Factors related to cognitive performance among black caregivers of persons living with a chronic illness: An exploratory study

This study investigated factors associated with cognitive performance among Black caregivers of persons living with two chronic conditions: dementia or cancer. Fifty-six Black caregivers of people living with dementia or cancer were recruited from clinic and community sources. Variables measured included: depression, anxiety, stress, sleep, fatigue, and caregiver burden. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). Descriptive statistics and non-parametric analyses were conducted to identify factors related to MoCA scores. Caregivers were 58.3 years of age and predominantly female. The average MoCA score was 25.23. Gender and education, along with positive appraisal of caregiving were significantly associated with cognitive performance. Several other factors approached significance including cohabitation with the care recipient, fatigue, and stress due to perceived individual and institutional racism. Our findings suggest several factors that warrant further investigation for understanding the relationship between caregiving and cognitive performance in Black caregivers of people living with cancer or dementia.

Correlations of Physical and Psychological Health in Parents of Individuals With Autism Spectrum Disorder

BACKGROUND

Individuals with autism spectrum disorder (ASD) have social communication difficulties and restricted, repetitive, and/or sensory behaviors or interests. The prevalence of ASD is now 1 in 36 individuals. Parents of individuals with ASD face challenges that can affect their physical and psychological well-being.

OBJECTIVE

With the long-term goal to tailor an exercise program, the purpose of this study was 2-fold: (1) establish the baseline physical and mental health of parents of individuals with ASD and (2) estimate the relationship of physiologic variables with psychological variables of health for parents of individuals with ASD.

METHODS

This descriptive, cross-sectional study (N = 44) explored physical health measures and the correlation between physical and psychological health, using measures of anxiety, stress, parenting depression, and positive thinking for parents who care for individuals with ASD.

RESULTS

The common characteristics that these parents shared was high body fat and low physical activity. Body fat was negatively correlated to total step count (r = -0.428, P < .05), grip strength (r = -0.319, P < .5), and total distance walked in the week (r = -0.661, P < .01), and positively correlated to 5-times sit to stand (r = 0.337, P < .05). Low activity correlated to increased parenting stress of advocating for child's needs (r = -0.310, P = .043).

CONCLUSIONS

Understanding relationships between physical and psychological health informs effective interventions and support systems for parents. Parents need supports to be able to prioritize exercise. Future studies should include a larger sample to verify these effects.

Techniques to increase lumbar puncture success in newborn babies: the NeoCLEAR RCT

Background

Lumbar puncture is an essential tool for diagnosing meningitis. Neonatal lumbar puncture, although frequently performed, has low success rates (50-60%). Standard technique includes lying infants on their side and removing the stylet 'late', that is, after the needle is thought to have entered the cerebrospinal fluid. Modifications to this technique include holding infants in the sitting position and removing the stylet 'early', that is, following transection of the skin. To the best of our knowledge, modified techniques have not previously been tested in adequately powered trials.

Objectives

The aim of the Neonatal Champagne Lumbar punctures Every time - An RCT (NeoCLEAR) trial was to compare two modifications to standard lumbar puncture technique, that is, use of the lying position rather than the sitting position and of 'early' rather than 'late' stylet removal, in terms of success rates and short-term clinical, resource and safety outcomes.

Methods

This was a multicentre 2 × 2 factorial pragmatic non-blinded randomised controlled trial. Infants requiring lumbar puncture (with a working weight ≥ 1000 g and corrected gestational age from 27+0 to 44+0 weeks), and whose parents provided written consent, were randomised by web-based allocation to lumbar puncture (1) in the sitting or lying position and (2) with early or late stylet removal. The trial was powered to detect a 10% absolute risk difference in the primary outcome, that is, the percentage of infants with a successful lumbar puncture (cerebrospinal fluid containing < 10,000 red cells/mm3). The primary outcome was analysed by modified intention to treat.

Results

Of 1082 infants randomised (sitting with early stylet removal, n = 275; sitting with late stylet removal, n = 271; lying with early stylet removal, n = 274; lying with late stylet removal, n = 262), 1076 were followed up until discharge. Most infants were term born (950/1076, 88.3%) and were aged < 3 days (936/1076, 87.0%) with a working weight > 2.5 kg (971/1076, 90.2%). Baseline characteristics were balanced across groups. In terms of the primary outcome, the sitting position was significantly more successful than lying [346/543 (63.7%) vs. 307/533 (57.6%), adjusted risk ratio 1.10 (95% confidence interval 1.01 to 1.21); p = 0.029; number needed to treat = 16 (95% confidence interval 9 to 134)]. There was no significant difference in the primary outcome between early stylet removal and late stylet removal [338/545 (62.0%) vs. 315/531 (59.3%), adjusted risk ratio 1.04 (95% confidence interval 0.94 to 1.15); p = 0.447]. Resource consumption was similar in all groups, and all techniques were well tolerated and safe.

Limitations

This trial predominantly recruited term-born infants who were < 3 days old, with working weights > 2.5 kg. The impact of practitioners' seniority and previous experience of different lumbar puncture techniques was not investigated. Limited data on resource use were captured, and parent/practitioner preferences were not assessed.

Conclusion

Lumbar puncture success rate was higher with infants in the sitting position but was not affected by timing of stylet removal. Lumbar puncture is a safe, well-tolerated and simple technique without additional cost, and is easily learned and applied. The results support a paradigm shift towards sitting technique as the standard position for neonatal lumbar puncture, especially for term-born infants during the first 3 days of life.

Future work

The superiority of the sitting lumbar puncture technique should be tested in larger populations of premature infants, in those aged > 3 days and outside neonatal care settings. The effect of operators' previous practice and the impact on family experience also require further investigation, alongside in-depth analyses of healthcare resource utilisation. Future studies should also investigate other factors affecting lumbar puncture success, including further modifications to standard technique.

Trial registration

This trial is registered as ISRCTN14040914 and as Integrated Research Application System registration 223737.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/188/106) and is published in full in Health Technology Assessment; Vol. 27, No. 33. See the NIHR Funding and Awards website for further award information.

Problem solving and collaborative involvement among adolescents with spinal cord injury and their caregivers

Objective

To determine the relationship between constructive adolescent problem solving (positive problem-solving orientation and rational problem-solving style) and caregiver problem solving and collaborative involvement with primary caregiver among adolescents with spinal cord injuries (SCIs). Positive constructive adolescent problem solving was hypothesized to be predicted by more effective caregiver problem solving and higher collaborative involvement.

Methods

Participants in this cross-sectional study were 79 adolescent and primary caregiver dyads recruited from a pediatric rehabilitation care system in North America. All participants completed a standardized problem-solving instrument and adolescent participants completed an adapted measure of collaborative parent involvement.

Results

More effective caregiver problem solving and adolescent perceptions of more collaboration with caregivers around SCI care were significantly associated with higher positive problem-solving orientation and higher rational problem-solving style among adolescents.

Conclusions

Results underscore the importance of caregiver problem-solving skills and their collaboration with adolescents with SCI when addressing care needs. Clinically, findings highlight opportunities for parent involvement and skill-building as an important factor of rehabilitation for adolescents with SCI.

Multisite randomized feasibility study of Problem-Solving Training for care partners of adults with traumatic brain injury during inpatient rehabilitation

BACKGROUND

Problem-Solving Training (PST) during inpatient rehabilitation could provide care partners the skills needed to manage their life roles after discharge.

