In many developed contexts, home-care services have been overhauled with the intent of increasing control and flexibility for those using social and health services. This change is associated with providing funds directly to individuals, and sometimes their families and supports, to arrange at home-care assistance with the activities of daily living. Directly funded home-care programs, or "direct funding" (DF), are not value-neutral policy interventions, but complex and politicised tools for the enact-ment of care in contemporary times. In this qualitative metasynthesis, we consider 47 research articles published between 2009 and 2017 that explore various DF programs for older persons in the United Kingdom, Australia, and the United States to identify core concepts in the literature. We find that choice emerges as a central concern. We then assess the literature to explore the questions: How does the existing literature conceptualise choice, and the mechanisms through which choice is enhanced , in DF programs for older persons? How is choice, and the benefit of choice to older service users, understood in relevant studies? We argue that the concept of "choice" manifests as a normative goal with presumed benefits among the studies reviewed. Particularly when discussing DF for older people, however, it is essential to consider which mechanisms improve care outcomes, rather than focusing on which mechanisms increase choice writ large. In the case of DF, increased choice comes with increased legal responsibilities and often administrative tasks that many older people and their supports find burdensome. Furthermore, there is no evidence that choice over all elements of one's services is the mechanism that improves care experiences. We conclude by presenting alternative models of understanding care emerging from feminist and other critical scholarship to consider if we are, perhaps, asking the wrong questions about why DF is so often preferred over conventional home-care delivery. K E Y W O R D S Choice, consumer-directed care, direct payments, individualised funding, home care, self-directed care, self-managed care

Introduction: Regarding to the importance of educational interventions to increase the preventive behaviors of urinary tract infection in children, this study was conducted aimed to investigate the effect of home care education to parents according to the HBM, on recurrence of urinary tract infection in children.

Materials & Methods: In this quasi-experimental study with a pre and post design, 120 children with UTI who were hospitalized in the pediatric department of Imam Khomeini Hospital in Boroujerd from 23/9/2017 to 23/12/2017 with their parents were selected by simple sampling method and assigned to control and case groups by random block method. The parents of the experimental group received the educational intervention.The data collection tool was questionnaire designed based on health belief model than distributed before and one month after educational intervention. Urin culture was also performed to determine the recurrence. Data were analyzed by SPSS 21 software, multivariate analysis, independent T-test, paired T-test, Chi-square and two-ratio comparison tests.

Findings: education reduced the recurrence of UTI in children) P˂0.001). Also, the mean scores of the whole dimensions of the model increased after training in the two groups (P˂0.001). While the difference in mean scores after training in the two groups was significant only in the dimensions of perceived threat (in the case group 3.84±1.21, in the control group 3.03±1.07) (P=0.039), benefits (in the case group 18.78±3.14, in the control group 20.1±2.8) (P=0.019), behavior (in the case group 30.81±3.77, in the control group 30.16±3.47)(P<0.001), and self-efficacy (in the case group 29.53±3.49, in the control group 25.2±3.07)(P<0.001).

Discussion & Conclusions: According to the effectiveness of home-based caring education based on the HBM to parents of children with UTI,on reducing the recurrence of UTI in children, it is better to before of children discharge with urinary tract infection from the hospital, Providing parenting education about the principles of child care, in order to prevent recurrence of UTI.

Commission (CEC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment and management of chronically ill patients at home such as congestive heart failure (CHF) patients. Such contact centers, which can use any type of communication and telematics technology, and can provide timely and preventive prompting to the patients are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center focusing on the telecommunication infrastructure, the communication protocols and procedures related to the vital parameters and signals, and finally the educational modules that are integrated into this contact center. We present examples of the communication means between the medical professionals using this contact center and the congestive heart failure patients, and elaborate on the telemedicine and educational issues involved.

Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. The European Union Geriatric Medicine Society (EUGMS) Geriatric Palliative Medicine (GPM) Interest Group set as one of its goals to better characterize geriatric palliative care in Europe. The goal of the current study was to map the existing palliative care structures for geriatric patients, the available policies, legislation, and associations in geriatric palliative medicine in different countries of Europe. A questionnaire was sent to Geriatric and Palliative Medicine Societies of European countries through contact persons. The areas of interest were (1) availability of services for the management of geriatric patients by using vignette patients (advanced cancer, severe cardiac disease, and severe dementia), (2) policies, legislation of palliative care, and (3) associations involved in geriatric palliative medicine. Out of 21 countries contacted, 19 participated. Palliative care units and home care palliative consultation teams are available in most countries. In contrast, palliative care in long-term care facilities and in geriatric wards is less developed. A disparity was found between the available services and those most appropriate to take care of the three cases described in the vignettes, especially for the patient dying from non-malignant diseases. The survey also demonstrated that caregivers are not well prepared to care for the elderly palliative patient at home or in nursing homes. One of the challenges for the years to come will be to develop palliative care structures adapted to the needs of the elderly in Europe, but also to improve the education of health professionals in this field.

