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Primary Caregivers (primary + caregiver)

Distribution by Scientific Domains

Medical Sciences	54%
Humanities and Social Sciences	27%
Psychology	15%

Selected Abstracts

Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department?

EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2007
Glenn Ryan
Abstract Objective:, To determine whether family members interfere with patient care when present during invasive procedures performed on their children in the ED. Methods:, A prospective observational study of consecutive cases of procedural sedation of children aged between 12 months and 16 years was conducted between March 2002 and March 2006 in the ED of a secondary-level regional hospital in south-east Queensland. Procedures performed included laceration repair, fracture reduction, foreign body removal and abscess incision and drainage. Parents/primary caregivers were encouraged to stay with their child. A stepwise explanation of the procedure and sedation to be used was undertaken, informed consent obtained and telephone follow up attempted 5,14 days post procedure. Results:, Six hundred and fifty-two patient encounters with parents or primary caregivers present for the procedure were included for a total of 656 procedures: 234 laceration repairs, 250 fracture reductions, 85 foreign body removals, 33 abscess incision and drainages, 14 dislocation reductions and 40 other procedures. Telephone follow up was successful in 65% (424) of cases. The mean age was 6.5 years. Family member interference occurred in one case (0.15%, 95% confidence interval 0,0.73%). In 17 cases (2.68%, 95% confidence interval 2.1,5.9%) family members present expressed concerns about the procedure during the telephone follow up but had not interfered at the time of the procedure. There were no significant differences between the concerned parents at follow up and the study group across key patient variables such as child's age (P = 0.369), weight (P = 0.379), respiratory rate (P = 0.477), sex (P = 0.308), procedure indication (P = 0.308) and airway manoeuvres (P = 0.153). Conclusion:, When family members are encouraged to stay for invasive procedures performed on their child, and careful explanation of the procedure, sedation, possible complications, choice of medication for sedation and possible side-effects is undertaken, family member interference is extremely rare. [source]

Coherent Accounts of Coping with a Chronic Illness: Convergences and Divergences in Family Measurement Using a Narrative Analysis

FAMILY PROCESS, Issue 4 2003
BARBARA H. FIESE Ph.D.
Researchers and clinicians have shown increasing interest in family narratives as an avenue for accessing the family meaning-making process. In this study, we examine the convergences and divergences between narrative assessment, family self-report, and verbal accounts of family climate. Sixty-two families with a child with pediatric asthma were interviewed about the impact that asthma had on family life. These interviews were coded for narrative coherence, relationship expectations, and engagement with the interviewer. Primary caregivers were also interviewed using the Five Minute Speech sample (FMSS) and completed self-report assessments of family functioning (Family Assessment Device [FAD] Impact on the Family Scale [IOF]). Contrary to prediction. Narrative coherence was higher in those cases where Emotional Over-involvement (EOI) was present on the FMSS. Narrative coherence and engagement with the interviewer were positively related to self-report of family problem solving, communication, and affective responsiveness as measured on the FAD. Divergences and convergences between different types of family measurement are discussed in light of meaning-making processes associated with coping with a chronic illness. [source]

Developmental, behavioural and somatic factors in pervasive developmental disorders: preliminary analysis

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2004
P. Whiteley
Abstract Objectives To ascertain the frequency of parental reporting of selected variables related to development, behaviour and physiology in subgroups diagnosed with pervasive developmental disorders (PDDs) and identify any significant intragroup differences. Design Retrospective cross-sectional analysis of records of patients (n = 512) held on a computerized database with a chronological age between 3 and 11 years resident in the UK/Republic of Ireland and with a formal diagnosis of autism, Asperger syndrome (AS) or autism spectrum disorder (ASD). Methods Non-parametric analysis (P > 0.01) of the frequency of specific variables for PDD subgroups reported by parents/primary caregiver. Variables included timing of symptom onset, presence of skills acquired prior to symptom onset, indications of regression and regression events, current language, history of viral infections, history of ear problems, achievement of continence, current skin complaints, current bowel habits and adverse events at parturition. Results Preliminary results showed general agreement with the principle diagnostic differences between the PDD subgroups with patients diagnosed with AS showing an increased frequency of skills acquired before symptom onset (two- to three-word phrase speech, toileting skills) and a decreased frequency of regression in acquired skills when compared with other PDD subgroups. Developmental milestones such as the achievement of bowel and bladder continence were also more frequently reported for the AS group. Infantile feeding problems defined as vomiting, reflux, colic and failure to feed were more frequently reported for the AS group as was a reported history of the bacterial skin infection impetigo. Results are discussed with reference to relationships between behavioural and somatic factors in PDD. [source]

