and travel; costs reimbursed to families for travel through the Patients Travel Subsidy (PTS) scheme; hospital outpatient clinic costs, project co-ordination and equipment and infrastructure costs. The mean costs per consultation were calculated for each approach. Air travel (n = 24) significantly affected the results. The mean cost of the HTP intervention was $294 and required no travel. The estimated mean cost per consultation in the hospital outpatient department was $748. The mean cost of home visits per consultation was $1214. Video consultation in the home is the most economical method of providing a consultation. The largest costs avoided to the health service are those associated with clinician time required for travel and the PTS scheme. While face-to-face consultations are the gold standard of care, for families located
Green, Shana M.; Lockhart, Elizabeth; Marhefka, Stephanie L.
2015-01-01
Within recent years public health interventions have become technologically based to reflect the digital age we currently live in and appeal to the public in innovative and novel ways. The Internet breaks down boundaries distance imposes and increases our ability to reach and connect with people. Internet-based interventions have the potential to expand access to effective behavioral interventions. The US National HIV/AIDS Strategy states that people living with HIV should have access to effective behavioral interventions like Healthy Relationships (HR) to help them develop safe sex and disclosure skills. However, access to HR is limited across the country, especially for people in remote or rural areas. Internet-based Healthy Relationships Video Groups (HR-VG) delivered at home or community based organizations (CBOs) can possibly expand access. This study assesses the preferences of women living with HIV (WLH) for participation in HR-VG among 21 WLH who participated in a randomized control trial (RCT) testing HR-VG and completed open-ended semi-structured telephone interviews. Transcripts were thematically analyzed to determine advantages, disadvantages and overall preference for home or agency delivery of HR-VG. Themes relating to convenience, technology access, privacy, distractions, HIV serostatus disclosure and social opportunities were identified as advantages or disadvantages to participating in HR-VG at each location. Overall privacy was the most salient concern of accessing HR-VG at home or at a CBO. Considering the concerns expressed by WLH, further studies are needed to assess how an Internet-based intervention delivered at home for WLH can maintain privacy while being cost effective. PMID:26357907
Green, Shana M; Lockhart, Elizabeth; Marhefka, Stephanie L
2015-01-01
Within recent years, public health interventions have become technology based to reflect the digital age we currently live in and appeal to the public in innovative and novel ways. The Internet breaks down boundaries distance imposes and increases our ability to reach and connect with people. Internet-based interventions have the potential to expand access to effective behavioral interventions (EBIs). The US National HIV/AIDS Strategy states that people living with HIV should have access to EBIs such as healthy relationships (HR) to help them develop safe sex and disclosure skills. However, access to HR is limited across the country, especially for people in remote or rural areas. Internet-based healthy relationships video groups (HR-VG) delivered at home or community-based organizations (CBOs) can possibly expand access. This study assesses the preferences of women living with HIV (WLH) for participation in HR-VG among 21 WLH who participated in a randomized control trial (RCT) testing HR-VG and completed open-ended semi-structured telephone interviews. Transcripts were thematically analyzed to determine advantages and disadvantages of home or CBO delivery of HR-VG. Themes relating to convenience, technology access, privacy, distractions, HIV serostatus disclosure, and social opportunities were identified as advantages or disadvantages to participating in HR-VG at each location. Overall, privacy was the most salient concern of accessing HR-VG at home or at a CBO. Considering the concerns expressed by WLH, further studies are needed to assess how an Internet-based intervention delivered at home for WLH can maintain privacy while being cost effective.
Web-based home telemedicine system for orthopedics
NASA Astrophysics Data System (ADS)
Lau, Christopher; Churchill, Sean; Kim, Janice; Matsen, Frederick A., III; Kim, Yongmin
2001-05-01
Traditionally, telemedicine systems have been designed to improve access to care by allowing physicians to consult a specialist about a case without sending the patient to another location, which may be difficult or time-consuming to reach. The cost of the equipment and network bandwidth needed for this consultation has restricted telemedicine use to contact between physicians instead of between patients and physicians. Recently, however, the wide availability of Internet connectivity and client and server software for e- mail, world wide web, and conferencing has made low-cost telemedicine applications feasible. In this work, we present a web-based system for asynchronous multimedia messaging between shoulder replacement surgery patients at home and their surgeons. A web browser plug-in was developed to simplify the process of capturing video and transferring it to a web site. The video capture plug-in can be used as a template to construct a plug-in that captures and transfers any type of data to a web server. For example, readings from home biosensor instruments (e.g., blood glucose meters and spirometers) that can be connected to a computing platform can be transferred to a home telemedicine web site. Both patients and doctors can access this web site to monitor progress longitudinally. The system has been tested with 3 subjects for the past 7 weeks, and we plan to continue testing in the foreseeable future.
ERIC Educational Resources Information Center
Scourfield, Peter
2012-01-01
This paper emerges from a case study of the system of statutory reviews in older people's care homes in the UK. Informed by a review of selected literature on gaining access, this paper provides a critical account of the process of negotiating access with gatekeepers (chiefly, care home managers). The negotiations were time-consuming and largely…
Tran, Diem; Davis, Aileen; McGillis Hall, Linda
2012-01-01
ABSTRACT Purpose: The objective of this study was to compare hospital and home care employers' rankings of both the importance and the feasibility of workforce strategies for recruiting and retaining rehabilitation professionals. Methods: An online self-administered questionnaire was distributed to all employers of rehabilitation professionals in Ontario hospitals (n=144) and Community Care Access Centre home care providers (n=34). Importance and feasibility rankings were based on the percentage of high ratings; 95% CIs were used to determine significant differences between hospital and home care rankings of recruitment and retention strategies. Results: The response rate was 50% (72/144) from hospitals and 73.5% (25/34) from home-care settings. The recruitment and retention strategies considered most important and feasible for rehabilitation therapists, regardless of setting, were communication between employer and worker, compensation packages, access to research, and professional development in budget planning. Tangible resources, support personnel, work safety, and marketing rehabilitation careers to high school students were ranked significantly higher by hospitals than by home care providers. Conclusions: Similarities exist between hospital and home care employers in terms of the importance and feasibility of recruitment and retention strategies for rehabilitation professionals. However, when developing a rehabilitation health human resources plan, the strategies identified as different between hospital and home care settings should be taken into account. PMID:23277683
Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan
2013-01-01
Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.
Condelius, Anna; Andersson, Magdalena
2015-10-26
There is little investigation into what care older people access during the last phase of their life and what factors enable access to care in this group. Illuminating this from the perspective of the next of kin may provide valuable insights into how the health and social care system operates with reference to providing care for this vulnerable group. The behavioural model of health services use has a wide field of application but has not been tested conceptually regarding access to care from the perspective of the next of kin. The aim of this study was to explore the care accessed by older people during the last phase of their life from the perspective of the next of kin and to conceptually test the behavioural model of health services use. The data collection took place in 2011 by means of qualitative interviews with 14 next of kin of older people who had died in a nursing home. The interviews were analysed using directed content analysis. The behavioural model of health services use was used in deriving the initial coding scheme, including the categories: utilization of health services, consumer satisfaction and characteristics of the population at risk. Utilization of health services in the last phase of life was described in five subcategories named after the type of care accessed i.e. admission to a nursing home, primary healthcare, hospital care, dental care and informal care. The needs were illuminated in the subcategories: general deterioration, medical conditions and acute illness and deterioration when death approaches. Factors that enabled access to care were described in three subcategories: the organisation of care, next of kin and the older person. These factors could also constitute barriers to accessing care. Next of kin's satisfaction with care was illuminated in the subcategories: satisfaction, dissatisfaction and factors influencing satisfaction. One new category was constructed inductively: the situation of the next of kin. A bed in a nursing
Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning
McPhaul, Kathleen; Phillips, Sally; Gershon, Robyn; Lipscomb, Jane
2009-01-01
The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process. PMID:19461108
Access to dental care among adults with physical and intellectual disabilities: residence factors.
Pradhan, A; Slade, G D; Spencer, A J
2009-09-01
There is limited information about access and barriers to dental care among adults with disabilities. A mailed questionnaire survey of carers of 18-44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV). Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes. Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed.
2014-01-01
Background Low fruit and vegetable (FV) consumption is one of the top 10 global risk factors for mortality, and is related to increased risk for cancer, cardiovascular disease and diabetes. Many environmental, sociodemographic and personal factors affect FV consumption. The purpose of this review is to examine the effects of interventions delivered in the home, school and other nutritional environments designed to increase FV availability for five to 18-year olds. Methods The search included: 19 electronic bibliographic databases; grey literature databases; reference lists of key articles; targeted Internet searching of key organization websites; hand searching of key journals and conference proceedings; and consultation with experts for additional references. Articles were included if: in English, French and Spanish; from high-, middle-, and low-income countries; delivered to anyone who could bring about change in FV environment for 5 to 18 year olds; with randomized and non-randomized study designs that provided before-after comparisons, with or without a control group. Primary outcomes of interest were measures of FV availability. Results The search strategy retrieved nearly 23,000 citations and resulted in 23 unique studies. Interventions were primarily policy interventions at the regional or state level, a number of curriculum type interventions in schools and community groups and a garden intervention. The majority of studies were done in high-income countries. The diversity of interventions, populations, outcomes and outcome measurements precluded meta-analysis. The most promising strategies for improving the FV environment for children are through local school food service policies. Access to FV was successfully improved in four of the six studies that evaluated school-based policies, with the other two studies finding no effect. Broader state or federally mandated policies or educational programs for food service providers and decision makers had mixed or
[Travel and cultural activities in care homes for the elderly].
Andriot, Hervé; Roumilhac, Vanessa
2010-01-01
Travel and cultural activities are still accessible for elderly people, in particular those living in care homes. With some precautions and adequate professional supervision, it is possible to carry out such activities, elderly people's limits being psychological rather than physical. Elderly people can thereby open up to the adventure of travelling whether it is an actual, physical trip or a virtual journey, through cultural activities. A report on the Residence Orpea des Noues care home's experience of such initiatives.
Solar Access: Issues and Policy Options | State, Local, and Tribal
: approximately 2,580 megawatts (MW) of new residential solar photovoltaic (PV) capacity was brought online in home with rooftop solar Figure 1. Example of a residential solar PV system. NREL 00565 The existing Governments | NREL Solar Access: Issues and Policy Options Solar Access: Issues and Policy
The unique experience of home for parents and carers of children with disabilities.
Aplin, Tammy; Thornton, Heloise; Gustafsson, Louise
2017-01-24
The aim of this paper was to investigate the experience of home for parents and carers of children with disabilities in Australia. Data for this qualitative study were gathered using semi-structured interviews with four families living in their own homes. An inductive thematic analysis revealed two main themes. The first was titled 'Aspects making everyday life easier' explored the aspects of the home environment that facilitated home life for the child, including access to transport, services, family and home modifications. The second theme 'Decisions and efforts to create opportunities for the child' emphasized the efforts made by parents and carers to promote their child's independence and participation including a strong consideration for their children's future needs. The study indicated that the location of home, appropriate home modifications and planning for the future defined the experience of home for parents and carers. These findings identify some important considerations for occupational therapists when providing services in the homes of families with children who have a disability.
The economic implications of case-mix Medicaid reimbursement for nursing home care.
Grabowski, David C
2002-01-01
In recent years, there has been large growth in the nursing home industry in the use of case-mix adjusted Medicaid payment systems that employ resident characteristics to predict the relative use of resources in setting payment levels. Little attention has been paid to the access and quality incentives that these systems provide in the presence of excess demand conditions due to certificate-of-need (CON) and construction moratoria. Using 1991 to 1998 panel data for all certified U.S. nursing homes, a fixed-effects model indicates that adoption of a case-mix payment system led to increased access for more dependent residents, but the effect was modified in excess demand markets. Quality remained relatively stable with the introduction of case-mix reimbursement, regardless of the presence of excess demand conditions. These results suggest that CON and construction moratoria are still important barriers within the nursing home market, and recent quality assurance activities related to the introduction of case-mix payment systems may have been effective.
Home Energy Management System - VOLTTRON Integration
DOE Office of Scientific and Technical Information (OSTI.GOV)
Zandi, Helia
In most Home Energy Management Systems (HEMS) available in the market, different devices running different communication protocols cannot interact with each other and exchange information. As a result of this integration, the information about different devices running different communication protocol can be accessible by other agents and devices running on VOLTTRON platform. The integration process can be used by any HEMS available in the market regardless of the programming language they use. If the existing HEMS provides an Application Programming Interface (API) based on the RESTFul architecture, that API can be used for integration. Our candidate HEMS in this projectmore » is home-assistant (Hass). An agent is implemented which can communicate with the Hass API and receives information about the devices loaded on the API. The agent publishes the information it receives on the VOLTTRON message bus so other agents can have access to this information. On the other side, for each type of devices, an agent is implemented such as Climate Agent, Lock Agent, Switch Agent, Light Agent, etc. Each of these agents is subscribed to the messages published on the message bus about their associated devices. These agents can also change the status of the devices by sending appropriate service calls to the API. Other agents and services on the platform can also access this information and coordinate their decision-making process based on this information.« less
7 CFR 226.18 - Day care home provisions.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... approval to provide day care services to children. Day care homes which cannot obtain their license because... access to its meal service and records during its normal hours of child care operations. For day care...
7 CFR 226.18 - Day care home provisions.
Code of Federal Regulations, 2011 CFR
2011-01-01
... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... approval to provide day care services to children. Day care homes which cannot obtain their license because... access to its meal service and records during its normal hours of child care operations. For day care...
Attributes of seasonal home range influence choice of migratory strategy in white-tailed deer
Henderson, Charles R.; Mitchell, Michael S.; Myers, Woodrow L.; Lukacs, Paul M.; Nelson, Gerald P.
2018-01-01
Partial migration is a common life-history strategy among ungulates living in seasonal environments. The decision to migrate or remain on a seasonal range may be influenced strongly by access to high-quality habitat. We evaluated the influence of access to winter habitat of high quality on the probability of a female white-tailed deer (Odocoileus virginianus) migrating to a separate summer range and the effects of this decision on survival. We hypothesized that deer with home ranges of low quality in winter would have a high probability of migrating, and that survival of an individual in winter would be influenced by the quality of their home range in winter. We radiocollared 67 female white-tailed deer in 2012 and 2013 in eastern Washington, United States. We estimated home range size in winter using a kernel density estimator; we assumed the size of the home range was inversely proportional to its quality and the proportion of crop land within the home range was proportional to its quality. Odds of migrating from winter ranges increased by 3.1 per unit increase in home range size and decreased by 0.29 per unit increase in the proportion of crop land within a home range. Annual survival rate for migrants was 0.85 (SD = 0.05) and 0.84 (SD = 0.09) for residents. Our finding that an individual with a low-quality home range in winter is likely to migrate to a separate summer range accords with the hypothesis that competition for a limited amount of home ranges of high quality should result in residents having home ranges of higher quality than migrants in populations experiencing density dependence. We hypothesize that density-dependent competition for high-quality home ranges in winter may play a leading role in the selection of migration strategy by female white-tailed deer.
Reduced Pain and Anxiety with Music and Noise-Canceling Headphones During Shockwave Lithotripsy.
Karalar, Mustafa; Keles, Ibrahim; Doğantekin, Engin; Kahveci, Orhan Kemal; Sarici, Hasmet
2016-06-01
We assessed the effects of music and noise-canceling headphones (NCHs) on perceived patient pain and anxiety from extracorporeal shockwave lithotripsy (SWL). Patients with renal calculi scheduled for SWL were prospectively enrolled. All 89 patients between the ages of 19 and 80 years were informed about this study and then randomized into three groups: Group 1 (controls), no headphones and music; Group 2, music with NCHs (patients listened to Turkish classical music with NCHs during SWL); and Group 3, music with non-NCHs (patients listened to Turkish classical music with non-NCHs during SWL). Hemodynamic and respiratory parameters were recorded before and just after the SWL session. All patient visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI) scores were recorded just after the SWL procedure. There were significant differences in VAS scores among the groups (5.1, 3.6, and 4.5, respectively, p < 0.001), including between Groups 2 and 3 (p = 0.018). There were also significant differences in STAI-State anxiety scores among the groups (43.1, 33.5, and 38.9, respectively, p = 0.001), including between Groups 2 and 3 (p = 0.04). Music therapy during SWL reduced pain and anxiety. Music therapy with NCHs was more effective for pain and anxiety reduction. To reduce pain and anxiety, nonpharmacologic therapies such as music therapy with NCHs during SWL should be investigated further and used routinely.
Structure, environment and strategic outcome: a study of Pennsylvania nursing homes.
Aaronson, W E; Zinn, J S; Rosko, M D
1995-02-01
This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.
Domino, Marisa Elena; Kilany, Mona; Wells, Rebecca; Morrissey, Joseph P
2017-10-01
To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses. Data were received from the Carolina Cost and Quality Initiative. The four estimation techniques consistently revealed generally positive associations between medical homes and access to primary care, specialty mental health care, greater medication adherence, slightly lower emergency room use, and greater expenditures. These findings were consistent across all three major severe mental illness diagnostic groups. Some heterogeneity in effects were noted, especially in preventive screening. Expanding access to primary care-based medical homes for people with severe mental illness may not save money for insurance providers, due to greater access for important outpatient services with little cost offset. Health services research examining more of the treatment heterogeneity may contribute to more realistic projections about medical homes outcomes. © Health Research and Educational Trust.
Pure random search for ambient sensor distribution optimisation in a smart home environment.
Poland, Michael P; Nugent, Chris D; Wang, Hui; Chen, Liming
2011-01-01
Smart homes are living spaces facilitated with technology to allow individuals to remain in their own homes for longer, rather than be institutionalised. Sensors are the fundamental physical layer with any smart home, as the data they generate is used to inform decision support systems, facilitating appropriate actuator actions. Positioning of sensors is therefore a fundamental characteristic of a smart home. Contemporary smart home sensor distribution is aligned to either a) a total coverage approach; b) a human assessment approach. These methods for sensor arrangement are not data driven strategies, are unempirical and frequently irrational. This Study hypothesised that sensor deployment directed by an optimisation method that utilises inhabitants' spatial frequency data as the search space, would produce more optimal sensor distributions vs. the current method of sensor deployment by engineers. Seven human engineers were tasked to create sensor distributions based on perceived utility for 9 deployment scenarios. A Pure Random Search (PRS) algorithm was then tasked to create matched sensor distributions. The PRS method produced superior distributions in 98.4% of test cases (n=64) against human engineer instructed deployments when the engineers had no access to the spatial frequency data, and in 92.0% of test cases (n=64) when engineers had full access to these data. These results thus confirmed the hypothesis.
Cultural competence: assessment and education resources for home care and hospice clinicians.
Hines, Deborah
2014-05-01
Home healthcare and hospice clinicians face many challenges in the complex healthcare system caring for patients and their families in the home environment. One of those challenges is providing culturally competent care for an increasingly diverse population. This article will highlight free, easily accessible, online resources to assist clinicians and organizations to assess organizational and individual cultural competence and provide many resources for cultural competency education programs.
There's no place like home: 35-year patient survival on home hemodialysis.
Yu, Jerry Z; Rhee, Connie M; Ferrey, Antoney; Li, Alex; Jin, Anna; Chang, Yongen; Reddy, Uttam; Lau, Wei Ling; Chou, Jason; Inrig, Jula; Kalantar-Zadeh, Kamyar
2018-05-01
The vast majority of maintenance dialysis patients suffer from poor long-term survival rates and lower levels of health-related quality of life. However, home hemodialysis is a historically significant dialysis modality that has been associated with favorable outcomes as well as greater patient autonomy and control, yet only represents a small minority of the total dialysis performed in the United States. Some potential disadvantages of home hemodialysis include vascular access complications, infection-related hospitalizations, patient fatigue, and attrition. In addition, current barriers and challenges in expanding the utilization of this modality include limited patient and provider education and technical expertise. Here we report a 65-year old male with end-stage renal disease due to Alport's syndrome who has undergone 35 years of uninterrupted thrice-weekly home hemodialysis (ie, every Sunday, Tuesday, and Thursday evening, each session lasting 3 to 3¼ hours in length) using a conventional hemodialysis machine who has maintained a high functional status allowing him to work 6-8 hours per day. The patient has been able to liberalize his dietary and fluid intake while only requiring 3-4 liters of ultrafiltration per treatment, despite having absence of residual kidney function. Through this case of extraordinary longevity and outcomes after 35 years of dialysis and a review of the literature, we illustrate the history of home hemodialysis, its significant clinical and psychosocial advantages, as well as the barriers that hinder its widespread adaptation. © 2017 Wiley Periodicals, Inc.
Selected Analytical Methods for Environmental Remediation and Recovery (SAM) - Home
The SAM Home page provides access to all information provided in EPA's Selected Analytical Methods for Environmental Remediation and Recovery (SAM), and includes a query function allowing users to search methods by analyte, sample type and instrumentation.
Bradley, Robert H.; Putnick, Diane L.
2011-01-01
This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. PMID:22277008
Nursing home bed capacity in the States, 1978-86
Harrington, Charlene; Swan, James H.; Grant, Leslie A.
1988-01-01
Trends in nursing home bed supply in the States show large variations in beds per population and a gradual decline in supply per aged population. A cross-sectional time-series regression analysis was used to examine some factors associated with nursing home bed supply. Variation was accounted for by economic factors, supply of alternative services, and climate. State Medicaid reimbursement rates had negative coefficients, with supply suggesting States may be increasing rates to improve access where supply is limited. Medicaid waiver policy was not found to be significant. PMID:10312634
Nursing home queues and home health users.
Swan, J H; Benjamin, A E
1993-01-01
Home health market growth suggests the need for models explaining home health utilization. We have previously explained state-level Medicare home health visits with reference to nursing home markets. Here we introduce a model whereby state-level Medicare home health use is a function of nursing home queues and other demand and supply factors. Medicare home health users per state population is negatively related to nursing home bed stock, positively to Medicaid eligibility levels and to Medicaid nursing home recipients per population, as well as to various other demand and supply measures. This explanation of home health users explains previously-reported findings for home health visits. The findings support the argument that home health use is explained by factors affecting lengths of nursing home queues.
Home birth attendants in low income countries: who are they and what do they do?
2012-01-01
Background Nearly half the world’s babies are born at home. We sought to evaluate the training, knowledge, skills, and access to medical equipment and testing for home birth attendants across 7 international sites. Methods Face-to-face interviews were done by trained interviewers to assess level of training, knowledge and practices regarding care during the antenatal, intrapartum and postpartum periods. The survey was administered to a sample of birth attendants conducting home or out-of-facility deliveries in 7 sites in 6 countries (India, Pakistan, Guatemala, Democratic Republic of the Congo, Kenya and Zambia). Results A total of 1226 home birth attendants were surveyed. Less than half the birth attendants were literate. Eighty percent had one month or less of formal training. Most home birth attendants did not have basic equipment (e.g., blood pressure apparatus, stethoscope, infant bag and mask manual resuscitator). Reporting of births and maternal and neonatal deaths to government agencies was low. Indian auxilliary nurse midwives, who perform some home but mainly clinic births, were far better trained and differed in many characteristics from the birth attendants who only performed deliveries at home. Conclusions Home birth attendants in low-income countries were often illiterate, could not read numbers and had little formal training. Most had few of the skills or access to tests, medications and equipment that are necessary to reduce maternal, fetal or neonatal mortality. PMID:22583622
The health care home model: primary health care meeting public health goals.
Grant, Roy; Greene, Danielle
2012-06-01
In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.
Perception, satisfaction and utilization of the VALUE home telehealth service.
Finkelstein, Stanley M; Speedie, Stuart M; Zhou, Xinyu; Potthoff, Sandra; Ratner, Edward R
2011-01-01
We conducted a randomized controlled trial to evaluate the perception, satisfaction and utilization of a home telehealth service for frail elderly people living independently in their home communities. Control group subjects continued with their usual care and intervention group subjects were able to supplement their usual care with the use of a web portal. The web portal allowed videoconferencing and electronic messaging between home care nurses and clients, ordering health-related and home care services, access to health-related information and general access to the Internet. A total of 99 eligible people (59 female, 40 male) from one urban and one rural study site agreed to participate in the study. Eighty-four subjects were active participants for nine months. There were no significant differences in perception of technology between the two groups at baseline. At 60-day follow-up, the intervention group was significantly more positive towards technology compared to their own baseline (P < 0.001) and compared to the 60-day scores for the controls (P < 0.001). The intervention group indicated that overall the telehealth service met their expectations (mean score 9 out of 10) and they would recommend it to others (mean score 9.5 out of 10). All subjects were able to use the portal without difficulty after brief instructions from the nurses. A total of 1054 videoconferences were conducted with the intervention subjects. Fifty-six of these (5%) had to be discontinued after successful connection because of technical problems. Intervention subjects made fewer emergency department visits than control subjects, more visits to the eye doctor, fewer visits in all categories of home care utilization, and lower use of transportation services. Frail elderly people are able to adopt home telehealth technologies which may enable them to maintain independent living arrangements.
Mark, Daniel B.; Anstrom, Kevin J.; McNulty, Steven E.; Flaker, Greg C.; Tonkin, Andrew M.; Smith, Warren M.; Toff, William D.; Dorian, Paul; Clapp-Channing, Nancy E.; Anderson, Jill; Johnson, George; Schron, Eleanor B.; Poole, Jeanne E.; Lee, Kerry L.; Bardy, Gust H.
2010-01-01
Background Public access automatic external defibrillators (AEDs) can save lives, but most deaths from out-of-hospital sudden cardiac arrest occur at home. The Home Automatic External Defibrillator Trial (HAT) found no survival advantage for adding a home AED to cardiopulmonary resuscitation (CPR) training for 7001 patients with a prior anterior wall myocardial infarction. Quality of life (QOL) outcomes for both the patient and spouse/companion were secondary endpoints. Methods A subset of 1007 study patients and their spouse/companions was randomly selected for ascertainment of QOL by structured interview at baseline and 12 and 24 months following enrollment. The primary QOL measures were the Medical Outcomes Study 36-Item Short-Form (SF-36) psychological well-being (reflecting anxiety and depression) and vitality (reflecting energy and fatigue) subscales. Results For patients and spouse/companions, the psychological well-being and vitality scales did not differ significantly between those randomly assigned an AED plus CPR training and controls who received CPR training only. None of the other QOL measures collected showed a clinically and statistically significant difference between treatment groups. Patients in the AED group were more likely to report being extremely or quite a bit reassured by their treatment assignment. Spouse/companions in the AED group reported being less often nervous about the possibility of using AED/CPR treatment than those in the CPR group. Conclusions Adding access to a home AED to CPR training did not affect quality of life either for patients with a prior anterior myocardial infarction or their spouse/companion but did provide more reassurance to the patients without increasing anxiety for spouse/companions. PMID:20362722
Morishima, Atsutomo; Kijima, Yasuaki
2012-12-01
In hospitals, information technology(IT)has been a natural part of care for some time. However, IT has not yet been widely introduced into home care. While performing home care, healthcare providers must carry numerous patients' medical records, and are unable to share the information included in those records with other providers. Thus, we introduced the system of sharing patient information using iPads. This system enables access to patient information regardless of time and place. In addition, we can share information such as X-ray images and computed tomography(CT)scans between different clinics. Thus, we are able to give clearer instructions to patients and other providers in a smoother way. This system could be used to construct a network for home care. In the future, we could aim to share patient information within a much wider network, including families and other kinds of organizations, for optimal care. This system will aid in the development of IT use in home care.
Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan
2012-01-01
Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486
Using scenarios to capture work processes in shared home care.
Hägglund, Maria; Scandurra, Isabella; Koch, Sabine
2007-01-01
Shared home care is increasingly common, and in order to develop ICT that support such complex cooperative work it is crucial obtain an understanding of the work routines, information demands, and other central preconditions at the clinical level before the development is initiated. Scenarios are proposed as a technique that can be useful for capturing work processes in shared home care and experiences from the Old@Home project are presented. The scenarios are useful not only in the initial phases of the development project but throughout the development process, improving the accessibility of end user requirements and usability issues for the design team, and as a basis for use cases and further design.