Rationale: Malnutrition in chronic respiratory failure (CRF) is associated with a poor outcome and not influenced by oral nutrition supplements (ONS) given alone (Ferreira et al. Cochrane 2005). The aim of this multicenter prospective randomized trial was to assess the effects on 6 min. walking distance (6MWD), Quality of life (CRQ), body composition (BIA) and exercise capacity of a 3-month integrated homecare compared with health education alone. Methods: 122 CRF patients on Long-Term Oxygen (LTO, n = 70), NIV-Non Invasive Ventilation+LTO (35), NIV (7), invasive ventilation , 66±10 y, 91 men, 109 with obstructive, 19 with restrictive or mixed respiratory disease were included in 8 centres from 2003 to 2007. Baseline data were: PaO2 7.7±1.2; PaCO2 5.9±0.9 kPa; FEV1 31±13% pred.; FEV1/FVC 39.4±13.4%; PMax 36±13 watts; endurance time 55%Pmax 8.50±7.14; 6MWD 290±130 m; CRQ 77±17 [20 140]. BMI was 21.5±3.9; Fat-Free Mass (FFM) 43.6±9.0; Albumin 36.9±4.5±g/L; Transthyretin 210±60 mg; CRP 6.45 [1 72]. Patients randomly received health education during 7 home visits by specialized nurse (Control group, n = 62) or integrated care (n = 60) combining health education, ONS (560 kcal/d), exercise on bicycle, and oral testosterone undecanoate (160 mg/d in men, 80 mg/d in women). Changes from D0 to D90 (% D0 value) in the 2 groups were compared by ANCOVA. Results: Blood gases, FEV1, FEV1/FVC, exacerbation rate were unaffected. 6MWD tended to increase (+29% p: 0.19), CRQ increased by 8.7%, p < 0.05; BMI by 2.5%, p = 0.004; FFM by 3.6%, p = 0.02; Transthyretin by 16.3%, p < 0.05; CRP by 3%, p = 0.04; Haemoglobin by 5.8%, p = 0.02; PMax 21%, p = 0.005; endurance time55%Pmax by 93%, p < 0.0001. After a 15-months, mortality was 11.5% vs. 23% in the Control (n = 52) vs. Treated (n = 52) patients (p = 0.20).

This article contributes to the ongoing debate on the role of poverty in the placement of children in out-of-home care and in family reunification. We examined court cases that successfully challenged policies of child welfare agencies resulting in children's placement into substitute care or in failure to reunite children with their families for 'reasons of poverty.' We briefly describe court mandated programs and evaluate the effectiveness of one of these programs in preventing substitute care placement, facilitating more timely reunification, and reducing agency costs. We conclude that child welfare agencies have removed children from their homes and have failed to reunite children with their families for 'reasons of poverty.' Our analysis also indicates that providing families with economic or material resources can prevent unnecessary substitute care placement, facilitate reunification, and be cost effective. Other child welfare practice, policy, and research implications are discussed. D

This report describes the major changes that have taken place in working conditions in care for older people from 2005 to 2015. Comparisons between the situation in Finland and other Nordic countries are also included. The report is based on the second wave of a Nordic questionnaire study among unionised care workers in Finland, Sweden, Norway and Denmark.

Title. Next-of-kin caregivers in palliative home care -from control to loss of control. Aim. This paper is a report of a study to describe situations influencing next-of-kin caregivers' ability to manage palliative care in the home. Background. Palliative home care often involves major resources from next-of-kin, municipal and county personnel. Next-of-kin caregivers' situation is depicted as so demanding and exhausting that it can affect their mental health and limit their ability to continue as a caregiver. Methods. A qualitative study using the Critical Incident Technique was conducted. Nine next-of-kin caregivers from palliative home care were strategically chosen and data were collected using audiotaped interviews in 2005.