Risk factors for adult male criminality in Colombia

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2001
Joanne Klevens
Objectives This study sought to establish, in Colombia, the importance of factors alleged to be causes or correlates of adult criminality according to the published literature from other countries. Methods A comparison was made of arrested male offenders from ages 18 to 30 (n = 223) and similar community controls (n = 222) selected from five cities in Colombia as to their family background, exposure to abuse, family stressors, perceived care and history of childhood disruptive behaviour problems. Results Compared with neighbourhood controls from similar social classes, offenders were significantly more likely to report having had parents with less education, a mother under the age of 18 or over the age of 35 at time of birth, family members involved in crime, experiencing extreme economic deprivation, parental absence, family conflict, severe punishments, physical abuse, and maternal unavailability, rejection and lack of supervision. Prevalence of childhood disruptive behaviour problems was similar among offenders and controls. These findings appear to be independent of economic status, family size or type, birth order, or primary caregiver. Although the independent contribution of most of these factors is small, once all others have been controlled for, their cumulative effect is strong. Conclusions The findings obtained in this Latin American setting do not support the generalized view that adult antisocial behaviour is necessarily preceded by a history of childhood behaviour problems. However, they do add evidence for the importance of family factors in the risk for adult criminality. Copyright © 2001 Whurr Publishers Ltd. [source]

Age-related differences in neural correlates of face recognition during the toddler and preschool years

DEVELOPMENTAL PSYCHOBIOLOGY, Issue 2 2003
Leslie J. Carver
Abstract Research on the development of face recognition in infancy has shown that infants respond to faces as if they are special and recognize familiar faces early in development. Infants also show recognition and differential attachment to familiar people very early in development. We tested the hypothesis that infants' responses to familiar and unfamiliar faces differ at different ages. Specifically, we present data showing age-related changes in infants' brain responses to mother's face versus a stranger's face in children between 18 and 54 months of age. We propose that these changes are based on age-related differences in the perceived salience of the face of the primary caregiver versus strangers. © 2003 Wiley Periodicals, Inc. Dev Psychobiol 42: 148,159, 2003 [source]

ANOTHER LOOK AT THE DEVELOPMENTAL RESEARCH

FAMILY COURT REVIEW, Issue 4 2001
Access Decisions for Young Children", Commentary on Kelly, Lamb's "Using Child Development Research to Make Appropriate Custody
Kelly and Lamb (2000) recently provided a summary of the attachment literature and a set of guidelines for visitation and custody for young children in divorced and separated families. Here, Solomon and Biringen review the same literature with an eye to critically evaluating these guidelines, especially the suggestion that more, rather than fewer, transitions between parents are appropriate for very young children. Three types of empirical findings raise questions regarding the appropriateness of Kelly and Lamb's guidelines. These include differences in the development of infant-mother and infant-father attachments, young children's sensitivity to overnight separations from the primary caregiver, and the possibility of infant preferences for primary versus secondary caregivers in times of stress. The authors argue that considerably more rigorous research is required before submitting Kelly and Lamb's suggestion to social policy. [source]

Combined effect of factors associated with burdens on primary caregiver

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2009
Hyuma Makizako
Background: It is argued that a multidimensional approach is necessary for burden assessment. Reducing caregiver burden is a social problem in the ageing Japan society. We examined the combined effect of factors affecting the care burden among community-dwelling handicapped people and their caregivers. Methods: The participants were 49 handicapped people (aged 53,104 years) who received home-visit rehabilitation, and their 49 caregivers (age 42,85 years). Caregivers were provided questionnaires consisting of questions on social support, subjective well-being, self-efficacy with regard to care continuation, the Motor Fitness Scale and caregiver burden. Care recipients were assessed using the Bedside Mobility Scale and the Barthel Index. Results: We prepared the hypothesis model using structural equation modeling with the bootstrap method within outcome measures. The hypothesis model did not fit the data well. The impact of the Motor Fitness Scale was shifted from the caregiver burden to care self-efficacy and well-being, having a cooperator for care and variable of spouse caregiver or others associated with caregiver well-being in the revised model. The fit of the revised model was acceptable (goodness of fit index, 0.903; comparative fit index, 0.998; root mean square error of approximation, 0.017). In the revised model, the care recipients' disabled state was associated with caregiver burden. In addition, higher burden and poor motor fitness of caregivers might lead to lower care self-efficacy in providing continuous care and lower caregiver well-being. Conclusion: These findings suggested that the program to reduce caregiver burden should focus on aspects of the care recipients' disabled state, the caregivers' well-being, fitness, and care self-efficacy. [source]

Children's prescription medicines: parents' perceptions on dosing intervals, dosing devices and prescription advice