OBJECTIVE

Determine the feasibility of PST+ Education versus Education for care partners of adults with traumatic brain injury (TBI) during inpatient rehabilitation.

METHODS

We conducted a multisite randomized feasibility trial across three sites. We present recruitment rates, reasons for refusal to participate, and reasons for non-completion of interventions. We measured client satisfaction, participant engagement, and fidelity for both interventions. We compared change in depressive symptoms and caregiver burden between PST and Education groups.

RESULTS

Though the interventions were generally feasible, recruitment and retention rates were lower than anticipated largely due to the COVID-19 pandemic. Participants who completed >3 sessions were less likely to be employed full-time and more often spouses and co-residing. Length of inpatient rehabilitation stay was correlated with number of sessions completed. We observed potential benefits of PST over Education, specifically for reducing depression symptoms and caregiver burden.

CONCLUSION

High satisfaction, engagement, and fidelity, overall recruitment and retention, and positive change in outcomes suggest that PST is generally feasible and beneficial for care partners of persons with TBI. Adaptations, such as developing a 3-session version of PST, could improve feasibility.

Anxiety levels in parents of asymptomatic neonates and young infants referred for echocardiography

INTRODUCTION

Previous studies in children with innocent murmurs have shown that parental concern is common.

METHODS

We assessed the anxiety levels among parents of asymptomatic neonates or infants up-to 6 weeks referred for cardiologic consultation because of a heart murmur. A six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) was completed by the parents before and after consultation.

RESULTS

The average STAI score decreased from 14.42 ± 4.54 on arrival to 9.69 ± 4.26 after the consultation (p < 0.001). Overall, the parents felt more calm, less tense, less upset, more relaxed, more content and less worried after the consultation (p < 0.001). Multivariable linear regression analysis showed that the STAI score prior to consultation was related to infants age (coefficient β = - 0.172; P = 0.046) and STAI score post consultation was related to the final diagnosis (β = 0.312; P < 0.001).

CONCLUSION

In conclusion, parents of asymptomatic neonates and young infants with a murmur exhibit moderate levels of anxiety which can be ameliorated after consultation. Parental education in the field is of paramount importance and the role of both paediatric cardiologists as well as primary care physicians is crucial and decisive.

Effectiveness of Family-Centered Empowerment Model on Psychological Improvement of Patients With Myocardial Infarction: A Bayesian Multivariate Approach

Objective

There is a limited understanding of the impact of the family-centered empowerment model (FCEM) on the psychological symptoms in post-myocardial infarction (MI). This study aimed to evaluate the effectiveness of the FCEM on the psychological improvement of patients with MI.

Methods

The present study was a randomized controlled trial (RCT) where patients experienced a standard home cardiac rehabilitation (CR) or CR utilizing the FCEM approach. The empowerment of patients was estimated during nine assessments, such as pre- and post-intervention. Factors, such as quality of life (QoL), state and trait anxiety, and perceived stress, were evaluated. A Bayesian multivariate mixed-effects model was used to simultaneously investigate the effect of the intervention group on study outcomes across the time.

Results

Among all the participants in this study, 24 (34.3%) were women with a total mean ± standard deviation (SD) of 61.40 ± 12.83 and 24.87 ± 3.80 for age and body mass index (BMI). The participants who were in the FCEM group had a significantly higher mean level of perceived stress (β = 28.80), state anxiety (β = 16.20), trait anxiety (β = 3.65), physical (β = 38.54), and mental QoL (β = 42.14). Moreover, the individuals in the FCEM group had a significantly higher mean level of general health (β = 31.64) in the physical dimension of QoL, vitality (β = 15.04), mental role limitation (β = 21.84), and mental health (β = 18.16) in the mental dimension of QoL.

Conclusions

The FCEM can be a valuable treatment mechanism for patients with post-MI to improve their stress, anxiety, and QoL.

Reflections of family caregivers and health professionals on the everyday challenges of caring for persons with amyotrophic lateral sclerosis and cognitive impairments: a qualitative study

Aims and objectives:

To explore reflections of family caregivers and health professionals regarding the challenges involved in caring for persons with amyotrophic lateral sclerosis and cognitive and/or behavioral impairments (PALS/CIs).

Background:

Family caregivers of PALS/CIs are highly burdened and at great risk of psychological sequela. Professionals working with these families can be negatively affected on their well-being and are at risk of burnout.

Design:

The design was a qualitative interview study.

Methods:

One focus group and 10 individual semi-structured interviews were conducted with seven family caregivers and nine professionals after the death of a PALS/CIs. The analysis was guided by the interpretive description methodology and the theory of sense of coherence. This study adheres to the COREQ guidelines and the ICMJE recommendations.

Results:

The family caregivers’ challenges regarding coping with everyday needs related to the sick person were associated with ‘Accepting that nothing else matters’, ‘Adjusting to new roles while balancing’, and ‘Realizing different values in relationships’; whereas the professionals’ challenges were related to ‘Collaboration a balancing act’, ‘Working in a home of sorrow’, and ‘Coordinating threads to tie’.

Conclusion:

Family caregivers found coping with the complexity of the diseases a challenge, and their everyday life needed constant adjustment to new roles, coping with inappropriate behavior, and navigating through the progression of the diseases of their sick relatives while collaborating with numerous professionals. The professionals struggled with coordinating and collaborating with the families and with other colleagues due to the severeness and complexity of diseases.

Relevance to clinical practice:

Findings point to the importance of relationships for caregivers and professionals and a need to provide support through an online palliative rehabilitation program that encompass coping strategies in relation to the diseases.

Trial registration details:

Id no. NCT 04638608.

Coping, Social Support, and Caregiver Well-Being With Families Living With SCI: A Mixed Methods Study

OBJECTIVES

To explore coping, problem solving, social support, and well-being among family caregivers of adults with spinal cord injury (SCI).

METHODS

This was a mixed methods study (qualitative interviews and standardized surveys) with a diverse sample of 39 adults with SCI and their caregivers from four rehabilitation hospitals in the United States, including one Veterans Affairs (VA) hospital. Cluster analysis was used to explore whether distinct profiles of caregivers could be identified, and it was used in conjunction with qualitative data to explore patterns in well-being. Measures of well-being included leisure time satisfaction, social integration, anxiety, depression, physical health complaints, caregiver burden, and quality of life.

RESULTS

The importance of individual and extra-individual resources, namely coping and social support, emerged from early qualitative analyses and guided subsequent mixed methods examination of the data. A cluster analysis yielded three caregiver profiles: (1) effective problem solvers with moderate satisfaction with social support, (2) mixed problem solvers with stronger negative orientations and mixed satisfaction with social support, and (3) low endorsers overall. Profiles helped us explore patterns across our data set and efficiently identify differences in caregiver social support, coping, well-being, and unmet needs.

CONCLUSION

Data echo the need for multimodal interventions aimed at skill development, respite options, and screening, support, information, and referral around mental health and burden. SCI care and rehabilitation programs should consider incorporating strategies for bolstering effective caregiver problem-solving skills, reducing negativity and ambivalence, and enhancing social support.

The validity of the state-trait anxiety inventory and the brief scale for anxiety in an inpatient sample with alcohol use disorder

BACKGROUND AND AIMS

The Brief Scale for Anxiety (BSA) and the State-Trait Anxiety Inventory Form Y-2 (STAI-Y-2) are self-report scales used to gauge anxiety symptoms in clinical settings. Co-occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI-Y-2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI-Y-2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients.

