Academic literature on the topic 'Home-based family assessment'

Home care arrangements for older people are coordinated via a client-centred assessment process. This article describes how storylines and discursive positioning are used among older people and their relatives when divergent opinions of care needs are expressed. Eleven assessment interviews were studied using discourse analysis. The results show that relatives and older people advanced three major storylines, and positioned themselves within them with respect to the need for help. These storylines were based on whether the persons viewed home care as an intrusion into daily routines and relationships, or as a complement and support in everyday life, or as a right. The content of the storylines and the ways in which positions were shaped within them illustrate how positioning is incorporated as part of the ongoing reflexive process in interaction in which participants form an image of the older person’s needs. Assessments clarify the views of the participants on home care, but they also reflect the discourses that are prevalent in the aged care community and in society in general. The article raises questions about strengthening older people’s participation in the decision making process and also whether a new communicative practice is needed for assessments, i.e., one that proceeds on the basis of a broader family perspective.

Aims:To develop an interview version of the HOME assessment tool and compare the interview version of the HOME with the home visit version.Methods:Families whose child under 10 years of age attending the Mater CAMHS, with first attendance in the past two years were contacted. 100 of the 247 contacted agreed to participate and consented to a family visit. The study had prior ethics approval. A brief interview version of the HOME devised by substituting questions for the observer rated part of the HOME questionnaire was administered prior to the home-visit, where the home-based version of the HOME was performed. Both interviews were then compared and statistically analysed.Results:The mean score for the home visit HOME was 46.93 ± SD. The comparison of the telephone data with the home visit data suggested that there is a small significant difference between total score for the telephone and the home visit HOME score, with a difference of 0.96 - 3.20 (95% CI), when each of the assessments were scored out of 100. Bell- curves and T-Pairing scores of subscales and individual questions of both interviews suggest similarity.Conclusion:These results suggest that an interview version of the HOME assessment can be administered in the clinic or by telephone.

Background: An increasing number of patients with terminal illnesses prefer to die in their own homes due to aging, high medical payments, a limited number of hospitalization days, and the ability to receive care from family members. However, few studies have been conducted on the subjective perception and value of caregivers for home-based palliative care (HBPC). Objective: To identify common themes and topics of primary family caregivers’ lived experiences with HBPC when taking care of terminally ill family members. Methods: We conducted audio-recorded transcripts of one-on-one in-depth interviews of primary family caregivers of HBPC. Through a purposive sampling method, the participants were all interviewed; these interviews were transcribed verbatim and analyzed using a grounded theory approach. Results: A total of 22 primary family caregivers participated in the study. “Wholeheartedly accompanying one’s family to the end of life at home” was the core category. Six main themes describing caregivers’ experiences emerged from the interviews: (1) learning the basic skills of end-of-life home care, (2) arranging the sharing and rotation of care, (3) preparing for upcoming deaths and funerals, (4) negotiating the cultural and ethical issues of end-of-life home care, (5) ensuring a comfortable life with basic life support, and (6) maintaining care characterized by concern, perseverance, and patience. Conclusions: Primary family caregivers of HBPC need support and must learn home care skills by means of the holistic approach. It is crucial to establish assessment tools for caregivers’ preparedness for HBPC, including biopsychosocial and cultural considerations.

Leveraging data from a nationally representative school-based adolescent survey, the current study aimed to provide a comprehensive assessment of how family income is associated with multiple cognitive and educational outcomes in China and examine the underlying material and psychosocial mechanisms. We found robust associations of family income with school grades, cognitive ability, and study attitude, but not with homework engagement. Moreover, we found that home amenities, i.e., measuring home-based material resources, played the largest mediating role in explaining family income effects on cognitive ability and study attitude. Among the non-monetary or intangible intervening factors, children’s own and peers’ educational aspirations along with mother-child communication were the most important mechanisms. To a lesser extent, family income effects were also attributable to harmonious parent-child and between-parent relationships. The key take-home message is that home environments constitute a prominent setting outside of school exerting powerful influences shaping school outcomes for Chinese adolescents. Our study contributes to a better understanding of how family economic resources are transmitted to children’s cognitive and educational advantages via home material resources, family non-monetary features, children’s agency, and peer influence. Policy implications and future research are discussed.

AbstractObjectiveThe Carer Support Needs Assessment Tool (CSNAT) was developed in the UK and has been shown to be effective to assess and address support needs of family carers of terminally ill patients at home. In German language, there is a lack of an evidence-based comprehensive assessment tool for family carers in palliative home care. The objectives of this study were to translate and develop a culturally adapted version of the CSNAT for a German-speaking context including the assessment of feasibility, face, and content validity.MethodA translation and validation study was conducted in three steps: (1) translation of CSNAT following International Society for Pharmacoeconomics and Outcomes Research criteria; (2) cognitive testing in five German-speaking regions in Germany, Austria, and Switzerland with 15 family carers; and (3) pilot testing in palliative home care services. Evaluation was by telephone interviews with those involved in the assessments (family carers, health care professionals) and a focus group discussion with the health care professionals. Data were analyzed using content analysis.ResultsThe regional idiomatic variety raised challenges in the process of translation. Cognitive testing revealed semantic, conceptual, syntactic, and idiomatic issues. During the pilot, 25 assessment conversations were held. Carers reported that the German version called “KOMMA” was brief, easy to understand and to complete, and helpful. They appreciated that the items adequately addressed their support needs and reminded them of their own strengths and resources. Health care professionals observed good acceptance by carers, the expression of unexpected patterns of needs, and extensive assessment conversations, but some raised concerns that the assessment process might shift attention to carers’ needs at the cost of the patients.Significance of resultsA multi-step process of translation, cognitive testing, and pilot testing led to a culturally well-acceptable German tool (KOMMA). Comprehensibility, acceptance, face, and content validity, as well as feasibility were demonstrated.