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2007
Dr. Therése Kairuz senior lecturer, pharmacy practice
Objective To gather information on devices used to administer liquid medicines, dosing intervals for antibiotic administration, and parents' perceptions of the advice received from pharmacists about prescription medicines, for children up to the age of six years. Setting Six schools from different socio-economic areas were selected within the Auckland area of New Zealand. To facilitate distribution and collection of questionnaires, the headmaster or a teacher was known to the researchers. Method An anonymous questionnaire was distributed to year 1 and 2 students (aged five and six years) to take home for completion by a parent or primary caregiver. Respondents were asked to refer to their youngest child and/or to the last time they had given medicines or received a prescription for a child. Key findings A total of 299 completed questionnaires were received (48.2%); 60 questionnaires had not been distributed by school teachers in error, and the overall return rate was thus adjusted to 53.4%. The device used most frequently to administer medicines to younger children up to the age of three years was an oral medicine syringe, while nearly one-third of children aged three to six years received medicine in a ,teaspoon'. Almost half the respondents (48.8%) indicated they would be most likely to forget the midday dose of antibiotics, and dosing deviated from recommended intervals. Most respondents had received advice from a pharmacist on how to take the medicine, and had understood instructions and had the opportunity to ask questions. Conclusion This study highlights areas that pharmacists can include when advising parents and guardians about children's medicines, such as ideal dosing intervals of antibiotics and the use of accurate dosing devices. [source]

Pattern recognition as a caring partnership in families with cancer

JOURNAL OF ADVANCED NURSING, Issue 3 2000
Emiko Endo RN PhD
Pattern recognition as a caring partnership in families with cancer The purpose of this study was to address the process of a caring partnership by elaborating pattern recognition as nursing intervention with families with cancer. It is based on Newman's theory of health as expanding consciousness within the unitary-transformative paradigm and is an extension of a previous study of Japanese women with ovarian cancer. A hermeneutic, dialectic method was used to engage 10 Japanese families in which the wife-mothers were hospitalized because of cancer diagnosis. The family included at least the woman with cancer and her primary caregiver. Each of four nurse-researchers entered into partnership with a different family and conducted three interviews with each family. The participants were asked to describe the meaningful persons and events in their family history. The family's story was transmuted into a diagram of sequential patterns of interactional configurations and shared with the family at the second meeting. Evidence of pattern recognition and insight into the meaning of the family pattern were identified further in the remaining meetings. The data revealed five dimensions of a transformative process. Most families found meaning in their patterns and made a shift from separated individuals within the family to trustful caring relationships. One-third of them went through this process within two interviews. The families showed increasing openness, connectedness and trustfulness in caring relationships. In partnership with the family, each nurse-researcher grasped the pattern of the family as a whole and experienced the meaning of caring. Pattern recognition as nursing intervention was a meaning-making transforming process in the family,nurse partnership. [source]

Does controlling for comorbidity matter?

AGGRESSIVE BEHAVIOR, Issue 3 2010
DSM-oriented scales, violent offending in chicago youth
Abstract Mental health problems have long been linked to antisocial behaviors. Despite an impressive body of literature demonstrating this relationship and claims that comorbidity matters, few studies examine comorbidity using multiple distinct mental health indicators, with most studies instead adopting single or composite mental health measures. This study tested separate and comorbid effects of five DSM-oriented mental health issues on self-reported violence using a community-based sample of Chicago youths from the Project on Human Development in Chicago Neighborhoods. Moreover, it utilized both primary caregiver and youth self-reports of psychopathology across four developmental stages of childhood and adolescence. When examined separately, the results indicated affective/depressive, anxiety, attention deficit hyperactivity, and oppositional defiant/antisocial personality problems independently predicted violence. When considering comorbidity, however, only oppositional defiant and antisocial personality problems significantly predicted violence at any stage, regardless of informant type. Implications for future studies and policy are discussed. Aggr. Behav. 36:141,157, 2010. © 2010 Wiley-Liss, Inc. [source]

Motherhood as a Status Characteristic

JOURNAL OF SOCIAL ISSUES, Issue 4 2004
Cecilia L. Ridgeway
We present evidence that many of the disadvantaging effects that motherhood has on women's workplace outcomes derive from the devalued social status attached to the task of being a primary caregiver. Using expectation states theory, we argue that when motherhood becomes a salient descriptor of a worker it, like other devalued social distinctions including gender, downwardly biases the evaluations of the worker's job competence and suitability for positions of authority. We predict that the biases evoked by the motherhood role will be more strongly discriminatory than those produced by gender alone because the perceived conflicts between the cultural definitions of the good mother and the ideal worker make motherhood seem more directly relevant to workplace performance. [source]