Home artificial nutrition in advanced cancer patients.
Ruggeri, Enrico; Agostini, Federica; Fettucciari, Luana; Giannantonio, Marilena; Pironi, Loris; Pannuti, Franco
2013-01-01
Malnutrition is over 50% in advanced cancer patients and is related to a decreased survival. Cachexia is the first reason for death in 4-23% of cases. The aim of the study was to estimate the appropriateness of the criteria to select patients for home artificial nutrition and its effectiveness to avoid death from cachexia and to improve quality of life in patients with advanced cancer assisted at home by the National Tumor Association (ANT) Foundation. The criteria for patient selection are: inadequate caloric intake ± malnutrition; life expectancy ≥6 weeks; suitable psycho-physical conditions; informed consent. The measured parameters were sex, age, tumor site, food intake, nutritional status, Karnofsky performance status, indication for home artificial nutrition, type of home artificial nutrition (enteral or parenteral), and survival after starting home artificial nutrition. The ANT Foundation assisted 29,348 patients in Bologna and its province from July 1990 to July 2012. Home artificial nutrition had been submitted to 618 patients (2.1%): enteral to 285/618 (46.1%) and parenteral to 333/618 (53.9%). Access routes for home artificial nutrition were: 39% nasogastric tube, 26% percutaneous endoscopic gastrostomy, 33% digiunostomy, and 2% gastrostomy. The central venous catheters used for home artificial nutrition were: 61% non-tunneled, 13 peripherally inserted, 8% partially tunneled, and 18% totally implanted. By July 2012, all the patients had died. Duration of life ≥6 weeks was 78% (484/618). Karnofsky performance status was related to survival ( P <0.0001): one month after starting home artificial nutrition, it decreased in 73 patients (12%), was unchanged in 414 (67%), and increased in 131 (21%). The low incidence of home artificial nutrition over all the patients assisted by the ANT Foundation and the achievement to avoid death from cachexia in 78% prove the efficacy of the criteria of patient selection in order to prevent its excessive and
Gambling and the Multidimensionality of Accessibility: More than Just Proximity to Venues
ERIC Educational Resources Information Center
Thomas, Anna Christina; Bates, Glen; Moore, Susan; Kyrios, Michael; Meredyth, Denise; Jessop, Glenn
2011-01-01
Accessibility to gambling has been linked to gambling behaviour but remains poorly understood. This study used data from semi-structured focus groups and interviews with 38 participants (Median age 42 years) to explore wider aspects of accessibility. People preferred venues which were open long hours and located close to home, work or regular…
Lim, Mei Ling; Yong, Bei Yi Paulynn; Mar, Mei Qi Maggie; Ang, Shin Yuh; Chan, Mei Mei; Lam, Madeleine; Chong, Ngian Choo Janet; Lopez, Violeta
2018-07-01
To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. Ninety-nine carers (n = 99) were recruited. Patient's mean age that they cared for was aged 77.7 years (SD = 11.2), and they had been on enteral feeding for a mean of 29 months (SD = 23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n = 20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition. © 2018 John Wiley & Sons Ltd.
Towards a virtual health record for mobile home care of elderly citizens.
Koch, Sabine; Hägglund, Maria; Scandurra, Isabella; Moström, Dennis
2004-01-01
Mobile work situations within home care of the elderly require immediate and ubiquitous access to patient-oriented data. The ongoing Swedish research project "Technical support for Mobile CloseCare" focuses on the development and evaluation of work-scenario oriented ICT support for enhanced home care of elderly citizens. The aim of the project is to provide a seamless and consistent information flow between different health care providers and to give intuitive access to information services for the elderly and their relatives. For that purpose, different independent software components are connected through a mobile communication platform. Flexible access to prioritized information for different users in different work situations will be given through a virtual health record. In order to obtain both usable and clinically relevant results, a user centered system development approach is followed. Evaluation of the project results will be based on usability tests and quasi-experimental studies on how system implementation influences quality of care and job- and life satisfaction for care providers, patients and relatives.
The Effect of the Home Environment on Physical Activity and Dietary Intake in Preschool Children
Østbye, Truls; Malhotra, Rahul; Stroo, Marissa; Lovelady, Cheryl; Brouwer, Rebecca; Zucker, Nancy; Fuemmeler, Bernard
2013-01-01
Background The effects of the home environment on child health behaviors related to obesity are unclear. Purpose To examine the role of the home physical activity (PA) and food environment on corresponding outcomes in young children, and assess maternal education/work status as a moderator. Methods Overweight or obese mothers reported on the home PA and food environment (accessibility, role modeling and parental policies). Outcomes included child moderate-vigorous PA (MVPA) and sedentary time derived from accelerometer data and two dietary factors (“junk” and healthy food intake scores) based on factor analysis of mother-reported food intake. Linear regression models assessed the net effect (controlling for child demographics, study arm, supplemental timepoint, maternal education/work status, child body mass index and accelerometer wear-time (for PA outcomes)) of the home environment on the outcomes and moderation by maternal education/work status. Data was collected in North Carolina from 2007–2011. Results Parental policies supporting PA increased MVPA time, and limiting access to unhealthy foods increased the healthy food intake score. Role modeling of healthy eating behaviors increased the healthy food intake score among children of mothers with no college education. Among children of mothers with no college education and not working, limiting access to unhealthy foods and role modeling reduced “junk” food intake scores while parental policies supporting family meals increased “junk” food intake scores. Conclusions To promote MVPA, parental policies supporting child PA are warranted. Limited access to unhealthy foods and role modeling of healthy eating may improve the quality of the child’s food intake. PMID:23736357
The effect of the home environment on physical activity and dietary intake in preschool children.
Østbye, T; Malhotra, R; Stroo, M; Lovelady, C; Brouwer, R; Zucker, N; Fuemmeler, B
2013-10-01
The effects of the home environment on child health behaviors related to obesity are unclear. To examine the role of the home physical activity (PA) and food environment on corresponding outcomes in young children, and assess maternal education/work status as a moderator. Overweight or obese mothers reported on the home PA and food environment (accessibility, role modeling and parental policies). Outcomes included child moderate-vigorous PA (MVPA) and sedentary time derived from accelerometer data and two dietary factors ('junk' and healthy food intake scores) based on factor analysis of mother-reported food intake. Linear regression models assessed the net effect (controlling for child demographics, study arm, supplemental time point, maternal education/work status, child body mass index and accelerometer wear time (for PA outcomes)) of the home environment on the outcomes and moderation by maternal education/work status. Data were collected in North Carolina from 2007 to 2011. Parental policies supporting PA increased MVPA time, and limiting access to unhealthy foods increased the healthy food intake score. Role modeling of healthy eating behaviors increased the healthy food intake score among children of mothers with no college education. Among children of mothers with no college education and not working, limiting access to unhealthy foods and role modeling reduced 'junk' food intake scores whereas parental policies supporting family meals increased 'junk' food intake scores. To promote MVPA, parental policies supporting child PA are warranted. Limited access to unhealthy foods and role modeling of healthy eating may improve the quality of the child's food intake.
Pressure ulcer prevention in care home settings.
Ellis, Michael
2017-03-31
Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.
Fathi, Roya; Sheehan, Orla C; Garrigues, Sarah K; Saliba, Debra; Leff, Bruce; Ritchie, Christine S
2016-08-01
The unique needs of homebound adults receiving home-based medical care (HBMC) (ie, home-based primary care and home-based palliative care services) are ideally provided by interdisciplinary care teams (IDTs) that provide coordinated care. The composition of team members from an array of organizations and the unique dimension of providing care in the home present specific challenges to timely access and communication of patient care information. The objective of this work was to develop a conceptual framework and corresponding quality indicators (QIs) that assess how IDT members for HBMC practices access and communicate key patient information with each other. A systematic review of peer-reviewed and gray literature was performed to inform a framework for care coordination in the home and the development of candidate QIs to assess processes by which all IDT members optimally access and use patient information. A technical expert panel (TEP) participated in a modified Delphi process to assess the validity and feasibility of each QI and to identify which would be most suitable for testing in the field. Thematic analysis of literature revealed 4 process themes for how HBMC practices might engage in high-quality care coordination: using electronic medical records, conducting interdisciplinary team meetings, sharing standardized patient assessments, and communicating via secure e-messaging. Based on these themes, 9 candidate QIs were developed to reflect these processes. Three candidate QIs were assessed by the TEP as valid and feasible to measure in an HBMC practice setting. These indicators focused on use of IDT meetings, standardized patient assessments, and secure e-messaging. Translating the complex issue of care coordination into QIs will improve care delivered to vulnerable home-limited adults who receive HBMC. Guided by the literature, we developed a framework to reflect optimal care coordination in the home setting and identified 3 candidate QIs to field-test in
Internationalisation at Home: Intercultural Learning for Social Psychology Students
ERIC Educational Resources Information Center
Brown, Patricia M.; Mak, Anita S.; Neill, James T.
2016-01-01
An internationalised curriculum could better prepare graduates for globalising and increasingly culturally diverse workplaces. There is a need to provide students with intercultural learning opportunities at home because many students do not have access to study abroad opportunities. This paper describes curriculum changes designed to enhance…
Project SMART (Summer Migrants Access Resources through Technology).
ERIC Educational Resources Information Center
Texas Education Agency, Austin. Div. of Migrant Education.
The SMART (Summer Migrants Access Resources through Technology) project provides Texas migrant students with supplemental instruction using a multi-media, nontraditional approach. Migrant students who remain in Texas during the summer are taught in their homes or other sites via televised instruction with additional instructional support from…
Or, Calvin K.L.; Valdez, Rupa S.; Casper, Gail R.; Carayon, Pascale; Burke, Laura J.; Brennan, Patricia Flatley; Karsh, Ben-Tzion
2010-01-01
Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention. PMID:19713630
7 CFR 1755.500 - RUS standard for service installations at customers access locations.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 7 Agriculture 11 2010-01-01 2010-01-01 false RUS standard for service installations at customers... customers access locations. (a) Sections 1755.501 through 1755.510 cover service installations at permanent or mobile home customer access locations. Sections 1755.501 through 1755.510 do not cover service...
Byrd, Mary E
2006-01-01
The purpose of this paper was to develop a nursing-focused use of social exchange theory within the context of maternal-child home visiting. The nature of social exchange theory, its application to client-nurse interaction, and its fit with an existing data set from a field research investigation were examined. Resources exchanged between the nurse and clients were categorized and compared across the patterns of home visiting, nursing strategies based on exchange notions were identified, and variations in exchange were linked with client outcomes. The nurse provided resources within the categories of information, status, service, and goods. Clients provided time, access to the home, space within the home to conduct the visit, opportunities to observe maternal-child interaction, access to the infant, and information. The ease and breadth of resource exchange varied across the patterns of home visiting. The social exchange perspective was useful in categorizing resources, specifying and uncovering new resource categories, understanding nursing strategies to initiate and maintain the client-nurse relationship, and linking client-nurse interactive phenomena with client outcomes. Social exchange theory is potentially useful for understanding client-nurse interaction in the context of maternal-child home visits.
Designing, testing, and implementing a sustainable nurse home visiting program: right@home.
Goldfeld, Sharon; Price, Anna; Kemp, Lynn
2018-05-01
Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.
Markkanen, Pia; Galligan, Catherine; Laramie, Angela; Fisher, June; Sama, Susan; Quinn, Margaret
2015-04-11
. Manufacturers and insurance providers can improve safety with more affordable and accessible sharps with injury prevention features for home users. Sharps disposal campaigns, free-of-charge disposal containers, and convenient disposal options remain essential. Sharps injuries are preventable through public health actions that promote needleless treatment methods, sharps with injury prevention features, and safe disposal practices. Communication about hazards regarding sharps is needed for all home healthcare stakeholders.
Home sweet home? Home physical environment and inflammation in children
Schmeer, Kammi K.; Yoon, Aimee J.
2016-01-01
The home environment includes important social and physical contexts within which children develop. Poor physical home environments may be a potential source of stress for children through difficult daily experiences. Using a sub-sample from the Los Angeles Family and Neighborhood Survey (N = 425), we consider how the home physical environment affects stress-related immune system dysregulation in children ages 3–18 years. Results indicated that children in poorer quality homes had higher inflammation (measured by C-reactive protein). The associations were particularly strong for younger children. We also found that part of the home physical environment association with CRP worked through increased risk of obesity for children living in low-quality homes. Future research should assess how home physical environments could be improved to reduce stress and improve health outcomes in children. PMID:27712682
Bradley, Robert H; Putnick, Diane L
2012-01-01
This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials a little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.
Internet access for delivery of health information to South Australians older than 50.
Wilson, Carlene; Flight, Ingrid; Hart, Elizabeth; Turnbull, Deborah; Cole, Steve; Young, Graeme
2008-04-01
An exploratory study to determine the proportion of people aged 50-76 years who have Internet access, the location of this access, predictive characteristics of such access, and preparedness to receive unsolicited health information through this medium. A random sample of 1,000 South Australians was identified from the Australian Electoral Commission roll and contacted by telephone in 2006. They were invited to answer questions about their access to the Internet and attitude towards receiving unsolicited health information via the Internet. Of those contacted, 41% provided information. Of this group, 59% indicated that they had Internet access, mostly at home. Men were more likely than women to have home access (p<0.05). Higher educational achievement, higher economic status and younger age were all significantly associated with access. Of those who had access, 65% would be willing to receive health information through the Internet. More than half the population older than 50 years has access to the Internet at some location, and there is a general acceptance of the possibility of receiving health-promoting material via this medium. However, delivery via the Internet alone would disadvantage those who are less educated, less financially well off and older. It is likely that a generational change in the entire nature of public communication will influence the efficiency and effectiveness of preventive health promotion delivery via the Internet. In order to facilitate improved health outcomes, issues of disparity of access must be addressed.
H.O.M.E.: Helping Ourselves Means Education.
ERIC Educational Resources Information Center
Blum-Anderson, Judy
A non-profit program based in Washington State that promotes access to college for low income groups/welfare recipients is described, along with results of research on the program. The H.O.M.E (Helping Ourselves Means Education) program is designed to help welfare recipients leave the welfare system by entering educational institutions. Additional…
ERIC Educational Resources Information Center
Beuermann, Diether W.; Cristia, Julian P.; Cruz-Aguayo, Yyannu; Cueto, Santiago; Malamud, Ofer
2013-01-01
This paper presents results from a randomized control trial in which approximately 1,000 OLPC XO laptops were provided for home use to children attending primary schools in Lima, Peru. The intervention increased access and use of home computers, with some substitution away from computer use outside the home. Beneficiaries were more likely to…
Intelligent Home Control System Based on ARM10
NASA Astrophysics Data System (ADS)
Chen, G. X.; Jiang, J.; Zhong, L. H.
2017-10-01
Intelligent home is becoming the hot spot of social attention in the 21st century. When it is in China, it is a really new industry. However, there is no doubt that Intelligent home will become a new economic growth point of social development; it will change the life-style of human being. To develop the intelligent home, we should keep up with the development trend of technology. This is the reason why I talk about the intelligent home control system here. In this paper, intelligent home control system is designed for alarm and remote control on gas- leaking, fire disaster, earthquake prediction, etc., by examining environmental changes around house. When the Intelligent home control system has detected an accident occurs, the processor will communicate with the GSM module, informing the house keeper the occurrence of accident. User can receive and send the message to the system to cut the power by mobile phone. The system can get access to DCCthrough ARM10 JTAG interface, using DCC to send and receive messages. At the same time, the debugger on the host is mainly used to receive the user’s command and send it to the debug component in the target system. The data that returned from the target system is received and displayed to the user in a certain format.
Laging, Bridget; Ford, Rosemary; Bauer, Michael; Nay, Rhonda
2015-10-01
To report a meta-synthesis of qualitative research studies exploring the role of nursing home staff in decisions to transfer residents to hospital. Nurses and nurse assistants provide the majority of care to residents living in nursing homes and may be the only health workers present when a resident deteriorates. To inform future strategies, it is vital to understand the role of nursing home staff in decisions to transfer to hospital. A systematic review identified 17 studies to be included. The process of meta-synthesis was undertaken using the Joanna Briggs Institute's guidelines. Qualitative research papers published between January 1989-October 2012 were identified in key databases including Cinahl, Embase, Medline and PsycInfo. Nursing home staff members play a key role in decision-making at the time of a resident's deterioration. Multiple factors influence decisions to transfer to hospital including an unclear expectation of the nursing home role; limited staffing capacity; fear of working outside their scope of practice; poor access to multidisciplinary support and difficulties communicating with other decision-makers. There is a lack of consensus regarding the role of the nursing home when a resident's health deteriorates. Nursing home staff would benefit from a clear prescription of their expected minimum clinical skill set; a staffing capacity that allows for the increased requirements to manage residents on-site, greater consistency in access to outside resources and further confidence and skills to optimize their role in resident advocacy. © 2015 John Wiley & Sons Ltd.
Misconceptions about case-mix payments for nursing homes.
Grimaldi, P L
1987-04-01
Despite the increasing use of case-mix payment systems for skilled and intermediate nursing home care (at least 10 state Medicaid programs have adopted or are considering adopting such a system), misconceptions about such systems still exist. Unless these inaccurate perceptions are corrected, a state may adopt a system that fails to realize its goals. Some of these misconceptions include the beliefs that case-mix payment systems: Apply to all nursing homes costs; Will benefit hospital-based facilities; Will resolve the access problems of heavy care public patients; Will result in higher statewide payment rates because patient characteristics are factored directly into the calculations. In fact, case-mix adjustments are applied only to costs that can be traced directly to patients' impairments. Nursing services and some ancillary services are dependent on case mix, while administrative and support services are largely independent of case mix. Capital costs usually can be ignored in formulating the case-mix adjustment. Although hospital-based facilities frequently have sicker patients than freestanding facilities, studies show that only a portion of the cost differential is explained by case-mix differences. In the case of heavy-care patients, some believe that case-mix payment systems will resolve access problems by paying higher rates in response to the higher treatment costs. Access may not improve, however, if the new rates are lower than those paid by comparable private patients. Perhaps a loosening in the certificate-of-need process will also be needed to resolve the access problem.(ABSTRACT TRUNCATED AT 250 WORDS)
Medical Home Disparities for Latino Children by Parental Language of Interview
DeCamp, Lisa Ross; Choi, Hwajung; Davis, Matthew M.
2015-01-01
Examination of Latino children in aggregate ignores important subgroup differences due to the parents’ English language ability. Previous reports of the pediatric medical home have not stratified Latino children by parental language differences to compare the two groups directly. We analyzed the 2007 National Survey of Children’s Health to determine medical home prevalence among Latino children, stratified by language of parental interview. Most Latino children with a Spanish-language parental interview had a usual source of care, but only one-quarter had a medical home. Striking medical home disparities persisted for Latino children with a Spanish-language interview, even after adjustment for potential confounders. Lack of a medical home was associated with disparities in the quality of care, more so than access disparities. Addressing health care disparities for Latino children requires particular attention to the unique needs of Latino children with parents who may experience language barriers during health care encounters. PMID:22080700
Case-mix payment for nursing home care: lessons from Maryland.
Feder, J; Scanlon, W
1989-01-01
Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.
Hospital Versus Home Death: Results from the Mexican Health and Aging Study
Cárdenas-Turanzas, Marylou; Torres-Vigil, Isabel; Tovalín-Ahumada, Horacio; Nates, Joseph L.
2013-01-01
Context Characterizing where people die is needed to inform palliative care programs in Mexico. Objectives To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. Methods We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. Results The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). Conclusion Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services. PMID:21146354
A Reconfigurable Design and Architecture of the Ethernet and HomePNA3.0 MAC
NASA Astrophysics Data System (ADS)
Khalilydermany, M.; Hosseinghadiry, M.
In this paper a reconfigurable architecture for Ethernet and HomePNA MAC is presented. By using this new architecture, Ethernet and HomePNA reconfigurable network card can be produced. This architecture has been implemented using VHDL language and after that synthesized on a chip. The differences between HomePNA (synchronized and unsynchronized mode) and Ethernet in collision detection mechanism and priority access to media have caused the need to separate architectures for Ethernet and HomePNA, but by using similarities of them, both the Ethernet and the HomePNA can be implemented in a single chip with a little extra hardware. The number of logical elements of the proposed architecture is increased by 19% in compare to when only an Ethernet MAC is implemented
77 FR 13195 - Exempting In-Home Video Telehealth From Copayments
Federal Register 2010, 2011, 2012, 2013, 2014
2012-03-06
.... (This is not a toll-free number.) SUPPLEMENTARY INFORMATION: Many of our nation's veterans must travel... consultations, improved access to primary and ambulatory care, reduced waiting times, and decreased veteran travel. VA provides various telehealth services, including clinical video telehealth and in-home video...
Exploring Adolescent-Parent Interaction Strategies for Accessing Alcohol at Home
ERIC Educational Resources Information Center
Dresler, Emma; Whitehead, Dean; Weaver, Kelly
2017-01-01
Purpose: The purpose of this paper is to determine the extent to which youth have ready access to alcohol and the extent to which immediate family influence affects consumption. Design/methodology/approach: This qualitative descriptive exploratory study undertook semi-structured peer-group interviews with 20 participants from four New Zealand high…
[Research on Barrier-free Home Environment System Based on Speech Recognition].
Zhu, Husheng; Yu, Hongliu; Shi, Ping; Fang, Youfang; Jian, Zhuo
2015-10-01
The number of people with physical disabilities is increasing year by year, and the trend of population aging is more and more serious. In order to improve the quality of the life, a control system of accessible home environment for the patients with serious disabilities was developed to control the home electrical devices with the voice of the patients. The control system includes a central control platform, a speech recognition module, a terminal operation module, etc. The system combines the speech recognition control technology and wireless information transmission technology with the embedded mobile computing technology, and interconnects the lamp, electronic locks, alarms, TV and other electrical devices in the home environment as a whole system through a wireless network node. The experimental results showed that speech recognition success rate was more than 84% in the home environment.
Telecommuting (Work-At-Home) at NASA Lewis Research Center
NASA Technical Reports Server (NTRS)
Srinidhi, Saragur M.
1994-01-01
This report presents a study in evaluating the viability of providing a work-at-home (telecommuting) program for Lewis Research Center's corporate employees using Integrated Services Digital Network (ISDN). Case studies have been presented for a range of applications from casual data access to interactive access. The network performance of telemedia applications were studied against future requirements for such level of remote connectivity. Many of the popular ISDN devices were characterized for network and service functionality. A set of recommendations to develop a telecommuting policy have been proposed.
Kristiansen, Anne Lene; Bjelland, Mona; Himberg-Sundet, Anne; Lien, Nanna; Andersen, Lene Frost
2017-05-01
First, to explore item pools developed to measure the physical home environment of pre-school children and assess the psychometric properties of these item pools; second, to explore associations between this environment and vegetable consumption among Norwegian 3-5-year-olds. Data were collected in three steps: (i) a parental web-based questionnaire assessing the child's vegetable intake and factors potentially influencing the child's vegetable consumption; (ii) direct observation of the children's fruit, berry and vegetable intakes at two meals in one day in the kindergarten; and (iii) a parental web-based 24 h recall. The target group for this study was pre-school children born in 2010 and 2011, attending public or private kindergartens in the counties of Vestfold and Buskerud, Norway. A total of 633 children participated. Principal component analysis on the thirteen-item pool assessing availability/accessibility resulted in two factors labelled 'availability at home' and 'accessibility at home', while the eight-item pool assessing barriers resulted in two factors labelled 'serving barriers' and 'purchase barriers'. The psychometric properties of these factors were satisfactory. Linear regression of the associations between vegetable intake and the factors showed generally positive associations with 'availability at home' and 'accessibility at home' and negative associations with 'serving barriers'. This age group has so far been understudied and there is a need for comparable studies. Our findings highlight the importance of targeting the physical home environment of pre-school children in future interventions as there are important modifiable factors that both promote and hinder vegetable consumption in this environment.
Home Delivery Medicament Program: access, inactivity and cardiovascular risk.
Araújo, Roque da Silva; Arcuri, Edna Apparecida Moura; Lopes, Victor Cauê
2016-10-10
to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%). verificar causas de inatividade no Programa Remédio em Casa, referidas por usuários de Unidade Básica de Saúde de São Paulo, comparando-as às registradas pelo programa e analisando-as no modelo teórico Conceito de Acesso à Saúde. estudo transversal entrevistando 111 usuários inativos; e documental, nos registros do programa. metade dos usuários desconhecia a condição de inatividade. Constatadas discrepâncias nas informações usuário versus programa, observando-se diferentes níveis de concordância: Falta de médico e funcion
Key Statistics from the National Survey of Family Growth: Vasectomy
... Birth Data NCHS Key Statistics from the National Survey of Family Growth - V Listing Recommend on Facebook ... What's this? Submit Button Related Sites NCHS Listservs Surveys and Data Collection Systems Vital Statistics: Birth Data ...
KernPaeP - a web-based pediatric palliative documentation system for home care.
Hartz, Tobias; Verst, Hendrik; Ueckert, Frank
2009-01-01
KernPaeP is a new web-based on- and offline documentation system, which has been developed for pediatric palliative care-teams supporting patient documentation and communication among health care professionals. It provides a reliable system making fast and secure home care documentation possible. KernPaeP is accessible online by registered users using any web-browser. Home care teams use an offline version of KernPaeP running on a netbook for patient documentation on site. Identifying and medical patient data are strictly separated and stored on two database servers. The system offers a stable, enhanced two-way algorithm for synchronization between the offline component and the central database servers. KernPaeP is implemented meeting highest security standards while still maintaining high usability. The web-based documentation system allows ubiquitous and immediate access to patient data. Sumptuous paper work is replaced by secure and comprehensive electronic documentation. KernPaeP helps saving time and improving the quality of documentation. Due to development in close cooperation with pediatric palliative professionals, KernPaeP fulfils the broad needs of home-care documentation. The technique of web-based online and offline documentation is in general applicable for arbitrary home care scenarios.
Remote access to medical specialists: home care interactive patient management system
NASA Astrophysics Data System (ADS)
Martin, Peter J.; Draghic, Nicole; Wiesmann, William P.
1999-07-01
Diabetes management involves constant care and rigorous compliance. Glucose control is often difficult to maintain and onset of complications further compound health care needs. Status can be further hampered by geographic isolation from immediate medical infrastructures. The Home Care Interactive Patient Management System is an experimental telemedicine program that could improve chronic illness management through Internet-based applications. The goal of the system is to provide a customized, integrated approach to diabetes management to supplement and coordinate physician protocol while supporting routine patient activity, by supplying a set of customized automated services including health data collection, transmission, analysis and decision support.
Nurse Assistant Communication Strategies about Pressure Ulcers in Nursing Homes
Alexander, Gregory L.
2018-01-01
There is growing recognition of benefits of sophisticated information technology (IT) in nursing homes. In this research, we explore strategies nurse assistants use to communicate pressure ulcer prevention practices in nursing homes with variable IT sophistication measures. Primary qualitative data was collected during focus groups with nursing assistants in 16 nursing homes located across Missouri. Nursing assistants (n=213) participated in 31 focus groups. Three major themes referencing communication strategies for pressure ulcer prevention were identified, including Passing on Information, Keeping Track of Needs and Information Access. Nurse assistants use a variety of strategies to prioritize care and strategies are different based on IT sophistication level. Nursing assistant work is an important part of patient care. However, little information about their work is included in communication, leaving patient records incomplete. Nursing assistant’s communication is becoming increasingly important in the care of the millions of chronically ill elders in nursing homes. PMID:25331206
Performance analysis and improvement of WPAN MAC for home networks.
Mehta, Saurabh; Kwak, Kyung Sup
2010-01-01
The wireless personal area network (WPAN) is an emerging wireless technology for future short range indoor and outdoor communication applications. The IEEE 802.15.3 medium access control (MAC) is proposed to coordinate the access to the wireless medium among the competing devices, especially for short range and high data rate applications in home networks. In this paper we use analytical modeling to study the performance analysis of WPAN (IEEE 802.15.3) MAC in terms of throughput, efficient bandwidth utilization, and delay with various ACK policies under error channel condition. This allows us to introduce a K-Dly-ACK-AGG policy, payload size adjustment mechanism, and Improved Backoff algorithm to improve the performance of the WPAN MAC. Performance evaluation results demonstrate the impact of our improvements on network capacity. Moreover, these results can be very useful to WPAN application designers and protocol architects to easily and correctly implement WPAN for home networking.
