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Agerskov H, Thiesson HC, Schultz H, Pedersen BD. Relationships and dynamics in families with a child with a kidney transplant-A study of parents' everyday life experiences. J Ren Care 2024; 50:151-158. [PMID: 36949556 DOI: 10.1111/jorc.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Paediatric kidney transplantation is often the best choice of treatment for kidney failure with replacement therapy and represents an important change in the child's well-being. There are, however, still a number of challenges in addition to the parental role. The magnitude of intensive parental caregiving and support required by children with a kidney transplant could be disruptive to family relationships and dynamics. OBJECTIVE To explore the experiences of family relationships and dynamics among parents of a child with a kidney transplant. DESIGN An explorative study using a qualitative method. PARTICIPANTS Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant were included. APPROACH A phenomenological-hermeneutic approach was applied. METHOD Semistructured, individual interviews were conducted. The data were analysed using Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS Three themes were generated: Emotions during ups and downs in everyday life; Balancing different needs among children; and Opportunities and having consideration in the family. CONCLUSION Relationships between parents that are based on mutual emotional support are significant and essential during periods of severe illness in a child. Parents who are alone or emotionally marked by their child's disease history feel vulnerable and struggle to overcome challenges. Different health situations among siblings lead to challenges in bringing up the children and emotional dilemmas among parents that impact family dynamics. Resilience in parents is a shifting phenomenon that can influence how they deal with family relationships and dynamics.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Family Focused Health Care Research Centre, University of Southern Denmark, Odense C, Denmark
| | - Helle C Thiesson
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Helen Schultz
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Surgical Department, Odense University Hospital, Odense C, Denmark
| | - Birthe D Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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2
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Carroll D, Wales M, Rintell LS, Hojlo M, Gonzalez-Heydrich J, Berbert L, Fitzpatrick M, D'Angelo E, Reed MP. Burden Experienced by Primary Caregivers of Children With Psychotic Disorders and at Clinical High Risk for Psychosis. J Am Psychiatr Nurses Assoc 2024; 30:518-531. [PMID: 36475411 DOI: 10.1177/10783903221141883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the existing research exploring caregiver burden in adult psychosis, few studies have examined the experience of providing care to children diagnosed with psychotic disorders (PDs) and those identified as having clinical high risk for psychosis (CHR-P). AIM This study measured the level of burden in caregivers of children with PD and CHR-P and examined associated risk factors, including social support, caregiver-child relationship, severity of illness, and frequency of psychiatric hospitalizations. METHODS A total of 56 caregivers completed validated measures and provided demographic information. Measures included the Zarit Burden Interview, the Multidimensional Scale of Perceived Social Support, the Behavior Assessment System for Children, Third Edition, Parenting Relationship Questionnaire-Child and Adolescent Form (BASC-3 PRQ-CA), and the Clinical Global Impression-Severity scale. RESULTS The majority of caregivers were women (86%), mothers (84%), White (63%), married (66%), working full-time (50%), college-educated (79%), and whose mean age was 45.7 years (SD = 8.09). Nearly half of the caregivers (45%) reported a high level of caregiver burden, 39% rated their burden in the mild to moderate range, and 16% reported little to no burden. There was no significant difference in mean burden between PD and CHR-P groups. Higher caregiver burden was associated with lower levels of social support (r = -.408, p = .002), lower levels of parenting confidence (r = -.514, p < .001), higher levels of relational frustration (r = .612, p < .001), and higher severity of illness (r = .316 p = .025). CONCLUSIONS These findings underscore the critical unmet need for support for caregivers of children with PD and CHR-P. Applications to clinical practice are discussed.
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Affiliation(s)
- Devon Carroll
- Devon Carroll, PMHNP-BC, MSN, Boston Children's Hospital, Boston, MA, USA; University of Rhode Island, Providence, RI, USA
| | - Meghan Wales
- Meghan Wales, RN, BA, Boston Children's Hospital, Boston, MA, USA
| | | | - Margaret Hojlo
- Margaret Hojlo, BA, Boston Children's Hospital, Boston, MA, USA
| | - Joseph Gonzalez-Heydrich
- Joseph Gonzalez-Heydrich, MD, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Laura Berbert
- Laura Berbert, MS, Boston Children's Hospital, Boston, MA, USA
| | - Molly Fitzpatrick
- Molly Fitzpatrick, MA, Boston Children's Hospital, Boston, MA, USA; William James College, Newton, MA, USA
| | - Eugene D'Angelo
- Eugene D'Angelo, PhD, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mary P Reed
- Mary P. Reed, PhD, RN, ANP, CNRN, NEA-BC, Boston Children's Hospital, Boston, Massachusetts, USA
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Azimi T, Johnson J, Campbell SM, Montesanti S. Caregiver burden among parents of children with type 1 diabetes: A qualitative scoping review. Heliyon 2024; 10:e27539. [PMID: 38524615 PMCID: PMC10958210 DOI: 10.1016/j.heliyon.2024.e27539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 02/05/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives Type one diabetes (T1D) in children places substantial responsibility on parents as caregivers. This study investigated caregiver burden in parents of children with T1D by exploring the financial, physical, social, spiritual, and emotional or psychological problems they experienced. Methods We conducted a qualitative scoping review of the databases PsycINFO, PROSPERO, OVID Medline, OVID EMBASE, Cochrane Library (CDSR and Central), EBSCO CINAHL, ProQuest Dissertations and Theses Global, and SCOPUS. Of 119 full text articles assessed for eligibility, 18 peer-reviewed qualitative studies were included. Studies were considered relevant if they focused on diabetes management and parental burden or the experience of caregiving for a child with T1D. Results Using thematic analysis, six interrelated themes were identified: (a) experiencing chronic sorrow, (b) assuming responsibility for glucose highs and lows, (c) managing T1D and nighttime sleep disturbances, (d) making career sacrifices and choices to optimize T1D care, (e) navigating social experiences postdiagnosis, and (f) discovering new sources of support through online platforms. Conclusions This synthesis highlights an all-encompassing experience involved in caretaking for a child with T1D. Caregiving duties lead to a constant sense of vigilance, especially due to fear of hypoglycemic incidents. Parents commonly experience challenges with balancing work demands with T1D management, which lead to career and financial sacrifices. Their burden of care is exacerbated by a lack of reliable respite care but helped somewhat by online peer support. Future research is needed on the care burden differences between mothers and fathers and how sociodemographic factors affect how caregiver burden is experienced.
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Affiliation(s)
- Tara Azimi
- School of Public Health, University of Alberta, Canada
| | - Jeff Johnson
- School of Public Health, University of Alberta, Canada
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Merino-Soto C, Livia-Segovia J, Aguirre-Morales M, Toledano-Toledano F. Validity evidence for the coping strategy indicator-short version (CSI-S) among psychology students. Sci Rep 2024; 14:5441. [PMID: 38443528 PMCID: PMC10914775 DOI: 10.1038/s41598-024-55659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
The abbreviated measurement of coping strategies is useful for monitoring and identifying the effects of stress. The Coping strategy indicator-Short version (CSI-S, including the dimensions of seeking support, problem solving and avoidance strategies) is a new adaptation of the full version of this indicator, and additional evidence of its validity is needed. Psychology students (n = 125) from a public university in Lima, Peru, were recruited to help provide such evidence of validity in terms of internal structure, reliability and associations with other variables (perceived stress and general efficacy in cope with difficulties), which were evaluated using nonparametric item response theory procedures. Support-seeking and problem-solving items from the Mokken scale and the avoidance scale exhibited limitations. The correlations between the scales were moderate or low and exhibited theoretical consistency, and the relationship with perceived stress highlighted the predictive capacity of avoidance and problem-solving strategies. In general, the CSI-S exhibits suitable psychometric properties; however, the avoidance score requires further examination or reconstruction of its items.
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Affiliation(s)
- César Merino-Soto
- Instituto de Investigación en Psicología, Universidad de San Martin de Porres, Surquillo, Peru
| | | | | | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Mexico City, Mexico.
- Unidad de Investigación Multidisciplinaria en Salud, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
- Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Mexico City, Mexico.
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Keramatikerman M, Varaei S, Vaezi M, Sayadi L. Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial. BMJ Support Palliat Care 2024:spcare-2023-004610. [PMID: 38272654 DOI: 10.1136/spcare-2023-004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The responsibility of caring for patients with leukaemia places a heavy burden on family caregivers (FCs) and negatively impacts their quality of life (QoL). This study aimed to investigate the effects of peer support (PS)-based online education programme on the burden of care (BoC) and QoL of FCs of patients with leukaemia. METHODS This before-after study involved a total of 80 eligible FCs of patients with leukaemia (40 individuals per group). The participants received the necessary information from a researcher and peers through online sessions and WhatsApp group. To collect data, the Zarit Burden Interview and the Caregiver Quality of Life Index-Cancer (CQOLC) had been been completed once before the intervention and once 1 month after the intervention. RESULTS There was no significant difference between the two groups regarding baseline variables except the mean BoC that was significantly higher in the intervention group (IG) (p<0.001). However, after controlling for the effects of confounding variables, the mean BoC score of participants in IG was significantly lower than that of the control group (p<0.001). Additionally, there was no significant difference between the two groups in terms of CQOLC before (p=0.178) and after (p=0.538) the intervention. CONCLUSION The PS-based online education programme had a positive impact on reducing the care burden of FCs of patients with leukaemia. This programme can effectively reduce costs, particularly during emergencies and crises such as pandemics, as it eliminates the need for FCs and peers to physically visit hospitals. REGISTRATION The study was registered at the Iranian Registry of Clinical Trials on 18 July 2021 (IRCT registration number: IRCT20210507051209N1).
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Affiliation(s)
| | - Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Oncology, Hematology and Cell Therapy Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Sayadi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Bezgin S, Özkaya Y, Akbaş Y, Elbasan B. An investigation of computer-game addiction, physical activity level, quality of life and sleep of children with a sibling with a chronic condition. Child Care Health Dev 2024; 50:e13228. [PMID: 38265131 DOI: 10.1111/cch.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/28/2023] [Accepted: 12/24/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND It is known that chronic condition also affects siblings without chronic illness. Healthy siblings of children with a chronic condition and aged 9-14 years and healthy children with a sibling without chronic illness and their parents were included in the study. AIM The aim of our study was to examine the internet-game addiction, physical activity, quality of life and sleep in children with a sibling with chronic condition and compare them with their peers with a healthy sibling. METHODS Computer game addiction, physical activity, sleep quality and quality of life were evaluated respectively by Computer Game Addiction Scale for Children, Child Physical Activity Questionnaire, Children's Sleep Disorder Scale and Children's Quality of Life Scale. RESULTS While the mean age of 75 children with chronically ill siblings was 10.65 ± 1.59 years, the mean age of 75 healthy children with healthy siblings was 10.46 ± 2.09 years. It was observed that children with a sibling with a chronic condition were more tend to computer-game addiction, had lower sleep quality, lower quality of life in terms of school functionality and psychosocial health compared to children with a healthy sibling (p < 0.05). CONCLUSIONS It was revealed that in families with children with a chronic condition, siblings with no health problems should also be evaluated in psychosocial terms and supported by appropriate approaches, such as to increase the level of physical activity.