Employment Status, Depressive Symptoms, and the Mediating/Moderating Effects of Single Mothers' Coping Repertoire

PUBLIC HEALTH NURSING, Issue 6 2007
Joan Samuels-Dennis
ABSTRACT Objective: Single mothers, especially those on social assistance, report significantly more depressive symptoms than the general public. This article examines the relationships among employment status, stressful life events, and depressive symptoms among single mothers, with a special focus on the potential mediating and moderating roles of coping repertoire. Design: Cross-sectional survey design. Sample: Ninety-six single mothers (48 employed and 48 single mothers on social assistance) who were the primary caregiver for at least 1 child 4,18 years old. Measurements: Mailed questionnaires that included an adapted version of the Social Readjustment Rating Scale, the Coping Strategy Inventory, and the Beck Depression Inventory, 2nd ed. were completed by study participants. Results: Coping repertoire did not mediate the relationship between either employment status or stress exposure and depressive symptoms. Coping had an antagonistic and differential moderating effect on the association between employment status and depressive symptoms for employed single mothers and mothers receiving social assistance. Conclusion: Effective strategies aimed at promoting single mothers' mental health need to address both the severity of depressive symptoms found among single mothers, and the social-system factors that threaten single mothers' psychological well-being. The implications for practice and policy are discussed. [source]

Development of a Brief Waiting Room Observation for Behaviours Typical of Reactive Attachment Disorder

CHILD AND ADOLESCENT MENTAL HEALTH, Issue 2 2010
Alexis McLaughlin
Objective:, To develop a brief standardised observational schedule for Reactive Attachment Disorder (RAD) in school-age children to aid clinician recognition of these behaviours. Design:, A new structured observational schedule for symptoms of RAD was developed using unstructured observation of children in a clinic waiting room setting. The measure's ability to discriminate between a sample of children with RAD and a normative sample was established by comparing scores in these two groups. Method:, Children aged 5,8 years (n = 77 [38 RAD cases and 39 controls]) were observed with their primary caregiver in a standardised waiting room setting. A structured observational tool was developed that tested the reliability, sensitivity and specificity of each item. Results:, The schedule has good internal consistency (0.75). The individual items on the observational schedule were predominantly highly discriminatory between cases and comparisons, showing both reasonable sensitivity and excellent specificity. Certain questions were dropped due to poor discrimination and/or poor inter-rater reliability. Conclusion:, The 10-item observational schedule for RAD in school-age children provides a promising tool for assessment, although further research will be required to evaluate its ability to discriminate between RAD and other disorders. [source]

Developmental Trajectories of Sex-Typed Behavior in Boys and Girls: A Longitudinal General Population Study of Children Aged 2.5,8 Years

CHILD DEVELOPMENT, Issue 5 2008
Susan Golombok
The stability of sex-typed behavior from the preschool to the middle school years was examined. The Preschool Activities Inventory, a measure of within-sex variation in sex-typed behavior, was completed by the primary caregiver when the child was 2.5, 3.5, and 5 years, and a modified version, the Child Activities Inventory, was completed by the child at age 8. The investigation involved a general population sample of 2,726 boys and 2,775 girls. Sex-typed behavior increased through the preschool years, and those children who were the most sex typed at age 2.5 were still the most sex typed at age 5, with those children who showed the highest levels of sex-typed behavior during the preschool years continuing to do so at age 8. [source]

Physician and emergency medical technicians' knowledge and experience regarding dental trauma

DENTAL TRAUMATOLOGY, Issue 3 2006
Shaul Lin
Abstract,,, The purpose of the present study was to evaluate the knowledge of physicians and emergency medical technicians (EMT) regarding primary treatment for dental trauma and to assess the experience they have in treating dental injuries. The study population consisted of 70 military physicians and EMT during their military service. A questionnaire was distributed relating to demographic data, such as age, gender, position, and type of military service, as well as the following issues: past experience in treating or witnessing dental trauma, former education regarding diagnosis and treatment of dental trauma, assessment of knowledge regarding dental trauma, etc. Of all participants, only 4 (5.9%), all physicians, received education regarding dental trauma. Nevertheless, 42 (61.8%) reported they witnessed such an injury during their military service. Dental injuries were first seen by the EMT in 41.2% of the cases, by the physician in 25%, and by a dentist in only 7.3%. Overall, 58 (85.3%) of the physicians and EMT stated that it was important to educate the primary health care providers regarding diagnosis and treatment of dental trauma. Special emphasis should be given to providing primary caregivers with the relevant education to improve their knowledge and ability of dealing with diagnosis and treatment of dental trauma. [source]

Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department?