Performance Analysis and Improvement of WPAN MAC for Home Networks
Mehta, Saurabh; Kwak, Kyung Sup
2010-01-01
The wireless personal area network (WPAN) is an emerging wireless technology for future short range indoor and outdoor communication applications. The IEEE 802.15.3 medium access control (MAC) is proposed to coordinate the access to the wireless medium among the competing devices, especially for short range and high data rate applications in home networks. In this paper we use analytical modeling to study the performance analysis of WPAN (IEEE 802.15.3) MAC in terms of throughput, efficient bandwidth utilization, and delay with various ACK policies under error channel condition. This allows us to introduce a K-Dly-ACK-AGG policy, payload size adjustment mechanism, and Improved Backoff algorithm to improve the performance of the WPAN MAC. Performance evaluation results demonstrate the impact of our improvements on network capacity. Moreover, these results can be very useful to WPAN application designers and protocol architects to easily and correctly implement WPAN for home networking. PMID:22319274
ERIC Educational Resources Information Center
Erwin, Heather E.; Woods, Amelia Mays; Woods, Martha K.; Castelli, Darla M.
2007-01-01
The purpose of this study was to examine levels of physical activity engagement, motor competence, and physical fitness as related to child access to physical activity facilities in the home and school environments. The present investigation attempts to further efforts to examine the relationship between physical activity levels and access.…
Luke, Josh
2016-01-01
Seniors and other hospital patients in the United States have traditionally had the option of being discharged to a skilled nursing facility (convalescent home) for post-acute services, or home with nursing and therapy services provided in the home setting. Traditionally, these home based services have been referred to as "home health." As more Americans have retired, home health services have expanded and are readily accessible. This growth put tremendous stress on the Medicare fund which pays for senior care services. However, "Home Care," which traditionally has been viewed as non-medical home based services, has also become a booming industry for the cost conscious in recent years as more Americans reach retirement age. With the passing of the Affordable Care Act in 2010, providers and payers are now finding themselves responsible for post-acute care and continuous patient health, so cost efficient solutions for post-acute care are thriving. For the first time in history, American hospitals and Insurers are recognizing Home Care as an effective model that achieves the Triple Aim of Health Care reform. Home Care, which is no longer completely non-medical services, has proven to be an integral part of the care continuum for seniors in recent years and is now becoming a viable solution for keeping patients well, while still honoring their desire to age and heal at home. This paper analyzes the benefits and risks of home care and provides a clear understanding as to why American hospitals are emphasizing SNF Avoidance and skipping home health, opting instead to refer patients directly to home care as the preferred discharge solution in a value based model.
'That would have been beneficial': LGBTQ education for home-care service providers.
Daley, Andrea; MacDonnell, Judith A
2015-05-01
This paper reports qualitative findings from a pilot study that explored the lesbian, gay, bisexual, transgender and queer (LGBTQ) education needs of home-care service providers working in one large, urban Canadian city. The pilot study builds upon research that has documented barriers to health services for diversely situated LGBTQ people, which function to limit access to good-quality healthcare. LGBTQ activists, organisations and allies have underscored the need for health provider education related to the unique health and service experiences of sexual and gender minority communities. However, the home-care sector is generally overlooked in this important body of research literature. We used purposeful convenience sampling to conduct four focus groups and two individual interviews with a total of 15 professionally diverse home-care service providers. Data collection was carried out from January 2011 to July 2012 and data were analysed using grounded theory methods towards the identification of the overarching theme, 'provider education' and it had two sub-themes: (i) experiences of LGBTQ education; and (ii) recommendations for LGBTQ education. The study findings raise important questions about limited and uneven access to adequate LGBTQ education for home-care service providers, suggest important policy implications for the education and health sectors, and point to the need for anti-oppression principles in the development of education initiatives. © 2014 John Wiley & Sons Ltd.
HoCaMA: Home Care Hybrid Multiagent Architecture
NASA Astrophysics Data System (ADS)
Fraile, Juan A.; Bajo, Javier; Abraham, Ajith; Corchado, Juan M.
Home Care is one of the main objectives of Ambient Intelligence. Nowadays, the disabled and elderly population, which represents a significant part of our society, requires novel solutions for providing home care in an effective way. In this chapter, we present HoCaMA, a hybrid multiagent architecture that facilitates remote monitoring and care services for disabled patients at their homes. HoCaMA combines multiagent systems and Web services to facilitate the communication and integration with multiple health care systems. In addition, HoCaMA focuses on the design of reactive agents capable of interacting with different sensors present in the environment, and incorporates a system of alerts through SMS and MMS mobile technologies. Finally, it uses Radio Frequency IDentification and JavaCard technologies to provide advanced location and identification systems, as well as automatic access control facilities. HoCaMA has been implemented in a real environment and the results obtained are presented within this chapter.
Accelerating the Delivery of Home Performance Upgrades through a Synergistic Business Model
DOE Office of Scientific and Technical Information (OSTI.GOV)
Schirber, Tom; Ojczyk, Cindy
Achieving Building America energy savings goals (40% by 2030) will require many existing homes to install energy upgrades. Engaging large numbers of homeowners in building science-guided upgrades during a single remodeling event has been difficult for a number of reasons. Performance upgrades in existing homes tend to occur over multiple years and usually result from component failures (furnace failure) and weather damage (ice dams, roofing, siding). This research attempted to: A) understand the homeowner's motivations regarding investing in building science based performance upgrades; B) determining a rapidly scalable approach to engage large numbers of homeowners directly through existing customer networks;more » and C) access a business model that will manage all aspects of the contractor-homeowner-performance professional interface to ensure good upgrade decisions over time. The solution results from a synergistic approach utilizing networks of suppliers merging with networks of homeowner customers. Companies in the $400 to $800 billion home services industry have proven direct marketing and sales proficiencies that have led to the development of vast customer networks. Companies such as pest control, lawn care, and security have nurtured these networks by successfully addressing the ongoing needs of homes. This long-term access to customers and trust established with consistent delivery has also provided opportunities for home service providers to grow by successfully introducing new products and services like attic insulation and air sealing. The most important component for success is a business model that will facilitate and manage the process. The team analyzes a group that developed a working model.« less
Healthy Efficient New Gas Homes (HENGH) Pilot Test Results
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chan, Wanyu R.; Maddalena, Randy L; Stratton, Chris
The Healthy Efficient New Gas Homes (HENGH) is a field study that will collect data on ventilation systems and indoor air quality (IAQ) in new California homes that were built to 2008 Title 24 standards. A pilot test was performed to help inform the most time and cost effective approaches to measuring IAQ in the 100 test homes that will be recruited for this study. Two occupied, single-family detached homes built to 2008 Title 24 participated in the pilot test. One of the test homes uses exhaust-only ventilation provided by a continuous exhaust fan in the laundry room. The othermore » home uses supply air for ventilation. Measurements of IAQ were collected for two weeks. Time-resolved concentrations of particulate matter (PM), nitrogen dioxide (NO2), carbon dioxide (CO2), carbon monoxide (CO), and formaldehyde were measured. Measurements of IAQ also included time-integrated concentrations of volatile organic compounds (VOCs), volatile aldehydes, and NO2. Three perfluorocarbon tracers (PFTs) were used to estimate the dilution rate of an indoor emitted air contaminant in the two pilot test homes. Diagnostic tests were performed to measure envelope air leakage, duct leakage, and airflow of range hood, exhaust fans, and clothes dryer vent when accessible. Occupant activities, such as cooking, use of range hood and exhaust fans, were monitored using various data loggers. This document describes results of the pilot test.« less
Residents' choice of and control over food in care homes.
Winterburn, Susan
2009-04-01
This study aimed to map food pathways in care homes to identify how residents exercised choice and control over their food intake and any associated or influencing factors. Four homes were visited, interviews were conducted with chefs and nursing staff and the dining facilities were noted. It was found that residents were dependent on the care home for the provision of food. There was almost no direct contact between residents and external food retailers. A food map was constructed, which identified three routes for potential improvements in practice: supply and delivery of food; serving of food; and consumption of food. Residents' choice and control over food could be improved through the design of new products for serving and consumption of food and eating aids, access to local food retailers and nutritional training.
ERIC Educational Resources Information Center
Hinson, Janice M
2005-01-01
This study presents a preliminary investigation into changes in the perceptions and behaviors of teachers and students when all have universal Internet access at home and school using Internet-on-TV technology. Four hundred fourth-grade students and their teachers from seven schools participated in the WISH TV (WorldGate Internet School to Home)…
Home-based intermediate care program vs hospitalization
Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael
2008-01-01
OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to
The resource utilization group system: its effect on nursing home case mix and costs.
Thorpe, K E; Gertler, P J; Goldman, P
1991-01-01
Using data from 1985 and 1986, we examine how New York state's prospective payment system affected nursing homes. The system, called Resource Utilization Group (RUG-II), aimed to limit nursing home cost growth and improve access to nursing homes by "heavy-care" patients. As in Medicare's prospective hospital reimbursement system, payments to nursing homes were based on a "price," rather than facility-specific rates. With respect to cost growth, we observed considerable diversity among homes. Specifically, those nursing homes most financially constrained by the RUG-II methodology exhibited the slowest rates of cost growth; we observed higher cost growth among the homes least constrained. This higher rate of cost growth raises a question about the desirability of using a pricing methodology to determine nursing home payment rates. In addition to moderating cost growth, we also observed a significant change in the mix of patients admitted to nursing homes. During the first year of the RUG-II program, nursing homes admitted more heavy-care patients and reduced days of care to lighter-care patients. Thus, through 1986, the RUG-II program appeared to satisfy at least one of its major policy objectives.
Home hemodialysis education during postdoctoral training: Challenges and innovations.
Glickman, Joel D; Seshasai, Rebecca Kurnik
2018-03-01
Inadequate education in home hemodialysis (HHD) fellowship training might contribute to underutilization of this modality in the United States. Most graduates of nephrology fellowships do not grade themselves as competent in HHD suggesting that fellowship training in HHD is inadequate. An essential component for fellow education is at least one faculty member with expertise in HHD who is passionate about promoting the use of this modality. At a minimum, fellow training should utilize a curriculum that includes both lectures about HHD and outpatient clinical exposure to this modality over a period of at least 6-12 months. Fellows benefit from the opportunity to transition at least three patients to a home modality to gain experience with modality education, access placement, initial prescriptions, and home dialysis training. They should spend time with HHD training nurses to learn more about modality education, observe nurse intake interviews with patients in order to learn the criteria for entrance into the home dialysis program as well as recognize how to identify potential barriers to successful home dialysis therapy. To expose fellows to problems that do not occur during clinic visits fellows are encouraged to take first call during the day for HHD patients. There are many opportunities to do research and quality improvement projects which might also propel some fellows into an academic career as a home dialysis nephrologist. © 2018 Wiley Periodicals, Inc.
Sensor-Based Optimization Model for Air Quality Improvement in Home IoT.
Kim, Jonghyuk; Hwangbo, Hyunwoo
2018-03-23
We introduce current home Internet of Things (IoT) technology and present research on its various forms and applications in real life. In addition, we describe IoT marketing strategies as well as specific modeling techniques for improving air quality, a key home IoT service. To this end, we summarize the latest research on sensor-based home IoT, studies on indoor air quality, and technical studies on random data generation. In addition, we develop an air quality improvement model that can be readily applied to the market by acquiring initial analytical data and building infrastructures using spectrum/density analysis and the natural cubic spline method. Accordingly, we generate related data based on user behavioral values. We integrate the logic into the existing home IoT system to enable users to easily access the system through the Web or mobile applications. We expect that the present introduction of a practical marketing application method will contribute to enhancing the expansion of the home IoT market.
Medicaid payment policies for nursing home care: A national survey
Buchanan, Robert J.; Madel, R. Peter; Persons, Dan
1991-01-01
This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access. PMID:10114935
ERIC Educational Resources Information Center
Tichnor-Wagner, Ariel; Garwood, Justin D.; Bratsch-Hines, Mary; Vernon-Feagans, Lynne
2016-01-01
Factors such as weak early literacy skills and living in poverty may put young students at risk for reading disabilities. While home literacy activities and access to literacy materials have been associated with positive reading outcomes for urban and suburban students, little is known about home literacy environments of rural early elementary…
Obesity and Supermarket Access: Proximity or Price?
Aggarwal, Anju; Hurvitz, Philip M.; Monsivais, Pablo; Moudon, Anne V
2012-01-01
Objectives. We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. Methods. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. Results. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk = 0.34; 95% confidence interval = 0.19, 0.63) Conclusions. Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another. PMID:22698052
Obesity and supermarket access: proximity or price?
Drewnowski, Adam; Aggarwal, Anju; Hurvitz, Philip M; Monsivais, Pablo; Moudon, Anne V
2012-08-01
We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk=0.34; 95% confidence interval=0.19, 0.63) Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another.
Indian adolescents' perceptions of the home food environment.
Rathi, Neha; Riddell, Lynn; Worsley, Anthony
2018-01-22
The home food environment has the potential to influence the eating behaviour of adolescents. This investigation aimed to understand Indian adolescents' perspectives of their home food environments. Adolescents aged 14-16 years (n = 1026, 65.3% girls) attending private secondary schools in Kolkata completed a paper-based questionnaire during school time which included questions about family food rules, availability and accessibility of foods at home, and domestic cooking responsibility. Boys' and girls' opinions and experiences were compared through cross-tabulation analyses. Almost all the adolescents reported that fruits (91.6%) and vegetables (95.7%) were always available in their homes. Approximately two-fifths reported that sugar-sweetened beverages (36.2%) and salty snack foods (38.0%) were readily available. In 56.1% households, adolescents were expected to follow certain food rules during mealtimes (e.g. not talking with my mouth full). The majority of the respondents (80.4%) identified mothers as the primary meal providers, only a minority reported that fathers (5.1%) were responsible for preparation of family meals. This understanding of the family-environmental determinants of adolescent dietary habits provides useful directions for nutrition promotion interventions. Health and educational professionals associated with adolescents could communicate about the development of healthy home food environments to provide positive health benefits for adolescents and their families.
Rousham, Emily K; Roschnik, Natalie; Baylon, Melba Andrea B; Bobrow, Emily A; Burkhanova, Mavzuna; Campion, M Gerda; Adle-Chua, Teresita; Degefie, Tedbabe; Hilari, Caroline; Kalengamaliro, Humphreys; Kassa, Tamiru; Maiga, Fadima; Mahumane, Bonifacio J; Mukaka, Mary; Ouattara, Fatimata; Parawan, Amado R; Sacko, Moussa; Patterson, David W; Sobgo, Gaston; Khandaker, Ikhtiar Uddin; Hall, Andrew
2011-08-01
In 2007 new World Health Organization (WHO) growth references for children aged 5-19 y were introduced to replace the National Center for Health Statistics (NCHS) references. This study aimed to compare the prevalence of stunting, wasting, and thinness estimated by the NCHS and WHO growth references. NCHS and WHO height-for-age z scores were calculated with the use of cross-sectional data from 20,605 schoolchildren aged 5-17 y in 11 low-income countries. The differences in the percentage of stunted children were estimated for each year of age and sex. The z scores of body mass index-for-age and weight-for-height were calculated with the use of the WHO and NCHS references, respectively, to compare differences in the prevalence of thinness and wasting. No systematic differences in mean z scores of height-for-age were observed between the WHO and NCHS growth references. However, z scores of height-for-age varied by sex and age, particularly during early adolescence. In children for whom weight-for-height could be calculated, the estimated prevalence of thinness (WHO reference) was consistently higher than the prevalence of wasting (NCHS reference) by as much as 9% in girls and 18% in boys. In undernourished populations, the application of the WHO (2007) references may result in differences in the prevalence of stunting for each sex compared with results shown when the NCHS references are used as well as a higher estimated prevalence of thinness than of wasting. An awareness of these differences is important for comparative studies or the evaluation of programs. For school-age children and adolescents across all ranges of anthropometric status, the same growth references should be applied when such studies are undertaken.
Prospective payment based on case mix: will it work in nursing homes?
Rosko, M D; Broyles, R W; Aaronson, W E
1987-01-01
This article evaluates the potential efficacy of implementing a prospective payment system based on case mix in the nursing home industry. The analysis of structural differences between the nursing home and hospital industries suggests that the mechanism of compensating long-term care facilities should be based on functional health status rather than on diagnosis and that incentives to improve quality and access should be strengthened. The article assesses several systems of classifying patients that have been proposed as the basis for implementing a prospective payment system in the nursing home industry. The article concludes with a discussion of policy issues related to the appropriate unit of payment and the scope of regulatory authority.
Evaluation of nursing manpower allocation in a nursing home.
Chen, Chun-Hsi; Tsai, Wen-Chen; Chang, Wei-Chieh
2007-03-01
The subjects of this study encompassed the nursing staffs (nurses and nursing aids) and residents of a public hospital-based nursing home. By intensive sampling, this study explored the differences in actual times that nurses spent caring for residents. We assessed the functional status of nursing home residents of various illness severities as well as measured the actual nursing manpower needed to meet the residents' care needs using Typology of the Aged with Illustration (TAI). Results showed that current nursing manpower levels in nursing homes was adequate, although some units had excessive manpower allocation. As a result, this study suggests the establishment of a resident classification system for use in long-term care (LTC) facilities to assist with manpower allocation and reasonable utilization of resources within the facility. Adequate nurse staffing will enhance the quality and accessibility of care for the residents with severe illnesses in LTC facilities.
Mansoor, D; Al Halabi, M; Khamis, A H; Kowash, M
2018-06-01
To investigate the challenges faced by Autism Spectrum Disorder (ASD) children and their families in Dubai from three different perspectives of dental care: oral care at home, oral care at the dentist and access to oral care, and to compare the results to their normally developing peers. A case-control comparative study of 84 ASD and 53 healthy children attending special needs centres and schools in Dubai including siblings of the autistic children. Data collection was by a survey questionnaire completed by parents or guardians. More parents of ASD children compared to parents of healthy children reported difficulties across almost all oral care variables explored. The majority of ASD children's parents (83.3%) reported that their children need assistance in brushing their teeth compared with 15.4% of the healthy controls (p-value < 0.001). The ASD children's uncooperative behaviour increased during dental visits and significantly more parents (37%) rated their child's experience as negative compared with 9.5% among the parents of control children (p-value=0.006). The autistic children had visited a dentist mostly for extractions. This study indicates that autistic children in Dubai experience more challenges and barriers to oral care than their typically developing healthy peers.
NASA Astrophysics Data System (ADS)
Abeywickrama, Sandu; Furdek, Marija; Monti, Paolo; Wosinska, Lena; Wong, Elaine
2016-12-01
Core network survivability affects the reliability performance of telecommunication networks and remains one of the most important network design considerations. This paper critically examines the benefits arising from utilizing dual-homing in the optical access networks to provide resource-efficient protection against link and node failures in the optical core segment. Four novel, heuristic-based RWA algorithms that provide dedicated path protection in networks with dual-homing are proposed and studied. These algorithms protect against different failure scenarios (i.e. single link or node failures) and are implemented with different optimization objectives (i.e., minimization of wavelength usage and path length). Results obtained through simulations and comparison with baseline architectures indicate that exploiting dual-homed architecture in the access segment can bring significant improvements in terms of core network resource usage, connection availability, and power consumption.
University Access for Disadvantaged Children: A Comparison across Countries
ERIC Educational Resources Information Center
Jerrim, John; Vignoles, Anna
2015-01-01
In this paper, we consider whether certain countries are particularly adept (or particularly poor) at getting children from disadvantaged homes to study for a bachelor's degree. A series of university access models are estimated for four English-speaking countries (England, Canada, Australia and the USA), which include controls for comparable…
Growth, behavior, development and intelligence in rural children between 1-3 years of life.
Agarwal, D K; Awasthy, A; Upadhyay, S K; Singh, P; Kumar, J; Agarwal, K N
1992-04-01
In a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of K.V. Block, Varanasi, 196 children were assessed for physical growth, development, intelligence and concept development between 1 and 3 years of age. Home environment was also assessed using Caldwell Home inventory. These rural children remained below 3rd centile of NCHS standard for weight, height, skull and mid-arm circumferences throughout the study. Malnourished children scored poorly in all the areas of development, i.e., motor, adaptive, language and personal social, 9% in Grade I and 16.6% children in Grade II + III had IQ less than 79 (inferior). Concept for color shape and size was poorly developed in malnourished children. Maternal involvement and stimulation was strongly associated with better behavior development and intelligence. Multiple regression analysis showed that the effect of home environment on development and intelligence was of a higher magnitude as compared to status and family variables and nutritional status during 1-3 years of age.
Romli, Muhammad H; Tan, Maw P; Mackenzie, Lynette; Lovarini, Meryl; Kamaruzzaman, Shahrul B; Clemson, Lindy
2018-03-01
Previous studies have investigated home hazards as a risk factor for falls without considering factors associated with the presence of home hazards. The present study aimed to determine patterns of home hazards among urban community-dwelling older Malaysians, and to identify factors contributing to home hazards. Cross-sectional data from the initial wave of the Malaysian Elders Longitudinal Research study were used. Basic demographics were obtained from the Global Questionnaire. Basic and instrumental activities of daily living were measured using the Katz and Lawton-Brody scales, and home hazards were identified using the Home Falls and Accidents Screening Tool. Participants were also asked if they had fallen in the previous 12 months. Data were analyzed from 1489 participants. Hazards were frequently identified (>30%) in the toilet and bathroom areas (no grab rail, no non-slip mat, distant toilet), slippery floors, no bedside light access and inappropriate footwear. Lower educational attainment, traditional housing, Chinese ethnicity, greater number of home occupants, lower monthly expenditure, poor vision and younger age were the factors independently associated with home hazards. This study provides evidence that home hazards are a product of the interaction of the individual's function within their home environment. Hazards are also influenced by local sociocultural and environmental factors. The relationship between home hazards and falls appears complex and deserves further evaluation. Geriatr Gerontol Int 2018; 18: 387-395. © 2017 Japan Geriatrics Society.
ERIC Educational Resources Information Center
Levy, Joel M.; Botuck, Shelly; Damiani, Marco R.; Levy, Philip H.; Dern, Thomas A.; Freeman, Stephen E.
2006-01-01
The shift in living situations for adults with intellectual and other developmental disabilities (IDDD) from family homes to group homes has raised questions about their healthcare needs and access to appropriate healthcare services. This study was undertaken to describe the disability characteristics and medical conditions in a sample of adults…
Testing an app for reporting health concerns-Experiences from older people and home care nurses.
Göransson, Carina; Eriksson, Irene; Ziegert, Kristina; Wengström, Yvonne; Langius-Eklöf, Ann; Brovall, Maria; Kihlgren, Annica; Blomberg, Karin
2018-06-01
To explore the experiences of using an app among older people with home-based health care and their nurses. Few information and communication technology innovations have been developed and tested for older people with chronic conditions living at home with home-based health care support. Innovative ways to support older people's health and self-care are needed. Explorative qualitative design. For 3 months to report health concerns, older people receiving home-based health care used an interactive app, which included direct access to self-care advice, graphs and a risk assessment model that sends alerts to nurses for rapid management. Interviews with older people (n = 17) and focus group discussions with home care nurses (n = 12) were conducted and analysed using thematic analysis. The findings reveal that a process occurs. Using the app, the older people participated in their care, and the app enabled learning and a new way of communication. The interaction gave a sense of security and increased self-confidence among older people. The home care nurses viewed the alerts as appropriate for the management of health concerns. However, all participants experienced challenges in using new technology and had suggestions for improvement. The use of an app appears to increase the older people's participation in their health care and offers them an opportunity to be an active partner in their care. The app as a new way to interact with home care nurses increased the feeling of security. The older people were motivated to learn to use the app and described potential use for it in the future. The use of an app should be considered as a useful information and communication technology innovation that can improve communication and accessibility for older people with home-based health care. © 2017 John Wiley & Sons Ltd.
Work experience, work environment, and blood exposure among home care and hospice nurses.
Leiss, Jack K
2012-01-01
Blood exposure rates among home care and hospice nurses (RNs) in the United States are markedly lower for nurses with more home care/hospice experience, whether or not they have more total years of nursing experience (i.e., in other work environments). This study examined whether the protective effect of home care/hospice experience was greater for nurses who worked under three types of circumstances that are typical of the home care/hospice work environment and conducive to blood exposure. A mail survey was conducted in 2006 among home care/hospice nurses in North Carolina, a largely rural state in the southeastern U.S. The adjusted response rate was 69% (n=833). Blood exposure rates were higher among nurses with ≤5 years' experience in home care/hospice. Contrary to expectations, the protective effect of more experience was greater among nurses who did not have limited access to safety devices/personal protective equipment, did not have to rush during home visits, and did not often visit homes with unrestrained pets, unruly children, poor lighting, or extreme clutter. These results suggest that characteristics of the home care/hospice work environment limit nurses' ability to use their experience to prevent blood exposure.
Disability and access to health care - a community based descriptive study.
Maart, Soraya; Jelsma, Jennifer
2014-01-01
The World Disability Report highlighted the need for adequate access to health and medical rehabilitation services for those with disability. Participants in a large community based survey in a low-income area were asked questions relating to their use of health related services. Using random, cluster sampling a representative sample of 1083 households in a deprived area of Cape Town were approached and 152 people with disability were interviewed. Those with disability were more likely to be male (χ² = 4.24, p = 0.03) and unemployed (χ² = 66.89, p > 0.001) compared to those without disability. The percentages reporting unmet needs were respectively: 54% for home-based care; 34.5% for assistive devices, 28.9% for medical rehabilitation services; and 2.5% for health services. Those over 65 years of age were less likely to have had the medical rehabilitation that they required (χ² = 8.00, p = 0.018). There were fewer respondents with sensory and language disorders but these groups reported proportionately more unmet needs. The main problems with accessing services included inadequate finances (71%) and transport problems (72%). It is recommended that all efforts be expended to extend appropriate rehabilitation services, including home based-care and appliances to those identified as having disability, particularly to those older than 65 years. In addition, the services need to be affordable and accessible in terms of suitable transport, particularly in the light of the high unemployment rate and the large number of respondents with mobility problems. Implications for Rehabilitation People with disability may be the most in need of additional health related care and the least able to access it. Transport and financial considerations were found to limit the ability to access appropriate care. Rehabilitation and health services need to reach out through home-based care and appropriate forms of rehabilitation delivery to ensure that those who are most in need
45 CFR 156.245 - Treatment of direct primary care medical homes.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 45 Public Welfare 1 2012-10-01 2012-10-01 false Treatment of direct primary care medical homes. 156.245 Section 156.245 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING...
Internet and computer access and use for health information in an underserved community.
Kind, Terry; Huang, Zhihuan J; Farr, Deeonna; Pomerantz, Karyn L
2005-01-01
The "digital divide" is the gap between those with access to information tools such as the Internet and those without access. The gap has been described by income, education, age, and race. Little information exists on computer and Internet access and use for health information by parents, particularly among populations of low income and low education level. To describe computer and Internet access and use, including health information retrieval, among low-income, urban, African American caregivers (parents). Cross-sectional survey administered in pediatric waiting rooms of urban community-based health centers in a low-income area. Caregivers of pediatric outpatients. Access to computers, Internet access, and use of Internet for health information. In 2003, among 260 African Americans who completed surveys, 58% had a computer and 41% had home Internet access. Fifty-two percent had used the Internet for finding health information. Ninety-three percent agreed or strongly agreed that there is useful health information on the Internet. Ninety-two percent agreed or strongly agreed that they would want to talk with a medical professional about health information on the Internet. Sixty-five percent of respondents had no additional schooling after high school. Annual household income was
Promoting cancer screening within the patient centered medical home.
