Nina Szczygiel

Early home-supported discharge for patients with stroke in Portugal: A randomised controlled trial

Objective: To evaluate an early home-supported discharge service for stroke patients. Design: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. Setting: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. Subjects: We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. Interventions: Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. Main measures: The primary outcome measure was the Functional Independence Measure at six months after stroke. Results: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78). Conclusions: It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

‘Call me if you need’: Social support experiences under economic and social change

ABSTRACT Social interactions play an important role in people’s life and people’s health but their scope and intensity tend to decrease with age, challenging social support dynamics and increasing the risk of social isolation and helplessness. In Portugal, policymakers still seem to rely on traditional social relations in eldercare, while contextual changes and trends are redefining family roles and behaviors and defying the established social support structure. In this work, we aim to examine the scope, structure and experiences of the informal social support network available in the country for stroke patients 6 months after their discharge from the acute care unit in the context of a larger study. The results seem to confirm the importance of family as a source of social support and shed light on different bonding experiences with non-kin social groups, such as neighbors and friends. A coordinated care provision, combining formal and informal support is vital and beneficial for patients, their caregivers and the care system.

Housing policies for the elderly: why should we care?

In aging societies, housing responses for the elderly are of increasing importance. The article deals with the problem of housing policies from the viewpoint of an elder person and analyzes an impact of the place of residence. The study suggests that community dwelling elderly have significantly higher quality of life and experience less loneliness. In view of these results, there are reasons to believe that a well-designed quality home care system for the elderly could be beneficial in that it allows aging in the household while maintaining the social networks. The study sheds light on consequences of social responses and contributes to the discussion on future directions in housing policies for the elder population.

Network analysis approach to stroke care and assistance provision: an empirical study

Abstract To model and analyse stroke care and assistance provision in the Portuguese context from the network perspective. We used the network theory as a theoretical foundation for the study. The model proposed by Frey et al. (2006) was used to elicit and comprehend possible interactions and relations between organisations expected to be involved in the provision of care and assistance to stroke patients in their pathway to rehabilitation. Providers were identified and contacted to evaluate the nature and intensity of relationships. Network analysis was performed with the NodeXL software package. Analysis of 509 entities based on about 260 000 entries indicates that stroke care provision in the evaluated context is best captured in the coalition-collaboration setting, which appears to best demonstrate the character of the network. Information from analysis of the collaboration stage was not sufficient to determine the network dynamics. Application of the network theory to understand interorganisational dynamics of the complex health care context. Empirical validation of the model proposed by Frey et al. (2006) in terms of its operationalisation and the way it actually reflects the practical context. Examination and analysis of interorganisational relationships and its contribution to management of compound health care context involving actors from various sectors.

Fossil fuel power generation and economic growth in Poland

ABSTRACT This paper explores the energy (electricity)–economic growth nexus in the case of Poland. The empirical investigation sheds some new light on the relationship between the electricity production from fossil fuel sources (oil, coal, and natural gas) and economic growth based on cointegration and Granger causality analyses with yearly data covering the period 1970–2014. Electricity generation from coal sources is likely to have a strong and positive impact upon economic growth in the long run. The Granger causality analysis supports the conservation hypothesis for the electricity production from natural gas sources, and the neutrality hypothesis for the use of oil and coal in the electric power energy mix. Therefore, it is inferred that energy conservation policies are not likely to harm economic growth and the same policies can be applied for all energy sources. The results complement previous findings in the literature despite differences in methods and data collection.