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Affiliation(s)
- Sabiha Bezgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Yunus Özkaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Yılmaz Akbaş
- Faculty of Medicine, Department of Child Neurology, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Bülent Elbasan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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García-Marín E, Valero-Moreno S, Schoeps K, Postigo-Zegarra S, Pérez-Marín M. Overburden in Caregivers of Chronically Ill Adolescents: A Comparative Study between Pulmonological and Endocrinological Diseases. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1840. [PMID: 38136042 PMCID: PMC10742129 DOI: 10.3390/children10121840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
Chronic pediatric disease has a major impact on the life of a child and his or her family. In this sense, the figure of the main caregiver is relevant, who may present adjustment difficulties before the disease, accompanied by high levels of stress and emotional discomfort, which interfere with the adolescent's adjustment before the new situation. The aim of this research was to carry out a comparative study among caregivers of adolescents with various diseases, analyzing the risk and protective factors for the stress presented by this population. For this purpose, a sample of 406 main caregivers of adolescents with an endocrinological or pneumological disease from different hospitals in Valencia was used, where characteristics related to the disease, attachment, type of family, and emotional distress of these caregivers were considered. In general, the results show higher levels of stress in caregivers of adolescents with an endocrinological disease, specifically DM1, and found significant predictors of anxiety-depressive symptomatology, the need for approval, and several variables related to the disease. These data reveal the importance of providing comprehensive care to the family system, offering health skills to overcome diseases, and reinforcing the protective factors offered by the family system.
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Affiliation(s)
- Elvira García-Marín
- Personality, Assessment and Psychological Treatment Department, Faculty of Psychology and Speech Therapy, University of Valencia, Avenida Blasco Ibáñez, 21, 46010 Valencia, Spain; (E.G.-M.); (K.S.); (S.P.-Z.); (M.P.-M.)
| | - Selene Valero-Moreno
- Personality, Assessment and Psychological Treatment Department, Faculty of Psychology and Speech Therapy, University of Valencia, Avenida Blasco Ibáñez, 21, 46010 Valencia, Spain; (E.G.-M.); (K.S.); (S.P.-Z.); (M.P.-M.)
| | - Konstanze Schoeps
- Personality, Assessment and Psychological Treatment Department, Faculty of Psychology and Speech Therapy, University of Valencia, Avenida Blasco Ibáñez, 21, 46010 Valencia, Spain; (E.G.-M.); (K.S.); (S.P.-Z.); (M.P.-M.)
| | - Silvia Postigo-Zegarra
- Personality, Assessment and Psychological Treatment Department, Faculty of Psychology and Speech Therapy, University of Valencia, Avenida Blasco Ibáñez, 21, 46010 Valencia, Spain; (E.G.-M.); (K.S.); (S.P.-Z.); (M.P.-M.)
- Faculty of Health Sciences, Department of Psychology, European University of Valencia, Passeig. de l’Albereda, 7, 46010 Valencia, Spain
| | - Marián Pérez-Marín
- Personality, Assessment and Psychological Treatment Department, Faculty of Psychology and Speech Therapy, University of Valencia, Avenida Blasco Ibáñez, 21, 46010 Valencia, Spain; (E.G.-M.); (K.S.); (S.P.-Z.); (M.P.-M.)
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Hirayama K, Kuribara T, Oshikiri M. Experiences of the older spousal caregivers of patients with cancer during palliative chemotherapy: a qualitative descriptive study. BMC Palliat Care 2023; 22:188. [PMID: 37993823 PMCID: PMC10666444 DOI: 10.1186/s12904-023-01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Several studies have characterized the experiences of family members caring for patients undergoing chemotherapy; however, information about the experiences of older spousal caregivers with intensive caregiving burdens is unclear. Recently, more older patients have been diagnosed with cancer due to the aging population worldwide. Therefore, this study evaluated the patterns in the experiences of older spousal caregivers of patients undergoing palliative chemotherapy for advanced cancer. METHODS Qualitative research using semi-structured interviews was used in this study involving 10 older spousal caregivers of patients undergoing palliative chemotherapy at a hospital providing advanced cancer care in Japan. The data obtained were analyzed qualitatively and inductively using thematic analysis by Braun and Clarke. RESULTS Four themes were identified from the narratives of the participants in this study. The first theme was "getting used to living with the disease," indicating that the older spouses gradually became accustomed to living with the patient through continued caregiving. The second theme was "deepening view of life and death," indicating that the older spouses' views of life and death were deepened by being confronted with patients' quality of life until death. The third theme was "anxious about the future," indicating the fear regarding the patient's progressive diseases and anxiety pertaining to continuing care for the patient while dealing with their health problems. The final theme was "desire for a better rest of life," indicating that the couple felt their bond was strengthened through caregiving and wishes to live well for the rest of their lives. CONCLUSIONS The patterns in the experience of older spousal caregivers caring for patients undergoing palliative chemotherapy indicated an aspect of rebuilding their lives as they became accustomed to caregiving, while strengthening their marital bond. The caregiving process involved a mix of emotions, including anxiety about the spousal caregiver's health problems worsening. However, the caregivers recognized the value of their remaining time. Therefore, they had deep concern for the patient's comfort, concealing their feelings so that the patient would feel comfortable. This study can contribute to understanding the challenges faced and support needed by older spousal caregivers.
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Affiliation(s)
- Kengo Hirayama
- School of Nursing, Sapporo City University, Kita 11, Nishi 13, Chuo-ku, Sapporo, Japan.
| | - Tomoki Kuribara
- School of Nursing, Sapporo City University, Kita 11, Nishi 13, Chuo-ku, Sapporo, Japan
| | - Miho Oshikiri
- Department of Nursing, Sapporo Sato Hospital, 4-10-15, Fushiko 2, Higashi-ku, Sapporo, Japan
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Kobos E, Rojkowska S, Szewczyk A, Dziedzic B. Burden of care and a sense of loneliness in caregivers of children with type 1 diabetes. a cross-sectional study. Biopsychosoc Med 2023; 17:34. [PMID: 37803450 PMCID: PMC10559508 DOI: 10.1186/s13030-023-00291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Treatment of type 1 diabetes is a process involving not only sick children, but also their caregivers. AIM To assess the burden of care and sense of loneliness in caregivers of children with type 1 diabetes. Also, an analysis was conducted of the connection between sociodemographic factors characterizing caregivers and the clinical factors characterizing sick children and between the burden of care and the sense of loneliness. MATERIALS AND METHODS The study included 125 caregivers of children with type 1 diabetes. In order to collect the research data, the Caregiver Burden Scale and the Revised UCLA Loneliness Scale were used. RESULTS In the research group, the total result in the caregiving burden scale was 2.14, which remains within the average burden level. Caregivers showed the highest burden level in the General Strain Subscale. The analysis showed that mothers experience a greater burden of care than fathers in the General Strain Subscale and that caregivers of younger children are more burdened with care within the Isolation and Disappointment Subscales. Moderate high degree of loneliness was shown in 4.8% of caregivers. A higher burden of care for caregivers of children with type 1 diabetes is accompanied by a higher sense of loneliness. CONCLUSIONS The results of this study may help healthcare professionals plan a holistic, family-centered care program that will take into account factors that increase the burden of care: younger age of the affected child, motherhood, caregiver unemployment, feelings of loneliness, lower education, caregiver unemployment, blood glucose meter measurements, and frequent night-time blood glucose measurements.
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Affiliation(s)
- Ewa Kobos
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
- Polish Federation for Diabetes Education, Warsaw, Poland
| | | | - Alicja Szewczyk
- Polish Federation for Diabetes Education, Warsaw, Poland
- Children’s Memorial Health Institute, Warsaw, Poland
| | - Beata Dziedzic
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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Limonero JT, Maté-Méndez J, Gómez-Romero MJ, Mateo-Ortega D, González-Barboteo J, Bernaus M, López-Postigo M, Sirgo A, Viel S, Sánchez-Julve C, Bayés R, Gómez-Batiste X, Tomás-Sábado J. Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties. BMJ Support Palliat Care 2023; 13:e177-e184. [PMID: 33277319 PMCID: PMC10646856 DOI: 10.1136/bmjspcare-2020-002608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools. AIM This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC). DESIGN Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA). RESULTS 138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale. CONCLUSIONS The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.