In this longitudinal study, 122 Swedish children were followed from an initial assessment at 16 months until they were 8.5 years of age. Parental ratings of field independence, ego-resilience, and ego-control were obtained using the California Child Q-set when the children averaged 28, 40, 80, and 101 months of age. These assessments of personality were then examined in the context of contrasting child care experiences. There was virtually no difference between the developmental trajectories of the children in home care and in centre-based day care. In contrast, ego-undercontrol decreased less, whereas ego-resilience and field independence increased less, in children who attended family day care than in the children in either centre care or exclusive parental care. The quality of home and out-of-home care, as well as socioeconomic status and family background, did not moderate or qualify these effects of the type of care experienced. The results are discussed in relation to previous work on the effects of early out-of-home care on child development.

The State of Nebraska Co-Lead agencies, who are responsible for developing statewide early intervention policies, rolled out professional development for two evidence-based strategies across several pilot sites. Implications of these strategies for child/family assessment, Individualized Family Service Plan (IFSP) development, and Early Intervention service delivery were examined utilizing family (n=30) and professional interviews (n=50), and analyses of IFSPs (n=30). The results of this mixed method study indicate widespread strategy implementation with fidelity fosters early working relationships with families and enables teams to generate, using family members’ own words, a robust group of high-quality child and family IFSP outcomes. Family engagement in planning services such as identifying service providers and setting the frequency and length of home visits was limited. In addition, further professional development is needed to strengthen use of routines-based interventions during home visits and promote family-professional collaboration to monitor child/family progress. Implications for systematic scale-up of evidence-based practices as a function of state policy implementation are reported.

Abstract Communication difficulties in nursing home (NH) residents with dementia make valid assessment of symptoms and quality-of-life (QOL) challenging. Thus, researchers and clinicians frequently rely on proxy-based measures. The End-of-life Dementia-Comfort Assessment in Dying (EOLD-CAD) and two single-item QOL measures (7-point item; 5-point item) have been used in several studies, though evaluation of their psychometric properties is limited. We used baseline data from an ongoing multi-site randomized trial (UPLIFT) to describe symptoms and QOL and examine the measures’ validity and reliability in 138 residents with moderate to severe dementia living at 16 facilities. Descriptive data and assessments of convergent validity and inter-rater reliability are provided. Based on assessments by 134 staff and 45 family, physical symptoms, physical distress, and emotional distress were reported as infrequent by staff and family; indications of well-being were more frequently observed. Median QOL was the same for staff and family observers (4=“Life is so-so” [7-point item]; 3=“Fair” [5-point item]). Inter-observer assessments of resident QOL (staff vs. family) were correlated (7-point item: r=0.47, ICC=.643; 5-point item: r=0.48, ICC=.645, p<.05 for all). Seven of 18 EOLD-CAD symptoms were significantly positively correlated. ICC values varied between high or moderately high: shortness-of-breath (ICC=.74), choking (ICC=.65), gurgling (ICC=.81), agitation (ICC=.51), fear (ICC=.46), crying (ICC=.65), peace (ICC=.57), and care resistance (ICC=.68) (p<.05 for all). Choking and gurgling were the most prominently reported symptoms by both groups.Early findings provide a contemporary assessment of QOL and symptoms among NH residents with dementia. Measurement properties affirm general reliability and validity of study instruments.

Background: Pediatric palliative cares involve the whole family, along with the interdisciplinary pediatric palliative care (PPC) team. The commitment of the PPC team and the engagement of the family at different levels can play a key role in advancing a better quality of life in children and families. Method: A descriptive pre-post educational intervention study was carried out. The creation of a training program (with the term “school” used to denote this effort) strives to prepare caretakers to master the skills as well as provide support for the care of children with serious conditions requiring palliative through home-based initiatives. The analysis includes aspects of learning and satisfaction with the activity in a final sample of 14 families who had one child enrolled into a home-based palliative care program. Results: After the educational intervention in our school, the mean score of the theoretical evaluation was 9.14 points (SD 0.96), showing improvement with respect to the initial assessment, (mean diff. of +0.98 points). Although the analysis of all conceptual areas demonstrates a trend towards a positive impact of the intervention, feeding-related instruction saw the highest level of improvement, with a mean difference of +1.43 points. All enrolled parents expressed having a very positive experience during their participation in the educational program. Conclusions: The educational program showed a positive trend in the acquisition of knowledge and skills, resulting in a positive impact on the self-perception of their abilities. This psycho-educational space allowed them to share their experience of daily care for a child with complex needs with other families, showing them that they were not alone and that they could help each other.

With the increase in the elderly, American's caregiver roles and responsibilities are also on the rise. Developing with this increase is the growing problem of caregiver burden. The Loma Linda V. A. Hospital has developed a service known as the Home-Based Primary Care program designed to combat caregiver burden. Studies were conducted among caregiver participants in this program in an effort to evaluate overall levels of burden and the program's efficiency at meeting caregiver needs. Overall this program provides a useful model for future programs aimed at reducing caregiver burden. Limitations that can be improved, however, include consistency in scheduling, reliable staffing, and continuity in care.

