Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.     

Differences in childhood sexual abuse experience between adult Hispanic and Anglo women in a primary care setting

The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.     

Estimation of Tuberculosis Risk and Incidence under Upper Room Ultraviolet Germicidal Irradiation in a Waiting Room in a Hypothetical Scenario

Environmental control measures (ventilation, high-efficiency particulate air filtration, and upper room ultraviolet germicidal irradiation [UVGI]) are recommended to effectively control tuberculosis (TB) transmission from unsuspected TB patients in high-risk settings, but the effectiveness of their use is not often clear. This study presents a simulation model for a hypothetical hospital waiting room, in which the number of susceptible immunocompetent people in the waiting room follows a Poisson distribution (M = 5) in either low (annual number of TB patients = 5) or high TB risk settings (annual number of TB patients = 50), and used the model to evaluate the reduction of TB transmission risk by upper room UVGI. An exponential dose-response model was used for TB transmission and a two-zone model was used for evaluating the effect of upper room UVGI. Upper room UVGI reduced TB risk by 1.6-fold at 3 microW/cm2 UV irradiance in the upper room in the low TB risk setting and by 4.1-fold at 15 microW/cm2 UV irradiance in the upper room in the high TB risk setting. Use of upper room UVGI also reduced the mean annual new infection rate from 2.2 to 1.3 infections per year at 3 microW/cm2 and to 0.6 infections per year at 15 microW/cm2 in our hypothetical high-risk settings. The effect of upper room UVGI was sensitive to both vertical air velocity (air mixing) and UV irradiance level. Results from partitioning variability indicate that most variability of TB transmission risk came from waiting time in our hypothetical hospital.     

Family-friendly benefits and full-time working mothers’ labor force persistence

Family-friendly benefits are intended to help mothers balance rather than juggle work and family. Prior research assumes that family-friendly benefits have a similar effect on mothers’ persistence in full-time work across parity. However, there is evidence that the transitions to first-time and second-time motherhood are qualitatively, as well as quantitatively, different experiences. Using the National Longitudinal Survey of Youth (NLSY79), we investigate women’s labor force status (full-time, part-time, and not working) after both parity transitions among women who were working in the labor force full-time prior to the birth of their first child. We find that mothers often persist in the same labor force status after the birth of their second child that they held after the birth of their first child, but there is wide variability in labor force and parity pathways. In addition, a wider array of family-friendly benefits is associated with second-time mothers’ full-time work than first-time mothers.     

Older children in preadoptive homes: issues before termination of parental rights

In many jurisdictions, after the end of reunification services to birthparents, but before termination of parental rights, children are placed with parents who are licensed as foster parents but are committed to adopting the child. Using case examples, this article discusses the emotional and psychological difficulties often encountered by children and their prospective adoptive parents when birthparent visitation takes place and legal uncertainties exist. In addition, this article offers clinical and policy recommendations to help both the children and families in these situations as well as the professionals who work with them.     

Educational expectations and the rise in women’s post-secondary attainments

This study examines the gender difference in educational expectations among black, white, and Hispanic high school seniors in 1972 and 1992. We link gender-related changes in expectations to students’ perceived parental encouragement for higher education and access to college-preparatory coursework, and then examine the influence of expectations on subsequent educational attainments. In contrast to 1972, girls in 1992 perceived their parents to be equally or more encouraging of their pursuit of higher education than did boys, and girls were more likely to be enrolled in college preparatory coursework. The changes were most dramatic among white students, and the rise in expectations among high school girls independently contributes to their recent advances in higher education.     

Can Bundled Payment Improve Quality and Efficiency of Care for Patients with Hip Fractures?

The current Medicare reimbursement for hip fractures lacks accountability and promotes cost cutting. A bundled payment system—analogous to the Medicare Acute Care Episodes Demonstration for Orthopedic and Cardiovascular Surgery—may help curtail costs, foster communication among health care providers, and improve their accountability for patient outcomes. In hip fracture care, bundled payment may spur development of multidisciplinary best practice guidelines, quality assessment, and reporting, and result in benchmarking and best practices sharing. However, its implementation may face challenges: the need for quality assessment criteria and risk adjustment methods and possible risks of pushing costs outside of Medicare boundaries.