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Affiliation(s)
- Joaquín T Limonero
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
| | - Jorge Maté-Méndez
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Psycho-oncology Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María José Gómez-Romero
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Psychology Unit, Egarsat, Mutua Colaboradora con la Seguridad Social nº 276, Terrassa, Barcelona, Spain
| | - Dolors Mateo-Ortega
- Palliative Care Unit, Consorci Sanitari de Terrassa, Terrassa, Catalunya, Spain
| | - Jesús González-Barboteo
- Palliative Care Unit, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Bernaus
- Palliative Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Montserrat López-Postigo
- Palliative Care Unit, Consorci Corporació Sanitària Parc Taulí de Sabadell, Sabadell, Barcelona, Spain
| | - Agustina Sirgo
- Psycho-oncology Unit, Oncology Department, University Hospital Sant Joan de Reus, Reus, Barcelona, Spain
| | - Silvia Viel
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
- Member of the Group of Psychologists of the Catalan-Balearic Society for Palliative Care, Barcelona, Spain
| | - Cruz Sánchez-Julve
- Palliative Care Unit, Sant Camil Hospital-Residence Foundation-Sant Pere de Ribes, Sant Pere de Ribes, Barcelona, Spain
| | - Ramon Bayés
- School of Psychology, Stress and Health Research Group, Universitat Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Catalunya, Spain
| | - Xavier Gómez-Batiste
- The 'Qualy' Observatory. WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
- Chair of Palliative Care, University of Vic, Vic, Barcelona, Spain
| | - Joaquín Tomás-Sábado
- University of Gimbernat and Tomas Cerda School of Nursing, Sant Cugat del Vallés, Barcelona, Spain
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Jacob SA, Bouck J, Daas R, Jackson MD, LaMotte JE, Carroll AE. Understanding caregiver burden with accessing sickle cell care in the Midwest and their perspective on telemedicine. BMC Health Serv Res 2023; 23:500. [PMID: 37198614 DOI: 10.1186/s12913-023-09383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Survival for children with sickle cell disease (SCD) has improved significantly. However, patients with SCD still encounter several impediments to accessing adequate healthcare. Rural and medically underserved areas, such as parts of the Midwest, can exacerbate these barriers, separating children with SCD from subspecialists even further. Telemedicine has been a means to close these gaps in care for children with other special healthcare needs, but few studies have discussed how caregivers of children with SCD perceive its use. METHODS The objective of this study is to understand the experiences of caregivers of pediatric SCD patients in a geographically diverse area in the Midwest in accessing care, and their perspectives of telemedicine. Caregivers of children with SCD completed an 88-item survey via a secured REDCap link either in-person or via secure text. Descriptive statistics (means, medians, ranges, frequencies) were performed for all responses. Univariate chi square tests were performed to analyze associations, particularly with telemedicine responses. RESULTS The survey was completed by 101 caregivers. Nearly 20% of families traveled more than 1 hour to reach the comprehensive SCD center. Other than their SCD provider, caregivers reported their child having at least 2 other healthcare providers. Most barriers caregivers identified were financial or resource based. Almost a quarter of caregivers expressed feeling as though these barriers impacted their and/or their child's mental health. Ease of access to team members, as well as scheduling, were common facilitators of care cited by caregivers. The majority were willing to participate in telemedicine visits, regardless of how far they lived from the SCD center, though many noted aspects requiring adaptation. CONCLUSION This cross-sectional study describes barriers to care experienced by caregivers of children with SCD, regardless of proximity to an SCD center, as well as caregiver perceptions of the usefulness and acceptability of telemedicine for SCD care.
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Affiliation(s)
- Seethal A Jacob
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 410 W. 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA.
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA.
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Jillian Bouck
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 410 W. 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Roua Daas
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 410 W. 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Meghan Drayton Jackson
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Julia E LaMotte
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Aaron E Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 410 W. 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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Toledano-Toledano F, Jiménez S, Moral de la Rubia J, Merino-Soto C, Rivera-Rivera L. Positive Mental Health Scale (PMHS) in Parents of Children with Cancer: A Psychometric Evaluation Using Item Response Theory. Cancers (Basel) 2023; 15:2744. [PMID: 37345081 DOI: 10.3390/cancers15102744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
Mental health is currently a public health issue worldwide. However, evidence is lacking regarding the validity of the instruments used to measure and assess positive mental health in specific populations. The objective of this study was to evaluate the psychometric properties of the PMHS using IRT. A cross-sectional retrospective study with non-probabilistic convenience sampling was conducted with 623 parents of children undergoing cancer treatment at the National Institute of Health in Mexico City. The participants responded to a battery of tests, including a sociodemographic questionnaire, the PMHS, Measurement Scale of Resilience, Beck Depression Inventory, Inventory of Quality of Life, Beck Anxiety Inventory, an interview regarding caregiver burden, and the World Health Organization Well-Being Index. PMHS responses were analyzed using Samejima's graded response model. The PMHS findings indicated that the IRT-based graded response model validated the single latent trait model. The scale scores were independent of depression, anxiety, well-being, caregiver burden, quality of life, and resilience. The PMHS scores were associated with low subjective well-being. The PMHS findings reveal that from an IRT-based perspective, this scale is unidimensional and is a valid, reliable, and culturally relevant instrument for assessing positive mental health in parents of children with chronic diseases.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
- Unidad de Investigación Multidisciplinaria en Salud, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico
- Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Periférico Sur 4860, Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico
| | - Said Jiménez
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León, Dr. Carlos Canseco, 110, Esq. Dr. Aguirre Pequeño, Col. Mitras Centro, Monterrey 64460, Mexico
| | - Cesar Merino-Soto
- Instituto de Investigación de Psicología, Universidad de San Martín de Porres, 34, Lima 15011, Peru
| | - Leonor Rivera-Rivera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Av. Universidad No. 655 Col. Santa María Ahuacatitlán, Cuernavaca 62100, Mexico
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Smith HS, Bonkowski ES, Hickingbotham MR, Deloge RB, Pereira S. Framing the Family: A Qualitative Exploration of Factors That Shape Family-Level Experience of Pediatric Genomic Sequencing. CHILDREN (BASEL, SWITZERLAND) 2023; 10:774. [PMID: 37238322 PMCID: PMC10217651 DOI: 10.3390/children10050774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Families of children with rare and undiagnosed conditions face many psychosocial and logistical challenges that may affect their approach to decisions about their child's care and their family's well-being. As genomic sequencing (GS) is increasingly incorporated into pediatric diagnostic workups, assessing the family-level characteristics that shape the experience of pediatric GS is crucial to understanding how families approach decision-making about the test and how they incorporate the results into their family life. We conducted semi-structured interviews with parents and other primary caregivers of pediatric patients who were evaluated for a suspected genetic condition and who were recommended to have GS (n = 20) or who had recently completed GS (n = 21). We analyzed qualitative data using multiple rounds of thematic analysis. We organized our thematic findings into three domains of factors that influence the family-level experience of GS: (1) family structure and dynamics; (2) parental identity, relationships, and philosophies; and (3) social and cultural differences. Participants conceptualized their child's family in various ways, ranging from nuclear biological family to support networks made up of friends and communities. Our findings can inform the design and interpretation of preference research to advance family-level value assessment of GS as well as genetic counseling for families.
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Affiliation(s)
- Hadley Stevens Smith
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Emily S. Bonkowski
- Institute for Public Health Genetics, University of Washington School of Public Health, Seattle, WA 98195, USA
- Center for Pediatric Neurological Disease Research, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Madison R. Hickingbotham
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - Raymond Belanger Deloge
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
This cross-sectional and descriptive study aimed to determine care burden of families of children with corrosive esophageal injuries. The study involved 112 parents who had children with corrosive esophageal injury. Caregiver's Stress Scale and Reactions to Helping Family Members Scale were used to assess care burden of families. Caregiver's Stress Scale median score was 7.0 [interquartile range 5.0], and Reactions to Helping Family Members Scale median score was 45.0 [interquartile range 14.0]. The burden of family caregivers was thus found to be high. Factors affecting the care burden were found to be child's age, parents' age, child's weight, substance type and pH, surgery status, and number of surgeries. Nurses should consider these factors when advising and educating these families. Additionally, initiatives including support groups should be planned with regard to the needs of these families with a high care burden.
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Affiliation(s)
- Nazife G Özer Özlü
- 37509Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey.,37508Faculty of Nursing, Department of Surgery Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Fatma Vural
- 37508Faculty of Nursing, Department of Surgery Nursing, Dokuz Eylül University, Izmir, Turkey
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15
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Basilious A, Villani S, Jang H, Kaberi KM, Malvankar-Mehta MS. Quality of life and caregiver burden in pediatric glaucoma: A systematic review. PLoS One 2022; 17:e0276881. [PMID: 36288373 PMCID: PMC9605022 DOI: 10.1371/journal.pone.0276881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
Pediatric conditions can lead to significant caregiver burden and poor quality of life (QoL). This systematic review describes research relating to caregiver burden and QoL of caregivers of pediatric glaucoma patients. A systematic database search of Embase, Medline, PsycINFO, CINAHL, Web of Science, and the three journals within the Association for Research in Vision and Ophthalmology (ARVO) was conducted in October 2021. Publications underwent abstract and full-text screening and were included if they reported pediatric caregivers' QoL using quantitative or qualitative methods. Review articles, publications not in English, and articles focusing on adult glaucoma patients were excluded. Studies then underwent risk of bias assessment and data extraction. Of the 105 publications identified, 8 publications with 667 participants were included in the review. Studies indicated significantly higher burden and poor QoL in caregivers. Female sex, lower education level, lower income, and working status of caregivers were associated with poorer QoL and greater burden. Additionally, more severe and longer duration of the child's disease negatively impacted these measures of caregiver wellbeing. Additionally, studies found significant improvement in caregiver QoL after patients underwent surgery with combined trabeculotomy-trabeculectomy. In conclusion, few studies have investigated the impact of pediatric glaucoma on caregivers. This review of the existing studies found poor QoL and high levels of caregiver burden within this population. Given the lifelong nature of pediatric glaucoma, there is a need for further longitudinal research focusing on the caregivers of these pediatric patients. Long-term follow-up would allow for a greater understanding of how caregiver QoL changes over the course of the disease.
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Affiliation(s)
- Amy Basilious
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Steven Villani
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hyunsoo Jang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karina M. Kaberi
- Department of Biology and The Biotron, Western University, London, Ontario, Canada
- Faculty of Nursing, School of Health Sciences, Western University, London, Ontario, Canada
| | - Monali S. Malvankar-Mehta
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Health Care, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- * E-mail:
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16
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Parents and Their Children in the Face of Cancer: Parents' Expectations, Changes in Family Functioning in the Opinion of Caregivers of Children with Neoplastic Diseases-Further Studies. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101562. [PMID: 36291498 PMCID: PMC9600004 DOI: 10.3390/children9101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
(1) Background: The onset and duration of the child’s illness is a difficult test for the entire family. The stress, in which the family lives from this moment, influences the relationships within it, as well as external relations with the environment. The child’s cancer fundamentally changes the way the family functions, the quality of interactions within the family, and life plans. (2) Patients and Approach: A population survey was run between 2015 and 2020. A cross-sectional study was conducted involving 800 family caregivers of children with cancer during active treatment. The aim of the study was to assess changes in the family functioning in the opinion of parents of a child with cancer. (3) Results: Parents experience chronic anxiety (67%), nervousness (60%), and worry (64%). For 50% of parents, the illness of their child entirely changed their plans. As many as 75% of parents feel guilty for exposing their child to carcinogens. According to the parents, the child’s illness is a psychological (89%), somatic (49%) and financial (77%) burden for them. Only 7% of children cause behavioural problems and 16% have trouble learning due to their sibling’s illness. (4) Conclusions: Cancer is a great difficulty for all members of a family system. The disease disturbs the balance within the family and relations in the family, as well as more distant psychological, social, and material consequences.