Sarfaty, Mona; Wender, Richard; Smith, Robert
2011-01-01
While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening. Copyright © 2011 American Cancer Society, Inc.
Portugal, Steven J; Ricketts, Rhianna L; Chappell, Jackie; White, Craig R; Shepard, Emily L; Biro, Dora
2017-08-19
Group living has been proposed to yield benefits that enhance fitness above the level that would be achieved through living as solitary individuals. Dominance hierarchies occur commonly in these social assemblages, and result, by definition, in resources not being evenly distributed between group members. Determinants of rank within a dominance hierarchy can be associated with morphological characteristics, previous experience of the individual, or personality traits such as exploration tendencies. The purpose of this study was to investigate whether greater exploration and positive responses to novel objects in homing pigeons ( Columba livia ) measured under laboratory conditions were associated with (i) greater initial exploration of the local area around the home loft during spontaneous exploration flights (SEF), (ii) faster and more efficient homing flights when released from further afield, and (iii) whether the traits of greater exploration and more positive responses to novel objects were more likely to be exhibited by the more dominant individuals within the group. There was no relationship between laboratory-based novel object exploration and position within the dominance hierarchy. Pigeons that were neophobic under laboratory conditions did not explore the local area during SEF opportunities. When released from sites further from home, neophobic pigeons took longer routes to home compared to those birds that had not exhibited neophobic traits under laboratory conditions, and had spontaneously explored to a greater extent. The lack of exploration in the neophobic birds is likely to have resulted in the increased costs of homing following release: unfamiliarity with the landscape likely led to the greater distances travelled and less efficient routes taken. Birds that demonstrated a lack of neophobia were not the dominant individuals inside the loft, and thus would have less access to resources such as food and potentially mates. However, a lack of
75 FR 39135 - Voluntary Public Access and Habitat Incentive Program
Federal Register 2010, 2011, 2012, 2013, 2014
2010-07-08
... Public Access and Habitat Incentive Program AGENCY: Farm Service Agency and Commodity Credit Corporation... available through the Farm Service Agency (FSA) home page at http://www.fsa.usda.gov/ . FOR FURTHER... Program (CREP) land; (4) Supplement funding and services from other Federal, State, tribal government, or...
Ambiguities: residents' experience of 'nursing home as my home'.
Nakrem, Sigrid; Vinsnes, Anne G; Harkless, Gene E; Paulsen, Bård; Seim, Arnfinn
2013-09-01
Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live at home. Uncovering what nursing home residents' view as quality of care in nursing homes will help further understanding of how best to provide high quality, person-centred care. To describe residents' experiences of living in a nursing home related to quality of care. The study utilises a descriptive exploratory design. In-depth interviews were undertaken with 15 residents who were not cognitively impaired, aged 65 and over and living in one of four nursing homes. The interviews were transcribed verbatim and analysed by categorising of meaning. Residents perceived the nursing home as their home, but at the same time not 'a home'. This essential ambiguity created the tension from which the categories of perceptions of quality emerged. Four main categories of quality of care experience were identified: 'Being at home in a nursing home', 'Paying the price for 24-hour care', 'Personal habits and institutional routines', and 'Meaningful activities for a meaningful day'. Ambiguities concerning the nursing home as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. High-quality care was when ambiguities were managed well and a home could be created within the institution. Implication for practice. Achieving quality care in nursing homes requires reconciling the ambiguities of the nursing home as a home. This implies helping residents to create a private home distinct from the professional home, allowing residents' personal habits to guide institutional routines and supporting meaningful activities. Using these resident developed quality indicators is an important step in improving nursing home services. © 2012 Blackwell Publishing Ltd.
12 CFR 950.4 - Limitations on access to advances.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Limitations on access to advances. 950.4 Section 950.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK ASSETS AND OFF... the Bank's judgment, such member: (i) Is engaging or has engaged in any unsafe or unsound banking...
Jack, Barbara A; Baldry, Catherine R; Groves, Karen E; Whelan, Alison; Sephton, Janice; Gaunt, Kathryn
2013-10-01
To explore health care professionals' perspective of hospice at home service that has different components, individually tailored to meet the needs of patients. Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients. An evaluation study. Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co-ordinator and two general practitioners participated in semi-structured interviews and a further 19 general practitioners completed the electronic survey. Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be. Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice. This service offers various components of a hospice
Hands-on curriculum teaches biomedical engineering concepts to home-schooled students.
Sagstetter, Ann M; Nimunkar, Amit J; Tompkins, Willis J
2009-01-01
University level outreach has increased over the last decade to stimulate K-12 student interest in engineering related fields. Home schooling students are one of the groups that are valued for engineering admissions due to diligent study habits and high achievement scores. However, home schooled students have inadequate access to science, math, and engineering related resources, which precludes the development of interdisciplinary teaching methods. To address this problem, we have developed a hands-on, STEM based curriculum as a safe and comprehensive supplement to current home schooling curricula. The ultimate goal is to stimulate university-student relations and subsequently increase engineering recruitment opportunities. Our pre and post workshop survey comparisons demonstrate that integrating disciplines, via the manner presented in this study, provides a K-12 student-friendly engineering learning method.
NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 1999-2000
The National Health and Nutrition Examination Survey (NHANES) is conducted by the nchs/">National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. The Case for Home-Grown, Sustainable, Next Generation Library Services
ERIC Educational Resources Information Center
Haefele, Chad
2011-01-01
While libraries offer next generation public services such as mobile access and e-books, these services are often neither home-grown nor sustainable. Libraries have a history of lending and services built on a simple model: they purchase an item and then provide it to the community. Unfortunately, the latest generation of services offered by…
2014-01-01
Background Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion This realist review will
[The suitability of sending nursing home residents over 75 to emergency departments].
Dang, Anne; Sanchez, Stéphane; Collart, Michèle; Mahmoudi, Rachid; Laplanche, David
The care provided to elderly people aged over 75 must be specific and multidisciplinary. An emergency department, which is seeing increasing numbers of patients passing through its doors, notably with the provision of an ambulatory care service, would not appear to be a suitable place for this fragile population, often with multiple pathologies. A study is looking at the suitability of the emergency department for nursing home residents, who have regular access to medical care, unlike elderly people living at home. Copyright © 2018. Published by Elsevier Masson SAS.
Hospital at home: What is its place in the health system?
Bentur, N
2001-01-01
Given the expansion of hospital at home in Western countries, policymakers, providers and financial managers are exploring the causes for this and examining whether hospital at home is an alternative to hospitalization for reasons of cost containment and quality of care. The purpose of this paper is to describe hospital at home, discuss its development and examine its role in the health system. A variety of models of hospital at home exist, serving a varied patient case-mix. This article claims that the reasons for the expansion of medical home care are not solely economic. Although a number of studies have examined the cost effectiveness of this service, no consensus has been reached. In fact, the growth of this service seems to be related to a number of other factors: the increase in the number of elderly and chronically ill people, the lack of availability and accessibility of acute and sub-acute inpatient services, technological innovation, improvements in the standard of living and the preference of some patients to be treated at home. Therefore, hospital at home must be examined, not as an independent service, but as part of a continuum of services, with the hospital system at one end and community services at the other end. Further research will help determine its optimal place along this continuum.
STEM learning activity among home-educating families
NASA Astrophysics Data System (ADS)
Bachman, Jennifer
2011-12-01
Science, technology, engineering, and mathematics (STEM) learning was studied among families in a group of home-educators in the Pacific Northwest. Ethnographic methods recorded learning activity (video, audio, fieldnotes, and artifacts) which was analyzed using a unique combination of Cultural-Historical Activity Theory (CHAT) and Mediated Action (MA), enabling analysis of activity at multiple levels. Findings indicate that STEM learning activity is family-led, guided by parents' values and goals for learning, and negotiated with children to account for learner interests and differences, and available resources. Families' STEM education practice is dynamic, evolves, and influenced by larger societal STEM learning activity. Parents actively seek support and resources for STEM learning within their home-school community, working individually and collectively to share their funds of knowledge. Home-schoolers also access a wide variety of free-choice learning resources: web-based materials, museums, libraries, and community education opportunities (e.g. afterschool, weekend and summer programs, science clubs and classes, etc.). A lesson-heuristic, grounded in Mediated Action, represents and analyzes home STEM learning activity in terms of tensions between parental goals, roles, and lesson structure. One tension observed was between 'academic' goals or school-like activity and 'lifelong' goals or everyday learning activity. Theoretical and experiential learning was found in both activity, though parents with academic goals tended to focus more on theoretical learning and those with lifelong learning goals tended to be more experiential. Examples of the National Research Council's science learning strands (NRC, 2009) were observed in the STEM practices of all these families. Findings contribute to the small but growing body of empirical CHAT research in science education, specifically to the empirical base of family STEM learning practices at home. It also fills a
Goodman, Claire; Davies, Sue L; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C; Iliffe, Steve; Bowman, Clive; Gladman, John R F; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria
2018-01-01
Abstract Introduction care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. Methods a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. Results context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ‘wraps around’ care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. Conclusion activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. PMID:29315370
Home Automation System Based on Intelligent Transducer Enablers.
Suárez-Albela, Manuel; Fraga-Lamas, Paula; Fernández-Caramés, Tiago M; Dapena, Adriana; González-López, Miguel
2016-09-28
This paper presents a novel home automation system named HASITE (Home Automation System based on Intelligent Transducer Enablers), which has been specifically designed to identify and configure transducers easily and quickly. These features are especially useful in situations where many transducers are deployed, since their setup becomes a cumbersome task that consumes a significant amount of time and human resources. HASITE simplifies the deployment of a home automation system by using wireless networks and both self-configuration and self-registration protocols. Thanks to the application of these three elements, HASITE is able to add new transducers by just powering them up. According to the tests performed in different realistic scenarios, a transducer is ready to be used in less than 13 s. Moreover, all HASITE functionalities can be accessed through an API, which also allows for the integration of third-party systems. As an example, an Android application based on the API is presented. Remote users can use it to interact with transducers by just using a regular smartphone or a tablet.
Home Automation System Based on Intelligent Transducer Enablers
Suárez-Albela, Manuel; Fraga-Lamas, Paula; Fernández-Caramés, Tiago M.; Dapena, Adriana; González-López, Miguel
2016-01-01
This paper presents a novel home automation system named HASITE (Home Automation System based on Intelligent Transducer Enablers), which has been specifically designed to identify and configure transducers easily and quickly. These features are especially useful in situations where many transducers are deployed, since their setup becomes a cumbersome task that consumes a significant amount of time and human resources. HASITE simplifies the deployment of a home automation system by using wireless networks and both self-configuration and self-registration protocols. Thanks to the application of these three elements, HASITE is able to add new transducers by just powering them up. According to the tests performed in different realistic scenarios, a transducer is ready to be used in less than 13 s. Moreover, all HASITE functionalities can be accessed through an API, which also allows for the integration of third-party systems. As an example, an Android application based on the API is presented. Remote users can use it to interact with transducers by just using a regular smartphone or a tablet. PMID:27690031
Implementation of home-based medication order entry at a community hospital.
Thorne, Alicia; Williamson, Sarah; Jellison, Tara; Jellison, Chris
2009-11-01
The implementation of a home-based order-entry program at a community hospital is described. Parkview Hospital is a 600-bed, community-based facility located in Fort Wayne, Indiana, that provides 24-hour pharmacy services. The main purpose for establishing a home-based order-entry program was to provide extra pharmacist coverage during the event of a spontaneous order surge in an effort to maintain excellent customer service. A virtual private network (VPN) was created to ensure the security and confidentiality of patients' health care information. The names of volunteer pharmacists who met specific criteria and who were capable of performing home-based order entry were collected. These pharmacists were trained and tested in the home-based order-entry process. When home-based order-entry is needed, the lead pharmacist contacts the pharmacists on the list by telephone. If available, the pharmacists (maximum of three) are notified to log into the Internet, access the VPN, and perform order entry with the same vigilance, confidentiality, and care as they would onsite. Home-based order entry is discontinued when off-trigger points are met. Pharmacists entering orders from home are paid by the time spent conducting order entry. Pharmacists reported that the program was easy to contact home-based order-entry volunteers, there were no problems with logging into the VPNs, and turnaround time was close to our target of 25 minutes. A community-based hospital successfully implemented a home-based medication order-entry program. The program alleviated the shortage of pharmacists during spontaneous surges of medication orders.
Sensor-Based Optimization Model for Air Quality Improvement in Home IoT
Kim, Jonghyuk
2018-01-01
We introduce current home Internet of Things (IoT) technology and present research on its various forms and applications in real life. In addition, we describe IoT marketing strategies as well as specific modeling techniques for improving air quality, a key home IoT service. To this end, we summarize the latest research on sensor-based home IoT, studies on indoor air quality, and technical studies on random data generation. In addition, we develop an air quality improvement model that can be readily applied to the market by acquiring initial analytical data and building infrastructures using spectrum/density analysis and the natural cubic spline method. Accordingly, we generate related data based on user behavioral values. We integrate the logic into the existing home IoT system to enable users to easily access the system through the Web or mobile applications. We expect that the present introduction of a practical marketing application method will contribute to enhancing the expansion of the home IoT market. PMID:29570684
Optical fiber cabling technologies for flexible access network
NASA Astrophysics Data System (ADS)
Tanji, Hisashi
2008-07-01
Fiber-to-the-home (FTTH) outside plant infrastructure should be so designed and constructed as to flexibly deal with increasing subscribers and system evolution to be expected in the future, taking minimization of total cost (CAPEX and OPEX) into consideration. With this in mind, fiber access architectures are reviewed and key technologies on optical fiber and cable for supporting flexible access network are presented. Low loss over wide wavelength (low water peak) and bend-insensitive single mode fiber is a future proof solution. Enhanced separable ribbon facilitates mid-span access to individual fibers in a cable installed, improving fiber utilizing efficiency and flexibility of distribution design. It also contributes to an excellent low PMD characteristic which could be required for video RF overlay system or high capacity long reach metro-access convergence network in the future. Bend-insensitive fiber based cabling technique including field installable connector greatly improves fiber/cable handling in installation and maintenance work.
Home Telehealth Video Conferencing: Perceptions and Performance
Morris, Greg; Pech, Joanne; Rechter, Stuart; Carati, Colin; Kidd, Michael R
2015-01-01
Background The Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet. Objective The aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology. Methods An action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users. Results The effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically
Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Huang, Hsiu-Li
2016-03-01
To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan. The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries. Qualitative descriptive study. Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis. Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role. Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff. Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants. © 2016 John
2012-01-01
Background This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine. Methods We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time. Results All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions. Conclusions As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine
Social Class, Ethnicity and Access to Higher Education in the Four Countries of the UK: 1996-2010
ERIC Educational Resources Information Center
Croxford, Linda; Raffe, David
2014-01-01
This paper compares access to full-time undergraduate higher education (HE) by members of less advantaged social classes and ethnic minorities across the four "home countries" of the UK. It uses data on applicants to HE in selected years from 1996 to 2010. In all home countries students from intermediate and working-class backgrounds…
[Perspective of informal caregivers on home care. Qualitative study with a computer program].
Prieto Rodríguez, M Angeles; Gil García, Eugenia; Heierle Valero, Cristina; Frías Osuna, Antonio
2002-01-01
A hot debate exists in our country as to the models of home care which must be developed. This study is aimed at ascertaining how the family caregivers of terminal cancer patients, of the elderly suffering from dementia and of individuals having undergone major operations in outpatient surgery programs rate the quality of the home care provided. A phenomenological type qualitative study based on discussion groups (9), triangular groups (5) and in-depth interviews (22). This study was conducted in Andalusia throughout the 1999-2000 period. The subjects of the study were the main caregivers of patients provided with home care through the healthcare centers. The information must be analyzed by means of a Nudist-4 software-aided content analysis. The analysis variables were those of the Servqual model. For the caregivers of cancer patients, the most important aspects of the quality of the home care provided were the Response Capacity and Accessibility. This analysis revealed that the patients suffered pain but the pain was not controlled. Negative aspects hindering accessibility were the lack of home care coverage outside of regular working hours, the difficulty of getting in touch by phone, the length of time it takes for someone to come and the visits solely on request. The caregivers of patients having undergone major outpatient surgery want Security and Reliability. They complain of the short length of time within which the patients are released from the hospital and of the home care provided by the health care center. The caregivers of the elderly with dementia place top priority on being provided with the materials they need to take care of these patients. Caregivers' and patients' expectations differ, depending on health problems, therefore, the type of home care provided should vary, according to the health problems involved. It is necessary to develop a flexible model, capable of adapting to different patient needs and the diverse circumstances that affect
Parental Perceptions of Home Internet Use among Rural African American Families
ERIC Educational Resources Information Center
Smith, Jeananne Oldham
2008-01-01
Despite the growth of home Internet use over the past decade, disparities still exist among certain socioeconomic groups of the population. Rural, lower socioeconomic and African Americans fall further behind in technology access than any other group. The purpose of this ex post facto qualitative study was to investigate parental perceptions…
75 FR 35901 - On-Site Completion of Construction of Manufactured Homes
Federal Register 2010, 2011, 2012, 2013, 2014
2010-06-23
... may access this number via TTY by calling the Federal Information Relay Service at 800-877-8339... the toll-free Federal Information Relay Service at 1-800-877-8339. SUPPLEMENTARY INFORMATION: I... report also must be submitted to the State Administrative Agencies (SAAs) of the states where the home is...
Work-related factors influencing home care nurse intent to remain employed.
Tourangeau, Ann E; Patterson, Erin; Saari, Margaret; Thomson, Heather; Cranley, Lisa
Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits, (c) ensuring manageable workloads to facilitate improved work-life balance, and (d) ensuring leaders are accessible and competent.
Evans, Erin M; Jennissen, Charles A; Oral, Resmiye; Denning, Gerene M
2017-11-01
Pediatric deaths and injuries from access to firearms are a significant public health problem. No studies have examined how experts determine child neglect regarding firearm access in the home. Our study objectives were to identify factors that influenced pediatric experts' finding of firearm-related child neglect and to assess their attitudes toward child access prevention (CAP) laws. A survey was distributed to the American Academy of Pediatrics Section on Child Abuse and Neglect members. Demographics, attitudes regarding CAP laws, and ages (up to 14 years old) at which experts deemed several scenarios as child neglect were determined. Scenarios tested potential versus actual loaded firearm access, presence or absence of a CAP law, and injury versus no injury when the firearm was accessed. One hundred ninety-three surveys were completed. Experts agreed (>95%) that CAP laws were important, even for children up to age 15 years. Although a high percentage considered potential access to a loaded firearm as child neglect, a CAP law significantly increased the percentage for each age. In addition, higher percentages of respondents from states with CAP laws than those without deemed potential access as child neglect for 12- and 14-year-olds. In contrast, if the child had accessed a loaded firearm, there were no significant differences in the high percentages that deemed the scenario as child neglect under any conditions, including with and without a CAP law. Although almost all child neglect experts considered potential and actual access to loaded firearms as child neglect, CAP laws increased the percentage for cases of potential access. Universal CAP laws may help ensure that determinations of child neglect are more consistent across states. The deterrent effect of potential child neglect findings may increase the number of parents securing firearms in ways that prevent child access and reduce firearm-related deaths and injuries. Epidemiologic study, level III.
Equity and Computers for Mathematics Learning: Access and Attitudes
ERIC Educational Resources Information Center
Forgasz, Helen J.
2004-01-01
Equity and computer use for secondary mathematics learning was the focus of a three year study. In 2003, a survey was administered to a large sample of grade 7-10 students. Some of the survey items were aimed at determining home access to and ownership of computers, and students' attitudes to mathematics, computers, and computer use for…
Characteristics of noise-canceling headphones to reduce the hearing hazard for MP3 users.
Liang, Maojin; Zhao, Fei; French, David; Zheng, Yiqing
2012-06-01
Three pairs of headphones [standard iPod ear buds and two noise-canceling headphones (NCHs)] were chosen to investigate frequency characteristics of noise reduction, together with their attenuation effects on preferred listening levels (PLLs) in the presence of various types of background noise. Twenty-six subjects with normal hearing chose their PLLs in quiet, street noise, and subway noise using the three headphones and with the noise-canceling system on/off. Both sets of NCHs reduced noise levels at mid- and high-frequencies. Further noise reductions occurred in low frequencies with the noise canceling system switched on. In street noise, both NCHs had similar noise reduction effects. In subway noise, better noise reduction effects were found in the expensive NCH and with noise-canceling on. A two way repeated measures analysis of variance showed that both listening conditions and headphone styles were significant influencing factors on the PLLs. Subjects tended to increase their PLLs as the background noise level increased. Compared with ear buds, PLLs obtained from NCHs-on in the presence of background noise were reduced up to 4 dB. Therefore, proper selection and use of NCHs appears beneficial in reducing the risk of hearing damage caused by high music listening levels in the presence of background noise.
Home-based HIV counseling and testing: Client experiences and perceptions in Eastern Uganda
2012-01-01
Background Though prevention and treatment depend on individuals knowing their HIV status, the uptake of testing remains low in Sub-Saharan Africa. One initiative to encourage HIV testing involves delivering services at home. However, doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. Methods We conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6–12 months prior to the interviews. Semi-structured questionnaires elicited information on clients’ experiences, from initial community mobilization up to receipt of results and access to HIV services post-test. Results We found that 95% of our respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. The majority of respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. Most respondents considered their own homes as more private than health facilities. Twelve respondents reported that they tested positive, 11 were referred for follow-up care, seven actually went for care, and only 5 knew their CD4 counts. All HIV infected individuals who were married or cohabiting had disclosed their status to their partners. Conclusion These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention. PMID:23146071
Home-based HIV counseling and testing: client experiences and perceptions in Eastern Uganda.
Kyaddondo, David; Wanyenze, Rhoda K; Kinsman, John; Hardon, Anita
2012-11-12
Though prevention and treatment depend on individuals knowing their HIV status, the uptake of testing remains low in Sub-Saharan Africa. One initiative to encourage HIV testing involves delivering services at home. However, doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. We conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6-12 months prior to the interviews. Semi-structured questionnaires elicited information on clients' experiences, from initial community mobilization up to receipt of results and access to HIV services post-test. We found that 95% of our respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. The majority of respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. Most respondents considered their own homes as more private than health facilities. Twelve respondents reported that they tested positive, 11 were referred for follow-up care, seven actually went for care, and only 5 knew their CD4 counts. All HIV infected individuals who were married or cohabiting had disclosed their status to their partners. These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention.
Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design.
Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte; Clemensen, Jane
2016-07-08
For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. To identify parental needs when wanting to provide neonatal home care supported by telemedicine. The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.
Lindberg, Birgitta; Nilsson, Carina; Zotterman, Daniel; Söderberg, Siv; Skär, Lisa
2013-01-01
Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering and giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies describing the use of ICT in home care for communication between patients, family members, and healthcare professionals. Methods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted, which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use of ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data, terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT was performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses in the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools used that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of their illness that promotes self-care. PMID:23690763
NASA Astrophysics Data System (ADS)
Ji, Wei
2013-07-01
Video on demand is a very attractive service used for entertainment, education, and other purposes. The design of passive optical networking+Ethernet over coaxial cable accessing and a home gateway system is proposed. The network integrates the passive optical networking and Ethernet over coaxial cable to provide high dedicated bandwidth for the metropolitan video-on-demand services. Using digital video broadcasting, IP television protocol, unicasting, and broadcasting mechanisms maximizes the system throughput. The home gateway finishes radio frequency signal receiving and provides three kinds of interfaces for high-definition video, voice, and data, which achieves triple-play and wire/wireless access synchronously.
Darragh, Amy Rowntree; Stallones, Lorann; Bigelow, Phillip L; Keefe, Thomas J
2004-02-01
The construction industry typically has one of the highest fatal and non-fatal injury rates compared with other industries. Residential construction workers are at particular risk of injury (work is in remote sites with small crews, there are often many subcontractors, and they have limited access to safety programs). Difficulty accessing information specific to this group has made research more challenging, therefore, there are few studies. This study evaluated the effectiveness of the HomeSafe Pilot Program, a safety education and training program designed to reduce injuries among residential construction workers. Researchers evaluated whether overall and severe injury incidence rates declined during the intervention period. Data were analyzed using incidence rates and Poisson regression to control for the effect of antecedent secular trend. Injury incidence rates declined significantly following HomeSafe; however, this effect was not statistically significant once temporal variation was controlled. The decline in injury rates following HomeSafe cannot be attributed solely to HomeSafe, however, programmatic and methodologic limitations contributed to the inconclusive results. Further research into the hazards faced by residential construction workers is needed. Am. J. Ind. Med. 45:210-217, 2004. Copyright 2004 Wiley-Liss, Inc.
Autonomy and Housing Accessibility Among Powered Mobility Device Users
Brandt, Åse; Lexell, Eva Månsson; Iwarsson, Susanne
2015-01-01
OBJECTIVE. To describe environmental barriers, accessibility problems, and powered mobility device (PMD) users’ autonomy indoors and outdoors; to determine the home environmental barriers that generated the most housing accessibility problems indoors, at entrances, and in the close exterior surroundings; and to examine personal factors and environmental components and their association with indoor and outdoor autonomy. METHOD. This cross-sectional study was based on data collected from a sample of 48 PMD users with a spinal cord injury (SCI) using the Impact of Participation and Autonomy and the Housing Enabler instruments. Descriptive statistics and logistic regression were used. RESULTS. More years living with SCI predicted less restriction in autonomy indoors, whereas more functional limitations and accessibility problems related to entrance doors predicted more restriction in autonomy outdoors. CONCLUSION. To enable optimized PMD use, practitioners must pay attention to the relationship between client autonomy and housing accessibility problems. PMID:26356666
... our e-newsletter! Aging & Health A to Z Nursing Homes Basic Facts & Information Nursing homes have changed ... guide care in nursing homes. Who lives in nursing homes? Almost half of all people who live ...
Saarnio, Lotta; Boström, Anne-Marie; Hedman, Ragnhild; Gustavsson, Petter; Öhlén, Joakim
2017-12-01
Older people are often living the last period of their lives in institutions such as nursing homes. Knowledge of this period, specifically related to at-homeness which can be described as wellbeing in spite of illness and has been regarded as one of the goals in palliative care, has been very little researched in the context of nursing homes and the experience of nursing home staff. The aim of this study was to explore the experiences of nursing home staff of how to enable at-homeness for residents. Qualitative interpretive description methodology guided the design. The data generation was conducted in winter 2014-2015, when seven repetitive reflective group discussions with staff in a nursing home were held. The results show five patterns for how healthcare staff enabled at-homeness for the residents: Striving to know the resident, Showing respect for the resident's integrity, Creating and working in family-like relationships, Helping to find a new ordinariness and Preparing and making plans to ensure continuity. Nursing home staff seem to have collegial knowledge of how to enable at-homeness for the residents in a nursing home. Close relationships with respect for the resident's integrity stand out as enabling at-homeness. Copyright © 2017 Elsevier Inc. All rights reserved.
Sahraro, Maryam; Barikani, Mehdi; Daemi, Hamed
2018-05-01
Novel mechanically reinforced nanocomposite hydrogels (NCHs) were developed based on methacrylated gellan gum (MGG) and cationic polyurethane nanoparticles (CPUNs) through a green chemical approach. A series of NCHs were synthesized by the incorporation of CPUNs with weight ratios of 0, 10, 30 and 50 w/w% into the MGG solution, with two different methacrylation degrees (1.2, 5.6%). The chemical structure, morphology, mechanical properties, stimuli-responsivity and cytotoxicity of synthesized NCHs were investigated. Analysis of the hydrogels mechanical testing demonstrated that the addition of CPUNs affords the significant increase in compressive properties. Meanwhile, the formulation of NCH containing the MGG with lower methacrylation degree and 30 w/w% CPUNs showed the highest mechanical properties. Furthermore, equilibrium swelling ratio of the hydrogels decreased by CPUNs addition. Finally, it is worth mentioning that NCHs showed no significant toxicity to human dermal fibroblast cells (HDFs) which idealize them as the suitable hydrogels for biomedical applications. Copyright © 2018 Elsevier Ltd. All rights reserved.
