Search Results (515)

Patients with a mesothelioma diagnosis often have relatively sedentary lifestyles and low physical activity. Reducing sedentary behaviour and being more active could be beneficial. A greater understanding of the factors associated with physical activity is needed to inform the development of interventions. Semi-structured interviews with patients with mesothelioma and informal carers were performed and analysed thematically. Three themes were generated: (1) the impact of disease burden and physical and psychological symptoms, (2) the psychosocial consequences and benefits of physical activity and (3) unpredictability and maintaining control. Participants had become increasingly sedentary during diagnosis and while undergoing treatment. Symptoms were key factors contributing to these reductions. Being less active reduced social connectedness and impacted psychological well-being. Some participants had lost confidence in being active and were worried about the potential negative consequences of doing more. Being able to walk was a priority, and they felt hopeful about increasing this in the future, but this depended on optimisation of symptoms. Clear guidance from healthcare professionals was needed to support engagement in physical activity. Declines in physical activity can have meaningful consequences for patients. Optimisation of symptoms is important to devise strategies to support patients with physical activity. Along with encouragement from healthcare professionals. Full article

Adolescence is a developmental period of significant change and increasing independence, during which parents and caregivers play a critical role guiding their teen toward adulthood. Parents of adolescents with disability face heightened challenges managing their teens’ growing independence and shift to adult-based services across health, recreation, and employment. Using a mixed-methods-treatment-group-only design, this study explored the implementation and outcomes of a program designed to build parenting capacity to support their adolescent with disability. Parents enrolled in one of ten groups were invited to attend three sessions covering content tailored to adolescent development including post-school opportunities, financial support, risk-taking and decision-making, future planning, relationships, and mental health. Surveys were administered pre-program, post-program, and six months after program participation (n = 160) to measure intervention outcomes including parenting self-efficacy, self-advocacy, adolescent self-advocacy, parent confidence to support their adolescent’s growing independence, confidence to support their adolescent through sensitive developmental stages, parental hopes and aspirations, and parental empowerment. A subset of parents (n = 11) also participated in semi-structured interviews about the program’s acceptability and usefulness, and their satisfaction with the program content and delivery. All outcome variables except parent hopes and aspirations increased significantly from pre- to post-program. Parent self-efficacy, self-advocacy, and parental empowerment remained higher 6 months after program completion. Thematic analysis identified program strengths as the co-facilitation model of program delivery, practical and actionable content, the use of narratives and the facilitator’s lived experience as parents of adolescents with disability, the use of visualizations (video, pictures, diagrams), and the service provider’s trusted reputation and credibility. In conclusion, an online co-facilitated group program for parents of adolescents with disability can contribute to positive change for families by improving parent confidence, self-advocacy, and parental empowerment. Full article

As global populations continue to age, alcohol consumption rises, and we strive to age in place, it is important to have an up-to-date understanding of domiciliary carers’ perspectives on older adults’ alcohol use in their care. Therefore, a systematic review and thematic synthesis of qualitative studies of the unique challenges faced by domiciliary care workers in front line roles regarding older adults’ alcohol use was conducted (PROSPERO registration number: CRD42024516660). Eight databases were searched on 22 February 2024 for qualitative studies focusing on older adults’ (defined as aged 50 or over) alcohol consumption and domiciliary care. The Critical Appraisal Skills Programme checklist was utilised for quality appraisal. Twenty articles reporting 14 unique studies of mainly medium to low quality were included. Three overarching themes (and associated subthemes) were identified as follows: identification (alcohol problems are common, no assessment for alcohol problems, and additional overt signs of excessive alcohol use), management (to buy or not to buy that is the question, balancing rights and risks, monitor and report but do not intervene, maintaining the vicious circle, home as a barrier to accessing support and services, and more support needed from healthcare professionals), and training (lack of alcohol education). Domiciliary carers are well placed to make every contact count to target alcohol consumption but would benefit from support and resources for alcohol consumption identification and management. Clear guidance on how to manage alcohol consumption to harmoniously balance rights and risks is crucial, particularly when caring for older adults with cognitive difficulties. Full article