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17
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Beattie A, Restaino MR. Ameliorating Caregiver Burden in the Pediatric Palliative Population Utilizing a Psychophysiological Intervention. Am J Hosp Palliat Care 2022:10499091221130760. [PMID: 36225169 DOI: 10.1177/10499091221130760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Providing long-term care for a family member can be a source of severe stress for the untrained caregiver, and is known to cause depression, poor overall health, and lower quality of life for the caregiver. This burden may lead to poorer outcomes for the patient, as well as contribute to overall increasing costs of an already strained healthcare system. The purpose of this quality improvement project was to reduce the stress that accompanies caregiver burden through the intervention of diaphragmatic breathing. Method: Diaphragmatic breathing is a low-cost, psychophysiological intervention found to be helpful for reducing stress, which is a significant component of caregiver burden. Caregivers of pediatric patients enrolled in a homecare program were assessed for caregiver burden utilizing the Zarit Burden Interview-12 (ZBI-12). Those who had scored 15 or higher on the ZBI-12 were taught diaphragmatic breathing, and assessed again, two months after using the intervention. Results: A paired dependent t-test revealed that palliative caregivers showed a reduction in ZBI-12 assessment score after implementation of a diaphragmatic breathing intervention (m = 17.4, s = 6.7), compared to before implementation of a diaphragmatic breathing intervention (m = 12.8, s = 8.6), t(11) = 2.513 , P < .05. Conclusion: The intervention resulted in less anxiety, stress, depression, and burnout among the pediatric palliative caregivers. Improvement of caregiver well-being was evidenced by decreased ZBI-12 scores in a postintervention assessment.
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18
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Barak S, Elad D, Gutman D, Silberg T. Using a biopsychosocial approach to examine parental sense of burden and competency associated with raising a child with a physical disability. Child Care Health Dev 2022; 49:518-528. [PMID: 36207992 DOI: 10.1111/cch.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/23/2022] [Accepted: 09/30/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Parents report both positive and negative experiences associated with raising a child with a physical disability. However, distinctive factors may affect children and families differently. AIMS Using a biopsychosocial approach, the current study expands on the existing literature on the general impact of raising a child with a disability. METHODS Participants were 98 parents of children/youth with a physical disability. Parents reported on child's level of physical disability, the impact of the disability on the family (financial, social, personal strain and mastery) and their general health. Data were analysed to examine how different biopsychosocial factors are associated with raising a child with a physical disability. RESULTS Parents reported that child's disability had a higher social impact, compared with the financial and personal burden, as well as compared with their sense of competency and mastery. Child's level of disability was associated with financial burden, whereas parental emotional distress was associated with parents' personal and social burden, with the latter also associated with parent's religiosity. Total impact was associated with parental emotional distress and educational level. CONCLUSIONS Altogether, parental characteristics, but not child's characteristics, were associated with greater caregiver burden. Furthermore, the social impact a child's physical disability has on the family exceeded other sources of burden within the family. Providing parents social and emotional support, tailored to their unique biopsychosocial needs, may mitigate burden and distress, and increase sense of competency among families of children with a physical disability.
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Affiliation(s)
- Sharon Barak
- School of Health Sciences, Ariel University, Ariel, Israel.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Dina Elad
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Dafna Gutman
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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19
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Using Latent Class Analyses to Examine Health Disparities among Young Children in Socially Disadvantaged Families during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137893. [PMID: 35805550 PMCID: PMC9265642 DOI: 10.3390/ijerph19137893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 12/10/2022]
Abstract
Rising income inequality is strongly linked to health disparities, particularly in regions where uneven distribution of wealth and income has long been a concern. Despite emerging evidence of COVID-19-related health inequalities for adults, limited evidence is available for children and their parents. This study aimed to explore subtypes of families of preschoolers living in the disadvantaged neighborhoods of Hong Kong based on patterns of family hardship and to compare their patterns of parenting behavior, lifestyle practices, and wellbeing during the COVID-19 pandemic. Data were collected from 1338 preschoolers and their parents during March to June 2020. Latent class analysis was performed based on 11 socioeconomic and disease indicators. Multivariate logistic regressions were used to examine associations between identified classes and variables of interest during the COVID-19 pandemic. Four classes of family hardship were identified. Class 1 (45.7%) had the lowest disease and financial burden. Class 2 (14.0%) had the highest financial burden. Class 3 (5.9%) had the highest disease burden. Class 4 (34.5%) had low family income but did not receive government welfare assistance. Class 1 (low hardship) had lower risks of child maltreatment and adjustment problems than Class 2 (poverty) and Class 3 (poor health). However, children in Class 1 (low hardship) had higher odds of suffering psychological aggression and poorer physical wellbeing than those in Class 4 (low income), even after adjusting for child age and gender. The findings emphasize the need to adopt flexible intervention strategies in the time of large disease outbreak to address diverse problems and concerns among socially disadvantaged families.
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20
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Chaghazardi M, Janatolmakan M, Rezaeian S, Khatony A. Care burden and associated factors in caregivers of children with cancer. Ital J Pediatr 2022; 48:92. [PMID: 35698160 PMCID: PMC9195224 DOI: 10.1186/s13052-022-01291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Evidence suggests that many parents who care for their children with cancer are affected by the care burden due to the chronic nature of the disease. The aim of this study was to determine the burden of care level and its related factors in the caregivers of children with cancer. Method A total of 270 caregivers of children with cancer were included in this cross-sectional study by convenience sampling method. Data collection tools were a personal information form and the Novak & Guest’s Caregiver Burden Inventory. Data were analyzed by descriptive and inferential statistics (chi-square and univariate linear regression model). Results The mean ages of caregivers and patients were 35.7 ± 7.0 and 3.1 ± 1.6 years, respectively. The mean care burden was 68.4 ± 1.5 out of 120. About 50 and 36% of caregivers had moderate and severe care burden, respectively. Conclusion Caregivers had moderate to high care burden. A number of factors associated with care burden were identified. Health authorities need to take family-centered measures to reduce the burden of caregivers.
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Affiliation(s)
- Mahnaz Chaghazardi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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21
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Dong S, Elliott TR, Luo W, Warren AM, Warren R. Personality metatraits predict resilience among family caregivers responsible for a dependent youth's chronic respiratory management. BMC Psychol 2022; 10:85. [PMID: 35365207 PMCID: PMC8973997 DOI: 10.1186/s40359-022-00791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Family caregivers of children and youth with severe neurodisabilities that require chronic respiratory management often report a compromised quality of life. In this cross-sectional study, we used DeYoung’s (Psychol Inq 21(1): 26–33, 2010. 10.1080/10478401003648674) conceptualization of two personality metatraits, Alpha and Beta, to test their theorized role in facilitating resilience among these family caregivers. We expected higher Alpha and Beta would exhibit direct, beneficial effects on caregiver mental and physical health quality of life (QoL), and they would operate through self-reported resilience and coping to exert positive, indirect effects on caregiver QoL. Methods Family caregivers of children and youth at an outpatient chronic respiratory management clinic were informed of the study. Of the 68 who consented, 61 provided complete data on measures of personality traits, coping styles, and physical and mental health-related QoL. Factor analytic techniques verified the two personality metatraits, consistent with the DeYoung model. The metatraits were then used as predictor variables in a path model to predict physical and mental health-related QoL. Self-reported resilience and a coping variable were examined as possible mediators of the personality-QoL relationship. Results Correlational analyses isolated a coping variable that met criteria as a possible mediator. The path model exhibited good fit to the data. The Alpha metatrait—characterized by emotional stability, self-regulation, perseverance, and intrinsic motivation—was directly predictive of caregiver mental health. The Beta metatrait, reflecting a disposition for adaptive flexibility, responsiveness, and interpersonal initiative, demonstrated significant indirect effects to physical and mental health through its positive association with coping efforts to maintain social support and a sense of self. Conclusions Consistent with DeYoung’s conceptualization, higher Alpha and Beta predicted caregiver resilience, albeit through different pathways. The emotional stability, perseverance and emotional regulation associated with Alpha likely accounted for its positive association with caregiver mental health. Beta, in contrast, may operate through their adaptive flexibility, personal resourcefulness and social engagement to augment coping efforts that involve others and support family activities, which, in turn, promote their own physical and mental health. Limitations of the cross-sectional design, and potential theoretical and clinical implications of the personality metatraits and their relation to resilience are discussed. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00791-y.
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Affiliation(s)
- Sidai Dong
- Department of Educational Psychology, Texas A&M University (4225 TAMU), College Station, TX, 77843-4225, USA
| | - Timothy R Elliott
- Department of Educational Psychology, Texas A&M University (4225 TAMU), College Station, TX, 77843-4225, USA.
| | - Wen Luo
- Department of Educational Psychology, Texas A&M University (4225 TAMU), College Station, TX, 77843-4225, USA
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Robert Warren
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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22
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Experiences and Needs of Families Caring for Children and Adolescents With Chronic Kidney Disease: A meta-Synthesis. J Pediatr Nurs 2022; 63:52-63. [PMID: 35007849 DOI: 10.1016/j.pedn.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
PROBLEM Families struggle to care for children and adolescents with chronic kidney disease (CKD). They face extensive burden of care and altered family dynamics. ELIGIBILITY CRITERIA A meta-synthesis review was conducted to explore the experiences and needs of families caring for children and adolescents with CKD using seven electronic databases (CINAHL, EMBASE, ProQuest Dissertations and Theses, PsycINFO, PubMed, Scopus, and Web of Science). The inclusion criteria are (1) qualitative English studies from January 2010 to December 2020 that (2) report personal experiences or needs of (3) family members caring for children and adolescents aged 19 years and below who have been diagnosed with CKD of any stage (4) across all settings. Quality appraisal was done using the Critical Appraisal Skill Program checklist. Data was synthesised using Sandelowski & Barroso's (2007) method. SAMPLE 2,236 records were identified and 13 eligible studies were included. Family members involved mothers (n = 190), fathers (n = 83), siblings (n = 5), and grandparents (n = 2). RESULTS Three themes emerged: (1) demands of caregiving, (2) support systems, and (3) defining and making sense of new reality. CONCLUSIONS Family caregivers experience overwhelming demands of caregiving and unmet support needs to cope. Appropriate interventions are needed to alleviate their burden. IMPLICATIONS Knowledge of learning and support needs of families caring for children with CKD may shape nursing education and practice to cultivate more effective communication for better psychosocial family support.