DESIGN

Participants were administered the BSA (n = 1005) on day 2 and the STAI-Y-2 (n = 483) between days 2 and 10 of the detoxification program. SCID-based clinical diagnoses of AUD and anxiety were made approximately on day 10.

SETTING AND PARTICIPANTS

Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n = 1010).

MEASUREMENTS

Inclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM-IV-TR or moderate to severe AUD according to DSM-5-RV, as well as available baseline BSA and/or STAI Y-2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1-specificity and positive and negative predictive values for each cut-point to determine the accuracy of scale outcomes in relation to SCID diagnoses.

FINDINGS

The BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut-point of ≥ 10. The STAI-Y-2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut-point of ≥ 51. The accuracy of the STAI-Y-2 increased (AUC = 0.74) when excluding post-traumatic stress disorder and obsessive-compulsive disorder from anxiety disorder classification.

CONCLUSIONS

Use of the Brief Scale for Anxiety (BSA) and/or State-Trait Anxiety Inventory Form Y-2 (STAI-Y-2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI-Y-2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder.

Effects of Peer Mentoring for Caregivers of Patients With Acquired Brain Injury: A Preliminary Investigation of Efficacy

Objective

To evaluate effectiveness of a peer mentor intervention for caregivers of patients with acquired brain injury (ABI) in encouraging caregiver participation in support services to prepare them for the role of caregiving and in reducing caregiver stress and depression.

Design

Controlled trial with participants randomized to either usual care or 1-to-1 visits with a family caregiver peer mentor during the ABI inpatient rehabilitation stay.

Setting

Nonprofit rehabilitation hospital specializing in care of persons with brain and spinal cord injury.

Participants

Caregivers (N=36) of patients with ABI admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 93% female; 58% White; mean age, 48±10.4y).

Interventions

One-to-one peer mentoring visits during the inpatient stay with a trained peer mentor who is also a family caregiver of a survivor of brain injury.

Main Outcome Measures

Frequency of participation in support services for family caregivers, reported caregiver stress, and reported caregiver depressive symptoms.

Results

There was no difference between groups in participation in support services for family caregivers. Participants in the peer mentor intervention group reported significantly greater improvement in caregiver stress at discharge and 30 days post discharge than participants in the usual care group. Reported depressive symptoms were also lower for the intervention group, but change scores did not achieve statistical significance at discharge or 30-day follow-up.

Conclusions

Peer mentoring appears to improve caregivers' ability to handle the stress of caregiving and reduces reported depressive symptoms. There was no between-group difference noted in participation in support services for families; however, participation was adversely affected by restrictions imposed during the coronavirus disease 2019 pandemic, which may have masked any effect.

Parental anxiety and misperceptions in children with innocent murmurs

BACKGROUND

Previous studies in children with innocent murmurs have shown that parental concern is common. Our aim was to assess the level of anxiety among parents of children referred for cardiology evaluation because of an innocent heart murmur and investigate their perceptions about innocent murmurs.

METHODS

A questionnaire was completed by parents before and after consultation. The questionnaire included a six-item short form of the state scale of the Spielberger State-Trait Anxiety Inventory. After the echocardiogram, a detailed consultation was offered including a thorough explanation that the results were normal, as well as a written report.

RESULTS

A total of 417 questionnaires were completed by parents of 340 children. Almost half of the parents believed that a heart murmur signifies heart disease or may interfere with child's ability to exercise; 21% of them stated that the siblings should also be investigated irrespective of the presence of a murmur. The mean Spielberger State-Trait Anxiety Inventory questionnaire score before pediatric cardiology consultation was 17.1 ± 4.3 and increased to 22.6 ± 2.8 after the consultation (Wilcoxon P < 0.001).

CONCLUSIONS

Parents of infants and children with innocent murmurs exhibit moderate levels of anxiety and this condition can be ameliorated significantly after pediatric cardiology consultation. Focused parental education is of paramount importance and the role of pediatric cardiologists is crucial and decisive.

Bilingual problem-solving training for caregivers of adults with dementia: A randomized, factorial-design protocol for the CaDeS trial

OBJECTIVE

Caregivers of individuals with Alzheimer's disease and related dementias (ADRD) often experience debilitating caregiver burden and emotional distress. To address these negative emotional consequences of caregiving, we will test and refine a strategy training intervention - Problem-Solving Training (PST) - that promotes self-efficacy and reduces caregiver burden and depressive symptoms. Previous research supports efficacy of PST; however, we do not know exactly how many PST sessions are needed or if post-training "boosters" are required to maintain PST benefits. Additionally, we translated and culturally-adapted PST into "Descubriendo Soluciones Juntos" (DSJ), our novel intervention for Spanish-speaking caregivers.

METHOD

In this 2 × 2 factorial design randomized controlled trial, we will test remotely-delivered PST/DSJ sessions for both English- and Spanish-speaking caregivers of persons with ADRD to determine the optimal number of PST/DSJ sessions and ongoing "booster" sessions needed to best help caregivers navigate their current and future needs.

AIMS

1) Compare the efficacy of three vs. six PST/DSJ sessions each with and without booster sessions for decreasing caregiver burden and depression and enhancing caregiver problem-solving; 2) Identify key factors associated with efficacy of PST/DSJ, including age, gender, primary language, relationship to care recipient, and uptake of the PST/DSJ strategy.

RESULTS

These results will establish guidelines needed for an evidence-based, culturally-adapted, and implementable problem-solving intervention to reduce caregiver stress and burden and improve caregiver health and well-being.

CONCLUSION

This work promotes inclusion of diverse and underserved populations and advances therapeutic behavioral interventions that improve the lives of caregivers of individuals with chronic conditions.

The Impact of Risk and Resistance Factors on Quality of Life in Caregivers of Individuals with Dementia

OBJECTIVES

The present study investigates the effect of caregiver and care recipient risk and resistance factors on caregiver quality of life (QOL). Risk factors are those characteristics that contribute to psychosocial maladjustment of the caregiver and reduce QOL, while resistance factors promote caregiver adjustment and improve QOL.

METHODS

One-hundred and three caregiver/care recipient dyads were recruited from a memory assessment clinic in Midwestern United States. Caregivers completed questionnaires estimating perceived social support, spirituality, social problem-solving, and care recipient functional dependence. Care recipients' results from the Mini-Mental State Examination and Animal Naming task were also collected.

RESULTS

In the final model, caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence each accounted for a significant portion of variance in caregiver QOL. The final model accounted for 46.1% of the variance in caregiver QOL.

CONCLUSION

Caregiver age, relationship type, social problem-solving, perceived social support, and care recipient functional dependence are important contributors to caregiver QOL. Further research is needed to specify which caregiver and care recipient characteristics are most important to caregiver QOL.

CLINICAL IMPLICATIONS

Health professionals should assess caregiver problem-solving skills, social support, and care recipient functional dependence, as these may provide important information about caregiver QOL. Study results also suggest that caregiving has more of a negative impact on caregiver QOL for midlife adult caregivers compared to older adult caregivers, and appears to have a greater negative effect on spouses than on children.

The Mediator Effects of Depressive Symptoms on the Relationship between Family Functioning and Quality of Life in Caregivers of Patients with Heart Failure

BACKGROUND

Caregivers of patients with heart failure (HF) report depressive symptoms and poor quality of life (QOL) related to caregiving and poor family functioning, placing them at risk for poor health.