This study assessed the feasibility of the newly manualized Prevent Teach Reinforce for Families (PTR-F) for use with Hispanic families of young children with autism spectrum disorders (ASD) who have difficulty adjusting to family routine. The study involved three families of children with ASD ages 3 to 6 years old who participated in the 5-step PTR-F process and who implemented the PTR intervention plan during naturally occurring family routines. A multiple-baseline across participants design was employed to examine the preliminary evidence of efficacy of using the PTR-F for children with ASD. The results indicated that Hispanic parents successfully implemented intervention strategies with the help of a facilitator using the PTR-F manual. All children’s alternate desirable behavior increased and problem behavior reduced a significant amount when the PTR-F intervention was implemented by the parents. The parents reported high social validity when implementing the PTR-F intervention.

Research Doctorate - Doctor of Philosophy (PhD)
Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.

Research Doctorate - Doctor of Philosophy (PhD)
Families with serious and/or chronic child protection risks often have complex personal and social issues. Statutory child protection services must manage escalating child protection reports with limited resources. Addressing families at immediate risk often takes precedence over comprehensive family assessment and planned intervention, so the child protection issues in the lower priority families persist, and child protection reports continue. The Montrose Home-Based Family Assessment Program assesses Department of Community Services registered families who are at risk of child removal because of chronic and/or severe child protection issues. Using an ecological perspective, the Montrose team conducts a five day comprehensive assessment in the family's home and community, and develops a caseplan to address child protection risks and family support needs. The assessment is voluntary, and the family is encouraged to participate in identifying the child protection issues and developing solutions. The primary goal of this study is to compare child protection outcomes, three years after referral, for 100 families who participated in a Montrose Assessment, and 100 Comparison Group families. The research questions also explore the relationship between demographic, family, parent, child and child protection service factors and child protection outcome. Outcome is measured by Family Outcome, Children's Outcome, Legal Status, Children's Placement, subsequent Child Protection Reports and Substantiated Child Protection Reports, and Type of Abuse. The results suggest that home-based family assessment is a cost-effective model that can measurably reduce the likelihood of further abuse, court intervention and out of home care even for complex, high risk families. The study also identifies specific child, parent and child protection service related variables that are significantly associated with child protection outcome. These findings have major relevance for current child protection policy and practice, and also for broader social policy that impacts on high risk families.

Children and adolescents in the general population and in clinical populations reveal surprisingly high rates of playing with fire or actual firesetting behavior. A single fire has the potential to cause a cascade of serious consequences to the child, family, and the community, some of which may continue forever. Yet, there is limited practical information and advice based on available empirical evidence to help programs or practitioners work effectively with children or adolescents who misuse fire, and their families. This book provides practical guidelines designed to facilitate the clinical assessment and treatment of youthful firesetting behavior based on nearly four decades of research and intervention experience with this population. The topics covered in this book address several important content areas. Initial chapters provide an overview of the significance of the problem, and some lessons learned based on case control, clinical trial, and real-world implementation projects. Recommendations for using screening and assessment measures that evaluate firesetting and general psychosocial issues are included. Several intervention methods are outlined for use with children, caregivers, and families. These methods encompass fire safety education materials and several cognitive-behavioral treatment skills-training procedures that focus on understanding of the fire, affect regulation and self-control, parenting practices, and home-based management programs. The book also includes suggestions to promote professional and program development which reflect on various educational, ethical, legal, collaborative, and community safety considerations. The book’s content is intended to help a diverse array of practitioners understand and target the context in which the misuse of fire occurs.

Our nation increasingly relies on family members or friends (i.e., informal caregivers) for needed care and support as we age. Family caregivers typically assume their caregiving role willingly and reap personal fulfilment from helping a family member, developing new skills, and strengthening family relationships. For these benefits, however, caregivers often sacrifice their own health and well-being. Depression, anxiety, poor physical health, and compromised immune function are more common among family caregivers than in adults not providing such care. The REACH OUT (Resources for Enhancing Alzheimer’s Caregiver Health: Offering Useful Treatments) program is a multicomponent, tailored, and flexible intervention for caregivers of people with dementia focused on the evidence-based therapeutic strategy of problem solving. This work is designed to guide clinicians through the process and provide them the necessary tools to share with caregivers with the goal of enhancing caregiver physical and mental health. Five common risk areas (home safety, caregiver health, social support, challenging behaviors, and emotional well-being) are described in the manual; and interventions are described that respect the nuances of each risk area. By beginning with an individualized risk assessment and being flexible to the needs and issues of the caregiver, the REACH OUT intervention helps clinicians identify risk areas and provide caregivers with tailored action plans to reduce risk and promote well-being.

This chapter discusses how to maximize the quality of life for dying patients. It illustrates the overall schema that the book follows, which emphasizes how an organized structure is useful to define the mechanics and fundamentals of hospice care and the overall goal of making high-quality interdisciplinary care during the last phase of life the standard. Therefore, the full range of evaluation, assessment, and interventions proposed may need to be changed to home in on the patient’s and family’s highest priorities to meet their most pressing needs before death. At admission, the likely longevity of the patient (i.e., prognosis) needs to be well considered so that the issues and goals elaborated in this guide might be realistically tailored to each patient’s needs and attainable goals. The most productive and “patient-centric” place to start, maintain, and deepen a trust-based relationship is with the question, “What matters most?”