Factors predicting a home death among home palliative care recipients
Ko, Ming-Chung; Huang, Sheng-Jean; Chen, Chu-Chieh; Chang, Yu-Ping; Lien, Hsin-Yi; Lin, Jia-Yi; Woung, Lin-Chung; Chan, Shang-Yih
2017-01-01
Abstract Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place. This study aimed to evaluate factors predicting home death among home palliative care recipients. This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death. The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93–5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06–4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34–0.95) had lower likelihood of a home death. Among home palliative care recipients, physician home visits increased the likelihood of a home death
Housing choices and care home design for people with dementia.
Hadjri, Karim; Rooney, Cliona; Faith, Verity
2015-01-01
This article reviews the current state of housing for people with dementia by exploring housing choices available to this group, and identifying potential issues with design of care homes. Older people who wish to age in place are faced with the challenge of adapting their domestic environment to ensure independence, accessibility, and social connectivity. This is even more challenging for people with dementia who continue to live at home, given the risks of self-harm and getting lost. More imaginative and inclusive forms of collective housing are needed. For people with dementia, a move to a new environment is often a stressful experience that causes shock, withdrawal, and anger. Hence, more research is needed to develop more fitting long-term housing options for people with dementia. This article presents a brief review on housing choices and housing design for people with dementia. Interviews with managers of 22 care homes were conducted to explore housing choices and design issues. Results show that the main housing choices available to people with dementia offer different levels of care. The choice of care homes relates to the atmosphere of a home as some occupants favor a homely or relaxing environment and others prefer dynamic settings. A combination of appropriate level of care, a good atmosphere, and design quality within the care home are elements that lead to a more enabling environment. Design of a successful caring environment also requires appropriate care and a positive therapeutic and domestic-looking environment. © The Author(s) 2015.
Gordon, Adam L; Goodman, Claire; Davies, Sue L; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C; Iliffe, Steve; Bowman, Clive; Gladman, John R F; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria
2018-01-05
care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.
Kjelle, Elin; Lysdahl, Kristin Bakke
2017-03-23
Demographic changes are leading to an ageing population in Europe, and predict an increase in the number of nursing home residents over the next 30 years. Nursing home residents need specialised healthcare services such as radiology due to both chronic and acute illnesses. Mobile radiography, x-ray examinations performed in the nursing homes, may be a good way of providing services to this population. The aim of this systematic review was to identify the outcomes of mobile radiography services for nursing home residents and society. A systematic review based on searches in the Medline, Cochrane, PubMed, Embase and Svemed + databases was performed. Titles and abstracts were screened according to a predefined set of inclusion criteria: empirical studies in the geriatric population, and reports of mobile radiography services in a clinical setting. All publications were quality appraised using MMAT or CASP appraisal tools. Data were extracted using a summary table and results were narratively synthesised. Ten publications were included. Three overarching outcomes were identified: 1) reduced number of hospitalisations and outpatient examinations or treatments, 2) reduced number of transfers between nursing homes and hospitals and 3) increased access to x-ray examinations. These outcomes were interlinked with the more specific outcomes for residents and society reported in the literature. For residents there was a reduction in burdensome transfers and waiting time and adequate treatment and care increased. For society, released resources could be used more efficiently, and overall costs were reduced substantially. This review indicates that mobile radiography services for nursing home residents in the western world are of comparable quality to hospital-based examinations and have clear potential benefits. Mobile radiography reduced transfers to and from hospital, increased the number of examinations carried out and facilitated timely diagnosis and access to
Diao, Kristen; Tripodis, Yorghos; Long, Webb E; Garg, Arvin
To evaluate whether socioeconomic (SES) and racial disparities in the parental perception and experience of having a medical home decreased from 2007 to 2011-2012. We used nationally representative samples of children aged 1 to 17 from the 2007 (n = 83,293) and 2011-2012 (n = 87,774) National Surveys of Children's Health. Multivariable logistic regression was used to test associations between SES (income, employment, and education) and race/ethnicity to the medical home and its subcomponents (personal doctor or nurse, usual source of care, family-centered care, referrals, care coordination), controlling for a priori identified covariates. From 2007 to 2011-2012, fewer children overall had access to a medical home (56.9% vs 54.0%, aOR = 0.91, 95% confidence interval 0.86-0.96). There were no significant changes in SES and racial trends in access to the medical home during this time period. For example, parents of children <100% federal poverty level (FPL) were significantly less likely to report having a medical home than parents of children ≥400% FPL in 2007 and 2011-2012; however, this disparity did not significantly change during the time period (aOR = 0.98, 95% confidence interval 0.75-1.27). There were also no significant changes in SES and racial/ethnic disparities over time for each medical home subcomponent. Despite widespread efforts to promote the medical home for all children, large SES and racial disparities in the parental perception and experience of having a medical home persisted from 2007 to 2011-2012. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Implementation of smoke-free homes in Poland.
Kaleta, Dorota; Fronczak, Adam; Usidame, Bukola; Dziankowska-Zaborszczyk, Elżbieta; Makowiec-Dąbrowska, Teresa; Wojtysiak, Piotr
2016-01-01
Exposure to environmental tobacco smoke (ETS) constitutes a threat to the health of many people. In order to diminish ETS exposure, countries (including Poland) implemented legal restrictions of smoking in public places and worksites. Currently more attention is also paid to reduce overall and residential ETS exposure by voluntary smoke-free home policy adoption. The aim of current analysis was to evaluate the prevalence and determinants of implementing smoking bans at place of residence among economically active males and females in Poland. Data from cross-sectional, household study - Global Adult Tobacco Survey (GATS 2009-2010) were analyzed. The logistic regression model was applied for appropriate calculations. Out of 3696 studied subjects only 37.1% adopted total smoking ban within the home. Decreased likelihood of adopting total smoking bans was associated with current smoker status, low education attainment, lack of awareness on adverse health consequences of ETS, low level of support for tobacco control policies, and cohabitation with a smoker in both genders. Having smoke-free homes was also linked with age in women, place of residence and work smoking policy in indoor areas in men. Targeted activities to encourage adopting voluntary smoke-free rules among groups least likely to implement 100% smoking bans in the home and activities to decrease social acceptance of smoking in the presence of nonsmokers, children, pregnant woman are urgently needed. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Experiences of overweight/obese adolescents in navigating their home food environment.
Watts, Allison W; Lovato, Chris Y; Barr, Susan I; Hanning, Rhona M; Mâsse, Louise C
2015-12-01
To explore perceived factors that impede or facilitate healthful eating within the home environment among overweight/obese adolescents. In the present qualitative photovoice study, participants were instructed to take photographs of things that made it easier or harder to make healthful food choices at home. Digital photographs were reviewed and semi-structured interviews were conducted to promote discussion of the photographs. Data were analysed using constant comparative analysis. Vancouver, Canada, in 2012-2013. Twenty-two overweight/obese adolescents who completed a family-based lifestyle modification intervention. The mean age of participants was 14 (sd 1.9) years, 77% were female and their mean BMI Z-score was 2.4 (sd 0.6). Adolescents talked about six aspects of the home environment that influenced their eating habits (in order of frequency): home cooking, availability and accessibility of foods/beverages, parenting practices, family modelling, celebrations and screen use/studying. In general, homes with availability of less healthful foods, where family members also liked to eat less healthful foods and where healthier foods were less abundant or inaccessible were described as barriers to healthful eating. Special occasions and time spent studying or in front of the screen were also conducive to less healthful food choices. Home cooked meals supported adolescents in making healthier food choices, while specific parenting strategies such as encouragement and restriction were helpful for some adolescents. Adolescents struggled to make healthful choices in their home environment, but highlighted parenting strategies that were supportive. Targeting the home food environment is important to enable healthier food choices among overweight/obese adolescents.
Bounthavong, Mark; Pruitt, Larry D; Smolenski, Derek J; Gahm, Gregory A; Bansal, Aasthaa; Hansen, Ryan N
2018-02-01
Introduction Home-based telebehavioural healthcare improves access to mental health care for patients restricted by travel burden. However, there is limited evidence assessing the economic value of home-based telebehavioural health care compared to in-person care. We sought to compare the economic impact of home-based telebehavioural health care and in-person care for depression among current and former US service members. Methods We performed trial-based cost-minimisation and cost-utility analyses to assess the economic impact of home-based telebehavioural health care versus in-person behavioural care for depression. Our analyses focused on the payer perspective (Department of Defense and Department of Veterans Affairs) at three months. We also performed a scenario analysis where all patients possessed video-conferencing technology that was approved by these agencies. The cost-utility analysis evaluated the impact of different depression categories on the incremental cost-effectiveness ratio. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model assumptions. Results In the base case analysis the total direct cost of home-based telebehavioural health care was higher than in-person care (US$71,974 versus US$20,322). Assuming that patients possessed government-approved video-conferencing technology, home-based telebehavioural health care was less costly compared to in-person care (US$19,177 versus US$20,322). In one-way sensitivity analyses, the proportion of patients possessing personal computers was a major driver of direct costs. In the cost-utility analysis, home-based telebehavioural health care was dominant when patients possessed video-conferencing technology. Results from probabilistic sensitivity analyses did not differ substantially from base case results. Discussion Home-based telebehavioural health care is dependent on the cost of supplying video-conferencing technology to patients but offers the opportunity to
Current status of home blood pressure monitoring in Asia: Statement from the HOPE Asia Network.
Chia, Yook-Chin; Buranakitjaroen, Peera; Chen, Chen-Huan; Divinagracia, Romeo; Hoshide, Satoshi; Park, Sungha; Shin, Jinho; Siddique, Saulat; Sison, Jorge; Soenarta, Arieska Ann; Sogunuru, Guru Prasad; Tay, Jam Chin; Turana, Yuda; Wang, Ji-Guang; Wong, Lawrence; Zhang, Yuqing; Kario, Kazuomi
2017-11-01
Hypertension represents a major burden in Asia, with a high prevalence rate but poor level of awareness and control reported in many countries in the region. Home blood pressure monitoring has been validated as an accurate and reliable measure of blood pressure that can help guide hypertension treatment as well as identify masked and white-coat hypertension. Despite its benefits, there has been limited research into home blood pressure monitoring in Asia. The authors reviewed the current evidence on home blood pressure monitoring in Asia, including but not limited to published literature, data presented at congresses, and national hypertension management guidelines to determine the current utilization of home blood pressure monitoring in clinical practice in the region. Public policies to enable greater access to home blood pressure monitoring and its use in clinical care would add considerably to improving hypertension outcomes in Asia. ©2017 Wiley Periodicals, Inc.
Access to war weapons and injury prevention activities among children in Croatia.
Kopjar, B; Wiik, J; Wickizer, T M; Bulajic-Kopjar, B; Mujki-Klaric, A
1996-01-01
To investigate the exposure of children in Croatia to war weapons, we surveyed random samples of children (n=986) aged 11 to 16 years and of parents (1469) of children aged 7 to 16 years in April 1994 in four war-affected districts in Croatia. The children's survey indicated that 57% of the boys and 36% of the girls had access to weapons at home, at some other place, or at both. Eighteen percent of the boys and 5% of the girls reported playing with weapons. The parents' survey showed that 68% of the households possessed weapons, with 19% of the children having access to weapons at home. Influenced by preliminary findings of these surveys, the Croatian government modified its national campaign (one partially supported by international aid) to prevent war-related injuries among children. This study demonstrates the feasibility of scientific evaluation of humanitarian aid programs. PMID:8604767
NASA Astrophysics Data System (ADS)
Cornaglia, Bruno; Young, Gavin; Marchetta, Antonio
2015-12-01
Fixed broadband network deployments are moving inexorably to the use of Next Generation Access (NGA) technologies and architectures. These NGA deployments involve building fiber infrastructure increasingly closer to the customer in order to increase the proportion of fiber on the customer's access connection (Fibre-To-The-Home/Building/Door/Cabinet… i.e. FTTx). This increases the speed of services that can be sold and will be increasingly required to meet the demands of new generations of video services as we evolve from HDTV to "Ultra-HD TV" with 4k and 8k lines of video resolution. However, building fiber access networks is a costly endeavor. It requires significant capital in order to cover any significant geographic coverage. Hence many companies are forming partnerships and joint-ventures in order to share the NGA network construction costs. One form of such a partnership involves two companies agreeing to each build to cover a certain geographic area and then "cross-selling" NGA products to each other in order to access customers within their partner's footprint (NGA coverage area). This is tantamount to a bi-lateral wholesale partnership. The concept of Fixed Access Network Sharing (FANS) is to address the possibility of sharing infrastructure with a high degree of flexibility for all network operators involved. By providing greater configuration control over the NGA network infrastructure, the service provider has a greater ability to define the network and hence to define their product capabilities at the active layer. This gives the service provider partners greater product development autonomy plus the ability to differentiate from each other at the active network layer.
Qato, Dima Mazen; Wilder, Jocelyn; Zenk, Shannon; Davis, Andrew; Makelarski, Jennifer; Lindau, Stacy Tessler
2016-01-01
Background Policy efforts to reduce the cost of prescription medications in the U.S. have failed to reduce disparities in cost-related underuse. Little is known about the relationships between pharmacy accessibility, utilization and cost-related underuse of prescription medications among residents of low-income minority communities. Objectives To examine the association between pharmacy accessibility, utilization and cost-related underuse of prescription medications among residents of predominantly low-income, Black and Hispanic urban communities. Methods Data from a population-based probability sample of adults 35 years and older residing on the South Side of Chicago in 2012–13 were linked with geocoded information on the type and location of primary and nearest pharmacy. Multivariable regression models were used to examine associations between pharmacy accessibility, utilization of, and travel distance to, primary pharmacy and cost-related underuse overall and by pharmacy type. Results One-third of South Side residents primarily filled their prescriptions at the pharmacy nearest to their home. Among those who did not use mail order, median distance traveled from home to the primary pharmacy was 1.2 miles. Residents whose primary pharmacy was at a community health center or clinic where they usually received care traveled the furthest but were least likely to report cost-related underuse of their prescription medications. Conclusions Most residents of minority communities on Chicago’s South Side were not using pharmacies closest to their home to obtain their prescription medications. Efforts to improve access to prescription medications in these communities should focus on improving the accessibility of affordable pharmacies at site of care. PMID:28153704
Job Satisfaction of Home Health Satisfaction Workers in the Environment of Cost Containment
ERIC Educational Resources Information Center
Egan, Marcia; Kadushin, Goldie
2004-01-01
This national survey examined the job satisfaction of 228 home health social workers in the restrictive reimbursement environment of the Medicare interim payment system. Administrators' helpfulness in resolving ethical conflicts between patient access to services and agency financial priorities contributed significantly to greater satisfaction in…
What Is the Impact of Full Access to Technology on the Achievement of the Hispanic Student?
ERIC Educational Resources Information Center
Carr, John E., Jr.
2013-01-01
The problem studied in this research was whether the impact of full access to technology both at home and in school would affect the achievement of Hispanic students. The purpose of this study was to examine the relationship between the access to technology and the achievement of the Hispanic students at a suburban middle school. What are the…
Gender differences in home environments related to childhood obesity in Nanchang, China.
Xie, Xiaoxu; Wu, Hongjiao; Lee, Thomas; Wang, Christina M B; Zhou, Xiaojun; Lu, Yuanan; Yuan, Zhaokang; Maddock, Jay E
2014-10-01
Childhood obesity is rapidly increasing in China, with rates doubling between 2000 and 2010. Several large, epidemiological studies have shown boys to be consistently more likely to be obese than girls. The aim of this study was to investigate gender differences in the home environment and parenting practices related to childhood obesity. A cross-sectional survey using a convenience sampling of 522 (86.1% response rate) primary caregivers of children ages 2-10 years was conducted in four locations in Nanchang, China, in the spring of 2013 using face-to-face, anonymous questionnaires. Boys were significantly (p<0.05) more likely than girls to watch more television (TV) per week, be allowed to have snacks/sweets or soft drinks without permission, and to have sugary drinks at snacks and meals. Girls were significantly more likely than boys to have parental encouragement and support for physical activity, participate in organized sports/group activities, and have fresh fruits accessible. Parents also believed that boys eat too much junk foods or their favorite foods if not controlled. Few differences were noted in the actual physical environment in the home, including access to sports equipment, junk food availability, and access to media. RESULTS indicate that parents tend to be more permissive with boys than girls, allowing them access to unhealthy foods and more TV time. These differences may contribute to the higher prevalence of obesity in boys in China.
Seymour, Jane E; Kumar, Arun; Froggatt, Katherine
2011-01-01
Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of ‘key’ external advocates and leverage of additional resources by adoption of care pathway tools. PMID:21282349
The HOME network: an Australian national initiative for home therapies.
Chow, Josephine; Fortnum, Debbie; Moodie, Jo-Anne; Simmonds, Rosemary; Tomlins, Melinda
2013-01-01
Longer, more frequent dialysis at home can improve life expectancy for patients with chronic kidney disease. Increased use of home dialysis therapies also benefits the hospital system, allowing for more efficient allocation of clinic resources. However, the Australian and New Zealand Data Registry statistics highlight the low uptake of home haemodialysis and peritoneal dialysis across Australia. In August 2009, the Australia's HOME Network was established as a national initiative to engage and empower healthcare professionals working in the home dialysis specialty. The aim was to develop solutions to advocate for and ultimately increase the use of home therapies. This paper describes the development, achievement and future plan of the Australian HOME Network. Achievements to date include: a survey of HOME Network members to assess the current state of patient and healthcare professional-targeted education resources; development of two patient case studies and activities addressing how to overcome the financial burden experienced by patients on home dialysis. Future projects aim to improve patient and healthcare professional education, and advocacy for home dialysis therapies. The HOME Network is supporting healthcare professionals working in the home dialysis specialty to develop solutions and tools that will help to facilitate greater utilisation of home dialysis therapies. © 2013 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Aquatic access for the disabled.
Walk, E E; Himel, H N; Batra, E K; Baruch, L; O'Connor, M B; Tanner, A E; Edlich, R F
1992-01-01
Innovations in rehabilitation engineering can now provide aquatic access for the disabled. In the regional burn center, the Bodi-Gard cart shower system (Hospital Therapy Products, Inc., Wood Dale, Ill.) uses three flexible hoses to provide precise hydrotherapy and debridement. Its main mixing valve controls temperature and pressure and is easily disinfected by an in-line chamber. This shower system is complemented by the foldable Bodi-Gard mobile seat shower system (Hospital Therapy Products, Inc.). This system, which is covered by a disposable liner, surrounds the patient with eight water jets that empty into any floor drain. The Bather 2001 (Silcraft Corp., Traverse City, Mich.) is a fiberglass hydrotherapy bathtub with a unique Aqua-Seal door (Silcraft Corp.) that can be raised to provide patient access. Its unique closed-loop disinfection system prevents contamination of its internal components. The Nolan Tublift (Aquatic Access, Louisville, Ky.) is a lightweight, removable lift that uses water power to gently raise and lower its seat. It can be manually swiveled to allow access from a wheelchair. Transfer benches span the tub wall to provide access to the shower and bathtub. Although they are a less expensive alternative to the Tublift, they allow water to spill outside the tub, which may create a slippery bathroom floor. The Nolan Poolift (Guardian Products, Arleta, Calif.) is a water-powered pool lift, which automatically rotates as it descends. It is capable of lifting up to 135 kg with a home water pressure of 55 psi. In contrast, the water-powered Aquatic Access Poolift is a less expensive pool lift, which rotates manually with assistance.(ABSTRACT TRUNCATED AT 250 WORDS)
2014-01-01
Background The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants’ quality of life, satisfaction with services
Tousignant, Michel; Corriveau, Hélène; Kairy, Dahlia; Berg, Katherine; Dubois, Marie-France; Gosselin, Sylvie; Swartz, Richard H; Boulanger, Jean-Martin; Danells, Cynthia
2014-01-30
The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient's home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants' quality of life, satisfaction with services received, and cost
Workshop AccessibleTV "Accessible User Interfaces for Future TV Applications"
NASA Astrophysics Data System (ADS)
Hahn, Volker; Hamisu, Pascal; Jung, Christopher; Heinrich, Gregor; Duarte, Carlos; Langdon, Pat
Approximately half of the elderly people over 55 suffer from some type of typically mild visual, auditory, motor or cognitive impairment. For them interaction, especially with PCs and other complex devices is sometimes challenging, although accessible ICT applications could make much of a difference for their living quality. Basically they have the potential to enable or simplify participation and inclusion in their surrounding private and professional communities. However, the availability of accessible user interfaces being capable to adapt to the specific needs and requirements of users with individual impairments is very limited. Although there are a number of APIs [1, 2, 3, 4] available for various platforms that allow developers to provide accessibility features within their applications, today none of them provides features for the automatic adaptation of multimodal interfaces being capable to automatically fit the individual requirements of users with different kinds of impairments. Moreover, the provision of accessible user interfaces is still expensive and risky for application developers, as they need special experience and effort for user tests. Today many implementations simply neglect the needs of elderly people, thus locking out a large portion of their potential users. The workshop is organized as part of the dissemination activity for the European-funded project GUIDE "Gentle user interfaces for elderly people", which aims to address this situation with a comprehensive approach for the realization of multimodal user interfaces being capable to adapt to the needs of users with different kinds of mild impairments. As application platform, GUIDE will mainly target TVs and Set-Top Boxes, such as the emerging Connected-TV or WebTV platforms, as they have the potential to address the needs of the elderly users with applications such as for home automation, communication or continuing education.
How Parents of Teens Store and Monitor Prescription Drugs in the Home
ERIC Educational Resources Information Center
Friese, Bettina; Moore, Roland S.; Grube, Joel W.; Jennings, Vanessa K.
2013-01-01
Qualitative interviews were conducted with parents of teens to explore how parents store and monitor prescription drugs in the home. Most parents had prescription drugs in the house, but took few precautions against teens accessing these drugs. Strategies for monitoring included moving the drugs to different locations, remembering how many pills…
Home hemodialysis: a comprehensive review of patient-centered and economic considerations
Walker, Rachael C; Howard, Kirsten; Morton, Rachael L
2017-01-01
Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD) continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD) has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL) advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients’ lifestyle. This is a comprehensive literature review of patient-centered and economic impacts of home HD with the studies published between January 2000 and July 2016. Data from the primary studies representing both efficiency and equity of home HD were presented as a narrative synthesis under the following topics: advantages to patients, barriers to patients, economic factors influencing patients, cost-effectiveness of home HD, and inequities in home HD delivery. There were a number of advantages for patients on home HD including improved survival and QoL and flexibility and potential for employment, compared to hospital HD. Similarly, there were several barriers to patients preferring or maintaining home HD, and the strategies to overcome these barriers were frequently reported. Good evidence reported that indigenous, low-income, and other socially disadvantaged individuals had reduced access to home HD compared to other forms of dialysis and that this situation compounds already-poor health outcomes on renal replacement therapy. Government policies that minimize barriers to home HD include reimbursement for dialysis-related out-of-pocket costs and employment-retention interventions for home HD patients and their family members. This review argues that home HD is a cost-effective treatment, and increasing the proportion of patients on this
Effects of mobility and location on food access.
Coveney, John; O'Dwyer, Lisel A
2009-03-01
Access to healthy food has become an important area of investigation for researchers interested in health disparities and inequalities. The debate about the existence and characteristics of 'food deserts' has increased the interest in food availability and equity in health research. This debate is crucial to an understanding of the factors leading to food security. Research reported here used in-depth interviews with respondents without private transport living within and outside food deserts in Adelaide, South Australia. The respondents came from a variety of households, including single and double parent families, and people living alone. The research found that living in a food desert did not, by itself, impose food access difficulties. Far more important was the access to independent transport to shops. A number of features were identified in this research including reliance on supermarkets, difficulties with public transport, and the provision of government schemes and systems that for some made food shopping much easier. The research suggests that food access problems in Adelaide are not so much the product of geographic distance between home and shop, as the social or welfare networks that allow people to access private transport.
Retrofitting a 1960s Split-Level, Cold-Climate Home
DOE Office of Scientific and Technical Information (OSTI.GOV)
Puttagunta, Srikanth
2015-07-13
National programs such as Home Performance with ENERGY STAR® and numerous other utility air-sealing programs have made homeowners aware of the benefits of energy-efficiency retrofits. Yet these programs tend to focus only on the low-hanging fruit: they recommend air sealing the thermal envelope and ductwork where accessible, switching to efficient lighting and low-flow fixtures, and improving the efficiency of mechanical systems (though insufficient funds or lack of knowledge to implement these improvements commonly prevent the implementation of these higher cost upgrades). At the other end of the spectrum, various utilities across the country are encouraging deep energy retrofit programs. Althoughmore » deep energy retrofits typically seek 50% energy savings, they are often quite costly and are most applicable to gut-rehab projects. A significant potential for lowering energy use in existing homes lies between the lowhanging fruit and deep energy retrofit approaches—retrofits that save approximately 30% in energy compared to the pre-retrofit conditions. The energy-efficiency measures need to be nonintrusive so the retrofit projects can be accomplished in occupied homes.« less
Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population
Freedman, Vicki A; Rogowski, Jeannette; Wickstrom, Steven L; Adams, John; Marainen, Jonas; Escarce, José J
2004-01-01
Objective To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans. Data Sources A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period. Study Design We estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees. Principal Findings Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment. Conclusions Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages. PMID:15333109
Public Reporting and Demand Rationing: Evidence from the Nursing Home Industry.
He, Daifeng; Konetzka, R Tamara
2015-11-01
This paper examines an under-explored unintended consequence of public reporting: the potential for demand rationing. Public reporting, although intended to increase consumer access to high-quality products, may have provided the perverse incentive for high-quality providers facing fixed capacity and administrative pricing to avoid less profitable types of residents. Using data from the nursing home industry before and after the implementation of the public reporting system in 2002, we find that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints. These effects, although small in magnitude, are consistent with provider rationing of demand on the basis of profitability and underscore the important role of institutional details in designing effective public reporting systems for regulated industries. Copyright © 2014 John Wiley & Sons, Ltd.
Improving Information Access through Technology: A Plan for Louisiana's Public Libraries.
ERIC Educational Resources Information Center
Jaques, Thomas F.
Strengthening technology in Louisiana's public libraries will support equitable and convenient access to electronic information resources for all citizens at library sites, in homes, and in business. The plan presented in this document is intended to enhance and expand technology in the state's public libraries. After discussion of the crucial…
When a desired home death does not occur: the consequences of broken promises.
Topf, Lorrianne; Robinson, Carole A; Bottorff, Joan L
2013-08-01
Evidence shows that most people prefer to die at home; however, the majority of expected deaths occur away from home. Although home deaths require family caregiver (FCG) commitment and care, we understand very little about their experiences in this context. The study's aim was to gain a better understanding of the experiences of FCGs when circumstances prevented a desired home death for a family member with advanced cancer. An interpretive description approach was used. Data collection involved semistructured interviews. Field notes and reflective journaling aided interpretive and analytical processes. The study was conducted in western Canada and included 18 bereaved FCGs. FCGs were committed to the promises made to care for their family member at home until death. These promises were challenged by a lack of preparedness for caregiving, difficulty accessing professional support and information, and frustration with the inadequate help they received. The events that precipitated dying family members leaving their home for hospital or hospice were unexpected and often influenced by FCGs' lack of situation-specific knowledge and ability to cope with complex caregiving responsibilities. FCGs found it extremely challenging to reconcile with breaking their promise to care at home until death and many were unable to do so. FCGs' despair about not being able to keep their promise for a home death was related to complicated bereavement. Prospective studies of the experiences of FCGs who are aiming for home deaths are needed to identify both short- and long-term interventions to effectively support death at home.
General practitioners' experiences as nursing home medical consultants.
Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro
2017-03-01
To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.
National Trends and Geographic Variation in Availability of Home Health Care: 2002-2015.
Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H
2017-07-01
To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care. Observational study. All counties in the United States. All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. The availability of home health care increased nationwide during the study period, but there was much geographic variation. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory
2017-11-01
The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Access to parks and physical activity: an eight country comparison.