OBJECTIVES

The purpose of this study was to examine the effect of depressive symptoms on the relationship between family functioning and quality of life in the HF caregiver.

METHODS

A sample of 92 HF caregivers were enrolled from an ambulatory clinic at a large academic medical center. A mediation analysis was used to analyze data obtained from the Family Assessment Device (FAD), the Patient Health Questionaire-9 (PHQ-9), and the Short Form-12 Health Survey Version 2 (SF-12v2).

RESULTS

Depressive symptoms were found to be a significant mediator in the relationship between family functioning and caregiver quality of life.

CONCLUSIONS

The results of this study suggest that interventions targeting caregiver depression and family functioning could be effective in enhancing HF caregivers' physical and mental QOL.

Attention bias to infant faces in pregnant women predicts maternal sensitivity

While research has shown that attention bias to infant faces is linked to parenting, this work is largely cross-sectional and limited to the postpartum period. Because the transition to motherhood from pregnancy to birth constitutes a sensitive period in cortical reorganization linked to the quality of mother-infant interactions, evaluating attention processes in the maternal cortex prior to the experience of mother-infant face-to-face interactions is critical. To assess behavioural attention and neural responses to infant faces in pregnant mothers, behavioral and electrocortical indices were collected using a Go/No Go task, in which infant and adult faces served as distractors. Results showed that heightened processing of infant faces relative to adult faces (behavioral and electrocortical indices) was related to observations of greater maternal sensitivity. These findings show that prenatal maternal attention bias to and the perceived salience of infant faces serves as an individual cognitive hallmark of maternal sensitivity that acts independently of caregiving experience.

Study protocol: NeoCLEAR: Neonatal Champagne Lumbar punctures Every time - An RCT: a multicentre, randomised controlled 2 × 2 factorial trial to investigate techniques to increase lumbar puncture success

Background

The neonatal period carries the highest risk of bacterial meningitis (~ 1 in 5000 births), bearing high mortality (~ 10%) and morbidity (20–50%) rates. Lumbar puncture (LP) remains essential to the diagnosis of meningitis. Though LP is a common procedure in neonates, success rates are lower (50–60%) than in other patient populations. None of the currently-practised neonatal LP techniques are supported by evidence from adequately-powered, randomised controlled trials (RCTs). NeoCLEAR aims to compare two modifications to the traditional technique which are free, accessible, and commonly practised: sitting (as opposed to lying) position, and ‘early’ (as opposed to ‘late’) stylet removal.

Methods/design

Written parental informed consent permitting, infants in neonatal/maternity wards, of 27^+ 0 to 44^+ 0 weeks corrected gestational age and weighing ≥1000 g, who require an LP, will be randomly allocated to sitting or lying position, and to early or late stylet removal. The co-primary objectives are to compare success rates (the proportion of infants with cerebrospinal fluid red cell count < 10,000/mm³ on first LP procedure) in 1020 infants between the two positions, and between the two methods of stylet removal. Secondary outcomes relate to LP procedures, complications, diagnoses of meningitis, duration of antibiotics and hospital stay. A modified intention-to-treat analysis will be conducted.

Discussion

Two modifications to the traditional LP technique (sitting vs lying position; and early vs late stylet removal) will be simultaneously investigated in an efficient and appropriately-powered 2 × 2 factorial RCT design. Analysis will identify the optimal techniques (in terms of obtaining easily-interpretable cerebrospinal fluid), as well as the impact on infants, parents and healthcare systems whilst providing robust safety data. Using a pragmatic RCT design, all practitioners will be trained in all LP techniques, but there will inevitably be variation between unit practice guidelines and other aspects of individual care.

An improved LP technique would result in:

• Fewer uninterpretable samples, repeated attempts and procedures

• Reduced distress for infants and families

• Decreased antibiotic use and risk of antibiotic resistance

• Reduced healthcare costs due to fewer procedures, reduced length of stay, shorter antibiotic courses, and minimised antibiotic-associated complications

Trial registration

ISRCTN14040914. Date assigned: 26/06/2018.

Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay

OBJECTIVE

To determine the feasibility of delivering an evidence-based self-management intervention, problem-solving training (PST), to care partners of individuals with traumatic brain injury (TBI), spinal cord injury (SCI), burn injury, or stroke during the inpatient hospital stay.

DESIGN

In this single group pre-post intervention pilot feasibility study.

SETTING

Inpatient rehabilitation or acute care and community.

PARTICIPANTS

Care partners (spouse or partner, family member, friend who is in any way responsible for the health or well-being of the care recipient) of individuals with TBI, SCI, burn injury, or stroke (N=39).

INTERVENTION

PST is a metacognitive self-management intervention that teaches individuals a global strategy for addressing self-selected problems. Participants received up to 6 sessions of PST in person or via telephone during their care recipient's inpatient stay.

MAIN OUTCOME MEASURES

We measured feasibility of recruitment, intervention delivery, and postintervention use of a smartphone app (Care Partner Problem Solving [CaPPS]) and participant satisfaction (Client Satisfaction Questionnaire [CSQ]) and engagement (Pittsburgh Rehabilitation Participation Scale [PRPS]) with the intervention.

RESULTS

Of 39 care partners approached, n=10 (25.6%) were ineligible. Of n=29 (74.4%) who were eligible, n=17 (58.6%) refused, and n=12 (41.4%) consented, of whom n=8 (66.7%) completed ≥3 PST sessions. Not perceiving any benefit was the most common reason for refusal, followed by no interest in research. Participants were very satisfied with PST (CSQ mean=3.35, SD=0.60), reported strong working alliance (Working Alliance Inventory mean=6.8, SD=3.1), and demonstrated very good engagement (PRPS mean=4.75, SD=1.41). CaPPS was downloaded and used by only n=3 participants.

CONCLUSIONS

Delivering a self-management intervention to care partners during the care recipient's acute hospital stay is feasible for a subset of potential participants. Short lengths of stay, language fluency, and perceiving no potential benefit were noted barriers. Boosters via smartphone app have potential, but several barriers must first be overcome.

Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: Secondary analysis of a randomized clinical trial

OBJECTIVES

Interventions addressing burden have limited impact among long-term family caregivers. We examined whether problem-solving therapy (PST) would reduce burden levels of caregivers of individuals diagnosed with mild cognitive impairment (MCI) or early-stage dementia (AD).

METHODS

Caregivers (N = 73) randomly received PST or nutritional training (NT). Burden measures were assessed over 1-year post-intervention.

RESULTS

Relative to NT, caregivers receiving PST endorsed improved perceived burden levels over time, regardless of the type of caregiver. Distress over the care recipient's dementia-related behaviors remained low over time among MCI caregivers receiving PST, while these burden levels among MCI caregivers receiving NT rose over time. AD caregivers receiving PST endorsed reductions in these burden levels over time, while AD caregivers in the NT group endorsed higher burden levels over time.

CONCLUSION

PST, taught early in the caregiving trajectory, improves subjective burden levels among caregivers of family members with relatively mild cognitive deficits.

