Growth in the elderly population and restraint in the health sector have led to decision makers placing an increasing priority on home care services. In Canada, there are three models of home care: a preventive and maintenance model which is designed to reduce the rate of deterioration for persons with relatively low level care needs; an acute care substitution model where home care substitutes for hospital care; and a long term care substitution model which uses home care as a substitute for facility care. This study focuses on the long term care substitution model. The research question is: In the British Columbia continuing care sector, is home care for the elderly a cost-effective alternative for government funders to care in long term care facilities, by level of care? To answer this question, data were obtained on three cohorts of clients for one year prior to initial assessment and three years post-assessment. The cohorts were new admissions to the British Columbia continuing care system in the 1987/88, 1990/91 and 1993/94 fiscal years. Costs to government for home care services, residential services, pharmaceuticals, fee-for-service physician services and hospital services were analyzed. The central finding of this study was that, on average, the overall health care costs to government for clients in home care are about one half to three quarters of the costs for clients in facility care, by level of care. A related finding was that costs differ by the type of client. The lowest home care costs were for individuals who were stable in their type and level of care. For clients who died the costs for home care were higher, compared to clients in long term care facilities. It was also found that some one half of the overall health care costs for home care clients were attributable to their use of acute care hospital services and that a significant portion of the health costs for home care clients occur at transition points, that is, when there is a change in the client's type, and/or level, of care. These findings are compared to the American literature which indicates that home care is not a cost-effective substitute for residential care. Possible reasons for the differences in findings are discussed. The study concludes with a discussion of the implications of the findings for a series of potential, future, policy agendas regarding: the organization and management of continuing care services; legislation and administrative policy; service delivery; resource allocation; information systems; and research. / Graduate

The ventral tegmental area (VTA) is an important component of the mesolimbic dopamine circuit and processes reward and motivational behaviors. In response to drug exposure, synaptic connections of this circuit can be rewired via synaptic plasticity—a phenomenon thought be responsible for the pathology of addiction. While much is known about dopamine neuron plasticity, less is known regarding plasticity exhibited by VTA GABA cells, specifically inhibitory inputs from outside the VTA. Expanding on the work of Bocklisch et al. (2013), we investigated the plasticity of inhibitory inputs to VTA GABA neurons. Using whole cell electrophysiology in GAD67 GFP mice, we observed that these VTA GABA cells can experience either long-term potentiation (LTP) or long-term depression (LTD) in response to a 5 Hz stimulus. While neither the LTP nor LTD appear to be mediated by the cannabinoid-1 receptor (CB1), the nitric oxide synthase (NOS) pathway, or the dopamine-2 (D2) receptor, the LTP is blocked by APV, an NMDA receptor antagonist, and the LTD is blocked by CGP 54626, an antagonist of the GABAB receptor. Additionally, µ-opioid and adenosine-1 receptors modulated plasticity at this synapse, but chronic morphine administration (10mg/kg) did not block the observed LTP or LTD. Furthermore, we used an optogenetic approach in VGAT-Cre mice to target inhibitory inputs from the lateral hypothalamus (LH) to the VTA. An optical stimulus (5 Hz) caused these inputs to depress, which has not been previously described and may be behaviorally important in reward processing. These novel findings increase our understanding of VTA neural circuitry, ultimately increasing our capacity to better comprehend and treat the pathology of addiction. Additionally, changes in synaptic strength in hippocampal CA1 pyramidal cells are thought to be responsible for the acquisition and retention of short-term memory. Feedforward stratum radiatum interneurons of many subtypes experience LTD, short-term depression (STD), or lack of plasticity, but it is not known whether plasticity correlates with specific interneuron subtypes. Using whole cell electrophysiology and qPCR, we characterized the plasticity expressed by hippocampal interneurons in correlation with their mRNA expression patterns to determine cell subtype. We also assessed the expression of endocannabinoid (eCB) biosynthetic enzymes as well as metabotropic glutamate receptor subunits known to mediate plasticity. Cells exhibiting LTD tended to express mRNA for at least one of the eCB biosynthetic enzymes and the metabotropic glutamate receptor subunit mGluR5. mGluR5 was not expressed by cells exhibiting STD or no plasticity. Cells that exhibited short-term depression tended to express mRNA for at least one of the eCB biosynthetic enzymes, but not mGluR5. This suggests that stratum radiatum interneuron plasticity can be predicted based on mGluR expression, and that these different types of plasticity may have some importance in hippocampal function.

Large numbers of baby boomers and a shift towards home-based long-term care designate a need for a greater understanding of caregiver attitudes surrounding the financing of long-term home-based care. This study examined more fully the types of home-based long-term care services that family caregivers were utilizing for their parents. In addition, the willingness and ability of caregivers to privately fund these services for aging parents were explored. The study utilized a preexisting data set of qualitative interviews that were conducted with 30 family caregivers helping to provide long-term care for an elderly parent or older-generation relative. Participants in the sample used many home- and community-based services such as home health aides and nurses, physical therapists, cleaning services and adult day centers. Often these services were funded via Medicare, Medicaid, care recipient funds, state programs, and caregiver funds. In addition, caregivers were often willing, but unable to pay for long-term parent care on their own. Many caregivers in the study found paying for long-term parent care unnecessary. Family expectations, moral and religious responsibility, and a high aversion to nursing home care were cited as reasons for willingness to fund long-term care at home. Similarly, lack of family support and other personal obstacles were noted as reasons for inability to pay for care. Those who found payment for care unnecessary noted that care recipients had sufficient funds for their own long-term care.