Schipperijn, Jasper; Cerin, Ester; Adams, Marc A; Reis, Rodrigo; Smith, Graham; Cain, Kelli; Christiansen, Lars B; van Dyck, Delfien; Gidlow, Christopher; Frank, Lawrence D; Mitáš, Josef; Pratt, Michael; Salvo, Deborah; Schofield, Grant; Sallis, James F
2017-10-01
Several systematic reviews have reported mixed associations between access to parks and physical activity, and suggest that this is due to inconsistencies in the study methods or differences across countries. An international study using consistent methods is needed to investigate the association between access to parks and physical activity. The International Physical Activity and Environment Network (IPEN) Adult Study is a multi-country cross-sectional study using a common design and consistent methods. Accelerometer, survey and Geographic Information Systems (GIS) data for 6,181 participants from 12 cities in 8 countries (Belgium, Brazil, Czech Republic, Denmark, Mexico, New Zealand, UK, USA) were used to estimate the strength and shape of associations of 11 measures of park access (1 perceived and 10 GIS-based measures) with accelerometer-based moderate-to-vigorous physical activity (MVPA) and four types of self-reported leisure-time physical activity. Associations were estimated using generalized additive mixed models. More parks within 1 km from participants' homes were associated with greater leisure-time physical activity and accelerometer-measured MVPA. Respondents who lived in the neighborhoods with the most parks did on average 24 minutes more MVPA per week than those living in the neighborhoods with the lowest number of parks. Perceived proximity to a park was positively associated with multiple leisure-time physical activity outcomes. Associations were homogeneous across all cities studied. Living in neighborhoods with many parks could contribute with up to 1/6 of the recommended weekly Having multiple parks nearby was the strongest positive correlate of PA. To increase comparability and validity of park access measures, we recommend that researchers, planners and policy makers use the number of parks within 1 km travel distance of homes as an objective indicator for park access in relation to physical activity.
Energy access and sustainable development
NASA Astrophysics Data System (ADS)
Kammen, Daniel M.; Alstone, Peter; Gershenson, Dimitry
2015-03-01
With 1.4 billion people lacking electricity to light their homes and provide other basic services, or to conduct business, and all of humanity (and particularly the poor) are in need of a decarbonized energy system can close the energy access gap and protect the global climate system. With particular focus on addressing the energy needs of the underserved, we present an analytical framework informed by historical trends and contemporary technological, social, and institutional conditions that clarifies the heterogeneous continuum of centralized on-grid electricity, autonomous mini- or community grids, and distributed, individual energy services. We find that the current day is a unique moment of innovation in decentralized energy networks based on super-efficient end-use technology and low-cost photovoltaics, supported by rapidly spreading information technology, particularly mobile phones. Collectively these disruptive technology systems could rapidly increase energy access, contributing to meeting the Millennium Development Goals for quality of life, while simultaneously driving action towards low-carbon, Earth-sustaining, energy systems.
Quality assessment of palliative home care in Italy.
Scaccabarozzi, Gianlorenzo; Lovaglio, Pietro Giorgio; Limonta, Fabrizio; Floriani, Maddalena; Pellegrini, Giacomo
2017-08-01
The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted. Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature. The evaluation strategy is based on Rasch analysis, allowing to objectively measuring both performances of facilities and quality indicators' difficulty on the same metric, using 14 quality indicators identified by the observatory's steering committee. Globally, 195 home care teams were registered in the observatory reporting globally 40 955 cured patients in 2013 representing 66% of the population of home palliative care units active in Italy in 2013. Rasch analysis identifies 5 indicators ("interview" with caregivers, continuous training provided to medical and nursing staff, provision of specialized multidisciplinary interventions, psychological support to the patient and family, and drug supply at home) easy to endorse by health care providers and 3 problematic indicators (presence of a formally established Local Network of Palliative care in the area of reference, provision of the care for most problematic patient requiring high intensity of the care, and the percentage of cancer patient dying at Home). The lack of Local Network of Palliative care, required by law 38/2010, is, at the present, the main barrier to its application. However, the adopted methodology suggests that a clear roadmap for health facilities
Family and home characteristics correlate with mold in homes.
Reponen, Tiina; Levin, Linda; Zheng, Shu; Vesper, Stephen; Ryan, Patrick; Grinshpun, Sergey A; LeMasters, Grace
2013-07-01
Previously, we demonstrated that infants residing in homes with higher Environmental Relative Moldiness Index were at greater risk for developing asthma by age seven. The purpose of this analysis was to identify the family and home characteristics associated with higher moldiness index values in infants' homes at age one. Univariate linear regression of each characteristic determined that family factors associated with moldiness index were race and income. Home characteristics associated with the moldiness index values were: air conditioning, carpet, age of the home, season of home assessment, and house dust mite allergen. Parental history of asthma, use of dehumidifier, visible mold, dog and cat allergen levels were not associated with moldiness index. Results of multiple linear regression showed that older homes had 2.9 units higher moldiness index (95% confidence interval [CI]=0.4, 5.4), whereas homes with central air conditioning had 2.5 units lower moldiness index (95% CI=-4.7, -0.4). In addition, higher dust mite allergen levels and carpeting were positively and negatively associated with higher moldiness index, respectively. Because older homes and lack of air conditioning were also correlated with race and lower income, whereas carpeting was associated with newer homes, the multivariate analyses suggests that lower overall socioeconomic position is associated with higher moldiness index values. This may lead to increased asthma risk in homes inhabited by susceptible, vulnerable population subgroups. Further, age of the home was a surrogate of income, race and carpeting in our population; thus the use of these factors should carefully be evaluated in future studies. Copyright © 2013 Elsevier Inc. All rights reserved.
Tertinger, D A; Greene, B F; Lutzker, J R
1984-01-01
Parents may be charged with child abuse or neglect or both on the basis of a variety of circumstances. Child neglect, for example, is often documented when caseworkers observe that the family's home itself is so poorly kept that it presents an environment in which young children have ready access to lethal hazards such as poisons, uncovered wall outlets, and firearms. In this study, we describe the development of a Home Accident Prevention Inventory (HAPI) which was validated and used to assess hazards in the homes of several families under state protective service for child abuse and neglect. The HAPI included five categories of hazards: fire and electrical, mechanical-suffocation, ingested object suffocation, firearms, and solid/liquid poisons. Following the collection of baseline data, parents were presented with a treatment package that included instructions and demonstrations on making hazards inaccessible to children, plus feedback regarding the number and location of hazards in the home. The multiple-baseline design across hazardous categories in each family's home showed that the package resulted in decreases in the number of these accessible hazards. These improvements were maintained over an extended period of unannounced follow-up checks. This research provides a model for the development and assessment of an area previously unexamined in the child abuse and neglect literature. PMID:6735949
... Skilled nursing - home health; Skilled nursing - home care; Physical therapy - at home; Occupational therapy - at home; Discharge - ... and any medicines that you may be taking. Physical and occupational therapists can make sure your home ...
Tandon, Pooja S; Zhou, Chuan; Sallis, James F; Cain, Kelli L; Frank, Lawrence D; Saelens, Brian E
2012-07-26
Children in households of lower socioeconomic status (SES) are more likely to be overweight/obese. We aimed to determine if home physical activity (PA) environments differed by SES and to explore home environment mediators of the relation of family SES to children's PA and sedentary behavior. Participants were 715 children aged 6 to 11 from the Neighborhood Impact on Kids (NIK) Study. Household SES was examined using highest educational attainment and income. Home environment was measured by parent report on a survey. Outcomes were child's accelerometer-measured PA and parent-reported screen time. Mediation analyses were conducted for home environment factors that varied by SES. Children from lower income households had greater media access in their bedrooms (TV 52% vs. 14%, DVD player 39% vs. 14%, video games 21% vs. 9%) but lower access to portable play equipment (bikes 85% vs. 98%, jump ropes 69% vs. 83%) compared to higher income children. Lower SES families had more restrictive rules about PA (2.5 vs. 2.0). Across SES, children watched TV/DVDs with parents/siblings more often than they engaged in PA with them. Parents of lower SES watched TV/DVDs with their children more often (3.1 vs. 2.5 days/week). Neither total daily and home-based MVPA nor sedentary time differed by SES. Children's daily screen time varied from 1.7 hours/day in high SES to 2.4 in low SES families. Media in the bedroom was related to screen time, and screen time with parents was a mediator of the SES--screen time relationship. Lower SES home environments provided more opportunities for sedentary behavior and fewer for PA. Removing electronic media from children's bedrooms has the potential to reduce disparities in chronic disease risk.
Connecting to the Internet Securely; Protecting Home Networks CIAC-2324
DOE Office of Scientific and Technical Information (OSTI.GOV)
Orvis, W J; Krystosek, P; Smith, J
2002-11-27
With more and more people working at home and connecting to company networks via the Internet, the risk to company networks to intrusion and theft of sensitive information is growing. Working from home has many positive advantages for both the home worker and the company they work for. However, as companies encourage people to work from home, they need to start considering the interaction of the employee's home network and the company network he connects to. This paper discusses problems and solutions related to protection of home computers from attacks on those computers via the network connection. It does notmore » consider protection of those systems from people who have physical access to the computers nor does it consider company laptops taken on-the-road. Home networks are often targeted by intruders because they are plentiful and they are usually not well secured. While companies have departments of professionals to maintain and secure their networks, home networks are maintained by the employee who may be less knowledgeable about network security matters. The biggest problems with home networks are that: Home networks are not designed to be secure and may use technologies (wireless) that are not secure; The operating systems are not secured when they are installed; The operating systems and applications are not maintained (for security considerations) after they are installed; and The networks are often used for other activities that put them at risk for being compromised. Home networks that are going to be connected to company networks need to be cooperatively secured by the employee and the company so they do not open up the company network to intruders. Securing home networks involves many of the same operations as securing a company network: Patch and maintain systems; Securely configure systems; Eliminate unneeded services; Protect remote logins; Use good passwords; Use current antivirus software; and Moderate your Internet usage habits. Most of
National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015
Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H
2017-01-01
Objectives To evaluate national trends and geographic variation in the availability of home health care from 2002–2015 and identify county-specific characteristics associated with home health care. Design Observational study Setting All counties in the United States Participants All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. Measurements County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. Results The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002–2003 and 2014–2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North-East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. Conclusion The availability of home health care increased nationwide during the study period, but there was much geographic variation. PMID:28322441
Effect of educational level and minority status on nursing home choice after hospital discharge.
Angelelli, Joseph; Grabowski, David C; Mor, Vincent
2006-07-01
The movement to publicly report data on provider quality to inform consumer choices is predicated on assumptions of equal access and knowledge. We examine the validity of this assumption by testing whether minority/less educated Medicare patients are at greater risk of being discharged from a hospital to the lowest-quality nursing homes in a geographic area. We used the 2002 national Minimum Data Set to identify 62601 new Medicare admissions to nursing homes in 95 hospital service areas with at least 4 freestanding nursing homes and at least 50 African Americans aged 65 years or older with Medicare admissions to nursing homes. The probability of African Americans' being admitted to nursing homes in the lowest-quality quartile in the area was greater (relative risk [RR]=1.26; 95% confidence interval [CI]=1.0, 8.45) in comparison with Whites. Individuals without a high-school degree were also more likely to be admitted to a low-quality nursing home (RR=1.22; 95% CI=1.0, 1.46). African American and poorly educated patients enter the worst-quality nursing facilities. This finding raises concerns about the usefulness of the current public reporting model for certain consumers.
ERIC Educational Resources Information Center
Watkins, Adam M.; Lizotte, Alan J.
2013-01-01
The aim of this research is to assess if home firearm access increases the risk of nonfatal suicidal attempts among adolescents. Such a gun focus has largely been limited to case-control studies on completed suicides. This line of research has found that household gun access increases the risk of suicide due to features of available firearms…
A diaper bank and home visiting partnership: Initial exploration of research and policy questions.
Sadler, Lois S; Condon, Eileen M; Deng, Shirley Z; Ordway, Monica Roosa; Marchesseault, Crista; Miller, Andrea; Alfano, Janet Stolfi; Weir, Alison M
2018-03-01
The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby ® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed. © 2017 Wiley Periodicals, Inc.
A diaper bank and home visiting partnership: Initial exploration of research and policy questions
Sadler, Lois S.; Condon, Eileen M.; Deng, Shirley Z.; Ordway, Monica Roosa; Marchesseault, Crista; Miller, Andrea; Alfano, Janet Stolfi; Weir, Alison M.
2018-01-01
Objectives The cost of diapering an infant can place a significant financial strain on families living in poverty. Partnerships between diaper banks and home visiting programs for young families may offer an innovative solution to expanding the reach and impact of diaper banks in low-income communities. The purpose of this pilot study was to uncover preliminary information about the functions of diaper distribution through home visiting programs, and to inform future research and policy questions regarding diaper distribution to families in need. Design and Sample In this descriptive qualitative pilot study, semi-structured interviews were conducted with 6 home visitors from Minding the Baby® (MTB), a home visiting intervention for young parents. MTB clinicians routinely distribute diapers in partnership with The Diaper Bank in Connecticut. We used directed content analysis to code and analyze interview transcripts. Results/Conclusion These preliminary findings indicate that partnerships between home visiting programs and diaper banks may benefit families by improving diaper access, reducing stigma, and fostering trusting relationships with home visitors. Home visiting program benefits including engagement or re-engagement with families may need to be balanced with potential effects on clinical and therapeutic relationships. Recommendations for next steps in research and related policy questions are discussed. PMID:29235668
A home health care approach to exercise for persons with Alzheimer's disease.
Logsdon, Rebecca G; McCurry, Susan M; Teri, Linda
2005-01-01
Regular exercise is a mainstay of preventive health care for individuals of all ages. Research with older adults has shown that exercise reduces risk of chronic illness, maintains mobility and function, enhances mood, and may even improve cognitive function. For individuals with dementia, exercise programs are particularly likely to improve health, mood, and quality of life; the challenge at this time is to make exercise accessible and enjoyable, demonstrate its benefits, and convince family caregivers of its worth for individuals with dementia. Home health providers are uniquely positioned to assist caregivers in developing and implementing a home exercise program for their care recipient with dementia. Results of a controlled critical trial conducted at the University of Washington have demonstrated the feasibility and efficacy of a home health exercise and problem solving intervention (Reducing Disability in Alzheimer's Disease, or RDAD) for decreasing physical, psychological, and behavioral disabilities associated with dementia. This article describes the RDAD program, discusses the role of home health providers in its delivery, and provides an example of its implementation.
24 CFR 982.612 - Group home: State approval of group home.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Group home: State approval of group home. 982.612 Section 982.612 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Types Group Home § 982.612 Group home: State approval of group home. A group home must be licensed...
24 CFR 982.612 - Group home: State approval of group home.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Group home: State approval of group home. 982.612 Section 982.612 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Types Group Home § 982.612 Group home: State approval of group home. A group home must be licensed...
24 CFR 982.612 - Group home: State approval of group home.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Group home: State approval of group home. 982.612 Section 982.612 Housing and Urban Development Regulations Relating to Housing and Urban... Types Group Home § 982.612 Group home: State approval of group home. A group home must be licensed...
24 CFR 982.612 - Group home: State approval of group home.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Group home: State approval of group home. 982.612 Section 982.612 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Types Group Home § 982.612 Group home: State approval of group home. A group home must be licensed...
24 CFR 982.612 - Group home: State approval of group home.
Code of Federal Regulations, 2013 CFR
2013-04-01
... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Group home: State approval of group home. 982.612 Section 982.612 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Types Group Home § 982.612 Group home: State approval of group home. A group home must be licensed...
Regional variations in the use of home care services in Ontario, 1993/95
Coyte, P C; Young, W
1999-01-01
BACKGROUND: Although regional variations in the use of many health care services have been reported, little attention has been devoted to home care practices. Given the dramatic shift in care settings from hospitals to private homes, it is important to determine the extent to which home care practices vary by geographic region. METHODS: Data from the Canadian Institute for Health Information and the Ontario Home Care Administration System database were used to assess regional variations in rates of home care use following inpatient care and same-day surgery for the fiscal years 1993, 1994 and 1995. Various measures of regional variation were employed. RESULTS: Of the 2,870,695 inpatient separations and 1,803,307 same-day surgery separations during the study period, 359,972 and 64,541, respectively, were followed by home care. The rate of home care use per 100 separations was 12.5 for inpatients and 3.6 for same-day surgery patients. There was a a 3.5-fold regional variation in the rates of home care use following inpatient care and a 7-fold variation in rates of use following same-day surgery. Additional home care funding to attain calculated target rates was estimated to be $48.9 million (30% of expenditures for patients recently discharged from hospital over the study period). For a 20% increase in service provision it was estimated that an additional injection of $42.2 million is required. INTERPRETATION: The wide regional variations in rates of home care use highlight the importance of modifying home care funding to ensure that all residents of Ontario have equal access to services. To achieve this our estimates suggest that a substantial increase in home care funding is warranted. PMID:10478160
Vialle-Valentin, Catherine E; Serumaga, Brian; Wagner, Anita K; Ross-Degnan, Dennis
2015-10-01
The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of
ERIC Educational Resources Information Center
Fairlie, Robert W.; Robinson, Jonathan
2013-01-01
Computers are an important part of modern education, yet large segments of the population--especially low-income and minority children--lack access to a computer at home. Does this impede educational achievement? We test this hypothesis by conducting the largest-ever field experiment involving the random provision of free computers for home use to…
Virtual rehabilitation: What are the practical barriers for home-based research?
Threapleton, Kate; Drummond, Avril; Standen, Penny
2016-01-01
Virtual reality technologies are becoming increasingly accessible and affordable to deliver, and consequently the interest in applying virtual reality within rehabilitation is growing. This has resulted in the emergence of research exploring the utility of virtual reality and interactive video gaming interventions for home use by patients. The aim of this paper is to highlight the practical factors and difficulties that may be encountered in research in this area, and to make recommendations for addressing these. Whilst this paper focuses on examples drawn mainly from stroke rehabilitation research, many of the issues raised are relevant to other conditions where virtual reality approaches have the potential to be applied to home-based rehabilitation. PMID:29942551
Food Insecurity is Related to Home Availability of Fruit, 100% Fruit Juice, and Vegetables
USDA-ARS?s Scientific Manuscript database
Household food security is defined as access to enough food at all times for active, healthy living. Low food security may influence consumption because those households may lack sufficient resources to purchase more healthful items like fruit and vegetables. Because home availability is related to ...
Hospital to home: a transition program for frail older adults.
Watkins, Lynn; Hall, Carol; Kring, Daria
2012-01-01
This study describes a social-worker navigator transitional care model for at-risk seniors being discharged from hospital to home. The model is designed to prevent rehospitalizations so as to improve quality of life and patient outcomes. This model is different from others with its focus on the psychosocial aspects of care transitions, medical needs, and individualized needs with the provision of nonreimbursable services. Care begins in the acute care hospital or inpatient rehabilitation facility and continues in the postdischarge home environment. Participants are connected to community services to support their independent living at home. Case managers, physicians, or others refer potential participants to the navigator. Criteria for inclusion include the following: age 65 years or older, Medicare and/or Medicaid recipient, living in the same county as the hospital, and having at least 2 of a list of 11 criteria that predict readmission. After the participant agrees to enroll, the navigator recommends in-home services at discharge. Within the first 72 hr, the navigator makes a home visit to evaluate the home environment, assess medical management, and make referrals for other services. Follow-up phone calls and other home visits are made by the navigator during the participant's enrollment, which is from 30 days to 4 months. Hospital readmissions were decreased by 61% for this high-risk population. Cost savings by preventing readmissions correlated to a cost savings of $628,202 per year. The 36-Item Short-Form Health Survey showed statistically significant improvements in quality-of-life scores for both physical and mental health summary scales and for all 8 subscales (p < .004). Almost all (99%) of respondents were satisfied with the overall Hospital to Home program. The results of this study demonstrate the importance of extending social support and health education into the home after discharge from the hospital. Access to immediate in-home care services such
State Regulatory Enforcement and Nursing Home Termination from the Medicare and Medicaid Programs
Li, Yue; Harrington, Charlene; Spector, William D; Mukamel, Dana B
2010-01-01
Objectives Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. Study Design Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006–2007. Principal Findings Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006–2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio=1.53, p=.018). Conclusions Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination. PMID:20819106
Novel transmucosal absorption enhancers obtained by aminoalkylation of chitosan.
Zambito, Ylenia; Uccello-Barretta, Gloria; Zaino, Chiara; Balzano, Federica; Di Colo, Giacomo
2006-12-01
Literature data suggest that quaternized chitosans have a transmucosal drug absorption enhancing property depending on their MW, quaternization degree and other structural features. With the purpose of preparing novel effective promoters, a chitosan (Ch) from crab shell (ChC; viscometric MW, 800 kDa; deacetylation: 90%, IR; 84%, NMR) and one from shrimp shell (ChS; viscometric MW, 590 kDa; deacetylation: 90%, IR; 82%, NMR) were reacted with 2-diethylaminoethyl chloride (DEAE-Cl) and novel derivatives containing different percentages of pendant quaternary ammonium groups were obtained. NMR analysis, based on HSQC, COSY, TOCSY and ROESY maps, indicated that three partially substituted N,O-[N,N-diethylaminomethyl(diethyldimethylene ammonium)(n)]methyl chitosans, coded N(+)-ChS-2 (degree of substitution, DS=40%; n=1.6), N(+)-ChS-4 (DS=132%; n=2.5), and N(+)-ChC-4 (DS=85%; n=1.7) resulted from the reaction, depending on whether the DEAE-Cl/Ch repeating unit molar ratio, was 2:1 or 4:1. The effects of the derivatives on the permeability of rhodamine 123 (Rh-123), hydrophobic, marker of the transcellular absorption route, and of fluorescein sodium (NaFlu), polar, marker of the paracellular route, across excised porcine cheek epithelium were assessed, using Franz type diffusion cells. Rh-123 permeability was enhanced by N(+)-ChS-4 (enhancement ratio, ER=8.4) and by N(+)-ChC-4 (ER=3.9), whereas N(+)-ChS-2 was ineffective. NaFlu permeability was enhanced by N(+)-ChS-2 (ER=7.2), N(+)-ChS-4 (ER=7.4) and N(+)-ChC-4 (ER=6.6). In conclusion, the three derivatives, whichever their DS, promote paracellular transport, while transcellular transport is substantially accelerated only by the most substituted one.
Home birth integration into the health care systems of eleven international jurisdictions.
Comeau, Amanda; Hutton, Eileen K; Simioni, Julia; Anvari, Ella; Bowen, Megan; Kruegar, Samantha; Darling, Elizabeth K
2018-02-13
The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences. © 2018 Wiley Periodicals, Inc.
DOE Zero Energy Ready Home Case Study: Palo Duro Homes — Palo Duro Homes, Albuquerque, NM
DOE Office of Scientific and Technical Information (OSTI.GOV)
none,
2014-09-01
This builder was honored for Most DOE Zero Energy Ready Homes Built in the 2014 Housing Innovation Awards. By July 2014, Palo Duro had completed 152 homes since the program began in 2013 (under the original program title DOE Challenge Home), all of them certified to the stringent efficiency requirements of DOE’s Zero Energy Ready Home program.
Candy, B; Holman, A; Leurent, B; Davis, S; Jones, L
2011-01-01
Hospice care supports patients and their families physically and emotionally through the dying phase. In many countries a substantial portion of specialised end-of-life care is provided through hospices. Such care has developed outside of general healthcare and is commonly provided in a patient's home or in dedicated facilities. Hospice provision may need to increase in the future due to an ageing population with a greater need for access to end-of-life care. In this systematic review we sought to identify the current evidence on (1) the effectiveness, including cost-effectiveness, of hospices, and hospice care in a patient's home and in nursing homes and (2) the experiences of those who use and of those who provide such services. We included quantitative and qualitative studies on hospice care that was provided in a patient's home, nursing home or hospice. We did not include studies on end-of-life care that was provided as part of general healthcare provision, such as by general practitioners in primary care, community nurses or within general hospitals. For quantitative evaluations we included only those that compared hospice care with usual generalist healthcare. The databases CINAHL, MEDLINE, EMBASE, and The Cochrane Library were searched from 2003 to 2009. Evidence was assessed for quality and data extractions double-checked. For quantitative studies we present the outcome data comparing hospice versus usual care. For qualitative evaluations we organise findings thematically. Eighteen comparative evaluations and four thematic papers were identified. Quantitative evidence, mostly of limited quality in design, showed that hospice care at home reduced general health care use and increased family and patient satisfaction with care. Main themes in the qualitative literature revealed that home hospice services support families to sustain patient care at home and hospice day care services generate for the patient a renewed sense of meaning and purpose. Although
A re-conceptualization of access for 21st century healthcare.
Fortney, John C; Burgess, James F; Bosworth, Hayden B; Booth, Brenda M; Kaboli, Peter J
2011-11-01
Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.
Beyond 'flood hotspots': Modelling emergency service accessibility during flooding in York, UK
NASA Astrophysics Data System (ADS)
Coles, Daniel; Yu, Dapeng; Wilby, Robert L.; Green, Daniel; Herring, Zara
2017-03-01
This paper describes the development of a method that couples flood modelling with network analysis to evaluate the accessibility of city districts by emergency responders during flood events. We integrate numerical modelling of flood inundation with geographical analysis of service areas for the Ambulance Service and the Fire & Rescue Service. The method was demonstrated for two flood events in the City of York, UK to assess the vulnerability of care homes and sheltered accommodation. We determine the feasibility of emergency services gaining access within the statutory 8- and 10-min targets for high-priority, life-threatening incidents 75% of the time, during flood episodes. A hydrodynamic flood inundation model (FloodMap) simulates the 2014 pluvial and 2015 fluvial flood events. Predicted floods (with depth >25 cm and areas >100 m2) were overlain on the road network to identify sites with potentially restricted access. Accessibility of the city to emergency responders during flooding was quantified and mapped using; (i) spatial coverage from individual emergency nodes within the legislated timeframes, and; (ii) response times from individual emergency service nodes to vulnerable care homes and sheltered accommodation under flood and non-flood conditions. Results show that, during the 2015 fluvial flood, the area covered by two of the three Fire & Rescue Service stations reduced by 14% and 39% respectively, while the remaining station needed to increase its coverage by 39%. This amounts to an overall reduction of 6% and 20% for modelled and observed floods respectively. During the 2014 surface water flood, 7 out of 22 care homes (32%) and 15 out of 43 sheltered accommodation nodes (35%) had modelled response times above the 8-min threshold from any Ambulance station. Overall, modelled surface water flooding has a larger spatial footprint than fluvial flood events. Hence, accessibility of emergency services may be impacted differently depending on flood mechanism
ERIC Educational Resources Information Center
Olson, Susan J.