Pediatric Stroke Caregiver Well-Being: A Holistic Wellness Perspective

Evidence-based models are critical for understanding caregiver well-being and treatment interventions from a holistic perspective. This study introduces the Indivisible Self: An Evidence-Based Model of Wellness (IS-WEL) as a means for examining the holistic wellness of pediatric stroke caregivers. In this exploratory study, 161 participants completed a demographic survey and the Five-Factor Wellness Inventory (FF-WEL). Results indicate significant wellness score differences between the current sample of pediatric stroke caregivers and the FF-WEL norming sample on the higher order Total Wellness factor, the second-order wellness factors of Creative Self and Social Self, and the third-order wellness factors of thinking, emotions, control, positive humor, and love. These results support the veracity of the IS-WEL as an additional empirically sound holistic approach for understanding and addressing the well-being of stroke caregivers. The authors discuss practical clinical and research implications for utilizing the IS-WEL with pediatric stroke caregivers.

Implementation and initial outcomes of a spinal cord injury home care program at a large veterans affairs medical center

OBJECTIVES

Describe an interdisciplinary spinal cord injury home care program (SCIHCP), sample demographics for the veteran participants, and initial impact of SCIHCP on health care utilization and mortality.

DESIGN

Retrospective review.

SETTING

SCIHCP of the Spinal Cord Injury Center, VA North Texas Health Care System (VANTHCS).

PARTICIPANTS

Patients with SCI/D enrolled in the SCIHCP during January 6, 2006 through January 9, 2012, whose injury occurred at least one year prior to enrollment(n = 125).

MAIN OUTCOME MEASURES

VANTHCS hospital admissions, length of stay (LOS), and emergency department (ED) visits evaluated one year before and one year after SCIHCP enrollment; mortality evaluated one-year post-enrollment.

RESULTS

There were no significant changes in number of ED visits, number of hospital admissions, or LOS over time. More home care visits and more mental health comorbidities predicted more hospital admissions. Older patients and those with more mental health comorbidities were more likely to experience increases in LOS. These prediction models were significant after adjusting for injury level, age, race, time since SCI, and number of medical comorbidities. More home care visits were associated with lower likelihood of mortality post-enrollment.

CONCLUSIONS

Inpatient and ED utilization did not change one year after enrollment, but more SCIHCP visits predicted more hospital admissions and lower likelihood of mortality in the post-evaluation year. The support, education, and care continuity SCIHCP generates might be related to increased inpatient access and lower mortality rate. Veterans with increased mental health comorbidities used inpatient services more, and might need additional support.

Changes in Cortical Sensitivity to Infant Facial Cues From Pregnancy to Motherhood Predict Mother-Infant Bonding

The transition to motherhood triggers changes in human brain structure that may facilitate mother-infant bonding. Although much research on maternal cortical responses to infant faces has focused on the postpartum period, no previous study has examined whether longitudinal functional changes in the maternal cortex during pregnancy and postpartum are associated with mother-infant bonding. Using electroencephalography, prenatal to postnatal changes in cortical sensitivity (P1, P2, late positive potential, N170 event-related potentials) to infant and adult faces were examined in relation to reported mother-infant bonding in 40 mothers (M_age  = 30.5 years). Prenatal to postnatal increases in P1 and P2 responses to infant faces predicted stronger bonding. Findings suggest that cortical changes in attention allocation rather than in face-specific encoding enhance bonding.

A Randomized Controlled Pilot Study of a Manualized Intervention for Caregivers of Patients With Traumatic Brain Injury in Inpatient Rehabilitation

OBJECTIVE

Investigate effectiveness of a 5-session manualized intervention for addressing needs of caregivers of persons in acute traumatic brain injury (TBI) rehabilitation.

DESIGN

Prospective, pilot randomized controlled trial.

SETTING

Inpatient brain injury rehabilitation unit, level 1 trauma center.

PARTICIPANTS

Patients (N=93) with moderate-to-severe TBI and their family members were enrolled in the study with 42 randomized to the treatment group, 51 to the control group.

INTERVENTION

Five-session manualized caregiver intervention with educational, stress and anxiety self-management, coping, and emotional support components.

MAIN OUTCOME MEASURES

Family Needs Questionnaire-Revised, knowledge assessment, Zarit Family Burden Scale, and Brief Symptom Inventory-18 were collected at pretreatment, posttreatment, and 3-month follow-up.

RESULTS

Treatment group caregivers showed an increase in met needs for emotional, instrumental, and professional support, and brain injury knowledge from baseline to posttreatment, whereas controls did not. Between-group differences were significant for only emotional support needs. Treatment effects were not sustained at 3-month follow-up.

CONCLUSIONS

Caregivers of persons undergoing acute TBI rehabilitation may benefit from interventions that target their unique needs. Caregivers may require additional and longer-term supports to sustain treatment benefits.

The Development of a New Computer Adaptive Test to Evaluate Anxiety in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Caregiver-Specific Anxiety

OBJECTIVE

To design a new measure of caregiver-specific anxiety for use in caregivers of individuals with traumatic brain injury (TBI), the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver-Specific Anxiety item bank.

DESIGN

Cross-sectional survey study.

SETTING

Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

PARTICIPANTS

Three hundred forty-four caregivers of civilians with TBI and 216 caregivers of service members/veterans with TBI (N=560).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

TBI-CareQOL Caregiver-Specific Anxiety item bank.

RESULTS

The retention of 40 Caregiver-Specific Anxiety items was supported by exploratory and confirmatory factor analyses. Graded response model (GRM) and differential item functioning analyses supported the retention of 33 items in the final measure. Expert review and GRM calibration data was used to select a 6-item static short form, and GRM calibration data was used to program the TBI-CareQOL Caregiver-Specific Anxiety computer adaptive test (CAT).

CONCLUSIONS

Established, rigorous measurement development standards were used to develop the new TBI-CareQOL Caregiver-Specific Anxiety CAT and corresponding 6-item short form. This measure is the first patient-reported outcome measure designed to assess caregiver-specific anxiety in caregivers of individuals with TBI. The measure exhibits strong psychometric properties.

Perspectives From Family Caregivers of Persons With Spinal Cord Injury in Hospital Versus Rehabilitation: A Pilot Study

PURPOSE

The study aims to assess differences in family preferences for involvement in the ongoing care of a hospitalized family member with spinal cord injury based on whether the patient was hospitalized for initial rehabilitation (Group R) or hospitalized to treat secondary complications (Group C).

DESIGN

Explorative cross-sectional design.

METHOD

Family members rated the importance and experience of involvement on five subscales of the Patient Participation in Rehabilitation Questionnaire. Differences among the importance and experience scores between the groups were tested using the Mann-Whitney U test.

FINDINGS

Group C scored the importance to be involved significantly higher than Group R (M = 3.17 vs. M = 4.04, p =.01). No other significant differences between groups were detected.

CONCLUSION

Family members of patients hospitalized for secondary complications want greater involvement in care compared to those hospitalized for rehabilitation.

CLINICAL RELEVANCE

Results indicate the need for tailored interventions using a family-centered approach and ongoing needs assessment.

Effectiveness of patient empowerment over stress related to knee arthroplasty surgery

OBJECTIVE

This study aims to show evidence of the Empowerment Session's effectiveness through measurements of surgery related emotional stress before and after this session.

METHOD

The study was performed on 41 patients with knee arthroplasty surgery prescription by measuring the evolution of their emotional stress generated by surgery expectative, during the empowerment session. Two sets of measurements per patient were performed, before and after the empowerment session. Each set consisted of recording an electrocardiogram for 10min while the patients were seated and then applying two standard psychometric tests: State-Trait Anxiety Inventory test and Visual Analog Stress test. Differences in emotional stress were analyzed using psychometric tests and heart rate variability (HRV) analysis as stress biomarkers.