The struggles of several women defending their territories and lives are marked by family tensions and reactions to the overload of care tasks and community rules according to their socially established roles. In this qualitative research, we analyze and discuss the cases of three women’s collectives from different suburban and rural communities in Jalisco. Information recollected through the new ethnography approach over six years was coded and analyzed with the Atlas ti program. Results: Women’s defense of their land involvement, organizing, and social mobilization actions move to an overload of care and raise adverse reactions in their community and families in response to what is seen as a transgression of women’s roles. This increases dominant demobilization emotions: fear, sadness, loneliness, guilt, and shame. Through emotional management strategies linked with alternative forms of appropriation of space, starting with their bodies and sharing emotions and actions with their companions, the women in these collectives produced emotions of resistance: pride, hope, friendship, and anger, which led to reconfiguring their identities, family relationships, and roles within other place domains: bodies, family, and community. Conclusions: Women defenders, as principal carers of life, have produced and inherited a set of strategies that configure a growing “politics of the ordinary. “These strategies, through emotional management, subvert dominant emotions, feelings, and acting rules, gradually questioning and reinventing their roles and human and nonhuman relations in their most immediate contexts. Full article

Introduction: Despite the increasing overrepresentation of Aboriginal and Torres Strait Islander (hereafter respectfully referred to as First Nations) children living in out-of-home care (OOHC) in Australia, little is known about their wellbeing needs. This comprehensive literature review aimed to identify these needs and the features of care required to meet them. Methods: MEDLINE, CINAHL, Scopus, Informit, PsycINFO, and Embase databases and relevant grey literature were searched from inception to December 2023 for articles presenting qualitative accounts and perspectives relevant to the wellbeing needs of First Nations children in OOHC. These included reports from First Nations children in OOHC; First Nations adults with lived experience of OOHC; carers, caseworkers, and organizational stakeholders; and First Nations community members with relevant lived and/or professional experience. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Braun and Clarke’s reflexive thematic analysis method for data analysis. Results: Thirty-five articles (19 peer-reviewed, 16 grey literature) met the inclusion criteria. Our analysis revealed six wellbeing needs of First Nations children in OOHC: Being seen, being heard; a sense of stability; holistic health support; social and cultural connections; culturally safe OOHC providers; and preparedness for transitioning out of care. A range of features of OOHC were also identified as critical for supporting these needs. Conclusions: Our findings suggest that First Nations children in OOHC have unique wellbeing needs in addition to safety, security, and health. Attention to the development and maintenance of social and cultural connections is an important concern that must be addressed by OOHC providers (caseworkers and organizations) and carers and supported by OOHC policy and the associated systems in Australia as part of providing culturally safe and supportive care. Full article

Electrical burn injuries to the scalp are at risk of extensive tissue damage and neurological complications. We present the case of a patient who came into contact with a high-voltage power line while cherry picking, resulting in a large full-thickness scalp defect. Early on in his presentation, he developed progressive global weakness which remained relatively static during his admission. An incidental finding of an extradural abscess complicated his management, requiring urgent surgical intervention with definitive tissue coverage. The scalp was reconstructed using a free myocutaneous anterolateral thigh flap. There were no postoperative complications. Following rehabilitation, the patient was discharged home with limited functional recovery. He mobilises independently with a wheelchair and requires full-time carers. Full article

Background: Reading nutritional labelling helps consumers select healthier food, thereby benefitting their oral health. The purpose of this study was to describe the knowledge, attitudes, and practices (KAPs) of parents and carers of children and preteens, associated with reading nutritional labelling, selecting sweetened ultra-processed foods, and their impact on oral health. Materials and Methods: This was a descriptive cross-sectional study in which a validated questionnaire was administered to 298 parents and caregivers of children aged 1–12 years from different districts in Villavicencio, Colombia. Participants’ scores, based on the number of correct answers, were used to classify their level of KAP as low, medium, or high. In addition, the frequency of responses, the KAP levels, and the median scores were analysed. Finally, associations were determined using the chi-square test. Results: Most participants reached a medium level in terms of knowledge (41.6%) and attitudes (49.3%) and a low level in terms of practices (43.3%). An association was found between participants’ level of KAPs and their socioeconomic and educational level (p < 0.05). Conclusions: The study findings reveal inadequate KAPs associated with nutritional labelling, adequate food selection, and the importance of oral health. Full article