No description available.

No description available.

Research indicates children's exposure to family violence results in long-term negative consequences, hindering social skill development and impacting on the ability to function as healthy, productive adults. Also, there exists a widely accepted theory, called the 'cycle of violence', which hypothesises that children who have experienced violence at the hands of their parents tend to grow up to become violent parents themselves. Some evidence for this theory has been found following research with groups of abusive parents and people who have committed crimes, This study explores the specific impacts of childhood exposure to family violence on the subsequent mothering of a group of women drawn from the general population. A qualitative approach using a methodology that combined feminist and narrative approaches was used. Nine women who have been exposed to family violence in childhood including physical, emotional/psychological, sexual abuse and witness to violence between parents participated in interviews which explored their experiences of mothering Each woman was interviewed twice to collect stories of childhood and of mothering experiences. These were analysed revealing that the women's mothering was affected by their childhood exposure to family violence in several ways, ranging from direct emotional impacts to indirect impacts of conceptualisations formed in the light of childhood experiences. This study adds to the existing knowledge of the long-term impacts of childhood exposure to family violence by focussing specifically on subsequent mothering. The findings encourage social work and health care personnel to appreciate that women exposed to family violence in childhood have specific issues with their mothering and there is a need to address these issues. It also challenges the weight given to the cycle of violence theory in intervention and prevention strategies in child abuse and family violence sectors

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 46-01, page: 0311. Adviser: Osama Mikhail. Includes bibliographical references.

The purpose of this study was to determine the extent to which nursing home organizational structure and cultural variables were related to the outcomes reported by the Health Care Finance Administration public use data set (HCFA-NHCD). A second purpose was to examine the effects of a new style of nursing home management called the Eden Alternative™ concept. A related purpose was to test the usefulness of the HCFA-NHCD in predicting the quality of care for residents in federally approved nursing homes. Secondary data analysis was conducted on the HCFA-NHCD, as published in December 2001. Descriptive statistics and measures of association were used to assess the degree of relationship between the organizational structure and culture variables and the eight clinical health indicators of the HCFA-NHCD. Multiple regression analyses were conducted to measure the impact of the organizational structure and culture variables on the quality of care for residents in federally approved nursing homes. When compared with previously collected statistics, these findings suggest that there is a nationwide trend towards smaller nursing homes; smaller Eden homes were associated with a higher level of individualized attention. Smaller Eden homes with council representation had better scores on a majority of the eight clinical health indicators when compared to their counterparts with no council representation. Council representation was inversely related to a nursing homes' reliance on RN and LPLVN services. However, a regression model assessing the impact of organizational structure and cultural variables on the quality of care for residents in federally approved nursing homes had very limited predictive power (R2=2.2%). The findings of this study suggest that quality improvements in the HCFA-NHCD are needed in order to better serve families.

Objective(s). An increasing demand exists for psychological interventions to increase recovery from depression and anxiety in people with long-term physical health conditions (LTCs). Guided self-help (GSH) may meet this need, however, there is limited evidence of GSH’s appropriateness for people with LTCs. Design. A mixed-methods study using qualitative interviews with people with stroke and Chronic Obstructive Pulmonary Disease (COPD), and a quantitative survey of professionals who support guided self-help, explored opinions about whether self-help is appropriate, and whether suggested adaptations varied across LTCs. Results. Opinions varied about the appropriateness of standard self-help and adaptations required. Illness beliefs may help explain differences between the two LTCs and individual interviewees. The majority of professionals surveyed felt competent supporting people with LTCs, and reported having access to appropriate self-help material. Conclusions. Recommendations for improving the appropriateness of contents of guided self-help for people with LTCs are provided. Supporting professionals need relevant knowledge and skills to integrate information about the LTC into the intervention, and offer flexible, personalised delivery to support participation.

BACKGROUND:Nephropathic cystinosis is an autosomal recessive disease resulting from intracellular accumulation of cystine leading to multiple organ failure.CASE REPORT:We describe the clinical course of a patient managed from the age of six until his death at the age of 33 years. He underwent multiple surgery, including two renal transplants, developed transplant renal artery stenosis that was managed medically, and progressive heart failure at the age of 33 years. His death from a ruptured pseudoaneurysm associated with a restrictive cardiomyopathy is noteworthy. A limited cardiac autopsy revealed the presence of cystine crystals in interstitial cardiac histiocytes and one myocardial cell, along with 1000-fold higher tissue cystine content of the left ventricular myocardium compared to patients without cystinosis, suggesting the possibility of direct cystine mediated metabolic injury.