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Jacob SA, Daas R, Feliciano A, LaMotte JE, Carroll AE. Caregiver experiences with accessing sickle cell care and the use of telemedicine. BMC Health Serv Res 2022; 22:239. [PMID: 35193570 PMCID: PMC8860730 DOI: 10.1186/s12913-022-07627-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with a wide range of complications. However, a multitude of barriers prevent SCD patients from receiving adequate healthcare, including difficulties with transportation and lack of provider knowledge about disease sequelae. Importantly, studies have demonstrated the benefits of telemedicine in addressing barriers to healthcare. While previous studies have identified barriers to care through quantitative methods, few studies have explored barriers which affect the pediatric SCD patient population in the Midwest, wherein the geographical landscape can prohibit healthcare access. Furthermore, few studies have established acceptability of telemedicine among caregivers and patients with SCD. METHODS This study aims to increase understanding of barriers to care and perceptions of telemedicine by caregivers of pediatric SCD patients in a medically under-resourced area in the Midwest. Researchers conducted semi-structured interviews with caregivers of children with SCD. The interviews were audio-recorded and transcribed. Thematic analyses were performed. RESULTS Researchers interviewed 16 caregivers of 15 children with SCD. Thematic analyses of the interview transcripts revealed four broad themes regarding caregiver burden/stress, both facilitators and barriers to SCD healthcare, and general thoughts on the acceptability/usefulness of telemedicine. CONCLUSION This qualitative study describes common burdens faced by caregivers of SCD, barriers to and facilitators of SCD care in the Midwest, and caregiver perceptions of the usefulness and efficacy of telemedicine for SCD care.
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Affiliation(s)
- Seethal A Jacob
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, HITS Building, 410 W. 10th St, Suite 2000A, Indianapolis, IN, 46202, USA. .,Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA. .,Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Roua Daas
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, HITS Building, 410 W. 10th St, Suite 2000A, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Anna Feliciano
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Julia E LaMotte
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Aaron E Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, HITS Building, 410 W. 10th St, Suite 2000A, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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24
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The Needs of Parents of Children Suffering from Cancer—Continuation of Research. CHILDREN 2022; 9:children9020144. [PMID: 35204865 PMCID: PMC8870376 DOI: 10.3390/children9020144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023]
Abstract
Background: Parents experience many healthcare needs when caring for their sick children. Research shows that parents of oncological children have a high level of unmet needs, including psychosocial, emotional, physical, informational, financial, educational, and spiritual needs. To date, little quantitative research has been carried out on the specific needs of parents of children with cancer, which creates uncertainty about what areas should be addressed in care. This study investigated the prevalence of unmet needs among parents of children with cancer. Methods: A population survey was conducted between 2015 and 2020. Caregivers of children diagnosed with cancer were invited to participate in the study to assess their problems and needs. Results: The analysis found that 97% of the participants experienced some level of need for one or more items, and 73% of the respondents reported a moderate or high need for one or more items. In the field of medical information, 70% of respondents had moderate or high needs, 55% of parents reported a moderate or high level of need for help in the psychological or emotional field, and 30% in the financial domain. The prevalence of moderate or high need in the remaining domains ranged from 10% to 15%. Conclusions: Parents of children with cancer experience a high level of needs, especially psychological, emotional, and information. These data suggest that the existing healthcare system does not meet the needs of parents of sick children. The results show the need to investigate the mechanisms by which healthcare providers can use the healthcare system to identify and meet needs.
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25
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Jiménez S, Moral de la Rubia J, Varela-Garay RM, Merino-Soto C, Toledano-Toledano F. Resilience measurement scale in family caregivers of children with cancer: Multidimensional item response theory modeling. Front Psychiatry 2022; 13:985456. [PMID: 36727086 PMCID: PMC9885114 DOI: 10.3389/fpsyt.2022.985456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Currently, information about the psychometric properties of the Resilience Measurement Scale (RESI-M) in family caregivers of children with cancer according to item response theory (IRT) is not available; this information could complement and confirm the findings available from classical test theory (CTT). The objective of this study was to test the five-factor structure of the RESI-M using a full information confirmatory multidimensional IRT graded response model and to estimate the multidimensional item-level parameters of discrimination (MDISC) and difficulty (MDIFF) from the RESI-M scale to investigate its construct validity and level of measurement error. METHODS An observational study was carried out, which included a sample of 633 primary caregivers of children with cancer, who were recruited through nonprobabilistic sampling. The caregivers responded to a battery of tests that included a sociodemographic variables questionnaire, the RESI-M, and measures of depression, quality of life, anxiety, and caregiver burden to explore convergent and divergent validity. RESULTS The main findings confirmed a five-factor structure of the RESI-M scale, with RMSEA = 0.078 (95% CI: 0.075, 0.080), TLI = 0.90, and CFI = 0.91. The estimation of the MDISC and MDIFF parameters indicated different values for each item, showing that all the items contribute differentially to the measurement of the dimensions of resilience. CONCLUSION That regardless of the measurement approach (IRT or CTT), the five-factor model of the RESI-M is valid at the theoretical, empirical, and methodological levels.
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Affiliation(s)
- Said Jiménez
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Mexico City, Mexico
| | | | - Rosa María Varela-Garay
- Departamento de Trabajo Social y Servicios Sociales, Facultad de Ciencias Sociales, Universidad Pablo de Olavide, Seville, Spain
| | - Cesar Merino-Soto
- Instituto de Investigación en Psicología, Universidad de San Martin de Porres, Lima, Peru
| | - Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, National Institute of Health, Mexico City, Mexico.,Unidad de Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.,Dirección de Investigación y Diseminación del Conocimiento, Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Mexico City, Mexico
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26
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Bucak IH, Tumgor G, Almis H, Kose S, Dogan CN, Turgut M. Evaluation of Burden and Anxiety in Caregivers of Patients with Pediatric Celiac Disease in the COVID-19 Pandemic. Avicenna J Med 2021; 11:152-155. [PMID: 34646792 PMCID: PMC8500068 DOI: 10.1055/s-0041-1735382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background
Anxiety and caregiver burden increase among caregivers for individuals with chronic disease. The purpose of this study was to compare the anxiety levels and caregiver burden among caregivers for cases with pediatric celiac disease (CD) before and during the COVID-19 pandemic.
Materials
The Zarit Burden Interview (ZBI) and the Beck Anxiety Inventory (BAI) were applied to 29 parents caring for pediatric CD patients in January 2020, when COVID-19 cases had not yet been seen in Turkey. The study was designed prospectively. The scales were also reapplied to the same study group online during the COVID-19 pandemic (May 2020). The results were then compared.
Results
Parents caring for 29 cases of pediatric CD; 21 mothers (72.4%), six fathers (20.7%), and two aunts (6.9%) took part in the study. Mean ZBI scores before and during the COVID-19 pandemic were 27.51 ± 14.12 (8–73) and 38.68 ± 10.95 (21–57), respectively (
p
< 0.01). Mean BAI scores before and during the COVID-19 pandemic were 13.27 ± 7.65 (1–27) and 23.48 ± 12.40 (2–48), respectively (
p
< 0.01).
Conclusion
Increased anxiety and caregiver burden among caregivers of pediatric CD cases during the COVID-19 pandemic were identified for the first time in the literature in this study.
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Affiliation(s)
- Ibrahim Hakan Bucak
- Department of Pediatrics, Adiyaman University School of Medicine, Adiyaman, Turkey
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana, Turkey
| | - Habip Almis
- Department of Pediatrics, Adiyaman University School of Medicine, Adiyaman, Turkey
| | - Sumeyye Kose
- Department of Pediatrics, Adiyaman University School of Medicine, Adiyaman, Turkey
| | - Cagla Nur Dogan
- Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
| | - Mehmet Turgut
- Department of Pediatric Infectious Disease, Adiyaman University School of Medicine, Adiyaman, Turkey
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Olagunju AT, Bioku AA, Ohaeri JU, Oluwaniyi SO, Li A, Olagunju TO, Esezobor CI, Onwuameze OE, Chaimowitz GA. A comparative study of perceived burden in parent caregivers of adolescents with epilepsy in a resource-restricted setting: Investigating the explanatory factors of perceived burden. Epilepsy Behav 2021; 120:107992. [PMID: 33962249 DOI: 10.1016/j.yebeh.2021.107992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Parent caregivers often play vital roles in the care of adolescents with epilepsy (AWE) in resource-restricted settings; however, little is known about the burden borne by these parents. This study investigated the burden perceived by parents of AWE and described the explanatory factors. METHODS An equal number (n = 121) of age- and gender-matched parent caregivers of AWE (cases) and parents of adolescents with sickle cell disease (comparison group) were interviewed with the Parent Illness Intrusiveness Rating Scale to assess disruptions in their relationships and lifestyle. Parents of AWE were assessed for psychological distress with the 12-item General Health Questionnaire, and AWE were interviewed with the Hospital Depression-Anxiety Scale. RESULTS The majority of the cases and the comparison group were mothers (76%), with mean (SD) ages of 44.11 (SD = 6.92) versus 43.59 (SD = 6.39) years, respectively. The prevalence rate of psychological distress in cases was 38%, and depressive-anxiety symptom was prevalent in 39.7% of AWE. The level of perceived burden was significant in all parent caregivers, albeit higher in cases relative to the comparison group across multiple domains, including relationship/personal development, intimacy, instrumental and global. A high level of burden in parents of AWE was predicted by a poor family financial and material support to the adolescents, increased contact hours with adolescents, psychological distress in the parent caregivers, and anxiety-depressive symptoms in AWE after controlling for cofounders. CONCLUSION The study findings underscore the need for psychosocial support to bolster resilience and adaptive coping styles in parents of AWE, particularly in resource-restricted settings. A culturally sensitive interdisciplinary blueprint of locally viable actions model for psychosocial support for parent caregivers of AWE is strongly suggested. Future studies are indicated to shed more light on the modifiable risks of perceived burden, and the effectiveness of psychosocial interventions in parents of AWE.
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Affiliation(s)
- Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry, University of Lagos, Mushin, Lagos State, Nigeria; Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.
| | | | - Jude U Ohaeri
- Department of Psychological Medicine, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Angela Li
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Tinuke O Olagunju
- Department of Health Research Method, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Obiora E Onwuameze
- Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
| | - Gary A Chaimowitz
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Schreiber JE, Cole JCM, Houtrow AJ, Kallan MJ, Thom EA, Howell LJ, Adzick NS. Maternal Depressive Risk in Prenatal versus Postnatal Surgical Closure of Myelomeningocele: Associations with Parenting Stress and Child Outcomes. Fetal Diagn Ther 2021; 48:479-484. [PMID: 34182547 DOI: 10.1159/000516602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Depressive risk is higher for mothers of infants with chronic medical conditions. The present study examined maternal depressive risk and associations with parent and child outcomes among mothers of young children who were randomized to either prenatal or postnatal surgical closure for myelomeningocele. METHODS Using the Management of Myelomeningocele Study database, maternal depressive risk was examined at 3 time points as follows: prior to birth, 12 months, and 30 months post birth. Separate multivariate analyses examined associations among change in depressive risk (between baseline and 30 months), parenting stress, and child outcomes at 30 months. RESULTS Mean scores were in the minimal depressive risk range at all the time points. Post birth depressive risk did not differ by prenatal versus postnatal surgery. Mean change scores reflected a decrease in depressive risk during the first 30 months. Only 1.1-4.5% of mothers reported depressive risk in the moderate to severe range across time points. Increased depressive risk during the first 30 months was associated with increased parenting stress scores and slightly lower child cognitive scores at 30 months. CONCLUSION Most mothers reported minimal depressive risk that decreased over time, regardless of whether their infant underwent prenatal or postnatal surgery. Only a small percentage of mothers endorsed moderate to severe depressive risk, but an increase in depressive risk over time was associated with higher parental stress and slightly lower child cognitive development.
