Search Results (58)

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: This study offers new insights into the diverse ethical perspectives of German LTC nurses on assisted suicide and suicide prevention. It extends existing knowledge through its explicit focus on the ethical issues and implications involved, both in residential and home-based LTC. The ethical challenges identified may enhance understanding of the factors underlying the development of moral distress in Germany and other countries where assisted suicide is a legal option. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services. Full article

Background/Objectives: Metastatic bone disease (MBD) poses an increasing challenge in orthopaedic oncology due to prolonged survival. While clinical prognostic factors are well established, the role of socio-economic determinants remains unclear, particularly within universal healthcare systems. Methods: We retrospectively analysed 243 patients who underwent surgery for MBD (excluding spine) between 2005 and 2024 at a German sarcoma centre. Socio-economic indicators were derived from national databases and linked to patients’ residential districts. Survival was analysed using Kaplan–Meier estimates and Cox regression, adjusting for clinical confounders. Results: Median postoperative survival was 22 months. Several socio-economic indicators—income, education, and employment—were associated with survival in univariate analysis. In multivariate models, only residential area size remained independently significant (p = 0.047). Patients from villages (<2000 inhabitants) and large cities (>100,000) had poorer survival than those from small or medium-sized towns. This effect persisted after adjustment for tumour type, pathological fractures, and year of surgery. Conclusions: Within a universal healthcare system, residential area size was associated with survival after surgery for MBD, suggesting that regional disparities may persist despite equal formal access to care. Further studies integrating individual-level socioeconomic data are needed to identify mechanisms and guide interventions to reduce geographic inequalities. Full article

Background: Older adults are a vulnerable population wherein their advancing age leads to limitations in physical and mental functionality that can compromise quality of life. Objective: The objective of this study was to analyze the relationship between mental health factors and quality of life in older adult users of long-term care services in Mexico. Methods: The present cross-sectional study was conducted with a convenience sample of 131 older adult users of long-term care services (three residential care homes and a day center) in Morelia, Michoacán, Mexico. A questionnaire including the World Health Organization Quality of Life Older Adults Scale (WHO-QoL-Old), Geriatric Depression Scale (GDS), Hamilton Anxiety Rating Scale (HARS), Cognitive Reserve Questionnaire (CRQ), and sociodemographic variables was administered. The analysis of the relationship between variables was performed using bivariate analysis (comparisons between groups and Pearson correlations). Due to the type of sampling, the representativeness of the sample obtained was not evaluated. Results: Depression and anxiety were found to inversely influence overall quality of life and its dimensions, while cognitive reserve is a factor that favors quality of life. Also, as related to cognitive reserve, level of education was found to be a factor that favors quality of life. Conclusions: Older adult users of long-term care services are a vulnerable group, given the negative impact on their quality of life that some mental health conditions could have, such as depression, anxiety, and low cognitive reserve. Full article

Background/Objectives: Later-stage melanoma at diagnosis is associated with increased mortality. Health care access, socioeconomic status, and neighborhood-level factors likely influence stage at presentation. This study aimed to examine whether neighborhood disadvantage, as measured by the Area Deprivation Index (ADI), is associated with later-stage melanoma diagnosis. Methods: We conducted a cross-sectional analysis of a retrospective cohort of 941 patients diagnosed with melanoma at a large academic medical center between 2010 and 2019. Residential addresses were geocoded and linked to ADI and rurality data. Covariates included race, ethnicity, age, gender, and insurance status. Multivariable logistic regression models with robust standard errors clustered at the census tract level were used to assess associations with melanoma stage at diagnosis. Results: Of 941 patients (63% male, 92.8% non-Hispanic White, mean age 64 years), 432 (46%) were diagnosed with late-stage melanoma. Mean ADI was higher among late-stage cases (5.4) compared to early-stage cases (3.3) (p < 0.001), even after adjustment for covariates. Non-Hispanic White race, private insurance, older age, and urban residences were associated with earlier stage at diagnosis. Racial disparities were attenuated after adjusting for ADI, with no significant interaction between race and ADI. Conclusions: Neighborhood disadvantage is significantly associated with later-stage melanoma diagnosis and contributes to observed racial and socioeconomic disparities. These findings highlight the need for targeted educational interventions and health policy initiatives to reduce late-stage melanoma diagnoses in vulnerable populations. Full article

