Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH)

This article provides background information and an overview on Resources for Enhancing Alzheimer's Caregiver Health (REACH) a multisite intervention trial for caregivers of persons with Alzheimer's disease designed to reduce caregiver burden and depression. REACH is the largest randomized controlled clinical trial to date, involving 1,222 caregiver and care recipient dyads recruited from 6 different sites in the United States. The authors describe the design of the study, summarize the interventions implemented at each site, and provide an overview of the 4 articles in this special section.     

The Resources for Enhancing Alzheimer's Caregiver Health (REACH): project design and baseline characteristics

The Resources for Enhancing Alzheimer's Cargiver Health (REACH) project was designed to test promising interventions for enhancing family caregiving for persons with dementia. The purpose of this article is to describe the research design, interventions, and outcome measures used in REACH and to characterize the sample recruited for the study. Nine interventions and 2 control conditions were implemented at 6 sites; 1,222 dyads were randomly assigned to an intervention or a control condition. The caregiver sample was 18.6% male with an average age of 62.3 years (56% Caucasian, 24% Black, and 19% Hispanic). Caregivers reported high levels of depressive symptoms and moderate burden. Care recipients were older, with a mean age of 79, and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30.     

Facing Up to Hopelessness: A Dialogal Phenomenological Study

Hopelessness is a fundamental human experience, and yet is often considered evidence either of sin or of illness. This dialogal phenomenological study, based on in-depth interviews, takes a fresh look at despair as experienced by people across a variety of ages and contexts, and at the consequences and outcomes of these feelings. At the heart of despair is a sense of isolation, impotence, and an immutable future, and yet it may give rise to new purpose or a new understanding and acceptance of life with its possibilities and limitations. The therapeutic implications of this understanding of despair are discussed with a focus on how presence can be healing.     

Darstellen und Rekonstruieren: Eine Hermeneutische Erwiderung auf Ian Hacking

Representing and Reconstructing: A Hermeneutical Reply to Ian Hacking. Hacking published in 1983 Representing and Intervening which has provoked, particularly in the US, the so called realism/anti-realism debate which is still alive today. He lays claim to anti-realism for theory and to realism for the experiment. Following him, only that which can be used for manipulating something (e.g., the path of an electon) is realistic. H. Putnam is a severe critic of this dualism. In my paper I am going to take the Hacking-Putnam controversy as a starting-point for the problem about the determination of the relation between theory and experiment in the natural sciences. I shall then follow M. Schlick's discussion of this problem and the current solution to the problem as offered by H. Pietschmann. The differing interpretation of Kant according to the three perspectives shall be the guideline for the argumentation. The goal of my argumentation is that theory and experiment do not live their own lives, that in experimenting one always continues traditional chains of action, and that natural science cannot be regarded independently of the life world it takes place in. This insight into the representing and reconstructing overturns in natural science, due to the necessity of human decisions, opens up their hermeneutical dimension. This revised version was published online in August 2006 with corrections to the Cover Date.     

The effects of mutual concern on joint welfare

Previous studies attempting to assess the impact of concern for an opponent bargainer's welfare (orientation) upon the integrativeness of the agreements reached have produced differing conclusions. The design of an earlier experiment by Kelley and Schenitzki was replicated using a different negotiation method and task. Participants took the role of either the buyer or the seller in a two-party negotiation. Bargainers received instructions emphasizing either a Team Orientation (i.e., concern for mutual profit) or an Individualistic Orientation (i.e., concern for only one's own profit) and bargained under either a Free Communication or a Restricted Communication condition. The Team Orientation produced more integrative agreements (i.e., higher joint outcomes) than the Individualistic Orientation, regardless of the communication condition. Process data suggested that distinct processes may promote the development of integrative solutions in the two communication conditions.     

Source Characteristics in Denying Rumors of Organizational Closure: Honesty Is the Best Policy

Effect of source honesty and appropriateness on effectiveness of rumor denial was tested. When the source was perceived as high on honesty, the denial was more successful in reducing belief and anxiety associated with the rumor. Source appropriateness (operationalized as a combination of source knowledgeability and status) did not have a main effect on belief or anxiety reduction. Honesty and appropriateness had an additive effect, such that the denial was most successful in reducing belief when the source was perceived as high on both honesty and appropriateness.     

Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery

Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.     

Causal learning mechanisms in very young children: two-, three-, and four-year-olds infer causal relations from patterns of variation and covariation

Three studies investigated whether young children make accurate causal inferences on the basis of patterns of variation and covariation. Children were presented with a new causal relation by means of a machine called the "blicket detector." Some objects, but not others, made the machine light up and play music. In the first 2 experiments, children were told that "blickets make the machine go" and were then asked to identify which objects were "blickets." Two-, 3-, and 4-year-old children were shown various patterns of variation and covariation between two different objects and the activation of the machine. All 3 age groups took this information into account in their causal judgments about which objects were blickets. In a 3rd experiment, 3- and 4-year-old children used the information when they were asked to make the machine stop. These results are related to Bayes-net causal graphical models of causal learning.     

Preschool children learn about causal structure from conditional interventions

The conditional intervention principle is a formal principle that relates patterns of interventions and outcomes to causal structure. It is a central assumption of experimental design and the causal Bayes net formalism. Two studies suggest that preschoolers can use the conditional intervention principle to distinguish causal chains, common cause and interactive causal structures even in the absence of differential spatiotemporal cues and specific mechanism knowledge. Children were also able to use knowledge of causal structure to predict the patterns of evidence that would result from interventions. A third study suggests that children's spontaneous play can generate evidence that would support such accurate causal learning.     

Depression and distress predict time to cardiovascular disease in dementia caregivers.

OBJECTIVE: This study assessed the impact of depressive symptoms and distress from patient problem behaviors on time to developing a diagnosis of cardiovascular disease (CVD) in a sample of 643 dementia family caregivers. DESIGN: A longitudinal, prospective design was used. Over an 18-month period, caregivers free from a CVD diagnosis at baseline were assessed at 6, 12, and 18-month follow-ups for the onset of CVD. MAIN OUTCOME MEASURES: Days to the onset of CVD was the primary outcome. RESULTS: Over the length of the study, 32 participants (5%) reported a diagnosis of CVD. After adjusting for sociodemographic and health factors (e.g., high blood pressure, age, smoking history), greater depressive symptoms (p = .040) and distress from patient problem behaviors (p = .034) were significant predictors of time to CVD diagnosis. CONCLUSION: This study suggests that increased depressive symptoms and reaction to patient problem behaviors (i.e., distress) may increase caregivers' risk for experiencing negative health outcomes, specifically CVD.