Nationalism: Past as Prologue began as a single volume being compiled by Ad Akande, a scholar from South Africa, who proposed it to me as co-author about two years ago. The original idea was to examine how the damaging roots of nationalism have been corroding political systems around the world, and creating dangerous obstacles for necessary international cooperation. Since I (Bruce E. Johansen) has written profusely about climate change (global warming, a.k.a. infrared forcing), I suggested a concerted effort in that direction. This is a worldwide existential threat that affects every living thing on Earth. It often compounds upon itself, so delays in reducing emissions of fossil fuels are shortening the amount of time remaining to eliminate the use of fossil fuels to preserve a livable planet. Nationalism often impedes solutions to this problem (among many others), as nations place their singular needs above the common good. Our initial proposal got around, and abstracts on many subjects arrived. Within a few weeks, we had enough good material for a 100,000-word book. The book then fattened to two moderate volumes and then to four two very hefty tomes. We tried several different titles as good submissions swelled. We also discovered that our best contributors were experts in their fields, which ranged the world. We settled on three stand-alone books:” 1/ nationalism and racial justice. Our first volume grew as the growth of Black Lives Matter following the brutal killing of George Floyd ignited protests over police brutality and other issues during 2020, following the police assassination of Floyd in Minneapolis. It is estimated that more people took part in protests of police brutality during the summer of 2020 than any other series of marches in United States history. This includes upheavals during the 1960s over racial issues and against the war in Southeast Asia (notably Vietnam). We choose a volume on racism because it is one of nationalism’s main motive forces. This volume provides a worldwide array of work on nationalism’s growth in various countries, usually by authors residing in them, or in the United States with ethnic ties to the nation being examined, often recent immigrants to the United States from them. Our roster of contributors comprises a small United Nations of insightful, well-written research and commentary from Indonesia, New Zealand, Australia, China, India, South Africa, France, Portugal, Estonia, Hungary, Russia, Poland, Kazakhstan, Georgia, and the United States. Volume 2 (this one) describes and analyzes nationalism, by country, around the world, except for the United States; and 3/material directly related to President Donald Trump, and the United States. The first volume is under consideration at the Texas A & M University Press. The other two are under contract to Nova Science Publishers (which includes social sciences). These three volumes may be used individually or as a set. Environmental material is taken up in appropriate places in each of the three books. * * * * * What became the United States of America has been strongly nationalist since the English of present-day Massachusetts and Jamestown first hit North America’s eastern shores. The country propelled itself across North America with the self-serving ideology of “manifest destiny” for four centuries before Donald Trump came along. Anyone who believes that a Trumpian affection for deportation of “illegals” is a new thing ought to take a look at immigration and deportation statistics in Adam Goodman’s The Deportation Machine: America’s Long History of Deporting Immigrants (Princeton University Press, 2020). Between 1920 and 2018, the United States deported 56.3 million people, compared with 51.7 million who were granted legal immigration status during the same dates. Nearly nine of ten deportees were Mexican (Nolan, 2020, 83). This kind of nationalism, has become an assassin of democracy as well as an impediment to solving global problems. Paul Krugman wrote in the New York Times (2019:A-25): that “In their 2018 book, How Democracies Die, the political scientists Steven Levitsky and Daniel Ziblatt documented how this process has played out in many countries, from Vladimir Putin’s Russia, to Recep Erdogan’s Turkey, to Viktor Orban’s Hungary. Add to these India’s Narendra Modi, China’s Xi Jinping, and the United States’ Donald Trump, among others. Bit by bit, the guardrails of democracy have been torn down, as institutions meant to serve the public became tools of ruling parties and self-serving ideologies, weaponized to punish and intimidate opposition parties’ opponents. On paper, these countries are still democracies; in practice, they have become one-party regimes….And it’s happening here [the United States] as we speak. If you are not worried about the future of American democracy, you aren’t paying attention” (Krugmam, 2019, A-25). We are reminded continuously that the late Carl Sagan, one of our most insightful scientific public intellectuals, had an interesting theory about highly developed civilizations. Given the number of stars and planets that must exist in the vast reaches of the universe, he said, there must be other highly developed and organized forms of life. Distance may keep us from making physical contact, but Sagan said that another reason we may never be on speaking terms with another intelligent race is (judging from our own example) could be their penchant for destroying themselves in relatively short order after reaching technological complexity. This book’s chapters, introduction, and conclusion examine the worldwide rise of partisan nationalism and the damage it has wrought on the worldwide pursuit of solutions for issues requiring worldwide scope, such scientific co-operation public health and others, mixing analysis of both. We use both historical description and analysis. This analysis concludes with a description of why we must avoid the isolating nature of nationalism that isolates people and encourages separation if we are to deal with issues of world-wide concern, and to maintain a sustainable, survivable Earth, placing the dominant political movement of our time against the Earth’s existential crises. Our contributors, all experts in their fields, each have assumed responsibility for a country, or two if they are related. This work entwines themes of worldwide concern with the political growth of nationalism because leaders with such a worldview are disinclined to co-operate internationally at a time when nations must find ways to solve common problems, such as the climate crisis. Inability to cooperate at this stage may doom everyone, eventually, to an overheated, stormy future plagued by droughts and deluges portending shortages of food and other essential commodities, meanwhile destroying large coastal urban areas because of rising sea levels. Future historians may look back at our time and wonder why as well as how our world succumbed to isolating nationalism at a time when time was so short for cooperative intervention which is crucial for survival of a sustainable earth. Pride in language and culture is salubrious to individuals’ sense of history and identity. Excess nationalism that prevents international co-operation on harmful worldwide maladies is quite another. As Pope Francis has pointed out: For all of our connectivity due to expansion of social media, ability to communicate can breed contempt as well as mutual trust. “For all our hyper-connectivity,” said Francis, “We witnessed a fragmentation that made it more difficult to resolve problems that affect us all” (Horowitz, 2020, A-12). The pope’s encyclical, titled “Brothers All,” also said: “The forces of myopic, extremist, resentful, and aggressive nationalism are on the rise.” The pope’s document also advocates support for migrants, as well as resistance to nationalist and tribal populism. Francis broadened his critique to the role of market capitalism, as well as nationalism has failed the peoples of the world when they need co-operation and solidarity in the face of the world-wide corona virus pandemic. Humankind needs to unite into “a new sense of the human family [Fratelli Tutti, “Brothers All”], that rejects war at all costs” (Pope, 2020, 6-A). Our journey takes us first to Russia, with the able eye and honed expertise of Richard D. Anderson, Jr. who teaches as UCLA and publishes on the subject of his chapter: “Putin, Russian identity, and Russia’s conduct at home and abroad.” Readers should find Dr. Anderson’s analysis fascinating because Vladimir Putin, the singular leader of Russian foreign and domestic policy these days (and perhaps for the rest of his life, given how malleable Russia’s Constitution has become) may be a short man physically, but has high ambitions. One of these involves restoring the old Russian (and Soviet) empire, which would involve re-subjugating a number of nations that broke off as the old order dissolved about 30 years ago. President (shall we say czar?) Putin also has international ambitions, notably by destabilizing the United States, where election meddling has become a specialty. The sight of Putin and U.S. president Donald Trump, two very rich men (Putin $70-$200 billion; Trump $2.5 billion), nuzzling in friendship would probably set Thomas Jefferson and Vladimir Lenin spinning in their graves. The road of history can take some unanticipated twists and turns. Consider Poland, from which we have an expert native analysis in chapter 2, Bartosz Hlebowicz, who is a Polish anthropologist and journalist. His piece is titled “Lawless and Unjust: How to Quickly Make Your Own Country a Puppet State Run by a Group of Hoodlums – the Hopeless Case of Poland (2015–2020).” When I visited Poland to teach and lecture twice between 2006 and 2008, most people seemed to be walking on air induced by freedom to conduct their own affairs to an unusual degree for a state usually squeezed between nationalists in Germany and Russia. What did the Poles then do in a couple of decades? Read Hlebowicz’ chapter and decide. It certainly isn’t soft-bellied liberalism. In Chapter 3, with Bruce E. Johansen, we visit China’s western provinces, the lands of Tibet as well as the Uighurs and other Muslims in the Xinjiang region, who would most assuredly resent being characterized as being possessed by the Chinese of the Han to the east. As a student of Native American history, I had never before thought of the Tibetans and Uighurs as Native peoples struggling against the Independence-minded peoples of a land that is called an adjunct of China on most of our maps. The random act of sitting next to a young woman on an Air India flight out of Hyderabad, bound for New Delhi taught