Depressive symptoms among mothers of children with epilepsy: A review of prevalence, associated factors, and impact on children

EPILEPSIA, Issue 11 2009
Mark A. Ferro
Summary The impact of epilepsy is not limited to the child experiencing seizures, but affects all members of the family. As primary caregivers, mothers are particularly at risk for experiencing increased depressive symptoms and risk for clinical depression. The objective of this systematic review was to critically assess available evidence regarding the prevalence, associated factors, and impact of maternal depressive symptoms on child outcomes in epilepsy. Using a modified version of the Quality Index, studies were rigorously evaluated in terms of reporting, external validity, and internal validity. Limitations in the study designs and analytic techniques of previous research are discussed, and study methods to overcome these barriers are presented in order to advance this research area. Up to 50% of mothers of children with epilepsy are at risk for clinical depression. Correlates of maternal depressive symptoms include a number of modifiable risk factors such as role ambiguity, worry, and satisfaction with relationships. In addition, studies suggest that depressive symptoms in mothers have a negative impact on child outcomes in epilepsy including behavior problems and health-related quality of life. The overall mean score on the Quality Index was 9.7, indicating a midrange quality score, suggesting a need for more methodologically robust studies. [source]

Negative emotionality, attachment quality, and behavior problems in early childhood

INFANT MENTAL HEALTH JOURNAL, Issue 1 2007
Ursula Pauli-Pott
Negative emotionality, as well as attachment security and disorganization, are seen as major contributors to social adjustment and maladjustment in childhood. However, relatively little is known about whether infant negative emotionality and attachment quality operate together to affect developing behavior problems. The present study thus aims to contribute to this question. Participants were 64 healthy firstborn children and their primary caregivers. Negative emotionality was assessed at the infant ages of 4, 8, and 12 months using laboratory routines. At 18 months, the Strange Situation procedure was conducted to assess infant attachment security and disorganization, and at 30 months, the child's behavior problems were assessed within a structured clinical interview. Attachment security and attachment disorganization were significantly associated with subsequent behavior problems. There was no significant relation between infant negative emotionality and behavior problems. However, there were indications of a stronger association between attachment disorganization and behavior problems in infants high in negative emotionality. The results underpin the importance of attachment quality as well as negative emotionality in social adjustment. Disorganized attachment precedes poor adjustment, especially in infants high in negative emotionality. [source]

Prenatal cocaine exposure and infant sleep at 7 months of age: The influence of the caregiving environment

INFANT MENTAL HEALTH JOURNAL, Issue 4 2006
Pamela Schuetze
The primary goal of this study was to examine sleep problems in a sample of cocaine-exposed 7-month-old infants and to determine if maternal psychopathology mediated any existing association between substance exposure and sleep behaviors. We also examined the differences in sleep behaviors of cocaine-exposed infants in parental custody and cocaine-exposed infants in nonparental custody. Participants were 65 cocaine-exposed and 53 nonexposed infants and their primary caregivers who were recruited at delivery and assessed at 7 months of infant age. As expected, women who used cocaine during pregnancy had more psychiatric symptoms than nonusers. Prenatal exposure to heavier amounts of cocaine was significantly related to more severe sleep difficulties, and maternal anxiety mediated this association. Approximately 28% of cocaine mothers lost custody of their infants by 7 months of age. Nonmaternal caregivers had significantly fewer symptoms of psychopathology than the cocaine-using women who retained custody of their children. Infants who were in nonparental care at 7 months of age also had less severe sleep problems than did infants who remained in parental care. [source]

Profile of depression in adolescents with inflammatory bowel disease: Implications for treatment

INFLAMMATORY BOWEL DISEASES, Issue 1 2009
Eva Szigethy MD
Abstract Background: The purpose was to determine the utility of including neurovegetative symptoms in assessments of depression in youth with inflammatory bowel disease (IBD). Methods: Forty-one youth with IBD and concurrent depressive symptomatology were enrolled in an intervention trial and received either 9 modules of cognitive-behavioral therapy (PASCET-PI) or treatment as usual (TAU). Youth and their primary caregivers completed the Children's Depression Inventory (CDI) at pre- (T1) and posttreatment (T2). Disease severity measures and current steroid dosage were obtained at each timepoint. Change in the individual items of the CDI was compared across groups and examined in association with change in physical illness course. Results: Paired sample t -tests revealed significant changes in CDI item scores from T1 to T2 for a majority of the depressive symptoms assessed in the PASCET-PI group, but not for the TAU group. These changes did not appear to be linked to changes in disease severity and/or steroid dosage across these same timepoints. Conclusions: The inclusion of somatic items in the assessment of depression in physically ill youth is important, as these symptoms seem to respond to psychotherapeutic intervention. The present results would suggest that improvements in depressive symptomatology are not solely related to improvements in the course of IBD and that these items do reflect an important part of the profile of depressive symptoms in youth with IBD. Future research is warranted to replicate present findings and explore the generalizability of these results to other pediatric illness populations. (Inflamm Bowel Dis 2008) [source]