Background and Objectives: Orthodontic treatment, whether fixed or removable, offers several benefits, including improved aesthetics, enhanced oral function, and increased self-confidence. However, it may also cause discomfort and pain, particularly following adjustment visits. This study aimed to assess pain characteristics (latency and continuity), food impairment, weight loss, and analgesic use in relation to treatment duration and appliance type. Methods: This observational study included 160 orthodontic patients who completed a structured questionnaire comprising 13 single-choice items. The questionnaire assessed age, gender, residential environment, educational status, type and duration of orthodontic treatment, pain characteristics (duration, latency, continuity), food impairment, and analgesic use. Inclusion criteria specified patients with moderate anterior crowding undergoing fixed orthodontic treatment or treatment with clear aligners on both arches, for at least one month. All fixed appliance cases involved 0.022-inch-slot Roth prescription brackets. Results: Patients undergoing fixed orthodontic treatment reported a higher frequency of pain (91.4%), greater need for analgesics (95.2%), and more food impairment compared to those with clear aligners. Patients treated for less than 6 months more frequently reported pain lasting 1 week (57.1%), while those treated for 1–2 years more commonly reported pain lasting several days (43.8%). Conclusions: Fixed orthodontic appliances are associated with greater discomfort, longer pain latency, more frequent analgesic use, and higher dietary impact compared to clear aligners. These findings emphasize the importance of personalized patient counseling and proactive pain management to improve compliance, enhance quality of life, and support informed decision-making in orthodontic care. Full article

The process of youth leaving residential care, for those who grew up in care, remains a global challenge. In South Africa, leaving care is complicated by the almost complete absence of aftercare support services, and a general lack of preparation for leaving care. This study aims to describe South African care-leavers’ views on how well they think they were prepared for care-leaving and what they believe could improve preparation for leaving care. This study is framed in resilience theory, to identify the interactional processes that facilitate better-than-expected outcomes. One-on-one qualitative interviews were conducted with 17 care-leavers, from both state-run and non-governmental residential care facilities. Grounded theory methods of data analysis were used. Participants identified both enablers of care-leaving (e.g., supportive relationships and early workplace exposure) and hinderances to their leaving care (e.g., overprotection and lack of family reunification services). This study concludes that more purposeful preparation for leaving care is required, with an emphasis on building youths’ capacity for interdependence, completion of education before leaving care, and ensuring family reunification work is done. Full article

The institutionalisation of older adults is often associated with negative perceptions from the past, influenced by asylums and hospices that were seen as marginalising older people. These views have contributed to a dominant social representation of residential care as undesirable, being associated with the ideas of social death, isolation and confinement. However, changes in family structures and longer life expectancies have increased the need for residential care. It is thus essential to rethink these institutions as integral parts of the community rather than isolating and marginalising them. Bridging the generation gap and integrating care institutions can help to combat negative perceptions, such as ageism, and promote a more inclusive view of elderly care. One way of involving older adults and recognising their rights and contributions is through community initiatives such as choirs. Community choirs can enhance social cohesion and music learning, offering older adults personal fulfilment, community involvement and resilience. These initiatives underscore respect for autonomy and emphasise their continuing value to society. This study explores the potential impact of community music on relieving feelings of loneliness among older adults in formal care settings. The project engaged 216 participants in singing classes held twice a week over six months. Utilising ethnographic observations and collective interviews with the participants, institutional staff, and family members, in this paper, the changes in participants’ self-perception of loneliness and perspectives from family members and staff are analysed. The findings indicate positive effects on the participants, especially in the psychological, educational and social dimensions, including increased autonomy, active participation, learning and social integration. The project engendered trust, empathy, mutual support and a sense of belonging and community, suggesting that community music contributes to mitigating loneliness and enhancing overall well-being. Full article

The Australian Royal Commission into Aged Care Quality and Safety has highlighted the chronic shortages of labour to provide care for those aged 65 and over in rural and remote areas of Australia. This descriptive cross-sectional study compares the availability of care provision in metropolitan regions with that in rural and remote regions. We analysed the 2021 Australian Census, grouped according to Aged-Care-Planning Region (ACPR), and investigated the numbers of people aged 65 years and over with different levels of care need, both in residential care and in-home. The available workforce in each ACPR was also examined in detail, using occupational classifications reported in the Census, and shortages of doctors, nurses, allied health and other care workers were identified. Overall, an additional 492,416 care hours were needed per week (or 12,958 full-time equivalent (FTE) care workers) in order to bring remote community ACPRs to parity with provision in metropolitan ACPRs. A further 95,342 FTE workers were needed in rural ACPRs to bring these areas to parity with metropolitan ACPRs. Our findings underscore the ongoing disparities in aged care workforce availability between metropolitan, rural, and remote regions of Australia. Addressing these workforce shortages is crucial to ensuring equitable access to care for older Australians, regardless of their geographical location. The implementation of targeted strategies to enhance workforce recruitment, retention, and training in these underserved areas is essential to bridge the gap and improve the quality of care provided to older adults in rural and remote communities. Such strategies could include targeted recruitment campaigns and incentives for professionals to relocate; further capacity for clinical placements and supervision in rural areas; tailoring funding and employment models for rural needs; and strengthening vocational education in regional areas. Full article