me that the Tibetans had something to share with the Lakota, the Iroquois, and hundreds of other Native American states and nations in North America. Active resistance to Chinese rule lasted into the mid-nineteenth century, and continues today in a subversive manner, even in song, as I learned in 2018 when I acted as a foreign adjudicator on a Ph.D. dissertation by a Tibetan student at the University of Madras (in what is now in a city called Chennai), in southwestern India on resistance in song during Tibet’s recent history. Tibet is one of very few places on Earth where a young dissident can get shot to death for singing a song that troubles China’s Quest for Lebensraum. The situation in Xinjiang region, where close to a million Muslims have been interned in “reeducation” camps surrounded with brick walls and barbed wire. They sing, too. Come with us and hear the music. Back to Europe now, in Chapter 4, to Portugal and Spain, we find a break in the general pattern of nationalism. Portugal has been more progressive governmentally than most. Spain varies from a liberal majority to military coups, a pattern which has been exported to Latin America. A situation such as this can make use of the term “populism” problematic, because general usage in our time usually ties the word into a right-wing connotative straightjacket. “Populism” can be used to describe progressive (left-wing) insurgencies as well. José Pinto, who is native to Portugal and also researches and writes in Spanish as well as English, in “Populism in Portugal and Spain: a Real Neighbourhood?” provides insight into these historical paradoxes. Hungary shares some historical inclinations with Poland (above). Both emerged from Soviet dominance in an air of developing freedom and multicultural diversity after the Berlin Wall fell and the Soviet Union collapsed. Then, gradually at first, right wing-forces began to tighten up, stripping structures supporting popular freedom, from the courts, mass media, and other institutions. In Chapter 5, Bernard Tamas, in “From Youth Movement to Right-Liberal Wing Authoritarianism: The Rise of Fidesz and the Decline of Hungarian Democracy” puts the renewed growth of political and social repression into a context of worldwide nationalism. Tamas, an associate professor of political science at Valdosta State University, has been a postdoctoral fellow at Harvard University and a Fulbright scholar at the Central European University in Budapest, Hungary. His books include From Dissident to Party Politics: The Struggle for Democracy in Post-Communist Hungary (2007). Bear in mind that not everyone shares Orbán’s vision of what will make this nation great, again. On graffiti-covered walls in Budapest, Runes (traditional Hungarian script) has been found that read “Orbán is a motherfucker” (Mikanowski, 2019, 58). Also in Europe, in Chapter 6, Professor Ronan Le Coadic, of the University of Rennes, Rennes, France, in “Is There a Revival of French Nationalism?” Stating this title in the form of a question is quite appropriate because France’s nationalistic shift has built and ebbed several times during the last few decades. For a time after 2000, it came close to assuming the role of a substantial minority, only to ebb after that. In 2017, the candidate of the National Front reached the second round of the French presidential election. This was the second time this nationalist party reached the second round of the presidential election in the history of the Fifth Republic. In 2002, however, Jean-Marie Le Pen had only obtained 17.79% of the votes, while fifteen years later his daughter, Marine Le Pen, almost doubled her father's record, reaching 33.90% of the votes cast. Moreover, in the 2019 European elections, re-named Rassemblement National obtained the largest number of votes of all French political formations and can therefore boast of being "the leading party in France.” The brutality of oppressive nationalism may be expressed in personal relationships, such as child abuse. While Indonesia and Aotearoa [the Maoris’ name for New Zealand] hold very different ranks in the United Nations Human Development Programme assessments, where Indonesia is classified as a medium development country and Aotearoa New Zealand as a very high development country. In Chapter 7, “Domestic Violence Against Women in Indonesia and Aotearoa New Zealand: Making Sense of Differences and Similarities” co-authors, in Chapter 8, Mandy Morgan and Dr. Elli N. Hayati, from New Zealand and Indonesia respectively, found that despite their socio-economic differences, one in three women in each country experience physical or sexual intimate partner violence over their lifetime. In this chapter ther authors aim to deepen understandings of domestic violence through discussion of the socio-economic and demographic characteristics of theit countries to address domestic violence alongside studies of women’s attitudes to gender norms and experiences of intimate partner violence. One of the most surprising and upsetting scholarly journeys that a North American student may take involves Adolf Hitler’s comments on oppression of American Indians and Blacks as he imagined the construction of the Nazi state, a genesis of nationalism that is all but unknown in the United States of America, traced in this volume (Chapter 8) by co-editor Johansen. Beginning in Mein Kampf, during the 1920s, Hitler explicitly used the westward expansion of the United States across North America as a model and justification for Nazi conquest and anticipated colonization by Germans of what the Nazis called the “wild East” – the Slavic nations of Poland, the Baltic states, Ukraine, and Russia, most of which were under control of the Soviet Union. The Volga River (in Russia) was styled by Hitler as the Germans’ Mississippi, and covered wagons were readied for the German “manifest destiny” of imprisoning, eradicating, and replacing peoples the Nazis deemed inferior, all with direct references to events in North America during the previous century. At the same time, with no sense of contradiction, the Nazis partook of a long-standing German romanticism of Native Americans. One of Goebbels’ less propitious schemes was to confer honorary Aryan status on Native American tribes, in the hope that they would rise up against their oppressors. U.S. racial attitudes were “evidence [to the Nazis] that America was evolving in the right direction, despite its specious rhetoric about equality.” Ming Xie, originally from Beijing, in the People’s Republic of China, in Chapter 9, “News Coverage and Public Perceptions of the Social Credit System in China,” writes that The State Council of China in 2014 announced “that a nationwide social credit system would be established” in China. “Under this system, individuals, private companies, social organizations, and governmental agencies are assigned a score which will be calculated based on their trustworthiness and daily actions such as transaction history, professional conduct, obedience to law, corruption, tax evasion, and academic plagiarism.” The “nationalism” in this case is that of the state over the individual. China has 1.4 billion people; this system takes their measure for the purpose of state control. Once fully operational, control will be more subtle. People who are subject to it, through modern technology (most often smart phones) will prompt many people to self-censor. Orwell, modernized, might write: “Your smart phone is watching you.” Ming Xie holds two Ph.Ds, one in Public Administration from University of Nebraska at Omaha and another in Cultural Anthropology from the Chinese Academy of Social Sciences, Beijing, where she also worked for more than 10 years at a national think tank in the same institution. While there she summarized news from non-Chinese sources for senior members of the Chinese Communist Party. Ming is presently an assistant professor at the Department of Political Science and Criminal Justice, West Texas A&M University. In Chapter 10, analyzing native peoples and nationhood, Barbara Alice Mann, Professor of Honours at the University of Toledo, in “Divide, et Impera: The Self-Genocide Game” details ways in which European-American invaders deprive the conquered of their sense of nationhood as part of a subjugation system that amounts to genocide, rubbing out their languages and cultures -- and ultimately forcing the native peoples to assimilate on their own, for survival in a culture that is foreign to them. Mann is one of Native American Studies’ most acute critics of conquests’ contradictions, and an author who retrieves Native history with a powerful sense of voice and purpose, having authored roughly a dozen books and numerous book chapters, among many other works, who has traveled around the world lecturing and publishing on many subjects. Nalanda Roy and S. Mae Pedron in Chapter 11, “Understanding the Face of Humanity: The Rohingya Genocide.” describe one of the largest forced migrations in the history of the human race, the removal of 700,000 to 800,000 Muslims from Buddhist Myanmar to Bangladesh, which itself is already one of the most crowded and impoverished nations on Earth. With about 150 million people packed into an area the size of Nebraska and Iowa (population less than a tenth that of Bangladesh, a country that is losing land steadily to rising sea levels and erosion of the Ganges river delta. The Rohingyas’ refugee camp has been squeezed onto a gigantic, eroding, muddy slope that contains nearly no vegetation. However, Bangladesh is majority Muslim, so while the Rohingya may starve, they won’t be shot to death by marauding armies. Both authors of this exquisite (and excruciating) account teach at Georgia Southern University in Savannah, Georgia, Roy as an associate professor of International Studies and Asian politics, and Pedron as a graduate student; Roy originally hails from very eastern India, close to both Myanmar and Bangladesh, so he has special insight into the context of one of the most brutal genocides of our time, or any other. This is our case describing the problems that nationalism has and will pose for the sustainability of the Earth as our little blue-and-green orb becomes more crowded over time. The old ways, in which national arguments often end in devastating wars, are obsolete, given that the Earth and all the people, plants, and other animals that it sustains are faced with the existential threat of a climate crisis that within two centuries, more or less, will flood large parts of coastal cities, and endanger many species of plants and animals. To survive, we must listen to the Earth, and observe her travails, because they are increasingly our own.

