Affectionate Care is the Hope for Overcoming AIDS

WE once felt lonely and helpless, and grieved to death. Luckily, we found Beijing You'an Hospital and all the staff from the infectious section warmly received us. Their affection warmed our hearts, their gentle words comforted us and their attentive treatment alleviated ou pain.... We are longing for the sunshine of love to melt the ice in our hearts, we are waiting for the advance of medical science and the arrival of the time that human beings can finally conquer AIDS. We are determined to struggle with the     

Meeting the Needs of the Social Care and Health Care Workforce: Can a Duck Sleep with a Hippopotamus?

In a period when recruitment and retention are crucial issues in health and social care the focus of this paper is:

? Who are the workforce of health and social care?

? What are the needs of that workforce?

? How safe is it for the much smaller partner, social care, to work together with the much larger health care?

The latter point heads us back to the sub‐title of the paper: can a duck sleep with a hippopotamus?

This question comes from an advert used in the UK for a bed manufacturer, where our British sensitivities and fear of sex prevents us from showing a man and a woman in a double bed, what the Spanish charmingly call a ‘cama de matrimonio’, a marriage bed, and instead we show a hippopotamus and a duck sleeping, safely, in the same bed.

To follow this analogy, we have to show:

? that health and social care are in the same bed;

? that one is as large as a hippopotamus, and the other as small as a duck;

? what the dangers are of this;

and ask the question:

? What is there in the place of ‘spring technology’ which would permit both to sleep together, and for the duck not to end up flat?

In doing so, I hope to answer the first three questions I posed.     

Women and Children's Health Care in the Yimeng Mountain Area

The Yimeng Mountain area in the central and southern part of Shandong Province, is very poor.     

Aging in Rural Japan—Limitations in the Current Social Care Policy

Owing to equal and increased opportunities for education and employment, today's trend in Japanese marriages is characterized by late and less frequent marriage. This paper discusses unavoidable diversity in rural families to point out the anticipated consequences of aging in rural areas and to discuss limitations in current public social care policies. Specifically, the averaged proportion of never-married and single persons at ages 45 to 49 and 50 to 54 in legally recognized depopulated cities, towns, and villages in Japan is calculated to illustrate the expected diversity in families in rural depopulated areas. It also illustrates the need for future studies to develop better social care policies for increasing numbers of single caregivers and single elders.     

Government guidance for the Care Act: undermining ambitions for change?

The UK Government claims to be creating a historic change to social care in England through the Care Act by putting people in control of their support. However, this is fundamentally contradicted by the draft guidance published to support the Act. This amounts to a formula for maintaining the prevailing resource-limited approach to assessing and meeting needs. This reality is obscured by a welter of choice and person-centred rhetoric. However, it need not be like this. Councils with a genuine commitment to being person-centred could refer directly to the Care Act to create an alternative future, while service users and their allies could bring about systemic changes if they use the Act to establish new rights.     

Do Foster Parents and Care Workers Recognize the Needs of Youth in Family Foster Care with a History of Sexual Abuse?

Children in family foster care have the right to participate in decisions regarding their life, however, adults often advocate on behalf of children. This Q methodological study explored whether shared perspectives among foster parents and care workers resemble shared perspectives of youth regarding the psychosocial needs experienced by youth with a history of sexual abuse. Participants sorted a set of statement cards according to what they thought was most important for youth. By-person factor analyses examined how the Q sorts of foster parents and care workers related to those of youth. The results showed that foster parents mostly recognized the group of youth who value an instrumental relationship with their carers, while care workers mostly recognized the group of youth who value support of both foster and birth parents with regard to their preparation for independent living. The two youth groups characterized by ambivalence and autonomy were barely recognized. Results are discussed in light of the expected roles of foster parents and care workers, and youth’s contact with birth parents. Lastly, this study highlights the importance of youth participation, because youth offer unique and varying perspectives about their needs.     

Why Has the Ethics of Care Become an Issue of Global Concern?

Since Carol Gilligan published her masterpiece, In a Different Voice, many scholars, especially feminist scholars in various fields, including moral theory, philosophy, and political and legal theory, have been inspired to establish a more inclusive approach to social injustice as well as sexual inequality. The purpose of this article is to explore the depth and expanse of the ethics of care for its potential as a political philosophy. To pursue this end, the article analyzes first the main claims of care ethics by responding to its typical counterarguments, which criticize the ethics of care as being too dependent on gender differences, particularism, and essentialism. The second section examines three challenges that care ethics poses to the male-oriented mainstream of political philosophy, especially the theory of justice. The ethics of care provides us with a new approach to moral and political issues because it focuses responsively on social injustice, proposes a new idea of relational self and takes the social connection model to justice. With these three perspectives proposed by the ethics of care in mind, the article turns its eyes to global implications of care ethics by referring to the issue of the “comfort women” of Japanese troops during the Second World War.     