RESULTS

Psychometric stress measurement shows a 17.8% reduction in stress according to the total stress scale value, and a 41.9% reduction in stress between test results before and after the session. Mean heart rate values increased by 7.4% with respect to the initial values, very low frequency power and total power also change in value suggesting more sympathetic and less parasympathetic activity.

CONCLUSIONS

Both psychological and physiological measurements suggest the effectiveness of the empowerment session due to a significant increase in the wellness state of patients. Additionally, the correlation between psychometric tests and HRV indices demonstrates that both emotional stress indicators could be used as feedback on the empowerment sessions or as a reference to enhance surgical outcomes.

Comparison of perioperative stress in patients undergoing thyroid surgery with and without neuromonitoring-a pilot study

PURPOSE

A comprehensive psychological comparison of preoperative stress in patients scheduled for thyroidectomy with versus without intraoperative neurophysiologic monitoring (IONM) has never been reported. The aim of this study was to assess whether a planned utilization of IONM had any effect on the reduction of stress and anxiety level before and after thyroid surgery.

METHODS

The outcomes of 32 patients scheduled for thyroidectomy with IONM were compared to the outcomes of a carefully matched control group of 39 patients operated on without IONM. All the patients were tested before the surgery and at 1-7 days postoperatively employing psychological self-report instruments: the Depression Anxiety Stress Scales (DASS), State-Trait Anxiety Inventory (STAI), 12-item General Health Questionnaire (GHQ), Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT H&N), and the visual analog scale (VAS).

RESULTS

The examined groups were homogenous and carefully matched in terms of mental health (GHQ), the quality of life (FACT H&N), and the intensity of depression level (DASS). The IONM group showed a significantly lower level of "the state anxiety"(STAI) 1 day before the operation (p < 0.05), greater trust in the doctor (VAS) (p < 0.05), and greater confidence in the treatment method (VAS) as compared to the patients in the control group (p < 0.05), while no significant differences were found when the remaining items were compared.

CONCLUSIONS

The planned use of IONM during thyroidectomy may reduce patient anxiety before surgery. However, further research in this area is necessary to confirm this preliminary finding in a larger population of patients.

The Anxiety Level of Caregivers of Neurological Patients with Dysphagia

We aimed to investigate anxiety level of caregivers of neurological patients with dysphagia, and the relationship of patient-related factors to anxiety level of dysphagia caregivers. A total of 103 adult neurological patients with dysphagia (study group), 30 without dysphagia (control group), and their primary caregivers were included. Types of feeding, condition of dependency in eating and drinking, dysphagia duration, and history of previous dysphagia treatment were recorded for study group. In study group, the Turkish version of the Eating Assessment Tool-10 (T-EAT-10) was used to determine dysphagia symptom severity. Penetration and aspiration severity was determined with the penetration-aspiration scale (PAS). The Spielberger State-Trait Anxiety Inventory (STAI) that has two subscales including state anxiety (S-STAI) and trait anxiety (T-STAI) was used to determine anxiety level of caregivers. There was no difference between groups in terms of age, gender, weight, and height. The mean S-STAI was 42.56 ± 10.10 for the study group and 29.20 ± 6.64 for the control group (p < 0.001). The mean T-STAI was 44.81 ± 8.98 for the study group and 29.37 ± 6.46 for the control group (p < 0.001). Significant correlation was detected between only T-STAI and history of previous dysphagia treatment (p = 0.01, r = 0.25). No correlation was found between STAI (in terms of both S-STAI and T-STAI) and T-EAT-10, PAS, types of feeding, condition of dependency in eating and drinking, dysphagia duration (p > 0.05). Caregivers of neurological patients with dysphagia have greater anxiety level than caregivers of neurological patients without dysphagia.

Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security -parenting and care as usual as interventions targeting infant mental health risks

BACKGROUND

Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security-Parenting (COS-P), currently being conducted in Denmark.

METHODS/DESIGN

In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2-12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12-16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing.

DISCUSSION

The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed.

TRIAL REGISTRATION

ClinicalTrials.govID: NCT02497677 . Registered July 15 2015.

Parental attitude, depression, anxiety in mothers, family functioning and breath-holding spells: A case control study

AIM

This study aimed to identify differences in the antenatal stressful life events, parenting style, family functioning, depression and anxiety of mothers who have children with breath-holding spells (BHS) compared with controls.

METHODS

This case control study divided 66 children into a group of children with BHS and a control group, with the children's ages ranging between 6 months and 5 years of age. This study explored underlying anxiety and depression in mothers as well as functioning of their families. Socio-demographical data and stressful life events that the mother experienced during pregnancy were analysed. In order to evaluate the effects of family structure, depression and anxiety in mothers on BHS in children, the Family Assessment Device, and both the Parental Attitude Research Instrument and the Beck Depression Inventory as well as the State-Trait Anxiety Inventory were used to assess both groups.

RESULTS

Exposure to stressful life events during pregnancy (P < 0.001), depressive traits (P < 0.001), state-trait anxiety (P < 0.001), overprotective maternal characteristics (P = 0.027) and most of the family functioning subscales were found to be significantly different between BHS and control groups.

CONCLUSIONS

The association of anxiety, depression, prenatal stressful events and poor family functioning in mothers who have children with BHS is significantly higher than controls. An evaluation of these problems may be beneficial in the management of BHS.

Inclusion of Respiratory Frequency Information in Heart Rate Variability Analysis for Stress Assessment

Respiratory rate and heart rate variability (HRV) are studied as stress markers in a database of young healthy volunteers subjected to acute emotional stress, induced by a modification of the Trier Social Stress Test. First, instantaneous frequency domain HRV parameters are computed using time-frequency analysis in the classical bands. Then, the respiratory rate is estimated and this information is included in HRV analysis in two ways: 1) redefining the high-frequency (HF) band to be centered at respiratory frequency; 2) excluding from the analysis those instants where respiratory frequency falls within the low-frequency (LF) band. Classical frequency domain HRV indices scarcely show statistical differences during stress. However, when including respiratory frequency information in HRV analysis, the normalized LF power as well as the LF/HF ratio significantly increase during stress ( p-value 0.05 according to the Wilcoxon test), revealing higher sympathetic dominance. The LF power increases during stress, only being significantly different in a stress anticipation stage, while the HF power decreases during stress, only being significantly different during the stress task demanding attention. Our results support that joint analysis of respiration and HRV obtains a more reliable characterization of autonomic nervous response to stress. In addition, the respiratory rate is observed to be higher and less stable during stress than during relax ( p-value 0.05 according to the Wilcoxon test) being the most discriminative index for stress stratification (AUC = 88.2 % ).