School building and classroom accessibility are the first factors considered in a discussion of making provisions for mainstreamed physically handicapped students in vocational home economics programs. Legal mandates are cited, and ideas for adapting food labs and sewing labs for wheelchair students and students with visual impairments are noted.…
Economic Evidence for U.S. Asthma Self-Management Education and Home-Based Interventions
Hsu, Joy; Wilhelm, Natalie; Lewis, Lillianne; Herman, Elizabeth
2016-01-01
The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (e.g., higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments. PMID:27658535
ERIC Educational Resources Information Center
Beaulieu, Barbara; And Others
This unit of instruction on selection and living styles for energy conservation in single-family and multi-family housing and mobile homes was designed for use by home economics teachers in Florida high schools and by home economics extension agents as they work with their clientele. It is one of a series of 11 instructional units (see note)…
Formal Home Care Utilization Patterns by Rural–Urban Community Residence
Spector, William; Van Nostrand, Joan
2009-01-01
Background We examined formal home care utilization among civilian adults across metro and nonmetro residential categories before and after adjustment for predisposing, enabling, and need variables. Methods Two years of the Medical Expenditure Panel Survey (MEPS) were combined to produce a nationally representative sample of adults who resided in the community for a calendar year. We established 6 rural–urban categories based upon Urban Influence Codes and examined 2 dependent variables: (a) likelihood of using any formal home care and (b) number of provider days received by users. The Area Resource File provided county-level information. Logistic and negative binomial regression analyses were employed, with adjustments for the MEPS complex sampling design and the combined years. Results Under controls for predisposing, enabling, and need variables, differences in likelihood of any formal home care use disappear, but differences in number of provider days received by users emerged, with fewer provider days in remote areas than in metro and several other nonmetro types. Conclusions It is important to fully account for predisposing, enabling, and need factors when assessing rural and urban home care utilization patterns. The limited provider days in remote counties under controls suggest a possible access problem for adults in these areas. PMID:19196690
Energy access and living standards: some observations on recent trends
NASA Astrophysics Data System (ADS)
Rao, Narasimha D.; Pachauri, Shonali
2017-02-01
A subset of Sustainable Development Goals pertains to improving people’s living standards at home. These include the provision of access to electricity, clean cooking energy, improved water and sanitation. We examine historical progress in energy access in relation to other living standards. We assess regional patterns in the pace of progress and relative priority accorded to these different services. Countries in sub-Saharan Africa would have to undergo unprecedented rates of improvement in energy access in order to achieve the goal of universal electrification by 2030. World over, access to clean cooking fuels and sanitation facilities consistently lag improved water and electricity access by a large margin. These two deprivations are more concentrated among poor countries, and poor people in middle income countries. They are also correlated to health risks faced disproportionately by women. However, some Asian countries have been able to achieve faster progress in electrification at lower income levels compared to industrialized countries’ earlier efforts. These examples offer hope that future efforts need not be constrained by historical rates of progress.
Teen Birth Rate. Facts at a Glance, 2002.
ERIC Educational Resources Information Center
Papillo, Angela Romano, Comp.; Franzetta, Kerry, Comp.; Manlove, Jennifer, Comp.; Moore, Kristin Anderson, Comp.; Terry-Humen, Elizabeth, Comp.; Ryan, Suzanne, Comp.
This publication reports trends in teen childbearing in the nation, in each state, and in large cities using data from the 2001 National Center for Health Statistics (NCHS). Rates of teenage childbearing continue to steadily decline, and the 2001 rates are historic lows for each age group. NCHS data showed that almost 80% of teen births nationwide…
ERIC Educational Resources Information Center
Foley, Eileen M.; Klinge, Allan; Reisner, Elizabeth R.
2007-01-01
The evaluation of the New Century High Schools (NCHS) initiative examined operations and student outcomes in 75 schools from 2002-2003 through 2005-2006. This report, the final in a series of annual evaluation reports, presents data collected over those years, with a focus on school year 2005-2006. The NCHS initiative grew out of a program theory…
Realistic expectations for public access defibrillation programs.
Atkins, Dianne L
2010-06-01
Public access defibrillation programs have increased dramatically over the past 15 years. This review will focus on their effectiveness and operational characteristics and discuss the characteristics of successful programs, which can improve outcomes. Automated external defibrillators increase survival from cardiac arrest when used by a bystander. Recent studies show that the best outcomes are achieved when devices are placed in areas with a high frequency of cardiac arrest and there is ongoing supervision with emergency plans and cardiopulmonary resuscitation training. Programs are cost-effective under these circumstances, but become very inefficient when placed in areas of low risk. There are few adverse events related to the public access defibrillation programs and volunteers are not harmed. Unguided placement results in devices not being used and a decline in organizational structure of the program. As most cardiac arrests occur in the home, the impact on overall survival remains low. Automated external defibrillators are highly effective at reducing death from ventricular fibrillation and easy access in public areas is most effective. Placement must be prioritized based on public health impact and characteristics of the community.
Medicaid nursing home pay for performance: where do we stand?
Arling, Greg; Job, Carol; Cooke, Valerie
2009-10-01
Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make recommendations for further development of nursing home P4P. We surveyed the six states with operational P4P systems in 2007. The range of performance measures employed by the states is quite broad: staffing level and satisfaction, findings from the regulatory system, clinical quality indicators, resident quality of life or satisfaction with care, family satisfaction, access to care for special populations, and efficiency. The main data sources for the measures are the Minimum Data Set (MDS), nursing home inspections, special surveys of nursing home residents, consumers or employees, and facility cost reports or other administrative systems. The most common financial incentive for better performance is a percentage bonus or an add-on to a facility's per diem rate. The bonus is generally proportional to a facility performance score, which consists of simple or weighted sums of scores on individual measures. States undertaking nursing home P4P programs should involve key stakeholders at all stages of P4P system design and implementation. Performance measures should be comprehensive, valid and reliable, risk adjusted where appropriate, and communicated clearly to providers and consumers. The P4P system should encourage provider investment in better care yet recognize state fiscal restraints. Consumer report cards, quality improvement initiatives, and the regulatory process should complement and reinforce P4P. Finally, the P4P system should be transparent and continuously evaluated.
Home-based intermediate care program vs hospitalization: Cost comparison study.
Armstrong, Catherine Deri; Hogg, William E; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S; Saginur, Raphael
2008-01-01
To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. Single-arm study with historical controls. Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P < .001), used more community care services following discharge (coefficient $729, P = .007), and were more likely to be readmitted to hospital within 3 months of discharge (coefficient 17%, P = .012) than patients treated in hospital. Total substituted costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs.
Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks
Alhuwail, Dari
2016-01-01
Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical
2012-01-01
Background Children in households of lower socioeconomic status (SES) are more likely to be overweight/obese. We aimed to determine if home physical activity (PA) environments differed by SES and to explore home environment mediators of the relation of family SES to children’s PA and sedentary behavior. Methods Participants were 715 children aged 6 to 11 from the Neighborhood Impact on Kids (NIK) Study. Household SES was examined using highest educational attainment and income. Home environment was measured by parent report on a survey. Outcomes were child’s accelerometer-measured PA and parent-reported screen time. Mediation analyses were conducted for home environment factors that varied by SES. Results Children from lower income households had greater media access in their bedrooms (TV 52% vs. 14%, DVD player 39% vs. 14%, video games 21% vs. 9%) but lower access to portable play equipment (bikes 85% vs. 98%, jump ropes 69% vs. 83%) compared to higher income children. Lower SES families had more restrictive rules about PA (2.5 vs. 2.0). Across SES, children watched TV/DVDs with parents/siblings more often than they engaged in PA with them. Parents of lower SES watched TV/DVDs with their children more often (3.1 vs. 2.5 days/week). Neither total daily and home-based MVPA nor sedentary time differed by SES. Children’s daily screen time varied from 1.7 hours/day in high SES to 2.4 in low SES families. Media in the bedroom was related to screen time, and screen time with parents was a mediator of the SES--screen time relationship. Conclusions Lower SES home environments provided more opportunities for sedentary behavior and fewer for PA. Removing electronic media from children’s bedrooms has the potential to reduce disparities in chronic disease risk. PMID:22835155
DOE Office of Scientific and Technical Information (OSTI.GOV)
none,
This builder was honored with an Affordable Builder award in the 2014 Housing Innovation Awards, for the first retrofit home certified to the DOE Zero Energy Ready home requirements.The 60-year-old, three-bedroom ranch home is expected to save its homeowner more than $1,000 a year in utility bills compared to a home built to the current 2009 International Energy Conservation Code.
Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review
Nancarrow, Susan; Dart, Jared; Gray, Leonard; Parkinson, Lynne
2018-01-01
Background Group therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions. Objective The aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional–led group videoconferencing to provide education or social support or both, into the home setting. Methods Electronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings. Results Of the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and
Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review.
Banbury, Annie; Nancarrow, Susan; Dart, Jared; Gray, Leonard; Parkinson, Lynne
2018-02-02
Group therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions. The aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional-led group videoconferencing to provide education or social support or both, into the home setting. Electronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings. Of the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and skills. Videoconference groups were able to
Exploring the first delay: a qualitative study of home deliveries in Makwanpur district Nepal
2014-01-01
Background In many low-income countries women tend to deliver at home, and delays in receiving appropriate maternal care can be fatal. A contextual understanding of these delays is important if countries are to meet development targets for maternal health. We present qualitative research with women who delivered at home in rural Nepal, to gain a contemporary understanding of the context where we are testing the effectiveness of an intervention to increase institutional deliveries. Methods We purposively sampled women who had recently delivered at home and interviewed them to explore their reasons for home delivery. Interviews were recorded, transcribed and analysed using thematic content analysis. We used the ‘delays’ model discussed in the literature to frame our analysis. Results Usually a combination of factors prevented women from delivering in health institutions. Many women were aware of the benefits of institutional delivery yet their status in the home restricted their access to health facilities. Often they did not wish to bring shame on their family by going against their wishes, or through showing their body in a health institution. They often felt unable to demand the organisation of transportation because this may cause financial problems for their family. Some felt that government incentives were insufficient. Often, a lack of family support at the time of delivery meant that women delivered at home. Past bad experience, and poor quality health services, also prevented women from having an institutional delivery. Conclusions Formative research is important to develop an understanding of local context. Sociocultural issues, perceived accessibility of health services, and perceived quality of care were all important barriers preventing institutional delivery. Targeting one factor alone may not be effective in increasing institutional deliveries. Our intervention encourages communities to develop local responses to address the factors preventing
The Virtual Dental Home: Implications for Policy and Strategy
Glassman, Paul; Harrington, Maureen; Mertz, Elizabeth; Namakian, Maysa
2012-01-01
Widely recognized problems with the U.S. health care system, including rapidly increasing costs and disparities in access and outcomes also exist in oral health. If oral health systems are to meet the “Triple Aim” of improving the experience of care, improving the health of populations, and reducing per capita costs of health care, new and innovative strategies will be needed including new regulatory, delivery, and financing systems. The virtual dental home is one such system. PMID:22916382
Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.
Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R
2016-06-01
The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. © The Author(s) 2015.
Suzuki, Lalita K; Beale, Ivan L
2006-01-01
The content of personal Web home pages created by adolescents with cancer is a new source of information about this population of potential benefit to oncology nurses and psychologists. Individual Internet elements found on 21 home pages created by youths with cancer (14-22 years old) were rated for cancer-related self-presentation, information dissemination, and interpersonal connection. Examples of adolescents' online narratives were also recorded. Adolescents with cancer used various Internet elements on their home pages for cancer-related self-presentation (eg, welcome messages, essays, personal history and diary pages, news articles, and poetry), information dissemination (e.g., through personal interest pages, multimedia presentations, lists, charts, and hyperlinks), and interpersonal connection (eg, guestbook entries). Results suggest that various elements found on personal home pages are being used by a limited number of young patients with cancer for self-expression, information access, and contact with peers.
Associations Between Home Death and the Use and Type of Care at Home.
McEwen, Rebecca; Asada, Yukiko; Burge, Frederick; Lawson, Beverley
2018-01-01
Despite wishes for and benefits of home deaths, a discrepancy between preferred and actual location of death persists. Provision of home care may be an effective policy response to support home deaths. Using the population-based mortality follow-back study conducted in Nova Scotia, we investigated the associations between home death and formal care at home and between home death and the type of formal care at home. We found (1) the use of formal care at home at the end of life was associated with home death and (2) the use of formal home support services at home was associated with home death among those whose symptoms were well managed.
NASA Astrophysics Data System (ADS)
Kimura, Hideaki
2013-03-01
Huge investment is needed for introducing a fiber-to-the-home system, so research and development strategy is very important. Requirements for fiber-to-the-home systems have been increased because communication systems have been recognized as one of the lifelines along with water, electricity, and gas. Furthermore, low energy consumption and recyclable eco-friendliness are required for products. NTT has been challenged to reduce capital expenditure, reduce operational expenditure, and create new applications for expanding the number of fiber-to-the-home subscribers from the viewpoint of a technological approach, including access infrastructure, fiber, transmission, and wireless technologies. Due to continuous and strategic technological development, the number of NTT's fiber-to-the-home subscribers is now over 17 million.
Trofholz, Amanda C.; Tate, Allan D.; Draxten, Michelle L.; Neumark-Sztainer, Dianne; Berge, Jerica M.
2015-01-01
Background Little research exists about the factors influencing the foods available at family meals. This study examines the home food environment factors contributing to the presence of fruit and vegetables at family meals. Methods Home food inventory (HFI) and survey data were collected from low-income, minority families (n=120) with children 6-12 years old. Observations from video-recorded family dinner meals, totaling 800 videos, were used to measure the frequency at which fruit and vegetables were served. Multiple regression was used to investigate how the fruit and vegetables in the HFI and other home food environment factors were related to the number of days fruit and vegetables were served at dinner during the observation period. Results Availability and accessibility of fruit and vegetables in the home were each found to be significantly associated with the presence of fruits and vegetables at family dinners. Of the fruit and vegetable categories (i.e., fresh, canned, or frozen), having fresh fruit and vegetables available in the home was found to be most strongly associated with serving fruit and vegetables at dinner, respectively. Higher parent intake of vegetables was associated with the presence of vegetables at dinners, and parent meal planning was associated with the presence of fruit at dinners. Conclusions Increasing the availability and accessibility of fresh fruit and vegetables in the home may be an effective approach to increasing the presence of fruits and vegetables at family dinners, especially among low-income, minority households. It is also essential to understand why families are not using all fruits and vegetables (e.g., canned and frozen) available in the home for family meals. Family meals are a place to promote the increased presence of both fruit and vegetables. PMID:26527254
Trofholz, Amanda C; Tate, Allan D; Draxten, Michelle L; Neumark-Sztainer, Dianne; Berge, Jerica M
2016-01-01
Little research exists about the factors influencing the foods available at family meals. This study examines the home food environment factors contributing to the presence of fruit and vegetables at family meals. Home food inventory (HFI) and survey data were collected from low-income, minority families (n = 120) with children 6-12 years old. Observations from video-recorded family dinner meals, totaling 800 videos, were used to measure the frequency at which fruit and vegetables were served. Multiple regression was used to investigate how the fruit and vegetables in the HFI and other home food environment factors were related to the number of days fruit and vegetables were served at dinner during the observation period. Availability and accessibility of fruit and vegetables in the home were each found to be significantly associated with the presence of fruits and vegetables at family dinners. Of the fruit and vegetable categories (i.e., fresh, canned, or frozen), having fresh fruit and vegetables available in the home was found to be most strongly associated with serving fruit and vegetables at dinner, respectively. Higher parent intake of vegetables was associated with the presence of vegetables at dinners, and parent meal planning was associated with the presence of fruit at dinners. Increasing the availability and accessibility of fresh fruit and vegetables in the home may be an effective approach to increasing the presence of fruits and vegetables at family dinners, especially among low-income, minority households. It is also essential to understand why families are not using all fruits and vegetables (e.g., canned and frozen) available in the home for family meals. Family meals are a place to promote the increased presence of both fruit and vegetables. Copyright © 2015 Elsevier Ltd. All rights reserved.
DOE Zero Energy Ready Home Case Study: Thrive Home Builders, Lowry Plan
DOE Office of Scientific and Technical Information (OSTI.GOV)
Pacific Northwest National Laboratory
Thrive Home Builders built this 4,119-ft2 home at the Lowry development in Denver, Colorado, to the high-performance criteria of the U.S. Department of Energy’s Zero Energy Ready Home Program. Despite the dense positioning of the homes, mono-plane roof designs afforded plenty of space for the 8.68 kW of photovoltaic panels. With the PV, the home achieves a Home Energy Rating System (HERS) score of 4 and the home owners should enjoy energy bills of about $-11 a year. Without the PV, the home would score a HERS 38 (far lower than the HERS 80 to 100 of typical new homes).
The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.
Linder, Susan M; Rosenfeldt, Anson B; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Bay, Curtis R; Wolf, Steven L; Alberts, Jay L
2013-01-01
Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.
Home Rx: The Health Benefits of Home Performance
DOE Office of Scientific and Technical Information (OSTI.GOV)
Wilson, Jonathan; Jacobs, David; Reddy, Amanda
Evidence in a new, groundbreaking U.S. Department of Energy report, Home Rx: The Health Benefits of Home Performance, shows that home performance upgrades can improve the quality of a home’s indoor environment by reducing the prevalence of harmful indoor air pollutants and contaminants. Until recently, no systematic review of this evidence had been conducted, limiting full understanding of the link between home performance and health. This new report summarizes current knowledge and identifies research gaps. The design characteristics and results of each of the 40 studies considered in the report are summarized in a searchable matrix.
ERIC Educational Resources Information Center
Ispa, Jean; Sharp, Elizabeth; Brookes, Sheila; Wolfenstein, Miriam; Thornburg, Kathy; Fine, Mark; Lane, Valeri
Noting that families in home visiting early intervention programs receive only about half the number of intended visits, this research used quantitative and qualitative methods to investigate how personality and other factors affect the mother-home visitor relationship and thereby, influence home visit intensity. Participating in the study were 5…
ERIC Educational Resources Information Center
Beeber, Linda S.; Schwartz, Todd A.; Holditch-Davis, Diane; Canuso, Regina; Lewis, Virginia; Matsuda, Yui
2014-01-01
Formidable barriers prevent low-income mothers from accessing evidence-based treatment for depressive symptoms that compromise their ability to provide sensitive, responsive parenting for their infant or toddler. interpersonal psychotherapy (IPT), an evidence-based psychotherapy for depression, was tailored for in-home delivery to mothers…
Qato, Dima Mazen; Wilder, Jocelyn; Zenk, Shannon; Davis, Andrew; Makelarski, Jennifer; Lindau, Stacy Tessler
Policy efforts to reduce the cost of prescription medications in the US have failed to reduce disparities in cost-related underuse. Little is known about the relationships between pharmacy accessibility, utilization, and cost-related underuse of prescription medications among residents of low-income minority communities. The aim of this work was to examine the association between pharmacy accessibility, utilization, and cost-related underuse of prescription medications among residents of predominantly low-income Black and Hispanic urban communities. Data from a population-based probability sample of adults 35 years of age and older residing on the South Side of Chicago in 2012-2013 were linked with the use of geocoded information on the type and location of the primary and the nearest pharmacy. Multivariable regression models were used to examine associations between pharmacy accessibility, utilization of and travel distance to the primary pharmacy, and cost-related underuse overall and by pharmacy type. One-third of South Side residents primarily filled their prescriptions at the pharmacy nearest to their home. Among those who did not use mail order, median distance traveled from home to the primary pharmacy was 1.2 miles. Residents whose primary pharmacy was at a community health center or clinic where they usually received care traveled the farthest but were least likely to report cost-related underuse of their prescription medications. Most residents of minority communities on Chicago's South Side were not using the pharmacies closest to their home to obtain their prescription medications. Efforts to improve access to prescription medications in these communities should focus on improving the accessibility of affordable pharmacies at site of care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Le, Ha; Engler-Stringer, Rachel; Muhajarine, Nazeem
2016-06-09
To identify characteristics of the food environment associated with child overweight/obesity that could, if subjected to intervention, mitigate the risk of childhood overweight/obesity. We examined whether the proximity to or density of grocery and convenience stores or fast food restaurants, or the prices of healthy food options were more strongly associated with overweight/obesity risk in children. We collected geocoded data by residential addresses for 1,469 children aged 10-14 years and conducted a census of all food outlets in Saskatoon. The Nutrition Environment Measures Survey (NEMS)-Stores and the NEMS-Restaurants were used to measure availability, quality and relative price of healthy food items in stores and restaurants. Children's weight status was calculated on the basis of measured height and weight. Logistic regression was used to test the associations between overweight/obesity and food environment variables. Within an 800 m walking distance from home, 76% of children did not have access to a grocery store; 58% and 32% had access to at least one convenience store or one fast-food restaurant respectively. A significantly lower odds of overweight/obesity was associated with lower price of healthy food items/options in grocery stores (odds ratio [OR] = 0.87, 95% confidence interval [CI] 0.77-0.99) and fast-food restaurants (OR = 0.97, 95% CI 0.95-0.99) within walking distance of home. Neither the distance to the closest food outlet nor the density of food outlets around children's homes was associated with odds of overweight/obesity. Improving economic access to healthy food in food outlets or fast-food restaurants is one strategy to counter childhood overweight/ obesity.
Biro, Dora; Guilford, Tim; Dell'Omo, Giacomo; Lipp, Hans-Peter
2002-12-01
Providing homing pigeons with a 5 min preview of the landscape at familiar sites prior to release reliably improves the birds' subsequent homing speeds. This phenomenon has been taken to suggest that the visual panorama is involved in familiar-site recognition, yet the exact nature of the improvement has never been elucidated. We employed newly developed miniature Global Positioning System (GPS) tracking technology to investigate how access to visual cues prior to release affects pigeons' flight along the length of the homing route. By applying a variety of novel analytical techniques enabled by the high-resolution GPS data (track efficiency, virtual vanishing bearings, orientation threshold), we localised the preview effect to the first 1000 m of the journey. Birds denied preview of a familiar landscape for 5 min before take-off flew an initially more tortuous path, including a high incidence of circling, possibly as part of an information-gathering strategy to determine their position. Beyond the first 1000 m, no differences were found in the performance of birds with or without preview. That the effect of the visual treatment was evident only in the early part of the journey suggests that lack of access to visual cues prior to release does not result in a non-specific effect on behaviour that is maintained throughout the flight. Instead, it seems that at least some decisions regarding the direction of home can be made prior to release and that such decisions are delayed if visual access to the landscape is denied. Overall, the variety of approaches applied here clearly highlight the potential for future applications of GPS tracking technology in navigation studies.
Protecting children from smoke exposure in disadvantaged homes.
Rowa-Dewar, Neneh; Lumsdaine, Colin; Amos, Amanda
2015-04-01
Smoke-free legislation and shifting norms in many countries have reduced secondhand smoke (SHS) exposure, but many children, particularly from disadvantaged homes, have high levels of exposure in homes and cars. We explored the particular challenges mothers who smoke face when attempting to protect their children from SHS exposure in disadvantaged homes. We conducted semi-structured interviews with 22 disadvantaged mothers of children aged 1-3 years in Scotland, using an innovative floor plan method to prompt accounts. Interviews were analyzed thematically. Disadvantaged mothers reported attempting to protect their children from both SHS and becoming smokers, motivated by the perceived future health and financial burdens these entail. The variable strategies used to protect children during early childhood were constrained and/or facilitated by limited and changing living circumstances, single parenthood, increasing child mobility and awareness of parental smoking, and complex social relationships. In the context of several intersecting dimensions of disadvantage (unemployment, low income, alcohol/drug abuse, and domestic abuse), the imperative to be and to be seen to be a good mother was also key in shaping smoking practices in the home. Challenging and changing domestic living circumstances and relationships and the increasing mobility of children in their first few years are key barriers to creating smoke-free homes for disadvantaged mothers. Key facilitators include mothers' concerns about children's increasing awareness of smoking and moving to accommodation with accessible outdoor space. Targeted public health initiatives need to acknowledge and support disadvantaged parents' existing motivations and attempts to protect children from both SHS and becoming smokers. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Meinow, Bettina; Kåreholt, Ingemar; Lagergren, Mårten
2005-07-01
Given the cutbacks which have been carried out in the Swedish welfare state despite the unchanged official policy of allocation of home help services according to needs, it is essential to evaluate the factors which guide the allocation of home help today. Whereas numerous studies have identified factors which predict entry into the home help system, the present paper concentrates on predictors of the amount of home help amongst those allocated assistance. Data were obtained from the population-based care and services section of the 2002 Swedish National Study of Aging and Care-Kungsholmen (SNAC-K). All home help recipients (> or = 65 years of age) living in an inner city district of Stockholm (Kungsholmen) were analysed with ordinary least squares regressions to identify predictors of the number of hours of home help (n = 943). Need indicators, i.e. dependency in activities of daily living (ADLs) and instrumental ADLs (IADLs), and cognitive impairment (Berger scale) were the strongest predictors of more hours of home help. The addition of sociodemographic (i.e. age, gender and income), environmental (i.e. informal care, housing adaptations and housing accessibility) and structural (i.e. variations in allocation decisions between one care manager and another) factors contributed only marginally to the explained variance. Hours of help entitlement increased slightly with greater age. Co-residing individuals were allocated significantly fewer home help hours than those living alone. Income and regular access to informal care were not significant predictors. The fact that services are provided according to need criteria does not necessarily mean that the provided services are adequate to meet needs. On the macro level, social policy decisions and available economic and manpower resources determine the allotment of municipal home help. However, this study in an urban sample suggests that, within the available resources, the amount of home help allocated is guided
The chaotic journey: Recovering from hip fracture in a nursing home.
Killington, Maggie; Walker, Ruth; Crotty, Maria
2016-01-01
To understand the journey experienced by nursing home residents following hip fracture and impressions of an outreach rehabilitation program offered after their return home. A qualitative investigation was undertaken in parallel with a randomised controlled trial investigating the efficacy and cost utility of providing a hospital outreach rehabilitation program for older nursing home residents who have recently returned from hospital following hip fracture. Family members and nursing home staff of 28 (out of the first 30) participants (14 from intervention and 14 from control) agreed to participate in interviews and focus groups to provide information and perceptions of each person's journey. NVivo 10 qualitative data analysis software package was used to identify major themes (via open, then axial and finally selective coding). Both family members and staff described nursing home residents with dementia as receiving poor post-operative care from hospital staff who seemed unfamiliar with dementia and delirium. Discharge from hospital soon after surgery (median 4.5days) occurred with poor transfer of information. Difficulties with residents' emotions, pain management and commencing mobilisation seemed more prevalent within usual care group, whereas fewer overall problems were encountered by those with access to a geriatrician and additional therapy. This research suggests that an integrated care pathway including the hospital stay and first weeks back at nursing homes should be developed. Performance indicators should include carer measures on the quality of the transfer, pain management measures in the first month and return to walking. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Goldfeld, Sharon; Price, Anna; Bryson, Hannah; Bruce, Tracey; Mensah, Fiona; Orsini, Francesca; Gold, Lisa; Hiscock, Harriet; Smith, Charlene; Bishop, Lara; Jackson, Dianne; Kemp, Lynn
2017-03-20
By the time children start school, inequities in learning, development and health outcomes are already evident. Sustained nurse home visiting (SNHV) offers a potential platform for families experiencing adversity, who often have limited access to services. While SNHV programmes have been growing in popularity in Australia and internationally, it is not known whether they can improve children's learning and development when offered via the Australian service system. The right@home trial aims to investigate the effectiveness of an SNHV programme, offered to women from pregnancy to child age 2 years, in improving parent care of and responsivity to the child, and the home learning environment. Pregnant Australian women (n=722) are identified after completing a screening survey of 10 factors known to predict children's learning and development (eg, young pregnancy, poor mental or physical health, lack of support). Consenting women-surveyed while attending clinics at 10 hospitals in Victoria and Tasmania-are enrolled if they report having 2 or more risk factors. The intervention comprises 25 home visits from pregnancy to 2 years, focusing on parent care of the child, responsivity to the child and providing a good quality home learning environment. The standard, universal, Australian child and family health service provides the comparator (control). Primary outcome measures include a combination of parent-reported and objective assessments of children's sleep, safety, nutrition, parenting styles and the home learning environment, including the Home Observation of the Environment Inventory and items adapted from the Longitudinal Study of Australian Children. This study is approved by the Royal Children's Hospital Human Research Ethics Committees (HREC 32296) and site-specific HRECs. The investigators and sponsor will communicate the trial results to stakeholders, participants, healthcare professionals, the public and other relevant groups via presentations and
The case for home based telehealth in pediatric palliative care: a systematic review
2013-01-01
Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology. PMID:23374676
Development of HIHM (Home Integrated Health Monitor) for ubiquitous home healthcare.
Kim, Jung Soo; Kim, Beom Oh; Park, Kwang Suk
2007-01-01
Home Integrated Health Monitor (HIHM) was developed for ubiquitous home healthcare. From quantitative analysis, we have elicited modal of chair. The HIHM could detect Electrocardiogram (ECG) and Photoplethysmography (PPG) non-intrusively. Also, it could estimate blood pressure (BP) non-intrusively, measure blood glucose and ear temperature. Detected signals and information were transmitted to home gateway and home server through Zigbee communication technology. Home server carried them to Healthcare Center, and specialists such as medical doctors could monitor by Internet. There was also feedback system. This device has a potential to study about ubiquitous home healthcare.
