Measuring the impact of informal caring

A factor-analysis of caregiving impact appraisals amongst a community-derived sample of informal carers of elderly people revealed two negative (care work strain and relationship dissatisfaction) and two positive (care work satisfaction and care lifestyle satisfaction) scales. Validity was assessed by means of concurrent correlations with levels of assistance with daily living tasks provided by carers and levels of behaviour problems exhibited by elderly dependents. Criterion validity was considered in relation to two important carer outcomes; willingness to care and a standardized measure of strain. Each of the four scales was significantly associated with concurrently assessed willingness to care. Care work strain and relationship dissatisfaction were associated with concurrently measured strain symptomology. Evidence of 6-month predictive validity was obtained for the care work strain scale.     

Informal Caregiving to Persons with AIDS in the United States: Caregiver Burden Among Central Cities Residents Eighteen to Forty-Nine Years Old

Characteristics and caregiving experiences of friends and family members caring for people with AIDS (PWAs) were examined. Based on a probability sample of informal AIDS caregivers ages 18–49 living in central cities of the United States (n = 260), analyses were conducted to (a) identify the sociodemographic characteristics of young central city caregivers; and (b) examine the effects of caregiver characteristics (relationship to PWA, gender, race/ethnicity, income, sexual orientation, HIV status, perceived susceptibility), and level of objective caregiving demands, on subjective caregiver burden. Results indicate that the largest group of caregivers in this age category are male friends of the PWA—a group not typically found among caregivers to persons with other types of illnesses. In general, gay or bisexual caregivers, caregivers who have traditional family ties to the PWA, men relative to women, and lower income caregivers, report the greatest burden. While level of caregiving demands represents the most influential predictor of caregiver burden, white and male caregivers experience greater burden, independent of level of involvement and other caregiver characteristics. Receiving instrumental support with caregiving buffers the impact of high objective demands on subjective burden.     

Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.     

Life of the Second-Order Patient: Factors Impacting the Informal Caregiver

Informal caregivers (ICs) are forced to make adaptive lifestyle changes to meet the significant demand of caring for loved ones who are terminally ill. Open-ended questions were administered with 26 ICs who cared for loved ones diagnosed with terminal illnesses whose prognosis was less than six months. The results add substantive information to parsimonious literature and demonstrate a correlation with existing studies that coincide with the debilitating effects that caregiving has on the informal carer. The study clarifies the complexities of the caregiving role characterized by the involvement that may adversely affect socialization, physical health conditions, and marital dynamics, among other areas of the IC’s personal life.     

A Burden to Others: A Common Source of Distress for the Terminally Ill

Recent research into the desire for death among people with terminal illness has begun to recognize the importance of “feeling oneself a burden to others” as a factor in suicidal behaviour. In this study, 69 patients with advanced cancer underwent semi‐structured interviews. The sense of self‐perceived burden was found to be a common experience, reported by 39.1% of participants as a minimal or mild concern and by 38% as a moderate to extreme concern. The sense of burden showed a low correlation with physical symptoms (r = 0.02–0.24) and higher correlations with psychological problems (r = 0.35–0.39) and existential issues (r = 0.45–0.49). Comparisons of participants with high or low levels of self‐perceived burden showed the importance of this factor for overall quality of life. In summary, self‐perceived burden is an important but underestimated dimension of social cognition in the medically ill.     

The cortisol awakening response in caregivers of schizophrenic offspring shows sensitivity to patient status

Abstract

Taking care of offspring during a prolonged period of time is probably one of the most stressful life experiences for parents. The present study compares the cortisol awakening response (CAR) in 38 long-term caregivers (mothers and fathers of schizophrenic relatives) with a control group of 32 non-caregivers. Factors such as general stress, caregiver burden, patient severity, and institutionalization were studied. Although a blunted CAR was observed in caregivers in comparison with controls, this difference was not significant. Among caregivers, the absence of institutionalization for the patient is associated with a lack of CAR in caregivers in comparison with caregivers of institutionally supported patients. General stress, caregiver burden, and patient severity themselves did not favor significant changes in CAR. CAR shows greater sensitivity to institutional support than patient severity and perceived stress. Further research is needed to explain the impact of these factors on health and the psychological factors involved.     

2002年:中国医疗纠纷处理的重大转折

2002年4月1日开始实施的《最高人民法院关于民事诉讼证据的若干规定》,要求医院对医疗行为与损害的因果关系和不存在医疗过错承担举证责任,一时间,医院对此忿忿不平,百姓对此拍手叫好,4月15日,期待已久的《国务院医疗事故处理条例》缍正式颁布,与1987年颁布的《医疗事故处理办法》相比有了重大改变,中国医疗纠纷的处理在2002年发生了重大转折,对此进行了详细分析,与大多数人的观点不同,认为前者恰恰对医院有利,而后者对医院更为严格。     

Beweislastverteilung und Intuitionen in philosophischen Diskursen

Allocating the burden of proof and intuitions in philosophical disputes.– This paper criticises the view that in philosophical disputes the onus probandi rests on those who advance a position that contradicts our basic intuitions. Such a rule for allocating the burden of proof may be an adequate reconstruction of everyday justification, but is unreasonable in the area of philosophy. In philosophy it is not only difficult to determine the plausibility of a proposition, at the same time contradictory claims may be equally plausible. – In contrast to such common sense proposals I try to show that in philosophical disputes the burden of proof does not depend on the material content of speech acts. A speaker simply bears the burden of proof for a proposition p if he has asserted that p and has agreed to justify it. This revised version was published online in August 2006 with corrections to the Cover Date.     

On the dark side of work: a longitudinal analysis using self-determination theory

As the nature of work has changed in recent decades, employees are increasingly exposed to psychological demands in the workplace, which have associated consequences for employees, organizations, and society. Using self-determination theory, this study examined the dark side of work, in which frustration of basic psychological needs is associated with higher levels of work-related stress. In this model, work-related stress is associated with higher levels of somatic symptom burden, which in turn is associated with higher levels of emotional exhaustion, turnover intention, and absenteeism. Results of a longitudinal analysis using data from four time points over 15 months supported these predictions. Taken together, this study advances the literature towards an understanding of the (potential) detrimental impact that need-thwarting work contexts can have on employee wellness and work-related outcomes.     

THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth –3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, 2015 ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.