Pressure ulcers are serious healthcare concerns, especially for the elderly with reduced mobility. Severe pressure ulcers are accompanied by pain, degrading patients’ quality of life. Thus, speedy and accurate detection and classification of pressure ulcers are vital for timely treatment. The conventional visual examination method requires professional expertise for diagnosing pressure ulcer severity but it is difficult for the lay carer in domiciliary settings. In this study, we present a mobile healthcare platform incorporated with a light-weight deep learning model to exactly detect pressure ulcer regions and classify pressure ulcers into six severities such as stage 1–4, deep tissue pressure injury, and unstageable. YOLOv8 models were trained and tested using 2800 annotated pressure ulcer images. Among the five tested YOLOv8 models, the YOLOv8m model exhibited promising detection performance with overall classification accuracy of 84.6% and a mAP@50 value of 90.8%. The mobile application (app) was also developed applying the trained YOLOv8m model. The mobile app returned the diagnostic result within a short time (≒3 s). Accordingly, the proposed on-device AI app can contribute to early diagnosis and systematic management of pressure ulcers. Full article

Cognitive impairment associated with schizophrenia (CIAS) represents one of the core features of the disorder and has a significant impact on functional and rehabilitation outcomes of people living with schizophrenia spectrum disorders (SSD). The aim of this critical review is to highlight the most recent evidence on effective treatments available for CIAS, to discuss the current challenges in this field, and to present future perspectives that may help to overcome them. Concerning psychopharmacological approaches, among the most indicated strategies for the management and prevention of CIAS is to favor second-generation antipsychotic medications and avoid long-term and high-dose treatments with anticholinergic medications and benzodiazepines. Moreover, non-pharmacological approaches such as cognitive remediation and physical exercise-based programs represent evidence-based interventions in the treatment of CIAS that have shown reliable evidence of effectiveness on both cognitive and functional outcomes. These treatments, however, are still delivered to people accessing mental health services with a diagnosis of CIAS in an uneven manner, even in high-income countries. Academic and clinical partnership and collaboration, as well as advocacy from service users, families, carers, and stakeholders’ organizations could help to reduce the bench to bedside gap in the treatment of CIAS. Future perspectives include the development of novel pharmacological agents that could be effective in the treatment of CIAS, the implementation of novel technologies such as telemedicine and virtual reality in the delivery of evidence-based interventions to improve accessibility and engagement, and further research in the field of non-invasive brain stimulation. Full article

Vaccine-preventable diseases continue to generate a substantial burden on health, healthcare systems, and societies, which is projected to increase with population ageing. There is a need to better understand the full value of adult immunisation programmes corresponding to the broader value of vaccine frameworks that are recommended for evidence-based decision-making. This review aims to summarise and map evidence for the value of selected adult immunisation programmes (seasonal influenza, pneumococcal disease, RSV, and HZ) in ten diverse countries. We conducted a structured literature review of evidence published from 2017 to 2023. An existing framework was used to structure the assessment, developing matrices demonstrating the elements of value evidenced for each vaccine and country of focus. Our analysis showed substantial evidence base on the value of adult immunisation programmes, but the availability of evidence varied by value element and by vaccine. The impact on the quality of life of the vaccinated individual was the most evidenced value element. Mortality benefits for vaccinated individuals and cost-offsets to healthcare systems were also well-evidenced. The availability of evidence for ‘broader’ societal value elements (such as transmission value, carer productivity and impact on social equity, and antimicrobial resistance prevention) varied. No evidence was identified relating to the broader value elements of macroeconomic effects, value to other interventions, or effects on the quality of life of caregivers. Robust evidence exists to show that adult immunisation programmes generate substantial value for population health and health systems, yet some elements of broader value remain underrepresented in the academic literature. Without such evidence, the full value of immunisation programmes is underestimated, risking suboptimal policy decisions. Full article

This study explores the resilience and resemblance among children of parents with alcohol-related problems in Botswana. Alcohol misuse affects both users and their families, particularly children. Although children raised in an alcoholic environment often face long-term adversities, some become resilient adults while others present behaviours resembling those of their parents. This study used socio-ecological resilience theory to explore the perceptions and experiences of adult children of parents and carers with alcohol-related problems, as well as the pathways they use to navigate risks. We collected data from seven adult children in a village in Botswana using in-depth, unstructured interviews. The study revealed two global themes: familial practices and protective factors. The vulnerability, resemblance, and resilience experienced by adult children of parents with alcohol-related problems are discussed. This study helps us to understand the adult children of parents and carers with alcohol-related problems in a rural cultural context. Their lived experiences demonstrate that resilience and resemblance coexist and are not mutually exclusive. Full article