This chapter deals with the development of a smart real-time indoor (offices and family homes) air quality monitoring device based on Internet of Things (IoT). Environmental data from the sensor nodes are sent over the ZigBee wireless communication protocol, and after collection are subjected to careful statistical analysis for exposure risk assessment. The free XCTU platform application in interaction with the XBee modules is used to visualize real-time temporal evolution of the measured data. This portable device is composed of a microcontroller board, XBee wireless transmission modules, and some low-cost air pollutant sensors including particulate matter (PM2.5) and toxic gas (ground-level ozone O3, carbon monoxide CO, sulfur dioxide SO2, nitrogen dioxide NO2) sensors. Particular attention is paid to indoor air quality in this chapter due to the long-term occupation of confined spaces by people. The results of measurements taken from September 21 to October 22, 2020, in two different confined spaces (home and office), in the city of Yaoundé-Cameroon, gave maximum exposure rates of 13.06 µg/m3 (home) and 10.71 µg/m3 (office) for PM2.5; 18.65 ppm (office) and 17.72 ppm (home) for SO2; 4.97 ppm (office) and 7.49 ppm (home) for NO2; 2.42 ppm (office) and 1.30 ppm (home) for O3 and, 18.03 ppm (office) and 13.66 ppm (home) for CO. Thus, both office and home spaces gave an internal Air Quality Index (AQI) lower than 50 and an Air Quality Health Index (AQHI), less than 1. The values are low, very varied but still acceptable compared to the WHO standard values. This is due to the diversity of potential sources of pollution which are the number of inhabitants of the confined space, the gas emissions of the installed devices and the intake of outside air. From the results obtained, it emerges that in addition to its low-cost and its flexibility, the proposed device exhibits interesting performance in terms of reliability and global functionality.

