Supporting relationships between family and staff in continuing care settings.

In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.

A dietary and behavioural programme for the treatment of obesity. A 4-year clinical trial and a long-term posttreatment follow-up.

OBJECTIVES: To evaluate weight loss maintenance after 4 years of nonpharmacological, nonsurgical obesity treatment, including a very low calorie diet (VLCD), diet and behavioural support. Furthermore, to assess weight development amongst completers and noncompleters beyond the active 4-year treatment period. DESIGN: Clinical trial. SETTING: Two Swedish county hospitals. SUBJECTS: A total of 113 patients were randomized to a 2-year treatment programme with or without an initial VLCD period. The 87 patients who completed the 2-year programme were offered the chance to continue a support programme for another 2 years. A total of 55 patients completed the entire 4-year programme. INTERVENTIONS: All the patients took part in a comprehensive support programme, including a hypocaloric diet and behavioural support, either as single treatment (non-VLCD group) or following the VLCD period (VLCD group). RESULTS: Significant 4-year weight losses were found in both groups, 7.6 +/- 12.2 kg (VLCD group) and 6.3 +/- 8.5 kg (non-VLCD group), (P < 0.01, n.s. between groups). The completers (n = 55) had maintained a weight loss of 3.3 +/- 10.7 kg (P < 0.05) 8 years after randomization. After 6 years, the noncompleters (n = 58) had gained 3.2 +/- 9.7 kg compared with baseline (P < 0.05). The difference in weight change between completers and non-completers was highly significant (P < 0.01). CONCLUSIONS: Highly significant weight losses can be maintained after a 4-year comprehensive treatment programme, including a hypocaloric diet and behavioural support. An initial VLCD period did not significantly affect the long-term weight loss. The posttreatment long-term weight loss was larger amongst completers than amongst patients who did not complete the treatment.