Cost of Alzheimer's disease in a developing country setting

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005
M. Zencir
Abstract Purpose To evaluate the economic impact of AD in Denizli, Turkey. Design and Methods This observational study was conducted with 42 AD patients and their primary caregivers. During the initial interview, demographic data and medical histories were collected with questionnaires. For an observational period of 15 days, data on time spent for patient care were collected using standard forms. Calculations on direct cost (e.g. per day medication, outpatient physician visits during the last 3 months), indirect cost (e.g. time spent for care by caregiver for daily living (ADL) and instrumental activity of daily living (IADL)) were made by summing up and taking averages of the appropriate items. ANOVA, and linear regressions were the methods for comparisons. Results The primary caregivers of the patients mainly were their children and/or spouses. The maximum mean time spent (h/week) was 21.0 (17.5) for severely damaged cognition. The average annual cost per case was between $1,766 [95% Confidence Intervals (CI); 1.300,2.231] and $4,930 (95% CI; 3.3714,6.147). The amount of caregiver cost was the most significant item in the overall cost and it showed an increase with the declining cognitive function of patients. Daily medication cost reflected the same pattern. In contrast, cost of outpatient physician was the lowest among the patients with the worst cognition. Conclusions These results suggest that recently AD has become a significant cost for developing countries. This pilot study gives an idea of the cost of AD in developing countries where determining the actual cost can be difficult. Copyright © 2005 John Wiley & Sons, Ltd. [source]

When Home Care Ends,Changes in the Physical Health of Informal Caregivers Caring for Dementia Patients: A Longitudinal Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2002
Elmar Gräsel MD
OBJECTIVES: To verify the change in health variables and parameters of health service utilization in a group of active caregivers for older persons with dementia in comparison with former caregivers who had ceased to provide home care for at least 6 months (death of the patient or institutionalized care). DESIGN: A prospective longitudinal study with 1-year follow-up. Active and former caregiver groups originated from a sample of active caregivers at baseline. SETTING: Participants were recruited mainly via advertisements placed in two magazines with large, nationwide circulation. The questionnaires were sent on request. PARTICIPANTS: Seven hundred twenty primary caregivers of dementia patients living in the community. All patients had a medical diagnosis of dementia and had a score of 20 or greater on the mental-mnestic disturbances factor of the Sandoz Clinical Assessment,Geriatric scale. Their care needs covered at least one of four activities of daily living (personal hygiene, eating, toilet use/excretion, mobility). After 12 months, 681 caregivers were reinterviewed. MEASUREMENTS: The physical complaints were assessed with the 24-item Giessen Symptom List (subscales: aching limbs, stomach complaints, heart complaints, physical exhaustion). Other key variables were the number of illnesses, number of somatic and psychotropic medications, and number of physician visits. RESULTS: Although the somatic symptoms of the active caregivers (n = 427) remained stable at a high level, they decreased significantly (24%) in the group of former caregivers (n = 121). Simultaneously, the number of visits former caregivers made to physicians almost doubled. The reason why home care was terminated (death or institutionalization) did not influence health variables or health service utilization. CONCLUSION: The physical health of former caregivers improves in the long term once they cease to provide home care. The fact that former caregivers go to the doctor much more frequently is to be interpreted as an indication that they take the time to attend to their own physical and medical needs. [source]

Effects of Maternal Depressive Symptoms and Infant Gender on the Interactions Between Mothers and Their Medically At-Risk Infants

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2008
June Cho
ABSTRACT Objective:, To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants. Design:, Longitudinal, descriptive secondary analysis. Setting:, Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East. Participants:, One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months. Main Outcome Measures:, Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results:, The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms. Conclusion:, Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants. [source]