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Affiliation(s)
- Jane E Schreiber
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joanna C M Cole
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Michael J Kallan
- Department of Biostatistics Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Thom
- George Washington University Biostatistics Center, Washington, District of Columbia, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Baddour K, Mady LJ, Schwarzbach HL, Sabik LM, Thomas TH, McCoy JL, Tobey A. Exploring caregiver burden and financial toxicity in caregivers of tracheostomy-dependent children. Int J Pediatr Otorhinolaryngol 2021; 145:110713. [PMID: 33882339 DOI: 10.1016/j.ijporl.2021.110713] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Measure the prevalence of and factors associated with financial toxicity (FT) and caregiver burden in families of tracheostomy-dependent children. FT is defined as the objective and subjective patient-level impact of the costs of medical care and has been associated with lower quality of life, decreased compliance with treatment, and increased mortality. METHODS A medical record review was performed on all children with a tracheostomy tube placed from 2009 to 2018 at a tertiary children's hospital to identify and include children younger than 18 years old, not deceased, and not decannulated at the time of review. Eligible children's caregivers were contacted to fill out a 36-item questionnaire and three validated instruments: The Comprehensive Score for Financial Toxicity (COST) and the Financial Distress Questionnaire (FDQ), both addressed to the parent/primary caregiver, and the Burden Scale for Family Caregivers - short version (BSFC-s). RESULTS Of the 140 eligible tracheostomy patients identified, 45 caregivers (32.1%) returned the survey. The average COST score was 18 ± 1.7 with 73.3% of caregivers reporting high toxicity based on FDQ, and 75.6% having severe-to-very severe caregiver burden. Significant increase in FT was seen in households where an adult had to leave a paid position (p = 0.047) or work less (p = 0.002) because of their child's condition; or needed to omit some of the child's medical services or medications due to cost-prohibitive reasons (p<0.001). Financial toxicity was associated with caregiver burden (by BSFC-s) [r = -596; beta coefficient = -0.95, t(43) = -4.87, p<0.001] and financial distress (by FDQ; p<0.001). CONCLUSION Caregivers of children with medically complex, tracheostomy-dependent conditions suffer from FT and caregiver burden. As a result, harmful financial coping mechanisms such as missing necessary care components or forgoing prescribed treatments, may be adopted for cost-prohibitive reasons.
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Affiliation(s)
- Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Leila J Mady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hannah L Schwarzbach
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Teresa H Thomas
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jennifer L McCoy
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Allison Tobey
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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30
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Mahmoud DAM, Saad A, Abdelhamid YH, El Hawary Y. Depression and psychosocial burden among caregivers of children with chronic kidney disease. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00092-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
More attention has recently targeted families of children with chronic kidney diseases displaying depressive symptoms and major psychosocial burden due to the long-standing nature of the illness and its alarming complications. A cross sectional comparative study was conducted to assess the rate of occurrence of both depression severity and psychological burden, personal and role strain in a sample of Egyptian caregivers of children with chronic kidney disease.
Results
Thirty caregivers of children with CKD were enrolled compared to 30 matched controls during a 6-month period. A short pre-designed sheet including socio-demographic data, and general medical, psychiatric and family history was used, and Beck Depression Inventory, Zarit Burden Interview, Holmes and Rahe Socioeconomic Stress Scale, and Occupational Stress Questionnaire were answered.
More than half of the caregivers of children with chronic kidney disease reported moderate depression (53.3%), while 30% and 16.7% reported mild and severe depression respectively. The majority of cases 80% had moderate psychological burden. And 70% of cases reported minimal socioeconomic stress compared to 40% in the control. Logistic regression analysis showed that ZBI and SRRS scores were significantly linked to depression and burden found in caregivers of children with CKD (P = 0.001 and 0.031) respectively.
Conclusion
The rate of occurrence of depression and psychological burden is significantly high in caregivers of children with chronic kidney disease; therefore, this population must be assessed and provided with liaison psychological rehabilitation.
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31
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Psychosocial Factors Predicting Resilience in Family Caregivers of Children with Cancer: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020748. [PMID: 33477253 PMCID: PMC7830523 DOI: 10.3390/ijerph18020748] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 01/10/2023]
Abstract
Chronic diseases in childhood can affect the physical and mental health of patients and their families. The objective of this study was to identify the sociodemographic and psychosocial factors that predict resilience in family caregivers of children with cancer and to define whether there are differences in the levels of resilience derived from these sociodemographic variables. Three hundred and thirty family caregivers of children with cancer, with an average age of 32.6 years were interviewed. The caregivers responded to a battery of tests that included a questionnaire of sociodemographic variables, the Measuring Scale of Resilience, the Beck Depression Inventory, the Inventory of Quality of Life, the Beck Anxiety Inventory, an interview of caregiver burden and the World Health Organization Well-Being Index. The main findings indicate that family caregivers of children with cancer reported high levels of resilience, which were associated positively with quality of life, psychological well-being and years of study and associated negatively with depression, anxiety and caregiver burden. The variables that predicted resilience in families of children with cancer were quality of life, psychological well-being, depression and number of children. Family caregivers who were married and Catholic showed higher resilience scores. We conclude that being a caregiver in a family with children with cancer is associated with symptoms of anxiety and with depressive episodes. These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.
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Toledano-Toledano F, Moral de la Rubia J, Nabors LA, Domínguez-Guedea MT, Salinas Escudero G, Rocha Pérez E, Luna D, Leyva López A. Predictors of Quality of Life among Parents of Children with Chronic Diseases: A Cross-Sectional Study. Healthcare (Basel) 2020; 8:healthcare8040456. [PMID: 33153086 PMCID: PMC7712866 DOI: 10.3390/healthcare8040456] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
Quality of life (QOL) is a key aspect of the health care process for children with chronic diseases and their families. Although clinical evidence regarding the impact of chronic disease on children exists, few studies have evaluated the effects of the interaction between sociodemographic and psychosocial factors on the family caregiver's QOL, indicating a significant gap in the research literature. The present study aimed to identify the predictors of the QOL of parents of children with chronic diseases. Three parental sociodemographic predictors (age, schooling, and family income) and four psychosocial predictors (family functioning, social support, depression, and resilience) were examined. In this cross-sectional study, 416 parents of children with chronic diseases who were hospitalized at a National Institute of Health in Mexico City were interviewed. The participants completed a sociodemographic variables questionnaire (Q-SV) designed for research on family caregivers of children with chronic disease. The predicted variable was assessed through the World Health Organization Quality of Life Questionnaire. The four psychosocial predictors were assessed through the Family Functioning Scale, Social Support Networks Scale, Beck Depression Inventory, and Measurement Scale of Resilience. The regression model explained 42% of the variance in parents' QOL. The predictors with positive weights included age, schooling, monthly family income, family functioning, social support networks, and parental resilience. The predictors with negative weights included depression. These findings suggest that strong social relationships, a positive family environment, family cohesion, personal resilience, low levels of depression, and a family income twice the minimum wage are variables associated with better parental QOL.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Evidence-Based Medicine Research Unit, Hospital Infantil de Mexico Federico Gómez, National Institute of Health, Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
- Correspondence: ; Tel.: +52-55-8009-4677
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León, Carlos Canseco, 110, Esq. Aguirre Pequeño, Col. Mitras Centro, Monterrey 64460, Mexico;
| | - Laura A. Nabors
- School of Human Services, College of Education, Criminal Justice, and Human Services, University of Cincinnati, Cincinnati, OH 45221-0068, USA;
| | - Miriam Teresa Domínguez-Guedea
- Department of Psychology and Communication Sciences, University of Sonora, Blvd. Luis Encinas y Rosales, Col. Centro S/N Hermosillo, Sonora 83000, Mexico;
| | - Guillermo Salinas Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de Mexico Federico Gómez, National Institute of Health, Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico;
| | - Eduardo Rocha Pérez
- Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria (Senasica), Anillo Perif. 5010, Insurgentes Cuicuilco, Coyoacán, Mexico City 04530, Mexico;
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-8° Piso, esq. Eje 5 Sur (Eugenia), Vertiz Narvarte, Benito Juárez, Mexico City 03020, Mexico;
| | - Ahidée Leyva López
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca Morelos 62100, Mexico;
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The Social Support Networks Scale (SSNS) for Family Caregivers of Children with Cancer: A Psychometric Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217820. [PMID: 33114556 PMCID: PMC7663442 DOI: 10.3390/ijerph17217820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Currently, information about the psychometric properties of the Social Support Networks Scale (SSNS) for family caregivers of children with cancer is not yet available; therefore, there is no empirical evidence of its validity and reliability to support its use in this population. The aim of this study is to determine a factorial model of the SSNS, estimate its internal consistency reliability, describe its distribution, and check its concurrent validity. A convenience sample of 633 family caregivers of children with cancer hospitalized in a National Institute of Health in Mexico City was collected. The SSNS, a sociodemographic variables questionnaire, and three instruments that evaluated family functioning, quality of life, and resilience were applied. The five-factor model had a poor data fit and lacked discriminant validity. The sample was divided. In a subsample of 316 participants, exploratory factor analysis suggested a four-factor model. When testing the four-factor model through confirmatory factor analysis, religious support was independent of family support, friend support, and lack of support. In the other subsample of 317 participants, the one-factor model for religious support had a good fit, and the correlated three-factor model, with the remaining factors, showed an acceptable fit. Reliability ranged from acceptable (Guttman's λ2 = 0.72) to good (λ2 = 0.88). Socio-family support and its three factors were correlated with family functioning, resilience, and quality of life. Religious support was correlated with four factors of resilience and quality of life. A scale of socio-family support with three factors and an independent scale for religious support are defined from the SSNS, and they showed internal consistency and construct validity.