The ability to adapt interpersonal interactions to temperamental characteristics is essential for high-quality care. We analyzed how temperamental and self-regulation differences among children in residential care were related to the affective relationships and discipline styles of their caregivers. A total of 144 children aged 9–16 years (42.6% boys) and their caregivers from 22 residential care homes (Spain) participated. The Early Adolescent Temperament Questionnaire-Revised (EATQ-R) was used to assess temperament, the Affect Scale and Rules and Demands Scale was used to assess children’s perceptions of affective relationships and discipline styles among their caregivers, and BRIEF-2 was used to assess children’s self-regulation. Perceived warmth/communication was significantly higher than criticism/rejection and children perceived more inductive than rigid or permissive styles. Temperamental-scale fear was positively related to warmth/communication and an inductive style, and negatively related to criticism/rejection and a rigid style, whereas high-intensity pleasure showed the opposite pattern. In addition, some self-regulation and temperament scales explained 26% of the perception of warmth/communication, while others explained 15% of the variability of the rigid discipline style used by care workers. These results can help care workers to adjust their educational strategies according to the temperamental characteristics of this specific population. Full article

Psychoactive substance abuse has become a pandemic in most parts of the globe. This study sought to assess the contributory factors and impacts of psychoactive substance abuse among the youth in Makokoba—a high-density residential area in Zimbabwe’s second largest city, Bulawayo. A mixed methods research design was used on a sample of 122 respondents who were invited to participate in the study. Data were gathered using questionnaires and semi-structured in-depth interviews. Statistical Package for Social Sciences (SPSS) version 25 was used to analyse quantitative data, while the qualitative component was analysed using thematic analysis. Findings revealed peer pressure, broken homes, poor parental care, and poverty as the main causes of psychoactive substance abuse among the youth. Development of health problems, violent behaviour, disrespect for the elderly, and teenage pregnancies were considered as the major effects of psychoactive substance abuse. Given the roles that peer pressure and the family environment played in psychoactive substance abuse among the youth, the study recommends family and community-based measures. Close monitoring at the family level in educational and religious institutions as well as socio-economic development are the key prescriptive measures recommended by this study. Full article

Background: The increasing number of institutionalized older individuals worldwide stresses the need to evaluate the association between the functional profile of institutionalized older adults and their quality of life (QoL), depressive symptoms and feelings of loneliness. Methods: A cross-sectional study was conducted in 19 residential facilities in Alentejo, Portugal. Between March and September 2023, all individuals aged ≥65 years were invited to complete a structured questionnaire (n = 1303). Sociodemographic and clinical data were collected, and validated scales for the Portuguese older population were used. Linear regression and unconditional binary logistic models were computed. Results: The highest level of dependence was observed in the self-care dimension (mean (SD) = 2.93 (1.21)), with 40% of participants exhibiting levels of dependence requiring daily care or total replacement. QoL was inversely associated with functionality in all dimensions, as well as with severe or complete dependence, even after adjusting for sex, age and education. Participants with depressive symptoms and feelings of loneliness were, respectively, three and two times more likely to be dependent on care (adjusted OR = 3.69, 95% CI: 1.80–7.52; adjusted OR = 2.04, 95% CI: 1.07–3.87). Conclusions: Public policies and interventions should include social and emotional support strategies alongside traditional medical interventions. Full article

This study addresses the gap in research on the educational experiences of adolescent human trafficking survivors, with a focus on their past, present, and future educational experiences and goals. Its objective is to inform the best practices for educational programming within female adolescent residential care centers in the United States. Drawing on a subset of data from a broader mixed-methods case study conducted at the Allasso House residential facility, this research involved 11 current residents. The data sources included case files detailing their past educational experiences, assessments of their current educational achievements, and interviews exploring their future aspirations. The findings reveal key themes related to the residents past risk factors, current educational successes and barriers, and tensions in setting future goals. Most of the residents expressed a desire to attain high school equivalency, identifying financial stability as a primary motivation. They also aspired to form healthy families, while placing significant value on material success. Unlike studies that define success primarily through survival, sobriety, and the avoidance of re-trafficking, this research highlights the broader aspirations of these adolescents, emphasizing the critical role of education in general wellbeing, risk mitigation, and future success. This study underscores the importance of prioritizing educational attainment and long-term aspirations in future research and in the design of residential programs for adolescent survivors of trafficking. Full article