Factors of complicated grief pre-death in caregivers of cancer patients

PSYCHO-ONCOLOGY, Issue 2 2008
Alexis Tomarken
Abstract Purpose: Over the past decade, Prigerson and her colleagues have shown that symptoms of ,complicated grief',intense yearning, difficulty accepting the death, excessive bitterness, numbness, emptiness, and feeling uneasy moving on and that the future is bleak,are distinct from depression and anxiety and are independently associated with substantial morbidity. Little is known about complicated grief experienced by family caregivers prior to the death. This study sought to examine differences in caregiver age groups and potential risk factors for complicated grief pre-death. Method: Two hundred and forty eight caregivers from multiple sites nationwide (20,86 years of age) identified themselves as primary caregivers to a terminally ill cancer patient. Each caregiver was interviewed using the following measures: the Pre-Death Inventory of Complicated Grief-Caregiver Version; the Brief Interpersonal Support Evaluation List; the Structured Clinical Interview for the DSM-IV Axis I; the Life Orientation Test-Revised; the SEPRATE Measure of Stressful Life Events; the Covinsky Family Impact Survey; and mental health access questions. Results: The study found that those under 60 years old had higher levels of complicated grief pre-death than caregivers 60 and older (t(246)=2.30, p<0.05). Significant correlations were also found between levels of complicated grief pre-loss and the following psychosocial factors: perceived social support (r=,0.415, p<0.001); history of depression (r=,0.169, p<0.05); current depression (r=,0.158, p<0.05); current annual income (Spearman rho =,0.210, p<0.01); annual income at time of patient's diagnosis (Spearman rho =,0.155, p=0.05); pessimistic thinking (r=0.320, p<0.001); and number of moderate to severe stressful life events (Spearman rho = 0.218, p=0.001). In a multi-variate analysis (R2=0.368), pessimistic thinking (Beta = 0.208, p<0.05) and severity of stressful life events (Beta = 0.222, p<0.05) remained as important factors to developing complicated grief pre-death. Conclusions: These results suggest that mental health professionals who work with caregivers should pay particular attention to pessimistic thinking and stressful life events, beyond the stress of the loved one's illness, that caretakers experience. Additionally, although not reaching significance, mental health professionals should also consider younger caregivers at greater risk for complicated grief pre-loss. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Conceptualization and sources of costs from breast cancer: Findings from patient and caregiver focus groups

PSYCHO-ONCOLOGY, Issue 5 2005
Sophie Lauzier
Assessment of economic burden of breast cancer to patient and family has generally been overlooked in assessing the impact of this disease. We explored economic aspects from the perspective of women and their caregivers. Focus groups were conducted in 3 Quebec cities representing urban and semi-urban settings: 3 with 26 women first treated for non-metastatic breast cancer in the past 18 months, and 3 with 24 primary caregivers. We purposefully selected participants with different characteristics likely to affect the nature or extent of costs. Thematic content analysis was conducted on verbatim transcripts. Costs of breast cancer could be substantial, but were not the most worrisome aspect of the illness during treatments. Some costs were considered unavoidable, others depended on ability to pay. Costs occurred over a long period, with long term impact, and were borne by the whole family and not just the woman. Principal cost sources discussed were those associated with accessing health care, wage losses, reorganization of everyday life, and coping with the disease. This study provided deeper understanding of cost dynamics and the experience of costs among Canadian women with non-metastatic breast cancer, whose treatment and medical follow-up costs are borne through a system of universal, publicly funded health care. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Predictors of burnout in the family caregivers of Alzheimer's disease: Evidence from Turkey

AUSTRALASIAN JOURNAL ON AGEING, Issue 1 2009
Aysegul Y, lmaz
Objective:The aim of this study was to investigate the factors related to burnout in the family caregivers of Alzheimer's disease. Methods:Subjects included in the study were 44 Alzheimer's disease patients and their primary caregivers. Patients were evaluated with Mini Mental State Examination, Brief Psychiatric Rating Scale, Physical Self-Maintenance Scale and Geriatric Depression Scale, and carers were administered Maslach Burnout Inventory, Ways of Coping Scale, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale. Results:The emotional exhaustion of caregivers revealed a significant relationship with the caregivers' anxiety, submissive approach for coping and the patient's self-maintenance. Depersonalisation was found to be related to the depression score of the patient. Discussion:This study may serve to increase clinicians' awareness of burnout in relatives of dementia patients. It points to the fact that research for determining the causes and consequences of burnout in the family caregivers is warranted. [source]

Family caregivers' perceptions of hospital-based allied health services post-stroke: Use of the Measure of Processes of Care to investigate processes of care

AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2010
Annette Lovat
Aim:,To investigate family caregiver perceptions of allied health professional processes of care and support in hospital following stroke, and to test an adapted version of the Measure of Processes of Care (MPOC) for its suitability of use in the stroke care setting. Methods:,The first stage involved the adaptation and refinement of the MPOC, designed to measure caregiver perceptions of processes of professional care and support across five care dimensions. The second stage involved mailing out of questionnaires to primary caregivers of stroke survivors. A total of 107 completed questionnaires were included in the analysis. The reliability of the adapted questionnaire was assessed and summary statistics were computed. Results:,The reliability of the adapted MPOC was found to be high, with good internal consistency of items within each subscale. Mean scores indicated that caregivers were most likely to report negative perceptions of the way allied health professionals engaged with and supported them, particularly in the area of information provision. Conclusion:,The number of families being affected by stroke is predicted to rise substantially in the near future. Allied health professionals have a significant role to play in supporting family caregivers. Results highlight caregiver-identified areas of weakness in current clinical practice. [source]