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Toledano-Toledano F, Moral de la Rubia J, Domínguez-Guedea MT, Nabors LA, Barcelata-Eguiarte BE, Rocha-Pérez E, Luna D, Leyva-López A, Rivera-Rivera L. Validity and Reliability of the Beck Anxiety Inventory (BAI) for Family Caregivers of Children with Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7765. [PMID: 33114144 PMCID: PMC7672631 DOI: 10.3390/ijerph17217765] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 12/30/2022]
Abstract
Currently, information about the psychometric properties of the Beck Anxiety Inventory (BAI) in family caregivers of children with cancer is not available; thus, there is no empirical evidence of its validity and reliability to support its use in this population in Mexico or in other countries. This study examined the psychometric properties of the BAI in family caregivers of children with cancer and pursued four objectives: to determine the factor structure of the BAI, estimate its internal consistency reliability, describe the distribution of BAI scores and the level of anxiety in the sample and test its concurrent validity in relation to depression and resilience. This cross-sectional study was carried out with convenience sampling. A sociodemographic questionnaire, the BAI, the Beck Depression Inventory and the Measurement Scale of Resilience were administered to an incidental sample of 445 family caregivers of children with cancer hospitalized at the National Institute of Health in Mexico City. Confirmatory factor analysis using the maximum likelihood method was performed to determine the factor structure and exploratory factor analysis using axis factorization with oblique rotation was conducted. The two-, three- and four-factor models originally proposed for the BAI did not hold. The exploratory factor analysis showed a model of two correlated factors (physiological and emotional symptoms). Confirmatory factor analysis revealed a lack of discriminant validity between these two factors and supported a single-factor model. The internal consistency of the scale reduced to 11 items (BAI-11) was good (alpha = 0.89). The distribution of BAI-11 scores was skewed to the left. High levels of symptoms of anxiety were present in 49.4% of caregivers. The scale was positively correlated with depression and negatively correlated with resilience. These findings suggest that a reduced single-factor version of the BAI is valid for Mexican family caregivers of children with cancer.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Research Unit in Evidence-Based Medicine, Hospital Infantil de México Federico Gómez National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, México City 06720, Mexico
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León, Dr. Carlos Canseco, 110, Esq. Dr. Aguirre Pequeño, Col. Mitras Centro, Monterrey 64460, Mexico;
| | - Miriam Teresa Domínguez-Guedea
- Department of Psychology and Communication Sciences, University of Sonora, Blvd. Luis Encinas y Rosales, Col. Centro S/N Hermosillo, Sonora 83000, Mexico;
| | - Laura A. Nabors
- School of Human Services, College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, OH 45221-0068, USA;
| | - Blanca E. Barcelata-Eguiarte
- Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Calz, Ignacio Zaragoza, Col. Ejército de Oriente, Mexico City 09230, Mexico;
| | - Eduardo Rocha-Pérez
- Servicio Nacional de Sanidad, Inocuidad y Calidad Agroalimentaria (Senasica), Anillo Perif, 5010, Insurgentes Cuicuilco, Coyoacán, Mexico City 04530, Mexico;
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-8° Piso, esq. Eje 5 Sur (Eugenia), Vertiz Narvarte, Benito Juárez, Mexico City 03020, Mexico;
| | - Ahidée Leyva-López
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Av. Universidad No. 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico; (A.L.-L.); (L.R.-R.)
| | - Leonor Rivera-Rivera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Av. Universidad No. 655 Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico; (A.L.-L.); (L.R.-R.)
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Toledano-Toledano F, Luna D. The psychosocial profile of family caregivers of children with chronic diseases: a cross-sectional study. Biopsychosoc Med 2020; 14:29. [PMID: 33110443 PMCID: PMC7583305 DOI: 10.1186/s13030-020-00201-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background A family caregiver is defined as a person who has a significant emotional bond with the patient; this caregiver is a family member who is a part of the patient’s family life cycle; offers emotional-expressive, instrumental, and tangible support; and provides assistance and comprehensive care during the chronic illness, acute illness, or disability of a child, adult, or elderly person. The objectives of this study were to identify the psychosocial profiles of family caregivers of children with chronic diseases and to establish the relationship between these profiles and sociodemographic variables. Methods A cross-sectional study was conducted involving 401 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City. The participants responded to the Sociodemographic Variables Questionnaire (Q-SV) for research on family caregivers of children with chronic disease and a battery of 7 instruments that examined anxiety, caregiver burden, family support, depression, resilience, parental stress, and the World Health Organization Well-Being Index. Results A hierarchical cluster analysis and its confirmation through a nonhierarchical cluster analysis confirmed two profiles of caregivers of pediatric patients with chronic diseases. Profile 1, called Vulnerability of family caregivers, is characterized by high levels of anxiety, depression, parental stress and caregiver burden, accompanied by low levels of family support, resilience, and well-being. Profile 2, called Adversity of family caregivers, shows an inverse pattern, with high levels of family support, resilience, and well-being and low levels of anxiety, depression, parental stress and caregiver burden. The sociodemographic characteristics are similar for both profiles, with the exception of the caregiver’s family type. Profile 1 shows more single-parent caregivers, while profile 2 includes more caregivers with a nuclear family. However, the type of family did not reach significance for predicting the caregiver’s profile in a bivariate logistic regression model. Conclusions The psychosocial profile of family caregivers of children with chronic diseases can be structured according to their psychosocial characteristics. Although no causal factors were detected that define criteria for belonging to one or another profile, the characteristics identified for each indicate the need for specific and differentiated intervention strategies for families facing adversity, risk and vulnerability during a child’s disease.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Evidence-Based Medicine Research Unit, Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, 06720 México City, Mexico
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-8° Piso, esq. Eje 5 Sur (Eugenia). Vertiz Narvarte, 03020, Benito Juárez, Mexico City, Mexico
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Maddocks S, Chetty V. Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community. S Afr Fam Pract (2004) 2020; 62:e1-e5. [PMID: 32633994 PMCID: PMC8377773 DOI: 10.4102/safp.v62i1.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Stacy Maddocks
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Toledano-Toledano F, Moral de la Rubia J, McCubbin LD, Cauley B, Luna D. Brief version of the coping health inventory for parents (CHIP) among family caregivers of children with chronic diseases. Health Qual Life Outcomes 2020; 18:104. [PMID: 32307007 PMCID: PMC7168940 DOI: 10.1186/s12955-020-01357-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 04/08/2020] [Indexed: 01/10/2023] Open
Abstract
Background The Coping Health Inventory for Parents (CHIP) has demonstrated good psychometric properties in several language forms and has been used to assess the coping behaviors of families facing disease. However, the CHIP has not been validated in Mexico among families of children with chronic conditions, where it could be useful for research and intervention. The objectives of this instrumental study were to obtain a version of the CHIP for the Spanish language in Mexico, establish the factor structure of the Mexican version of the CHIP, probe its internal consistency reliability, and assess its concurrent construct validity. Methods A nonprobability sample of 405 family caregivers of children with chronic diseases responded to a battery of measurement instruments that included the CHIP, the Beck Anxiety Inventory, and the Beck Depression Inventory. The sample was randomly divided into two parts. In one subsample (190 participants), an exploratory factor analysis was performed using a principal component analysis and oblique rotation. In the second subsample (215 participants), a confirmatory factor analysis was performed using maximum likelihood estimation. Results The scale was reduced to 16 items (CHIP-16) with factorial loads greater than .50. The empirical criteria used to determine the number of factors converged on the following five factors: belief and trust (McDonald ω = .85), spouse/partner relationship (ω = .79), home care (ω = .77), family involvement (ω = .75), and security/stability (ω = .79). The overall internal consistency was good (ω = .88). The five-factor model showed acceptable fit indices and high parsimony. The mean CHIP-16 scores and the Spouse/partner relationship scores among the caregivers with anxiety were greater than those among the caregivers without anxiety. The mean home-care scores among the women were greater than those among men. Conclusions The 16-item version of the CHIP showed good internal consistency and construct validity; thus, the CHIP-16 is a useful instrument for measuring and assessing coping in family caregivers of children with chronic diseases.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Unidad de investigación en Medicina Basada en Evidencias del Hospital Infantil de México Federico Gómez National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, 06720, México City, Mexico.
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León, Dr. Carlos Canseco, 110, Esq. Dr. Aguirre Pequeño, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - Laurie D McCubbin
- College of Education and Human Development, University of Louisville, 1905S1st St, Louisville, KY, 40208, USA
| | - Bridget Cauley
- College of Education and Human Development, University of Louisville, 1905S1st St, Louisville, KY, 40208, USA
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-10° Floor, esq. Axis 5 South (Eugenia). Col. Narvarte, 03020, Benito Juárez, Mexico City, Mexico
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Theodore-Oklota C, Egan S, Paulich M, Evans CJ, Hartman DS, Hoffman DL, Björnsson HT. Caregiver-reported clinical characteristics and the burden associated with Kabuki syndrome. Am J Med Genet A 2020; 182:1592-1600. [PMID: 32246746 PMCID: PMC7383624 DOI: 10.1002/ajmg.a.61584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 03/19/2020] [Indexed: 02/03/2023]
Abstract
Kabuki syndrome is a genetic disorder that can affect multiple body systems and manifest as congenital abnormalities and both developmental and socio-emotional delays. The condition is largely unknown by most primary care physicians and has no available treatment other than symptomatic management. This research sought to obtain caregiver-reported data about the experience of living with and caring for someone with Kabuki syndrome to fill a gap in the available literature. Fifty-seven caregivers participated in an online survey and reported that Kabuki syndrome affected their children in a wide variety of ways, including a high frequency of visits to various healthcare professionals. Caregivers reported their child experienced problems with hearing, eating, eyes, mouth, immune system, anxiety, depression, autism, teeth, joints, seizures, kidneys, and heart. Caregivers also described the challenges of caring for someone with Kabuki syndrome, including an impact on emotional well-being and the ability to work outside the home. This unique research characterizes the caregiver experience of living with and caring for someone with Kabuki syndrome, both through observed manifestations of Kabuki syndrome in their own children and their experience managing their treatment. Additional research is needed to investigate the patient experience of living with Kabuki syndrome.
