Managing multiple chronic conditions in Singapore – Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis

Objective: Diabetes mellitus (DM) is the commonest cause of end stage renal disease (ESRD). Despite increasing DM-ESRD prevalence and high dependency on care, there is a lack of literature on DM-ESRD caregivers. We sought to explore the perspectives and experiences of caregivers of patients with DM undergoing haemodialysis in Singapore.

Design: This study employed an exploratory, qualitative design comprising in-depth interviews with caregivers of DM-ESRD patients.

Methods: Semi-structured interviews were conducted with a sample of 20 family caregivers (54.2 ± 12.6 years; 75% female) of DM-ESRD patients. Data were analysed using Thematic Analysis.

Results: Key caregiving challenges identified were managing diet, care recipients’ emotions and mobility dependence. Patients’ emotional reactions caused interpersonal conflicts and hindered treatment management. Difficulties in dietary management were linked to patients’ erratic appetite, caregivers’ lack/poor understanding of the dietary guidelines and caregivers’ low perceived competence. Limited resources in terms of social support and finances were also noted. Physical and psychological well-being and employment were adversely affected by caregiving role.

Conclusion: This study highlights distinctive aspects of the DM-ESRD caregiving experience, which impact on caregivers’ health and challenge care. Disease management programmes should be expanded to support caregivers in dealing with multimorbidity.     

Determinants of fear over the course of avoidance learning

Most theorists have explained attenuation of fear over the course of avoidance learning by assuming that fear extinguishes with repeated nonreinforced avoidance trials. Experiment 1 replicates the finding that rats trained to a criterion of 27 consecutive avoidance responses (CARs) show less fear during the CS than rats trained to a criterion of 3 or 9 CARs. This attenuation of fear cannot, however, be accounted for by simple Pavlovian fear extinction, because yoked partners receiving the exact same pattern of CSs and USs did not show this attenuation and did not differ from yoked partners receiving only reinforced CS presentations. Experiment 2 found that feedback from the master avoidance learner's response is sufficient to produce this attenuation in yoked animals; “control” per se is not necessary. Several possible explanations are discussed regarding the mechanism underlying this role of feedback in diminishing fear of the CS in the avoidance learning context.     

Birth weight and cognitive ability in childhood: a systematic review

Individual differences in cognitive ability may in part have prenatal origins. In high-risk (low birth weight/premature) babies, birth weight correlates positively with cognitive test scores in childhood, but it is unclear whether this holds for those with birth weights in the normal range. The authors systematically reviewed literature on the relationship between normal birth weight (more than 2,500 g) and childhood intelligence in term (37-42-week gestation) deliveries. Six studies met the inclusion criteria, and the authors present a comprehensive narrative review of these studies. There was a small, consistent, positive association between birth weight and childhood cognitive ability, even when corrected for confounders. Parental social class accounted for a larger proportion of the variance than birth weight, and these 2 variables were largely independent.