Development and validation of a questionnaire measuring quality of life in primary caregivers of children with atopic dermatitis (QPCAD)

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2009
K. Kondo-Endo
Summary Background, Disease-specific health-related quality of life (HRQoL) instruments for primary caregivers of children with atopic dermatitis are useful in evaluating the efficacy of treatment in clinical practice and study. However, no such scale has been available in Japan. Objectives, To develop and validate a self-administered instrument specifically designed to measure quality of life in primary caregivers of children with atopic dermatitis (QPCAD). Methods, This study consisted of three successive phases: the item generation phase, pilot test phase and validation phase. In the item generation phase, questionnaire items were derived from 33 qualitative interviews with primary caregivers. In the pilot test phase, the face and content validity of the preliminary scale were assessed (n = 33). In the validation phase, the questionnaire was finalized and assessed in terms of statistical performance (n = 416). Results, The QPCAD included 19 items in the following categories: ,exhaustion', ,worry about atopic dermatitis', ,family cooperation' and ,achievement'. The reliability of internal consistency was fair (Cronbach's alpha coefficients 0·66,0·87). The QPCAD subscales and total score were significantly correlated with psychological health, physical health, anxiety, depression and severity score, with mild to moderate correlation coefficients. Test,retest reliability and responsiveness to change in severity were also satisfactory. Conclusions, The QPCAD is an appropriate tool for assessing HRQoL of primary caregivers of children with atopic dermatitis in clinical practice and clinical trials. [source]

Comparative study of early interactions in mother,child dyads and care centre staff,child within the context of Chilean crèches

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2010
M. Pía Santelices
Abstract Background Bowlby developed the concept of ,caregiver' to refer to significant adults with whom young children interact daily. Not only parents are considered significant caregivers but also the care centre staff where the child attends regularly. Within caregiver,infant interactions, sensitive response on the part of the adult is a key concept in the assessment of the quality of the relationship, as it integrates the experiences and emotions that will influence the attainment of a secure attachment and a favourable emotional, social and cognitive development in the child. Methods This study is a comparative analysis between the dyadic interactions between a child and its principal caregivers in the home and in the crèche; it is based on a group of 185 children between 8 and 24 months old, who attend a crèche regularly. The Care-Index instrument was used to assess interaction between children and adults, analysing sensitive response in the adults and cooperativeness in the children. Results The sensitive response of adults to children was complementary; mothers and primary caregivers showed greater sensitivity in the affective aspects of the interaction, while the care centre staff showed greater sensitivity in the cognitive aspects. The fact that caregivers show significant differences in response sensitivity is consistent with existing studies, as are corresponding significant differences in the children's cooperativeness, which demonstrates that a child could benefit from interacting with adults whose different skills could strengthen diverse aspects of health child development. Conclusions The presence of children in the crèche can be a positive experience in that it favours quality exchanges with the child, developing cognitive aspects of the interaction which are cultivated to a lesser degree by mothers or primary caregivers who principally develop affective aspects. [source]

Parenting, autonomy and self-care of adolescents with Type 1 diabetes

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2009
C. Dashiff
Abstract Background During adolescence diabetes creates a juncture of very complex disease management demands with developmental needs, including the striving of adolescents for greater autonomy. Parents' concerns and fears about the teen's diabetes self-management abilities during this time can heighten parental attachment behaviour and affect the parents' ability to support autonomy development necessary for effective self-care. Maternal parenting processes may be especially important for those adolescents who have Type 1 diabetes because mothers are the primary caregivers. Purpose Based on attachment theory, the aim was to test a model of the influence of mother,adolescent developmental conflict, maternal separation anxiety and maternal inhibition of autonomy and relatedness on cognitive autonomy and self-care of adolescents with Type 1 diabetes. Method A total of 131 families with an adolescent, aged 11,15 years, contributed data annually across three waves. Mothers and adolescents completed paper-and-pencil measures and two interaction scenarios that were coded by trained staff from audio-tapes. The adolescent also completed a structured interview and questionnaire to assess self-care. Results Maternal separation anxiety when adolescents were 11,15 years of age directly predicted cognitive autonomy at 1-year follow-up, and that cognitive autonomy was directly related to self-care 1 year later, but did not mediate between separation anxiety and self-care. Conclusions Future investigation of the influence of separation anxiety of parents on adolescent autonomy development is warranted, as well as the contribution of autonomy development to diabetes self-management behaviours of adolescents. [source]