Stressreduktion durch Binaurale Stimulation? Eine experimentelle Untersuchung zum Effekt einer Alpha-Stimulation auf die psychophysiologische Entspannungsreaktion

Zusammenfassung. Binaurale Stimulationen sind akustisch erzeugte Schwebungen, die im Hirnwellenspektrum liegen und daher als Möglichkeit diskutiert werden, neurophysiologische Entspannungszustände zu induzieren. Die Qualität und Aussagekraft bisheriger Studien ist wissenschaftlich jedoch stark umstritten. In der vorliegenden Arbeit ist daher der Effekt einer binauralen Alpha-Stimulation auf subjektive und physiologische Entspannungs-Parameter untersucht worden. Hierzu wurden 102 Probanden zufällig drei Gruppen zugewiesen: (1) Audio-Beschallung mit binauraler Stimulation, (2) Audio-Beschallung ohne binaurale Stimulation, (3) keine akustische Beschallung. Die subjektive Entspannung wurde vor und nach einer 20-minütigen Stimulation erfasst, die physiologische Entspannungsreaktion über Herzrate, Atemfrequenz und ausgewählte Parameter der Herzratenvariabilität während der Intervention erhoben. Die Ergebnisse zeigen keine spezifische Zunahme an subjektiver oder physiologischer Entspannung. Der aktuelle Forschungsstand zur binauralen Stimulation wird im Lichte dieses Ergebnisses diskutiert.

Predictors of psychological distress in caregivers of older persons with wet age-related macular degeneration

OBJECTIVES

Several studies have investigated the biopsychosocial impacts of age-related macular degeneration (AMD) in regards to the older patient, little is known about the impacts associated with caring for individuals with AMD. We aimed to determine the predictors of subjective caregiver distress and other negative outcomes associated with caring for someone with advanced AMD.

METHODS

Cross-sectional, self-complete survey involving 500 caregivers of persons with advanced AMD. Respondents were identified from the Macular Disease Foundation of Australia client database. Logistic regression tested the independent effects of care recipient and caregiver characteristics on study outcomes, including: caregiver psychological well-being, participation in recreational/social activities and retirement plans.

RESULTS

Around one third of caregivers self-reported a high level of care recipient dependence. Over one in two caregivers reported a negative state of mind. Comorbid chronic illnesses in the care recipient were associated with the caregiver reporting psychological distress, multivariable-adjusted odds ratio, OR, 1.45 (95% confidence intervals, CI, 1.14-1.86). If the care recipient was highly dependent on the caregiver, there was 99% greater likelihood of caregiver distress, OR 1.99 (95% CI 1.01-3.93). Comorbid chronic conditions in the care recipient was associated with 49% and 31% higher odds of the caregiver reporting disruption to other areas of their life and retirement plans related to the caregiving experience, respectively.

CONCLUSIONS

A high prevalence of caregiver distress related to caring for persons with advanced AMD was observed. Level of dependence on the caregiver and presence of comorbid chronic illnesses were independent predictors of the caregiver experiencing psychological distress.

Commitment language and homework completion in a behavioral employment program for gang-affiliated youth

Research with substance-abusing samples suggests that eliciting commitment language during treatment may improve motivation to change, increase treatment engagement, and promote positive treatment outcomes. However, the relationship between in-session client language and treatment success is not well-understood for youth offender populations. This study evaluated the relationship between commitment language, treatment engagement (i.e., homework completion), and weekly employment outcomes for six gang-affiliated juvenile offenders participating in an employment counseling intervention. Weekly counseling sessions were audio-recorded, transcribed, and coded for commitment language strength. Multilevel models were fit to the data to examine the relationship between commitment language and counseling homework or employment outcomes within participants over time. Commitment language strength predicted subsequent homework completion but not weekly employment. These findings imply that gang-affiliated delinquent youth who express motivation to change during employment counseling will be more likely to comply with counselor-initiated homework. Further research on counselor techniques for promoting commitment language among juvenile gang offenders is needed.

Psychological distress, quality of life, and burden in caregivers during community reintegration after spinal cord injury

OBJECTIVES

To examine relations between psychological distress, health-related quality of life (HR-QOL), and burden among caregivers of people with traumatic spinal cord injury (SCI) over time, and to determine whether the data are more consistent with a wear and tear or adaptation trajectory.

DESIGN

Prospective longitudinal cohort study with measurements at 4 time points (6wk prior to discharge from subacute inpatient rehabilitation and 6wk, 1y, and 2y postdischarge to community).

SETTING

Rehabilitation units.

PARTICIPANTS

Participants (N=44; spouses, parents, others) nominated as a primary caregiver by the person with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

General Health Questionnaire-28 (GHQ-28), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index (CSI) assessed the extent of psychological distress, HR-QOL, and burden, respectively, among caregivers. Functional status and community participation/care needs of the persons with SCI were assessed by the FIM and Craig Handicap Assessment and Reporting Technique, respectively.

RESULTS

Multilevel piecewise models showed that psychological distress (GHQ-28 score) decreased significantly after discharge (slope estimate =-.03, P<.008). At the predischarge time point, the caregivers' mental component summary score on the SF-36 was significantly lower than Australian national norms. The scores improved from predischarge to 6 weeks postdischarge (slope estimate =.39, P<.001), but they did not change significantly across the following 2 time points (slope estimate =.02, P=.250). At all 3 postdischarge time points, the mental component summary scores were not significantly different to national norms. In contrast, the physical component summary score of the SF-36 did not significantly change across the predischarge and 6-week postdischarge time points (slope estimate =-.14, P=.121) and the 3 postdischarge time points (slope estimate <.01, P=.947). Scores at all 4 time points were not significantly different to the national norms. Caregiver burden showed no significant change over the study period (predischarge to 6wk postdischarge slope estimate =.02, P=.426; 3 postdischarge time point slope estimates <-.01, P=.334). Reflecting this, 42% of caregivers met CSI caseness criterion at the first time point, and 46% met the criterion at the fourth (2y) time point. Higher burden was significantly correlated with increased hours of care being provided by the caregiver and lower FIM scores and lower community participation (for the person with SCI) at each time point. Psychological distress correlated with caregiver burden at 6 weeks and 1 year postdischarge but not at 2 years postdischarge.

CONCLUSIONS

The trajectory of scores for psychological distress and HR-QOL was consistent with caregiver adaptation to the challenge of providing support to a person with SCI in the early postdischarge period. Caregiver burden did not display similar reductions but did not worsen over the study period.

Perceived facilitators and barriers to self-management in individuals with traumatic spinal cord injury: a qualitative descriptive study

Background

Current evidence has suggested the need for increased self-management support efforts in spinal cord injury (SCI) to reduce secondary complications. However, current self-management programs may not be suitable for the unique needs of individuals with SCI, including reduced mobility and the importance of attendant care. There is a need for greater understanding of the self-management strategies adopted by individuals with SCI and the potential need for a tailored self-management program. Thus, the purpose of the current study was to understand the perceived facilitators and barriers to self-management to prevent secondary complications.

Methods

A descriptive qualitative approach was used and involved telephone interviews. Semi-structured interviews were conducted with individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Participants were recruited between September 2011 and May 2012. Analysis was conducted using inductive thematic analysis to understand the perceived facilitators and barriers to self-management to prevent secondary complications.

Results

A total of 26 interviews were conducted and they included 7 individuals with traumatic SCI, 7 family/caregivers (i.e., 7 SCI-caregiver dyads), and 12 acute care/rehabilitation managers from across the province of Ontario. The following five facilitators to self-management were identified: physical support from the caregiver, emotional support from the caregiver, peer support and feedback, importance of positive outlook and acceptance, and maintaining independence/control over care. The following five barriers to self-management were identified: caregiver burnout, funding and funding policies, lack of accessibility, physical limitations and secondary complications, and difficulties achieving positive outlook or mood.