Socioeconomic inequalities in children's diet: the role of the home food environment.
Ranjit, Nalini; Wilkinson, Anna V; Lytle, Leslie M; Evans, Alexandra E; Saxton, Debra; Hoelscher, Deanna M
2015-07-27
It is well documented in the literature that low socioeconomic status (SES) is associated with lower consumption of healthy foods and that these differences in consumption patterns are influenced by neighborhood food environments. Less understood is the role that SES differences in physical and social aspects of the home food environment play in consumption patterns. Using data on 4th grade children from the 2009-2011 Texas School Physical Activity and Nutrition (SPAN) study, we used mixed-effects regression models to test the magnitude of differences in the SPAN Health Eating Index (SHEI) by parental education as an indicator of SES, and the extent to which adjusting for measures of the home food environment, and measures of the neighborhood environment accounted for these SES differences. Small but significant differences in children’s SHEI by SES strata exist (-1.33 between highest and lowest SES categories, p<0.01). However, incorporating home food environment and neighborhood environment measures in this model eliminates these differences (-0.7, p=0.145). Home food environment explains a greater portion of the difference. Both social (mealtime structure) and physical aspects (food availability) of the home food environment are strongly associated with consumption of healthy and unhealthy foods. Our findings suggest that modifiable parent behaviors at home can improve children’s eating habits and that the neighborhood may impact diet in ways other than through access to healthy food.
Hirdes, John P; Poss, Jeff W; Curtin-Telegdi, Nancy
2008-01-01
Background Home care plays a vital role in many health care systems, but there is evidence that appropriate targeting strategies must be used to allocate limited home care resources effectively. The aim of the present study was to develop and validate a methodology for prioritizing access to community and facility-based services for home care clients. Methods Canadian and international data based on the Resident Assessment Instrument – Home Care (RAI-HC) were analyzed to identify predictors for nursing home placement, caregiver distress and for being rated as requiring alternative placement to improve outlook. Results The Method for Assigning Priority Levels (MAPLe) algorithm was a strong predictor of all three outcomes in the derivation sample. The algorithm was validated with additional data from five other countries, three other provinces, and an Ontario sample obtained after the use of the RAI-HC was mandated. Conclusion The MAPLe algorithm provides a psychometrically sound decision-support tool that may be used to inform choices related to allocation of home care resources and prioritization of clients needing community or facility-based services. PMID:18366782
Dispenza, Jason
2017-12-27
A home energy assessment, also known as a home energy audit, is the first step to assess how much energy your home consumes and to evaluate what measures you can take to make your home more energy efficient. An assessment will show you problems that may, when corrected, save you significant amounts of money over time. This video shows some of the ways that a contractor may test your home during an assessment, and helps you understand how an assessment can help you move toward energy savings. Find out more at: http://www.energysavers.gov/your_home/energy_audits/index.cfm/mytopic=11160
Bruening, Meg; McClain, Darya; Moramarco, Michael; Reifsnider, Elizabeth
2016-01-01
Objective Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e. Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing. Design Cross-sectional study among vulnerable families. Sample Low-income, multi-ethnic families with children participating in WIC (n=54). Measurements Dietary intake was assessed with 24-hour recalls. Home food availability was assessed with an adapted home food inventory for low-income, multi-ethnic families. Validation results from adapted home food inventory for these families are also reported. Results SNAP households had more foods than non-SNAP households; few significant associations were observed between food availability and child dietary intake. Conclusions With few exceptions, the home food environment was not related to children’s dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing. PMID:28084013
Modelling home televisiting services using systems dynamic theory.
Valero, M A; Arredondo, M T; del Nogal, F; Gallar, P; Insausti, J; Del Pozo, F
2001-01-01
A quantitative model was developed to study the provision of a home televisiting service. Systems dynamic theory was used to describe the relationships between quality of care, accessibility and cost-effectiveness. Input information was gathered from the telemedicine literature, as well as from over 75 sessions of a televisiting service provided by the Severo Ochoa Hospital to 18 housebound patients from three different medical specialties. The model allowed the Severo Ochoa Hospital to estimate the equipment needed to support increased medical contacts for intensive cardiac and other patients.
In search of a common agenda for planned home birth in america.
Vedam, Saraswathi
2012-01-01
Leading maternity provider organizations in North America have been in conflict about birth at home and birth centers, debating issues related to safety, access, the value of obstetric intervention, and patient autonomy. In today's environment, childbirth educators and doulas are often required to explain to parents why physiological birth and evidence-based, low-technology methods of labor and birth care are not available in every setting, and why maternity providers disagree about birth place. There are very few regions in the United States where home birth providers are integrated into interprofessional provider networks that allow for seamless care across birth settings. In October 2011, multidisciplinary leaders met at a Home Birth Consensus Summit in Warrenton, Virginia, to discuss the status of home birth within the greater context of maternity care in the United States. This article describes the intent and outcomes of the summit. Four of the nine consensus statements developed at the summit are of particular interest and importance to mothers and families and, hence, to childbirth educators and advocates. Consumers, educators, and birth advocates are encouraged to widen the circle, identify communications experts, lead individual projects, or serve as advisors.
Storage of Poisonous Substances and Firearms in Homes with Young Children Visitors and Older Adults
Coyne-Beasley, Tamera; Runyan, Carol W.; Baccaglini, Lorena; Perkis, David; Johnson, Renee M.
2011-01-01
Background Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children’s access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only. Methods Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population. Results There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged ≥70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present. Conclusions Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors. PMID:15626565
Weaver, Meaghann S; Wichman, Brittany; Bace, Sue; Schroeder, Denice; Vail, Catherine; Wichman, Chris; Macfadyen, Andrew
2018-06-01
The national nursing shortage translates into a gap in home nursing care available to children with complex, chronic medical conditions and their family caregivers receiving palliative care consultations. A total of 38 home health nursing surveys were completed by families receiving pediatric palliative care consultation services at a freestanding children's hospital in the Midwest. The gap in the average number of nursing hours allotted versus received was 40 h/wk per family, primarily during evening hours. Parents missed an average of 23 hours of employment per week to provide hands-on nursing care at home, ranking stress regarding personal employment due to nursing shortage at 6.2/10. Families invested an average of 10 h/mo searching for additional nursing coverage and often resorted to utilizing more than 6 different home nurse coverage personnel per month. Families reported multiple delays to hospital discharges (mean, 15 days per delay) due to inability to find home nursing coverage. Respiratory technology and lack of Medicaid coverage ( P < .02) correlated with the gap in home nursing access. This study examines how the pediatric home nursing shortage translates into a lived experience for families with children with complex medical conditions receiving palliative care.
ERIC Educational Resources Information Center
Brooks, Lara; Whitacre, Brian; Shideler, Dave; Muske, Glenn; Woods, Mike
2012-01-01
Small and home-based businesses have long been identified by Extension educators as an important component of economic development, particularly in rural areas. The services available to these businesses can take many forms, including management training, accessibility of local funding, providing incubation facilities, or setting up mentoring…
The Joy of Telecomputing: Everything You Need to Know about Going On-Line at Home.
ERIC Educational Resources Information Center
Pearlman, Dara
1984-01-01
Discusses advantages and pleasures of utilizing a personal computer at home to receive electronic mail; participate in online conferences, software exchanges, and game networks; do shopping and banking; and have access to databases storing volumes of information. Information sources for the services mentioned are included. (MBR)
Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program.
Walus, Ashley N; Woloschuk, Donna M M
2017-01-01
Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist's recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model of service provision remains unclear. More research
Impact of Pharmacists in a Community-Based Home Care Service: A Pilot Program
Walus, Ashley N; Woloschuk, Donna M M
2017-01-01
Background Historically, pharmacists have not been included on home care teams, despite the fact that home care patients frequently experience medication errors. Literature describing Canadian models of pharmacy practice in home care settings is limited. The optimal service delivery model and distribution of clinical activities for home care pharmacists remain unclear. Objectives The primary objective was to describe the impact of a pharmacist based at a community home care office and providing home visits, group education, and telephone consultations. The secondary objective was to determine the utility of acute care clinical pharmacy key performance indicators (cpKPIs) in guiding home care pharmacy services, in the absence of validated cpKPIs for ambulatory care. Methods The Winnipeg Regional Health Authority hired a pharmacist to develop and implement the pilot program from May 2015 to July 2016. A referral form, consisting of consultation criteria used in primary care practices, was developed. The pharmacist also reviewed all patient intakes and all patients waiting in acute care facilities for initiation of home care services, with the goal of addressing issues before admission to the Home Care Program. A password-protected database was built for data collection and analysis, and the data are presented in aggregate. Results A total of 197 referrals, involving 184 patients, were received during the pilot program; of these, 62 were excluded from analysis. The majority of referrals (95 [70.4%]) were for targeted medication reviews, and 271 drug therapy problems were identified. Acceptance rates for the pharmacist’s recommendations were 90.2% (74 of 82 recommendations) among home care staff and 47.0% (55 of 117 recommendations) among prescribers and patients. On average, 1.5 cpKPIs were identified for each referral. Conclusions The pilot program demonstrated a need for enhanced access to clinical pharmacy services for home care patients, although the best model
Roby, Dylan H; Pourat, Nadereh; Pirritano, Matthew J; Vrungos, Shelley M; Dajee, Himmet; Castillo, Dan; Kominski, Gerald F
2010-08-01
The Medical Services Initiative program--a safety net-based system of care--in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment. Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER visits or multiple ER visits. The findings provide evidence that successful implementation of the patient-centered medical home model in a county-based safety net system is possible and can reduce unnecessary ER use.
The beliefs and expectations of patients and caregivers about home haemodialysis: an interview study
Tong, Allison; Palmer, Suetonia; Manns, Braden; Craig, Jonathan C; Ruospo, Marinella; Gargano, Letizia; Johnson, David W; Hegbrant, Jörgen; Olsson, Måns; Fishbane, Steven; Strippoli, Giovanni F M
2013-01-01
Objectives To explore the beliefs and expectations of patients and their caregivers about home haemodialysis in Italy where the prevalence of home haemodialysis is low. Design Semistructured, qualitative interview study with purposive sampling and thematic analysis. Setting Four dialysis centres in Italy without home haemodialysis services (Bari, Marsala, Nissoria and Taranto). Participants 22 patients receiving in-centre haemodialysis and 20 of their identified caregivers. Results We identified seven major themes that were central to patient and caregiver perceptions of home haemodialysis in regions without established services. Three positive themes were: flexibility and freedom (increased autonomy, minimised wasted time, liberation from strict dialysis schedules and gaining self-worth); comfort in familiar surroundings (family presence and support, avoiding the need for dialysis in hospital) and altruistic motivation to do home haemodialysis as an exemplar for other patients and families. Four negative themes were: disrupting sense of normality; family burden (an onerous responsibility, caregiver uncertainty and panic and visually confronting); housing constraints; healthcare by ‘professionals’ not ‘amateurs’ (relinquishing security and satisfaction with in-centre services) and isolation from peer support. Conclusions Patients without direct experience or previous education about home haemodialysis and their caregivers recognise the autonomy of home haemodialysis but are very concerned about the potential burden and personal sacrifice home haemodialysis will impose on caregivers and feel apprehensive about accepting the medical responsibilities of dialysis. To promote acceptance and uptake of home haemodialysis among patients and caregivers who have no experience of home dialysis, effective strategies are needed that provide information about home haemodialysis to patients and their caregivers, assure access to caregiver respite, provide continuous
RDI's Wisdom Way Solar Village Final Report: Includes Utility Bill Analysis of Occupied Homes
DOE Office of Scientific and Technical Information (OSTI.GOV)
Robb Aldrich, Steven Winter Associates
2011-07-01
In 2010, Rural Development, Inc. (RDI) completed construction of Wisdom Way Solar Village (WWSV), a community of ten duplexes (20 homes) in Greenfield, MA. RDI was committed to very low energy use from the beginning of the design process throughout construction. Key features include: 1. Careful site plan so that all homes have solar access (for active and passive); 2. Cellulose insulation providing R-40 walls, R-50 ceiling, and R-40 floors; 3. Triple-pane windows; 4. Airtight construction (~0.1 CFM50/ft2 enclosure area); 5. Solar water heating systems with tankless, gas, auxiliary heaters; 6. PV systems (2.8 or 3.4kWSTC); 7. 2-4 bedrooms, 1,100-1,700more » ft2. The design heating loads in the homes were so small that each home is heated with a single, sealed-combustion, natural gas room heater. The cost savings from the simple HVAC systems made possible the tremendous investments in the homes' envelopes. The Consortium for Advanced Residential Buildings (CARB) monitored temperatures and comfort in several homes during the winter of 2009-2010. In the Spring of 2011, CARB obtained utility bill information from 13 occupied homes. Because of efficient lights, appliances, and conscientious home occupants, the energy generated by the solar electric systems exceeded the electric energy used in most homes. Most homes, in fact, had a net credit from the electric utility over the course of a year. On the natural gas side, total gas costs averaged $377 per year (for heating, water heating, cooking, and clothes drying). Total energy costs were even less - $337 per year, including all utility fees. The highest annual energy bill for any home evaluated was $458; the lowest was $171.« less
Hospice use among nursing home and non-nursing home patients.
Unroe, Kathleen T; Sachs, Greg A; Dennis, M E; Hickman, Susan E; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M
2015-02-01
For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients. Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05). Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.
Lavin, Tina; Preen, David B
2017-08-01
More than 50% of women worldwide give birth at home, but little is known about home birth and subsequent neonatal hospitalisation. The objective of the study was to investigate home birth and neonatal hospitalisation of term neonates in Peru. The relationship between birth setting [home - with or without skilled birth attendant (SBA), health centre, hospital] and neonatal hospitalisation (n = 1656) and incubator care (n = 1651) was investigated using data from the 2002 Young Lives Study. Infants were sampled from 20 sentinel sites across Peru. At each sentinel site 100 households with children aged 6-18 months were randomly sampled (therefore the sample only captured children surviving to 6 months of age). Multivariate regression modelling was used with models adjusted for a range of demographic and clinical factors. After adjustment, the odds of hospitalisation were lower in neonates born at home (with SBA OR 0.20, 95% CI 0.0-0.8, p = 0.021; without SBA OR = 0.4, 95% CI 0.2-0.7, p = 0.002) than in those born in hospital. Socio-demographic factors such as ethnicity, rural living, education, socio-economic status and access to transport did not influence neonatal hospitalisation, time in hospital, incubator care or time under incubator care. Neonates born at home were less likely to be hospitalised after birth owing to neonatal morbidity than neonates born in hospital. It is unclear whether this finding reflects poorer accessibility to hospital care for neonates born at home, or if neonates born at home required hospitalisation less frequently than neonates born in hospital owing to lower neonatal morbidity or other factors such as lower rates of medical intervention for home births. Further research is needed to explore the underlying mechanisms of these findings.
... venous catheter - home; Port - home; PICC line - home; Infusion therapy - home; Home health care - IV treatment ... is given quickly, all at once. A slow infusion, which means the medicine is given slowly over ...
Integrated care organizations: Medicare financing for care at home.
Davis, Karen; Willink, Amber; Schoen, Cathy
2016-11-01
As the boomer population ages, there is a growing need for integrated care organizations (ICOs) that can integrate both medical care and long-term services and supports in the home. This paper presents a policy proposal to support the creation of ICOs, redesign care, and provide financing for home- and community-based services (HCBS), with the goal of enhancing financial protection for beneficiaries, coordinating care, and preventing costly hospital and nursing home use. This study used the 2012 Medicare Current Beneficiary Survey (MCBS) Cost and Use File, inflated to 2016 figures, to describe the characteristics of Medicare beneficiaries and their healthcare utilization and spending. The costs of covering up to 20 hours of personal care services a week were estimated using MCBS population counts, participation assumptions based on the literature, and financing design parameters. A targeted HCBS benefit could be added to Medicare and financed with income-related cost sharing ranging from 5% to 50%, a premium paid by Medicare beneficiaries of approximately $42 a month, and payroll taxes estimated at around 0.4% of earnings on employers and employees. Adoption of an HCBS benefit in Medicare would improve financial protection for beneficiaries with physical and/or cognitive impairment and provide the financing for health organizations to better integrate medical and social services. ICOs and delivery models of care emphasizing care at home would improve accessibility of care and avoid costly institutionalization; additionally, it would also reduce beneficiary reliance on Medicaid.
Trondsen, Marianne V.
2014-01-01
Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is limited research on patients’ use of e-health services for home-based ulcer treatment. This article reports an exploratory qualitative study of the first Norwegian web-based counselling service for home-based ulcer treatment, established in 2011 by the University Hospital of North Norway (UNN). Community nurses, general practitioners (GPs) and patients are offered access to a web-based record system to optimize ulcer care. The web-based ulcer record enables the exchange and storage of digital photos and clinical information, by the use of which, an ulcer team at UNN, consisting of specialized nurses and dermatologists, is accessible within 24 h. This article explores patients’ experiences of using the web-based record for their home-based ulcer treatment without assistance from community nurses. Semi-structured interviews were conducted with a total of four patients who had used the record. The main outcomes identified were: autonomy and flexibility; safety and trust; involvement and control; and motivation and hope. These aspects improved the patients’ everyday life during long-term ulcer care and can be understood as stimulating patient empowerment. PMID:27429289
Bolin, Jane N; Gamm, Larry; Vest, Joshua R; Edwardson, Nick; Miller, Thomas R
2011-01-01
Many are calling for the expansion of the patient-centered medical home model into rural and underserved populations as a transformative strategy to address issues of access, efficiency, quality, and sustainability in the delivery of health care. Patient-centered medical homes have been touted as a promising cost-saving model for comprehensive management of persons with chronic diseases and disabilities, but it is unclear how rural practitioners in medically underserved areas will implement the patient-centered medical home. This article examines how the Patient Protection & Affordable Care Act of 2010 will enhance rural providers' ability to provide patient-centered care and services contemplated under the Act in a comprehensive, coordinated, cost-effective way despite leaner budgets and health workforce shortages.
77 FR 72738 - Contracts and Provider Agreements for State Home Nursing Home Care
Federal Register 2010, 2011, 2012, 2013, 2014
2012-12-06
... State Home Nursing Home Care AGENCY: Department of Veterans Affairs. ACTION: Interim final rule. SUMMARY... into contracts or provider agreements with State homes for the nursing home care of certain disabled... submitted in response to ``RIN 2900-AO57--Contracts and Provider Agreements for State Home Nursing Home Care...
Mental health of mothers caring for ventilator-assisted children at home.
Kuster, Patricia A; Badr, Lina K
2006-10-01
The complex management of ventilator-assisted children cared for in the home can place emotional and mental strain on parents, in particular, mothers. The purpose of this study was to explore the relationships among functional status of the child, impact of ventilator-assistance on the family, coping, social support, and depression in mothers caring for ventilator-assisted children at home. Thirty-eight mothers participated in the study. Almost half of the mothers experienced depressive mood symptoms. Impact on family was positively related to depression and social support was inversely related to depression. In addition, social support was a significant predictor of depression. The findings show that the high demands related to the care of ventilator-assisted children can be a significant risk factor for poor mental health outcomes of those mothers providing care at home. Interventions by mental health and pediatric nurses should focus on enhancing mothers' coping skills and assisting mothers in accessing a positive social network to help mediate the stress related to caring for their child.
What Use Patterns Were Observed for PEV Drivers at Publicly Accessible AC Level 2 EVSE Sites?
DOE Office of Scientific and Technical Information (OSTI.GOV)
Francfort, James Edward
2015-12-01
The EV Project deployed over 4,000 ACL2 EVSE for drivers to charge their plug-in electric vehicle (PEV) when away-from-home. The vast majority of these EVSE stations were installed to be available to all PEV drivers at publicly accessible locations. Some were also deployed for use at workplaces and fleets. This paper examines only the use patterns of PEV drivers using the EVSE intended to be publicly accessible.
The Use of Social Media Tools by School Principals to Communicate between Home and School
ERIC Educational Resources Information Center
Mazza, Joseph A., Jr.
2013-01-01
Research has documented numerous benefits of parent involvement in children's education including increased attendance, increased test scores and better behavior. Access to increased and meaningful communication between home and school enhances parent involvement. The utilization of technology through the use of the Internet and e-mail for school…
Nursing home checklist Name of nursing home: ____________________________________________________ Address: ________________________________________________________________ Phone number: __________________________________________________________ Date of visit: _____________________________________________________________ Basic information Yes No Notes Is the nursing home Medicare certified? Is the nursing ...
Modification of Obstetric Emergency Simulation Scenarios for Realism in a Home-Birth Setting.
Komorowski, Janelle; Andrighetti, Tia; Benton, Melissa
2017-01-01
Clinical competency and clear communication are essential for intrapartum care providers who encounter high-stakes, low-frequency emergencies. The challenge for these providers is to maintain infrequently used skills. The challenge is even more significant for midwives who manage births at home and who, due to low practice volume and low-risk clientele, may rarely encounter an emergency. In addition, access to team simulation may be limited for home-birth midwives. This project modified existing validated obstetric simulation scenarios for a home-birth setting. Twelve certified professional midwives (CPMs) in active home-birth practice participated in shoulder dystocia and postpartum hemorrhage simulations. The simulations were staged to resemble home-birth settings, supplies, and personnel. Fidelity (realism) of the simulations was assessed with the Simulation Design Scale, and satisfaction and self-confidence were assessed with the Student Satisfaction and Self-Confidence in Learning Scale. Both utilized a 5-point Likert scale, with higher scores suggesting greater levels of fidelity, participant satisfaction, and self-confidence. Simulation Design Scale scores indicated participants agreed fidelity was achieved for the home-birth setting, while scores on the Student Satisfaction and Self-Confidence in Learning indicated high levels of participant satisfaction and self-confidence. If offered without modification, simulation scenarios designed for use in hospitals may lose fidelity for home-birth midwives, particularly in the environmental and psychological components. Simulation is standard of care in most settings, an excellent vehicle for maintaining skills, and some evidence suggests it results in improved perinatal outcomes. Additional study is needed in this area to support home-birth providers in maintaining skills. This pilot study suggests that simulation scenarios intended for hospital use can be successfully adapted to the home-birth setting. © 2016 by
Screen Time at Home and School among Low-Income Children Attending Head Start
Fletcher, Erica N.; Whitaker, Robert C.; Marino, Alexis J.; Anderson, Sarah E.
2013-01-01
Objective To describe the patterns of screen viewing at home and school among low-income preschool-aged children attending Head Start and identify factors associated with high home screen time in this population. Few studies have examined both home and classroom screen time, or included computer use as a component of screen viewing. Methods Participants were 2221 low-income preschool-aged children in the United States studied in the Head Start Family and Child Experiences Survey (FACES) in spring 2007. For 5 categories of screen viewing (television, video/DVD, video games, computer games, other computer use), we assessed children’s typical weekday home (parent-reported) and classroom (teacher-reported) screen viewing in relation to having a television in the child’s bedroom and sociodemographic factors. Results Over half of children (55.7%) had a television in their bedroom, and 12.5% had high home screen time (>4 hours/weekday). Television was the most common category of home screen time, but 56.6% of children had access to a computer at home and 37.5% had used it on the last typical weekday. After adjusting for sociodemographic characteristics, children with a television in their bedroom were more likely to have high home screen time [odds ratio=2.57 (95% confidence interval: 1.80–3.68)]. Classroom screen time consisted almost entirely of computer use; 49.4% of children used a classroom computer for ≥1 hour/week, and 14.2% played computer games at school ≥5 hours/week. Conclusions In 2007, one in eight low-income children attending Head Start had >4 hours/weekday of home screen time, which was associated with having a television in the bedroom. In the Head Start classroom, television and video viewing were uncommon but computer use was common. PMID:24891924
DOE Office of Scientific and Technical Information (OSTI.GOV)
Achieving Building America energy savings goals (40 percent by 2030) will require many existing homes to install energy upgrades. Engaging large numbers of homeowners in building science-guided upgrades during a single remodeling event has been difficult for a number of reasons. Performance upgrades in existing homes tend to occur over multiple years and usually result from component failures (furnace failure) and weather damage (ice dams, roofing, siding). This research attempted to: A) Understand the homeowner's motivations regarding investing in building science based performance upgrades. B) Determining a rapidly scalable approach to engage large numbers of homeowners directly through existing customermore » networks. C) Access a business model that will manage all aspects of the contractor-homeowner-performance professional interface to ensure good upgrade decisions over time. The solution results from a synergistic approach utilizing networks of suppliers merging with networks of homeowner customers. Companies in the $400 to $800 billion home services industry have proven direct marketing and sales proficiencies that have led to the development of vast customer networks. Companies such as pest control, lawn care, and security have nurtured these networks by successfully addressing the ongoing needs of homes. This long-term access to customers and trust established with consistent delivery has also provided opportunities for home service providers to grow by successfully introducing new products and services like attic insulation and air sealing. The most important component for success is a business model that will facilitate and manage the process. The team analyzes a group that developed a working model.« less
Martinez-Harms, Maria Jose; Bryan, Brett A; Wood, Spencer A; Fisher, David M; Law, Elizabeth; Rhodes, Jonathan R; Dobbs, Cynnamon; Biggs, Duan; Wilson, Kerrie A
2018-09-15
Experiences with nature through visits to protected areas provide important cultural ecosystem services that have the potential to strengthen pro-environmental attitudes and behavior. Understanding accessibility to protected areas and likely preferences for enjoying the benefits of nature visits are key factors in identifying ways to reduce inequality in access and inform the planning and management for future protected areas. We develop, at a regional scale, a novel social media database of visits to public protected areas in part of the Chilean biodiversity hotspot using geotagged photographs and assess the inequality of access using the home locations of the visitors and socio-economic data. We find that 20% of the population of the region make 87% of the visits to protected areas. The larger, more biodiverse protected areas were the most visited and provided most cultural ecosystem services. Wealthier people tend to travel further to visit protected areas while people with lower incomes tend to visit protected areas that are closer to home. By providing information on the current spatial flows of people to protected areas, we demonstrate the need to expand the protected area network, especially in lower income areas, to reduce inequality in access to the benefits from cultural ecosystem services provided by nature to people. Copyright © 2018 Elsevier B.V. All rights reserved.
An access to care center as a learning organization.
Parris, U
2000-01-01
The Durham Access to Care (DATC) is one of the new streamlined vehicles for the delivery of integrated home-based and community-based health services across Ontario. Management and staff in this change transition have undertaken to become a learning organization. To implement this visionary process leadership qualities and style is key. This article gives a brief account of DATC and its move to becoming a learning organization and the author's observational reflections of an effective leadership style.
Gary Nash: Preeminent Scholar and Committed Educator
ERIC Educational Resources Information Center
Symcox, Linda
2009-01-01
The author has known Gary Nash as a friend since 1969, but she only began to work with him as a colleague in 1989, when he invited her to join the National Center for History in the Schools (NCHS) as it was just forming. During the seven years she spent as Assistant and then Associate Director of the NCHS, they shared the extraordinary experience…
16 CFR 460.16 - What new home sellers must tell new home buyers.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 16 Commercial Practices 1 2011-01-01 2011-01-01 false What new home sellers must tell new home... LABELING AND ADVERTISING OF HOME INSULATION § 460.16 What new home sellers must tell new home buyers. If you are a new home seller, you must put the following information in every sales contract: The type...
16 CFR 460.16 - What new home sellers must tell new home buyers.
Code of Federal Regulations, 2013 CFR
2013-01-01
... 16 Commercial Practices 1 2013-01-01 2013-01-01 false What new home sellers must tell new home... LABELING AND ADVERTISING OF HOME INSULATION § 460.16 What new home sellers must tell new home buyers. If you are a new home seller, you must put the following information in every sales contract: The type...
16 CFR 460.16 - What new home sellers must tell new home buyers.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 16 Commercial Practices 1 2010-01-01 2010-01-01 false What new home sellers must tell new home... LABELING AND ADVERTISING OF HOME INSULATION § 460.16 What new home sellers must tell new home buyers. If you are a new home seller, you must put the following information in every sales contract: The type...