When monitoring an animal’s welfare, it helps to have comprehensive and day-to-day information about the animal’s life. The goal is to ensure that animal guardians (carers, keepers, and owners) use such information to act in the animals’ best interests. This article introduces the Mellorater, an animal welfare monitoring app based on the 2020 Five Domains Model. This framework provides a means of capturing comprehensive information about the world in which individual animals exist. The Mellorater asks animal guardians to rate their agreement with 18 statements covering any focal animal’s nutrition, environment, health, and behavioural interactions using a five-point Likert scale. No specialist training is required other than following straightforward instructions on using the app, which are provided. The Mellorater is not proposed as a validated welfare auditing tool because it relies on reflective self-reporting and, thus, is vulnerable to the user’s subjectivity. If users’ subjectivity is stable over time, then the longitudinal data may be considered useful proxies for trends in quality of life. That said, it has the potential to be used by trained auditors if scientifically validated, species-specific indicators are applied. The Mellorater collects anonymous data and has been approved for a study to explore how the use of such scales may differ among guardians of different species and in different contexts. In this paper, we conduct the following: (1) summarise the app’s purposes; (2) clarify its capabilities and limitations; and (3) invite animal welfare scholars, veterinarians, health and welfare professionals, and animal guardians to use it. Full article

Musical improvisation is a generative process of spontaneously creating music ‘in the moment’. For people with young onset dementia, musical improvisation provides an extended opportunity for creative self-expression and connection to one’s own body and life story. Using visual research methods, including video elicitation interviews, this paper explores the ‘in the moment’ musical experiences of five people living with young onset dementia who took part in a 15-week improvised music-making programme (Music in Mind). We frame the exploration of the group’s musical experiences through the emerging lens of ‘care aesthetics’—a concept that identifies the sensory relations and embodied practices between two (or more) people in a caring relationship. In the context of this analysis, we look to the caring practices by, with, and between people living with dementia, their family members, and the musicians who lead the programme and the relationship of these practices to feelings of self-expression and meaningful connection. Musical improvisation has the potential to support the psychological, social, and spiritual wellbeing of people living with young onset dementia. In applying a lens of care aesthetics, it is possible to observe the micro-level experiences of people living with dementia and their family carers. Full article

Malnutrition rates in Advanced Liver Disease (ALD) are significantly higher than those in well-compensated liver disease. In addition to its physiological impact, malnutrition is detrimental for quality of life and social, emotional, and psychological well-being. Studies within oncology and renal supportive care have identified the influence of non-physiological factors on malnutrition risk. Integrating similar factors into malnutrition screening for ALD could improve identification of at-risk patients to optimize treatment planning. This qualitative study aimed to understand the holistic factors influencing nutritional status in the ALD population. Semi-structured interviews with 21 patients, carers, and clinicians explored the experiences of malnutrition in ALD. Thematic analysis revealed five key themes: (i) appropriateness of healthcare delivery; (ii) health- and food-related factors; (iii) high symptom burden, (iv) social support impacting well-being, and (v) physical and structural supports. Current screening methods do not adequately capture all potential drivers of malnutrition in the ALD population. Adopting a more supportive approach including both physiological and non-physiological factors in ALD malnutrition screening may promote more timely and comprehensive nutritional interventions that address the complex and holistic needs of patients living with ALD. Full article

A total of 10% of children looked after in residential care in Scotland are aged 5–11. Although there has been a significant amount of information published about the care trajectories of adolescents in residential care, there is limited information about the experiences of younger children. In this paper, we explore the care trajectories and nature of care received by 5–11-year-olds identified as being in need of residential care. Our results show that younger children who enter residential care have significant trauma histories and experience significant levels of emotional and behavioural dysregulation that foster carers find challenging to manage, resulting in recurrent placement breakdowns. Residential care, particularly small-group-sized care that adopts social pedagogical and psychotherapeutic approaches, was considered beneficial for addressing the psychosocial and emotional needs of younger children. Despite these findings, there were concerns about the long-term use of residential care for younger children. Our results highlight that there is a need to improve access to paediatric mental health services for children in family-based placements. There is also a need to invest in better training and support for foster carers looking after children in severe distress. Community-based outreach services and in-home respite services provided by residential care teams are one way this could be achieved. Finally, in order to promote earlier and more timeous use of residential care, there is a need to shift societal views around residential care being a placement of last resort to rather being a place of recovery and healing that should sometimes be used as a placement of first resort. Full article