Conclusions

This study demonstrated that the caregiver and the individual’s own mood/outlook, among other facilitators and barriers, make significant contributions to the self-management of individuals with traumatic SCI. The issues of timing/readiness and comorbidities and aging were observed across many of these themes. As such, the development of a tailored self-management program for individuals with traumatic SCI and their caregivers should incorporate these considerations.

The functional implications of motor, cognitive, psychiatric, and social problem-solving states in Huntington's disease

OBJECTIVE

Huntington's disease (HD) is a genetic, neurodegenerative disorder characterized by motor, cognitive, and psychiatric dysfunction. In HD, the inability to solve problems successfully affects not only disease coping, but also interpersonal relationships, judgment, and independent living. The aim of the present study was to examine social problem-solving (SPS) in well-characterized HD and at-risk (AR) individuals and to examine its unique and conjoint effects with motor, cognitive, and psychiatric states on functional ratings.

METHOD

Sixty-three participants, 31 HD and 32 gene-positive AR, were included in the study. Participants completed the Social Problem-Solving Inventory-Revised: Long (SPSI-R:L), a 52-item, reliable, standardized measure of SPS. Items are aggregated under five scales (Positive, Negative, and Rational Problem-Solving; Impulsivity/Carelessness and Avoidance Styles). Participants also completed the Unified Huntington's Disease Rating Scale functional, behavioral, and cognitive assessments, as well as additional neuropsychological examinations and the Symptom Checklist-90-Revised (SCL-90R). A structural equation model was used to examine the effects of motor, cognitive, psychiatric, and SPS states on functionality.

RESULTS

The multifactor structural model fit well descriptively. Cognitive and motor states uniquely and significantly predicted function in HD; however, neither psychiatric nor SPS states did. SPS was, however, significantly related to motor, cognitive, and psychiatric states, suggesting that it may bridge the correlative gap between psychiatric and cognitive states in HD.

CONCLUSION

SPS may be worth assessing in conjunction with the standard gamut of clinical assessments in HD. Suggestions for future research and implications for patients, families, caregivers, and clinicians are discussed.

Physical and mental health among caregivers: findings from a cross-sectional study of Open University students in Thailand

BACKGROUND

Caregivers constitute an important informal workforce, often undervalued, facing challenges to maintain their caring role, health and wellbeing. Little is known about caregivers in middle-income countries like Thailand. This study investigates the physical and mental health of Thai adult caregivers.

METHODS

This report derives from distance-learning students working and residing throughout Thailand and recruited for a health-risk transition study in 2005 (N=87,134) from Sukhothai Thammathirat Open University. The cohort follow-up questionnaire in 2009 (N = 60,569) includes questions on caregiver status which were not available in 2005; accordingly, this study is confined to analysis of the 2009 data. We report cross-sectional associations between caregiver status and health.

RESULTS

Among the study participants in 2009, 27.5% reported being part-time caregivers and 6.6% reported being full-time caregivers. Compared to male non-caregivers, being a part-time or full-time male caregiver was associated with lower back pain (covariate-Adjusted Odds Ratios, AOR 1.36 and 1.67), with poor psychological health (AOR 1.16 and 1.68), but not with poor self-assessed health. Compared to female non-caregivers, being a part- or full-time female caregiver was associated with lower back pain (AOR 1.47 and 1.84), psychological distress (AOR 1.32 and 1.52), and poor self-assessed health (AOR 1.21 and 1.34).

CONCLUSIONS

Adult caregivers in Thailand experienced a consistent adverse physical and mental health burden. A dose-response effect was evident, with odds ratios higher for full-time caregivers than for part-time, and non-caregivers. Our findings should raise awareness of caregivers, their unmet needs, and support required in Thailand and other similar middle-income countries.

Caregivers of Adults With Traumatic Brain Injury: The Emotional Impact of Transition From Hospital to Home

Primary Objective:To explore levels of depression, anxiety, stress and strain symptomatology experienced by caregivers of adults with traumatic brain injury (TBI) during the phase of transition from hospital to home.Research Design: Prospective study with data collected at three time-points: pre-discharge, 1-month post-discharge, and 3-months post-discharge.Methods and Procedures: Twenty-nine caregivers of adults with TBI (mean age 48 years), recruited on patient discharge from rehabilitation, completed the Caregiver Strain Index and the Depression, Anxiety and Stress Scale at the three time points.Results: Pairedttests showed significantly lower levels of caregiver strain at one month compared to pre-discharge, and significantly less strain and depression symptoms at 3-month follow-up compared to pre-discharge. Non-significant reductions were observed in level of stress and anxiety across the follow-up time points. Independent groupttests found that female caregivers experienced greater strain than male caregivers at 3 months post-discharge, and caregivers who were immediate family members of the patient experienced greater anxiety than those who were spouses/partners of the patient at 1-month follow-up.Conclusions: The rate of depressive symptoms in caregivers of people with TBI was greater than the general population, and strain was prevalent during the transition period. The results suggest more specific caregiver support and preparation is needed before patient discharge from hospital, and that adequate time spent in rehabilitation is beneficial for caregiver wellbeing.

Adapting problem-solving therapy for depressed older adults in methadone maintenance treatment

Late-life depression is prevalent in older adults who are dependent on opiates. Depressive disorders among opiate abusers have detrimental effects on their well-being and ability to refrain from illegal drugs. There are numerous barriers to the provision of appropriate mental health care to older adults receiving methadone maintenance treatment. This article focuses on problem-solving therapy (PST) and presents evidence that PST may be a promising nonpharmacological treatment for older methadone clients with comorbid depressive disorders that can be applied within the staffing and resource limits of methadone maintenance treatment facilities. The advantages of PST relative to other behavioral therapies for this population are based on evidence that PST is less cognitively demanding for an older adult population with mood and substance use disorders. A properly modified PST for an older adult substance-dependent population with subsyndromal or diagnosed depression may be a viable option for methadone maintenance programs with limited resources.

Efficient assessment of social problem-solving abilities in medical and rehabilitation settings: a Rasch analysis of the Social Problem-Solving Inventory-Revised

The Social Problem Solving Inventory-Revised Scale (SPSI-R) has been shown to be a reliable and valid self-report measure of social problem-solving abilities. In busy medical and rehabilitation settings, a brief and efficient screening version with psychometric properties similar to the SPSI-R would have numerous benefits including decreased patient and caregiver assessment burden and administration/scoring time. Thus, the aim of the current study was to identify items from the SPSI-R that would provide for a more efficient assessment of global social problem-solving abilities. This study consisted of three independent samples: 121 persons in low-vision rehabilitation (M age=71 years old, SD=15.53), 301 persons living with diabetes mellitus (M age=58, and SD=14.85), and 131 family caregivers of persons with severe disabilities (M age=56 years old, SD=12.15). All persons completed a version of the SPSI-R, Center for Epidemiological Studies Depression Scale (CES-D), and the Satisfaction with Life Scale (SWLS). Using Rasch scaling of the SPSI-R short-form, we identified a subset of 10 items that reflected the five-component model of social problem solving. The 10 items were separately validated on the sample of persons living with diabetes mellitus and the sample of family caregivers of persons with severe disabilities. Results indicate that the efficient 10-item version, analyzed separately for all three samples, demonstrated good reliability and validity characteristics similar to the established SPSI-R short form. The 10-item version of the SPSI-R represents a brief, effective way in which clinicians and researchers in busy health care settings can quickly assess global problem-solving abilities and identify those persons at-risk for complicated adjustment. Implications for the assessment of social problem-solving abilities are discussed.