This chapter discusses the results of a writing activity during Family Literacy Night at a predominantly Hispanic, Title I school in the Southwest. This study, based on Socio-Cultural Theory (Moll, 2013), demonstrates the efficacy of asset-based approaches for instruction and assessment versus more traditional deficit models of minority education. As an analytic, the researchers applied the six Capitals from the Community Cultural Wealth (CCW) model (Yosso, 2005) to the children's writing samples. This framework revealed a variety of strengths common to Latino and bilingual households including the metalinguistic skill of translanguaging. Data was processed through Holistic Content Analysis (Lieblich, 2005) followed by thematic analysis (Falk & Blumenreich, 2005) supported by CCW. Results underscore the importance of out-of-school literacies and their affective impact on children from underserved communities. Moreover, results argue for more home- and community-based writing assignments to reveal student values, desires, and emotions, which encourage the joy of writing.

The chapter “Managing Disruptive Behavior,” in School Mental Health Services for Adolescents, outlines identification and treatment concerns, evidence-based treatment recommendations, and service delivery considerations for behavior problems associated with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) in adolescence. Going beyond the psychiatric categories of ADHD, ODD, and CD, it uses a developmental psychopathology perspective to discuss the interrelationships of contextual factors throughout development that increase risk for disruptive behavior problems during adolescence. Next, it reviews recommendations for school mental health providers to facilitate linking assessment strategies to evidence-based intervention and outcome evaluation. Finally, it discusses strategies for working across systems to engage stakeholders in the service of improving home-school communication and family-school-medical partnership.

The evidence suggests that medical care for frail, old people should be interdisciplinary, coordinated, and accessible. Analysis of the current system suggests it should begin with comprehensive assessment of the individual, including physical function, emotional state, degree of social engagement, support system, and medical insurance. Next, the ideal interdisciplinary team should determine the person’s goals of care. Finally, a plan of care should be developed, taking both goals and needs into account. Implementing the plan will require a robust home care program as well as family support. Achievement of such a system will necessitate reforming the complex adaptive system that makes up American health care today. The most promising change agent is the Medicare program itself, which could introduce requirements into medical training programs to assure competence in geriatric medicine and communication skills. With appropriate legislative changes, Medicare could also negotiate with drug companies over price and set reimbursement for medical technology based on cost-effectiveness. Medicare could also develop a new benefit plan for frail elders that offered more intensive home care and other services in exchange for decreased coverage of invasive, expensive, and often non-beneficial hospital-based technology.