Introduction: Virtually all adults in aged care facilities are frail, a condition which contributes to falls, cognitive decline, hospitalisation, and mortality. Polypharmacy, malnutrition, sedentariness, and sarcopenia are risk factors amenable to intervention. The Asia–Pacific Frailty Management Guidelines recommend anabolic exercise and the optimisation of medications and nutrition. However, no study has evaluated this best practice intervention triad in aged care. Methods: The Frailty Reduction via the Implementation of Exercise, Nutrition, and Deprescribing (FRIEND) Trial (ANZCTR No.ACTRN12622000926730p) is a staged 6-month translational trial evaluating resident outcomes, staff/caregiver knowledge, and institutional implementation in a Townsville aged care facility. Residents received high-intensity resistance exercise and balance training and medication and nutrition optimisation co-implemented by investigators (exercise physiologist, geriatrician, pharmacist, and nutritionist) and facility staff. Staff and caregivers completed comprehensive education modules and training. We report the trial protocol and recruitment results. Results: 29 residents (21 female, age: 88.6 ± 6.3 years) were recruited. At baseline, the residents were frail (frailty scale nursing home (FRAIL-NH); 6.3 ± 2.4/14), cognitively impaired (Montreal Cognitive Assessment; 13.8 ± 6.8/30), functionally impaired (Short Physical Performance Battery; 4.9 ± 3.1/12, 6 min walk distance; 222.2 ± 104.4 m), and were prescribed numerous medications (15.5 ± 5.9). Two residents died and one withdrew before the intervention’s commencement. Thirty family members and 19 staff (carers, allied health assistants, nurse managers, registered nurses, lifestyle–leisure officers, kitchen/hospitality staff, and senior leadership) were recruited to receive frailty education modules. Conclusions: The FRIEND trial is currently being implemented with results expected in mid-2024. This is the first trial to evaluate the implementation of the best practice frailty guidelines including anabolic exercise and medication/nutritional optimisation in residential aged care. Full article

Background: Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to provide a global perspective on the oral health status and behaviours of CYP in care and care leavers. It also aimed to synthesise interventions that have been trialled in this population to improve oral health. Methods: Five databases were searched, Ovid Embase, Ovid MEDLINE, CINAHL (EBSCOhost), SocINDEX (EBSCOhost) and Dentistry and Oral Sciences Source (EBSCOhost), alongside grey literature sources up to January 2023. Eligibility criteria were studies that (i) reported on children and adolescents aged 25 years or younger who are currently in formal/informal foster or residential care and care leavers, (ii) pertained to oral health profile, behaviours or oral health promotion interventions (iii) and were published in the English language. Thematic analysis was used to develop the domains for oral health behaviours and interventions. Results: Seventy-one papers were included. Most papers were published from very high or medium Human Development Index countries. CYP in care were found to experience high levels of decay, dental trauma, periodontal disease and poorer oral health-related quality of life. Oral health behaviours included limited oral health self-care behaviours and a lack of oral health-based knowledge. The trialled interventions involved oral health education, supervised brushing and treatment or preventative dental care. Conclusions: This scoping review reveals that CYP in care experience poorer oral health in comparison to their peers. They are also less likely to carry out oral health self-care behaviours. This review highlights a scarcity of interventions to improve the oral health of this population and a paucity of evidence surrounding the oral health needs of care leavers. Full article

Residential education often both challenges and reinforces the norms and systems supporting children and young people’s need for homely environments. In this context, studies on pupils’ sense of home when attending residential schools provide a ground for exploring broader infrastructures of care available to them as they move through different spaces. Drawing on autoethnography, life-story interviews, and semi-structured interviews, we illustrate how, for children within the Latvian residential school system, homeliness may be found at a relative’s apartment, school bus or youth center affected by how each of the spaces relates to children’s safety and control, privacy, community, identity, everyday life, and time. While normative discourses remain fixated on home as a family space where infrastructures of care can be limited, but educational settings emphasize control as a measure for safety without being attentive to peer-to-peer relationships, children’s agency in achieving a sense of homeliness becomes fragmented and stronger in some places more than others. Full article