Where Are the Children? Extent and Determinants of Preschoolers' Child Care Time

According to the 1988 National Health Interview Child Health Supplement, half of all children under age six attended nonparental child care on a regular basis. Close to a quarter of all children spent 40 or more hours per week in care. Average time in care was 30.5 hours for children in care. Statistical tests indicate that (a) the predictors of whether parents use any child care differ from the predictors of the number of hours care is used, and (b) estimates for children under three years of age differ from estimates for children from three to five years of age. The probability of attending care is related to a child's age, mother's education, race, family type, number and age of siblings, type of adults living in the household, income, poverty status, and region and size of the community in which a family resides. For children from three to five years of age, hours in care are associated with child's age, mother's education, race, family type, siblings, income, poverty status, and region. For children under three years of age, relatively few factors (mother's education, race, siblings, and region) predict the number of hours spent in child care.     

What’s the Relationship Got to do with It? Understanding the Therapeutic Relationship in Therapeutic Foster Care

The therapeutic relationship is increasingly recognized as important to understanding how process variables contribute to treatment outcomes. In this paper, we examine the therapeutic relationship between children with serious emotional and behavioral disorders and their treatment providers in the context of an observational study of Therapeutic Foster Care (TFC). Our findings suggest that the quality of the relationship between the treatment parent and youth in a TFC setting is significantly associated with better emotional and behavioral functioning for the youth. It appears from these findings that the quality of the relationship between the youth and treatment parent in a TFC setting is at least one of the mechanism or process factors that contribute to improved functioning for the youth.     

Doing the Scut Work of Infant Care: Does Religiousness Encourage Father Involvement?

Considerable debate exists regarding whether religiousness promotes or impedes greater father involvement in parenting. Our study addresses this issue using a Midwestern longitudinal dataset that tracks the transition to first parenthood for 169 married couples. We focus on performance of the "messier" tasks of infant care. We find little evidence that religiousness enhances father involvement in this domain. Biblically conservative couples exhibit a greater gender gap in childcare than others, with mothers more involved than fathers. The gender gap is also greater the more fathers work outside the home, the greater mothers' knowledge of infant development, and the more unadaptable the infant. Average daily childcare is lower the greater spouses' work hours, but higher with difficult pregnancies or fussy babies.     

Direct,Facilitate, Enable—the Juxtaposition of the Duty of Care and the Duty of Disclosure in Social Work Field Education

This article examines the significance of field education placements within contemporary social work field education, particularly considering the increasingly complex issues of the duty of care (to student, agency and field teacher) and the duty to disclose (to student, to field teacher) which schools of social work must negotiate. The dilemmas facing schools and field educators, and the steps taken to resolve them at the University of Melbourne (Australia), are considered to highlight the ongoing liability and accountability difficulties which continue to face social work education.     

Pre-foster Care Maltreatment Class as a Predictor of Maltreatment in Foster Care

The majority of youth in the foster care system have been removed from their homes as means of protection against parental maltreatment. Studies have shown, however, that foster youth may continue to experience maltreatment after they have entered the child welfare system (Poertner et al. in Child Youth Serv Rev 21(7):549–563, 1999; Tittle et al. in Urbana 51:61801, 2008). In this study, we explore how maltreatment prior to foster care entry may predict maltreatment while in care for youth who are preparing to emancipate. Using latent class analysis and multinomial logistic regression, we find that current or former foster youth with histories of multiple maltreatment (particularly, combined pre-foster care histories of neglect and physical abuse) are more likely to report neglect, physical abuse and sexual abuse in care than those with histories of low maltreatment. These youth should be the target of prevention efforts in child welfare agencies.     

Who Pays for Seniors Housing and Care Communities? Evidence from the Residents Financial Survey

To examine the financial characteristics of residents in assisted living and independent living communities and to see how they currently pay for their care arrangements, we surveyed 2,617 residents in assisted living and independent living communities. We asked them how they pay for their current costs and verified their answers by examining self-reported information on their cost and income. Residents stated that they are largely paying for their community costs independently. Approximately one third of respondents reported using their assets and income to cover their current costs. The data supported the notion that individuals living in assisted living and independent living communities are largely mid- to high-income elderly. However, the cross-sectional analysis showed that length of time in the community was positively associated with paying for their expenses independently out of income, after controlling for many confounders including age, education, and lifetime earnings to try to rule out differential longevity and differential selection over time. Further longitudinal analysis is needed to understand the cause and the implications of the positive correlation between ability to pay one's bills out of income and the length of time in the community before conclusions about spend-down can be made.     

Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

The United States Department of Veterans Affairs (VA) is facing pressures to rebalance its long-term care system. Using VA administrative data from 2004–2011, we describe changes in the VA’s nursing homes (called Community Living Centers [CLCs]) following enactment of directives intended to shift CLCs’ focus from providing long-term custodial care to short-term rehabilitative and post-acute care, with safe and timely discharge to the community. However, a concurrent VA hospice and palliative care expansion resulted in an increase in hospice stays, the most notable change in type of stay during this time period. Nevertheless, outcomes for Veterans with non-hospice short and long stays, such as successful discharge to the community, improved. We discuss the implications of our results for simultaneous implementation of two initiatives in VA CLCs.     

Togetherness—The Health Care Team

Abstract

In order to evaluate the progress of a health service, certain criteria (indices) should be established and monitored. If any health center wishes to compare its situation with others, a valid instrument for measuring morbidity is required, and the criteria must be in conformity with national and/or international standards. This paper details methods of producing health indices from medical diagnoses. It is based on experience in a health service for students. Three systems are offered to cover centers with and without computer facilities: 1) a minimum for student health services; 2) the “minima” requested by the World Health Organization; 3) a classification of conditions of special interest in student health. It is strongly recommended that the International Classification of Diseases (ICD-9) of the World Health Organization be accepted as the local and international basis for these diagnostic categories.

“Epidemic Non-A, Non-B Hepatitis in Nepal: Recovery of a Possible Etiologic Agent and Transmission Studies in Marmosets,” MARK A. KANE, et al. An epidemic of non-A, non-B hepatitis occurred in Kathmandu Valley, Nepal, during 1981–1982, with approximately 7.6% of households and 1.4% of individuals affected. Cases occurred preponderantly in the 15- to 34-year-old age group (70%), with most cases (75%) occurring in males. A high mortality rate (21%) occurred in pregnant women admitted to the hospital. No single water source was implicated, but epidemic peaks occurred during monsoon rains, and multiple opportunities for enteric transmission existed. One of eight patient stools examined by immune electron microscopy revealed aggregated, antibody-coated, 27-nm viruslike particles when convalescent serum samples were used as sources of antibody. Inoculation of two chimpanzees and four marmosets with a suspension of this stool resulted in elevated liver enzyme activity in three marmosets. Fecal excretion of 27-nm particles during the acute phase of disease (with temporally coincident antigen activity by radioimmunoassay) was observed in one marmoset, which also developed convalescent antibody against the particles in the original inoculum. (Journal of the American Medical Association 1984;252:3140–3145.)

“High-dose Vitamin C Versus Placebo in the Treatment of Patients with Advanced Cancer who Have Had No Prior Chemotherapy; A Randomized Double-Blind Comparison,” CHARLES G. MOERTEL, et al. It has been claimed that high-dose vitamin C is beneficial in the treatment of patients with advanced cancer, especially patients who have had no prior chemotherapy. In a double-blind study 100 patients with advanced colorectal cancer were randomly assigned to treatment with either high-dose vitamin C (10 g daily) or placebo. Overall, these patients were in very good general condition, with minimal symptoms. None had received any previous treatment with cytotoxic drugs. Vitamin C therapy showed no advantage over placebo therapy with regard to either the interval between the beginning of treatment and disease progression or patient survival. Among patients with measurable disease, none had objective improvement. On the basis of this and our previous randomized study, it can be concluded that high-dose vitamin C therapy is not effective against advanced malignant disease regardless of whether the patient has had any prior chemotherapy. (New England Journal of Medicine 1985;312:137–41.)     

Migrant Care Workers or Migrants Working in Long-Term Care? A Review of Australian Experience

Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.     

Child‐Care Instability and Behavior Problems: Does Parenting Stress Mediate the Relationship?

Child‐care instability is associated with more behavior problems in young children, but the mechanisms of this relationship are not well understood. Theoretically, this relationship is likely to emerge, at least in part, because care instability leads to increased parenting stress. Moreover, low socioeconomic status and single‐mother families may be more vulnerable to the effects of instability. This study tested these hypotheses using data from the Fragile Families and Child Wellbeing study (N = 1,675) and structural equation modeling. Three types of child‐care instability were examined: long‐term instability, multiplicity, and needing to use back‐up arrangements. Overall, findings showed little evidence that parenting stress mediated the associations between care instability and child behavior problems among the full sample. Among single‐mother and low‐income families, however, needing to use back‐up arrangements had small positive associations with parenting stress, which partially mediated the relationship between that type of care instability and child externalizing behavior problems.