Separation of housing and care: more or less care? Consequences for health care services utilization by the elderly

The Dutch policy for the care of the elderly has been mainly characterised by the aim to improve the possibility for elderly people to live independently for as long as possible. One measure that has been taken to achieve this goal is the separation of the financing of care from the accommodation in which care is given. Recent discussions have brought to light some possible positive and negative effects of this separation on the use of care. It is, however, largely unknown to what extent there are differences concerning the nature and intensity of care and the type of caregivers provided to dwellers of houses where care and housing are separated (so-called 'life-time houses') and the elderly who live in homes for residential care and nursing homes. To gain insight in this matter an explorative study was conducted in Rotterdam of the use of several health facilities by matching 35 dwellers of 'life-time houses' on the criteria age, health needs and social status with 35 dwellers of residential care homes and nursing homes. On the basis of interviews, questionnaires and patient records data were collected and analysed on the nature and amount of help that has been given (per minute per week) and the kind of caregiver. The main finding is that the use pattern differs between the research groups. Dwellers of 'life-time houses' generally make more use of some care facilities and make more use of different types of care and caregivers. These differences however do not seem to be exclusively caused by the separation of housing and care.     

Domiciliary care for the elderly sick--economy or neglect?

This paper reports an investigation of the costs of domiciliary care for 139 elderly sick patients under the care of the home nursing service. The data suggest that there may be little economic advantage in home care for seriously disabled elderly people. The revenue cost of domiciliary care was equal to or greater than the average associated with residential or hospital custodial care in such patients. Even so, the cost of services received at home did not disclose the real need for domiciliary care, since at present this is obscured by compulsory rationing and the separation of responsibility between health and social services. It is suggested that the supposed economic advantage of domiciliary care will depend increasingly on restricting such services, thus increasing the degree of neglect to some patients.     

When should cuckolded males care for extra-pair offspring?

In socially monogamous species with bi-parental care, males suffer reduced reproductive success if their mate engages in extra-pair copulations (EPCs). One might therefore expect that males should refuse to care for a brood if they can detect that an EPC has occurred. Here, we use a game-theory model to study male brood care in the face of EPCs in a cooperatively breeding species in which offspring help to raise their (half-) siblings in their parents' next breeding attempt. We show that under certain conditions males are selected to care even for broods completely unrelated to themselves. This counterintuitive result arises through a form of pseudo-reciprocity, whereby surviving extra-pair offspring, when helping to rear their younger half-siblings, can more than compensate for the cost incurred by the male that raised them. We argue that similar effects may not be limited to cooperative breeders, but may arise in various contexts in which cooperation between (half-) siblings occurs.     

Durable power of attorney for health care. Are we ready for it?

Health care professionals need to be well informed about advance directives for medical care in the event a patient becomes incapacitated. The Patient Self-Determination Act requires that all patients be advised of their options at the time of hospital admission. Hospitals and health care professionals will need to work together to plan for implementing this law. We surveyed 215 physicians, nurses, and social workers at a Veterans Affairs Medical Center about the California advance directive, the Durable Power of Attorney for Health Care. Attitudes were generally positive. All of the social workers had heard of the durable power of attorney directive, but 36% of physicians and nurses had never heard of it and an additional 20% had no experience with one. For respondents who had heard of the directive, the mean knowledge score was 6.35 of a possible 10 (5 predicted by chance). Respondents brought up the issue of durable power of attorney with patients before a crisis only 19% of the time and determined whether one had been signed for only 16% of older patients in hospital. The most commonly cited reasons for failure to discuss this with patients were lack of proper forms, pamphlets, or a place to refer a patient. Of those who had ever seen such a document in use, 42% were aware of a problem with it at some time. Whereas attitudes toward advance directives are positive, many physicians and nurses had little knowledge of the Durable Power of Attorney for Health Care and were poorly equipped to discuss it with patients. We encourage educating hospital staff to prepare for the enactment of the Patient Self-Determination Act. We also recommend that the concerns raised by professionals about the use of a durable power of attorney be addressed.     

Requirements for a minimum standard of care for phenylketonuria: the patients’ perspective

Phenylketonuria (PKU, ORPHA716) is an inherited disorder that affects about one in every 10,000 children born in Europe. Early and continuous application of a modified diet is largely successful in preventing the devastating brain damage associated with untreated PKU. The management of PKU is inconsistent: there are few national guidelines, and these tend to be incomplete and implemented sporadically. In this article, the first-ever pan- European patient/carer perspective on optimal PKU care, the European Society for Phenylketonuria and Allied Disorders (E.S.PKU) proposes recommendations for a minimum standard of care for PKU, to underpin the development of new pan-European guideline for the management of PKU. New standards of best practice should guarantee equal access to screening, treatment and monitoring throughout Europe. Screening protocols and interpretation of screening results should be standardised. Experienced Centres of Expertise are required, in line with current European Union policy, to guarantee a defined standard of multidisciplinary treatment and care for all medical and social aspects of PKU. Women of childbearing age require especially intensive management, due to the risk of severe risks to the foetus conferred by uncontrolled PKU. All aspects of treatment should be reimbursed to ensure uniform access across Europe to guideline-driven, evidence-based care. The E.S.PKU urges PKU healthcare professionals caring for people with PKU to take the lead in developing evidence based guidelines on PKU, while continuing to play an active role in serving as the voice of patients and their families, whose lives are affected by the condition.     

‘One Health' for the people of Hong Kong and the world

正Translational medicine refers to the conversion of scientific discoveries into improvements in medical practice.‘From bench to bedside and back’is a phrase that is often used to describe the two-way information flow in translational medicine.On one hand,scientists working at the bench make new discoveries that enable clinicians to revolutionize     

Chitosan: An option for development of essential oil delivery systems for oral cavity care?

Microencapsulation of bioactive compounds has received increased attention in the last decade. Among the polymers used for developing microparticulated systems, chitosan has been widely cited. Obtained by deacetylation of chitin, chitosan is a natural, biodegradable, biocompatible and mucoadhesive polymer with permeability enhancement properties. These data justify its use for overcoming the reduced efficacy of conventional treatments of oral diseases. Various tests simulating the buccal environment have described controlled drug release profile and significant activity against buccal pathogens by chitosan microparticles entrapping antimicrobial agents. Considering the increasing microbial resistance to conventional antibiotics, essential oils have shown to be an important option against these pathogens. For sustained stability and prolonged release of essential oils from pharmaceutical formulations, some authors have studied the association of chitosan to them. This review disserts about the application of chitosan and essential oils on oral cavity care pointing out their association may be an interesting option.