Paediatric OCD is the disorder, in child psychiatry, whose clinical picture most closely resembles its adult counterpart. Despite a relative diversity, the symptom pool is remarkably finite, and very similar to that seen in older individuals. Prevalence, comorbidity, and response to behavioural and drug treatment also appear similar across the lifespan. For tic disorders, there is continuity between child and adult presentations, but the disease is much more prone to resolve spontaneously, or to be less disruptive in adulthood. Both OCD and tics occur more often in males than in females, and are likely to be linked to an array of neurobiological abnormalities, many of which remain to be understood. Invaluable benefits can now be obtained from available behavioural and pharmacological treatments, but complete remission remains uncertain and long-term management may be required. Thus, the treatment of OCD and tics in children and adolescents remains a clinical challenge. It requires careful assessment of the targeted symptoms and, in many cases, comorbidity; attention to the quality of the child's functioning at home and with peers; use of specific CBT interventions, which are not readily available (or accessible) in all communities; patience and caution in the choice and adjustment of medication; and vigilance in watching potential side effects. Given the possible chronicity of OCD and/or tic disorders, and their changing patterns in severity and impact over the childhood and adolescent years, optimal treatment generally requires a long-term ongoing relationship with the child and family. Current conceptualizations of OCD and tic disorders have been shaped by advances in systems neuroscience and functional in vivo neuroimaging. Continued success in these areas should lead to the targetting of specific brain circuits for more intensive research. This should include testing novel pharmacological agents, tracking treatment response using neuroimaging techniques, and possibly investigating circuit-based therapies using deep-brain stimulation for refractory cases. The identification of the PANDAS subgroup of patients, with an abrupt onset and dramatic exacerbations, certainly brings new insights into the pathophysiology of OCD and tic disorders, and may lead to new assessment and treatment strategies. The increasing evidence for susceptibility genes in OCD and tic disorders will also doubtless point to new therapeutic directions. Furthermore, it is likely that many of the empirical findings used in research on paediatric OCD and tic disorders will be relevant to a better understanding of both normal development, and other disorders of childhood onset.

Background: The family is the main provider of care for the elderly, which generates stress, with negative effects on the caregiver’s health. It is necessary to relieve the stress of caregivers for the safety of the caregiver and the dependent family member. Objective: To evaluate the effect of a nursing intervention based on a psychoeducational program for caregivers of elderly family members. Methods: This is a quasi-experimental study, with a sample of caregivers (n = 77), distributed between the intervention group (n = 37) and the control group (n = 40). The instruments comprised a questionnaire with the Zarit Burden scales and the Carers Management Assessment Index. The intervention group benefited from the psychoeducational program, and the control maintained the usual care. Results: The intervention group increased coping and decreased the burden compared to the control group. After six months, both groups decreased coping, but it was lower in the intervention group compared to the control group. The intervention group slightly decreased the burden while the control group increased it. Conclusions: The nursing intervention is a procedure that relieves the caregiver’s burden and increases the coping, contributing to reduce the impact of the damage caused by the provided care.

This article describes how a tablet-based communication technology designed for older adults was explored for its adoption and impact on family relationships. A case study methodology was employed to collect and analyze interviews, field notes, observations and messaging activity over a 12 week period. Twelve participants, eight with a Montreal Cognitive Assessment (MoCA) score suggestive of Mild Cognitive Impairment (MCI), were paired with a student to learn and use InTouch. 1212 messages were sent, from which text, audio, photo, and video data types were used 705, 280, 143 and 84 times, respectively. Most participants voiced that personalized text messaging was not the easiest feature to use, but was their preferred mode. Two participants used audio more than text, highlighting a need for feature customization. Older adults view a simplified tablet-based interface as a valuable means of enhancing communication with friends and family. With guided weekly support older adults learned to use this technology independently and integrated its use into their daily lives.

Background: Adolescents living in institutional settings are more susceptible to the EBPs than others as they are deprived of a family's love, support, attachment and care. Objective: To assess the prevalence of EBPs among adolescents and explore the perceptions of caretakers living in children’s home. Method: A mixed method, descriptive cross-sectional study among 134 adolescents from 5 children’s homes of Gokarneshwor Municipality, was done. All the adolescents from 10-19 years living in the children’s home were assessed using a self-administered questionnaire, Youth Self-Report (YSR-11/18) 2001, developed by Achenbach System of Empirical Based Assessment and self-developed socio- demographic questionnaires. Data was coded and analyzed using SPSS (25). Descriptive statistics and Chi square were used to analyze the quantitative data, while narrative summary was used for qualitative through IDI. Results: Prevalence of EBPs was 48.5% among the adolescents. While the EBPs factors prevalence was found to be anxious depression (46.3%), withdrawn depressed (46.3%), attention problems (46.3%), somatic complaints (50.7%), social problems (42.5%), thought problems (38.8%), attention problems (46.3%), rule breaking behaviour (41%) and aggressive problems (50%). The occurrence of EBPs was significantly associated with status of adolescent (ꭓ2=6.015, p=0.014, df=1). Similarly, there was the significant association between dependent variable (prevalence of EBPs and EBP variables such as anxious depressed (ꭓ2=20.078, p<0.001, df=1), withdrawn depressed (ꭓ2=38.616, p<0.001, df=1), social problems (ꭓ2=32.678, p<0.001, df=1), attention problems (ꭓ2=30.479, p<0.001, df=1), rule breaking behavior (ꭓ2=25.322, p<0.001, df=1), thought problems (ꭓ2=31.14, p<0.001, df=1), somatic complaints (ꭓ2=20.248, p<0.001, df=1) and aggressive problem (ꭓ2=32.536, p<0.001, df=1). Conclusion: EBPs are a serious mental health concern among adolescents and especially living in children’s homes. The provision of the appropriate counseling, life skill educations and ECAs engagements help to address the EBP factors. Keywords: Adolescents, EBPs, Children’s home, YSR, Gokarneshwor Municipality, Nepal.

As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.