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Affiliation(s)
| | - Shayna Egan
- Endpoint Outcomes, Long Beach, California, USA
| | | | | | | | | | - Hans T Björnsson
- Johns Hopkins University, Baltimore, Maryland, USA.,University of Iceland, Reykjavik, Iceland
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Luo J, Zhou Y, Liu H, Hu J. Factors related to the burden of family caregivers of elderly patients with spinal Tumours in Northwest China. BMC Neurol 2020; 20:69. [PMID: 32111172 PMCID: PMC7047359 DOI: 10.1186/s12883-020-01652-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Family caregivers of elderly patients with spinal tumours experience considerable pain and burden during the care process. This study aims to investigate the factors associated with caregiver burden in family caregivers of elderly patients with spinal tumours. Methods A total of 220 elderly patients with spinal tumours (age ≥ 65 years) hospitalized at the spine centre of our hospital from January 2015 to December 2017 and their family caregivers were recruited for this cross-sectional study. All participants completed a sociodemographic questionnaire. Caregiver burden, social support and self-efficacy were assessed by the Chinese version of the Zarit Burden Interview (ZBI), the Social Support Rating Scale (SSRS) and the General Self-Efficacy Scale (GSE), respectively. The factors related to caregiver burden were analysed by multivariate analysis. P < 0.05 was considered statistically significant. Results The 216 elderly patients with spinal tumours were 71.59 ± 8.49 years old, and their caregivers were 70.46 ± 9.13 years old. A total of 170 patients were cared for by their spouses, who accounted for 78.7% of all caregivers. The ZBI score for the family caregivers was 35.5 ± 7.5, and most caregivers (84.5%) reported a moderate or heavy burden. The factors related to caregiver burden included patient paralysis, the primary cancer site, chemotherapy and/or radiation, cognitive dysfunction, functional status, monthly income, pain score, caregivers’ SSRS score, and GSE score. Conclusions Most family caregivers of elderly patients with spinal tumours have a considerable caregiver burden. Interventions based on social support and self-efficacy can help reduce caregiver burden.
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Affiliation(s)
- Jing Luo
- Department of Nursing Administration, Honghui Hospital, Xi'an Jiaotong University College of Medicine, 555# You-yi East Road, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Yongchun Zhou
- Department of Orthopedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Haiping Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Jing Hu
- Department of Nursing Administration, Honghui Hospital, Xi'an Jiaotong University College of Medicine, 555# You-yi East Road, Xi'an, 710054, Shaanxi, People's Republic of China.
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Guo LY, Sun H, Hu M, Jiang YH, Luo ZH. Mental health status of parents of young patients with high myopia. J Int Med Res 2020; 48:300060519873474. [PMID: 31992100 PMCID: PMC7254601 DOI: 10.1177/0300060519873474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective The study aim was to investigate the mental health status of parents of patients with high myopia using the Symptom Checklist-90 (SCL-90). Methods The parents of 160 young patients with high myopia (high myopia group) and 80 healthy children (control group) participated in the study. The SCL-90 was used to evaluate mental health status. The SCL-90 total score and scores on each factor were calculated and compared between the two groups. Results The total SCL-90 score, total mean score, positive score and scores on somatization, interpersonal sensitivity, depression, anxiety, hostility, psychosis, diet and sleep were significantly higher in fathers and mothers of patients with high myopia than in parents of control group children. There were statistically significant between-group differences in the above indices. Conclusion Parents of children with high myopia are more likely to develop mental health problems than parents of healthy children. This suggests that mental health interventions for parents should not be ignored in the treatment and control of high myopia patients.
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Affiliation(s)
- Li-Yun Guo
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Ophthalmology, Yunnan Eye Institute, Kunming, China.,Department of Ophthalmology, Key Laboratory of Yunnan Province for the Prevention and Treatment of ophthalmology, Kunming, China.,Yunnan Clinical Medical Center of Ophthalmology, Kunming, China.,Clinical Medical Research Center for Ophthalmic Disease, Kunming, China
| | - Heng Sun
- Department of Ophthalmology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China.,Yunnan Clinical Medical Center of Ophthalmology, Kunming, China.,Clinical Medical Research Center for Ophthalmic Disease, Kunming, China
| | - Min Hu
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Ophthalmology, Yunnan Eye Institute, Kunming, China.,Department of Ophthalmology, Key Laboratory of Yunnan Province for the Prevention and Treatment of ophthalmology, Kunming, China.,Yunnan Clinical Medical Center of Ophthalmology, Kunming, China.,Clinical Medical Research Center for Ophthalmic Disease, Kunming, China
| | - Yun-Hai Jiang
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Ophthalmology, Yunnan Eye Institute, Kunming, China.,Department of Ophthalmology, Key Laboratory of Yunnan Province for the Prevention and Treatment of ophthalmology, Kunming, China.,Yunnan Clinical Medical Center of Ophthalmology, Kunming, China.,Clinical Medical Research Center for Ophthalmic Disease, Kunming, China
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Farajzadeh A, Maroufizadeh S, Amini M. Factors associated with quality of life among mothers of children with cerebral palsy. Int J Nurs Pract 2020; 26:e12811. [DOI: 10.1111/ijn.12811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/04/2019] [Accepted: 11/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ata Farajzadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation SciencesIran University of Medical Sciences Tehran Iran
| | - Saman Maroufizadeh
- School of Nursing and MidwiferyGuilan University of Medical Sciences Rasht Iran
| | - Malek Amini
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation SciencesIran University of Medical Sciences Tehran Iran
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Toledano-Toledano F, Rodríguez-Rey R, Moral de la Rubia J, Luna D. A Sociodemographic variables questionnaire (Q-SV) for research on family caregivers of children with chronic disease. BMC Psychol 2019; 7:85. [PMID: 31864414 PMCID: PMC6925508 DOI: 10.1186/s40359-019-0350-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background Chronic diseases in childhood can affect the physical and mental health of patients and their families. The literature on pediatric chronic diseases has found important associations between the sociodemographic variables of children and their caregivers and negative health consequences in families. Methods In this study, we aimed to design and validate a questionnaire on sociodemographic variables that would be useful for research on pediatric chronic diseases; and investigate the relationship between sociodemographic variables and psychosocial variables among family caregivers. First, we created a questionnaire that consists of 20 demographic, medical, and family-related items based on a literature review and expert evaluations. This questionnaire was then validated by 335 expert reviewers in the field of Social Work, who work daily with the families of patients with chronic diseases in 10 National Institutes of Health of Mexico. The validation was based on three empirical criteria created specifically for this study, and the reviewers evaluated the usefulness, relevance, and permanence of the items. In a second cross-sectional, correlational and comparative study, a total of 446 family caregivers of children with chronic diseases were interviewed, and they completed the Sociodemographic Variables Questionnaire for research on family caregivers of children with chronic sociodemographic diseases and four psychosocial measurement instruments for evaluating anxiety, depression, caregiver burden and quality of life. Results Based on the results of the first study, we created the Sociodemographic Variables Questionnaire (Q-SV) for research on family caregivers of children with chronic diseases, and it includes 17 items that assess demographic, medical, and family characteristics. The results of the second study showed that the 17 sociodemographic variables obtained in the validation by expert judges are useful for measuring and evaluating the relationship between psychosocial variables in families of children with chronic diseases. Conclusions Psychosocial and sociodemographic factors are relevant for the development of research processes for families that care for children with chronic diseases.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Dr. Márquez 162, Doctores, Cuauhtémoc, 06720, México City, Mexico.
| | - Rocío Rodríguez-Rey
- Universidad Europea de Madrid. Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León. Dr. Carlos Canseco, 110, Esq. Dr. Aguirre Pequeño, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-10° Piso, esq. Eje 5 Sur (Eugenia). Col. Narvarte, 03020, Benito Juárez, Mexico City, Mexico
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Ho AHY, Dutta O, Tan-Ho G, Choo PY, Low XC, Chong PH, Ng C, Ganapathy S. Thematic analysis of spousal interaction patterns among Asian parents of children with chronic life-threatening illness. BMJ Open 2019; 9:e032582. [PMID: 31748309 PMCID: PMC6887006 DOI: 10.1136/bmjopen-2019-032582] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This is the first known study which examines the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from the time of providing care to their child through bereavement. This study is informed by earlier findings that when a child is diagnosed with a chronic life-threatening illness, parents are faced with multiple stressors, leaving them with little time to invest in their spousal relationship. PARTICIPANTS AND SETTING A constructivist-phenomenological research paradigm was adopted and meaning-oriented interviews were conducted with 20 parental units (i.e., 6 couples, 12 lone mothers and 2 lone fathers) of Chinese, Malay and Indian ethnicities who lost their child to chronic life-threatening illness in Singapore. RESULTS Qualitative thematic analysis of the data revealed four themes, which describe the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from caregiving through bereavement. Findings reveal participants' tendency to concentrate on pragmatic, solution-focused communication during the period of caregiving (pragmatic interaction), avoid discussion about their emotional pain as a means of protecting their spouse (partner-oriented self-regulation), respect and acknowledge their spouse's personal coping strategies (empathic responding) and show greater appreciation and emotional expression within the spousal relationship after their child's death (affective appreciation). CONCLUSION Engaging in pragmatic discussions, deferring emotion-focused and potentially distressing conversations, and acknowledging their spouse's need for personal space are important coping strategies for Asian couples facing their child's chronic life-threatening illness and in the immediate aftermath of his/her death. Bereaved couples who have processed their grief individually feel ready to share their reflections with their spouse, deriving meaning and greater relational closeness through such disclosure. These findings are discussed from a cultural lens, with recommendations for healthcare professionals working with Asian parents of children with chronic life-threatening illness.
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Affiliation(s)
- Andy Hau Yan Ho
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- The Palliative Care Centre for Excellence in Education and Research (PalC), Singapore, Singapore
| | - Oindrila Dutta
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Ping Ying Choo
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Carolyn Ng
- Portland Institute for Loss and Transitiom, Portland, Oregon, USA
- Children's Cancer Foundation, Singapore, Singapore
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The measurement scale of resilience among family caregivers of children with cancer: a psychometric evaluation. BMC Public Health 2019; 19:1164. [PMID: 31455340 PMCID: PMC6712960 DOI: 10.1186/s12889-019-7512-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/18/2019] [Indexed: 01/10/2023] Open
Abstract
Background Resilience to disease is a process of positive adaptation despite the loss of health, it involves the development of vitality and skills to overcome the negative effects of adversity, risks, and vulnerability caused by disease. In Mexico, cancer is the leading cause of death in children. Both the diagnosis and the treatment of childhood cancer affect the health of family caregivers. However, resilience is a personality trait that can be protective in these situations. Therefore, resilience is an important psychological construct to measure, evaluate and develop in specific populations and contexts. In Mexico, a scale to assess this trait has been developed. This study aimed to test the reliability and factor structure of the Mexican Measurement Scale of Resilience (RESI-M), describe its distribution, evaluate its relationship with sociodemographic variables, and verify its concurrent validity with psychological well-being, depression, anxiety and parental stress and its independence from social desirability. Methods A cross-sectional study was conducted involving an intentional nonprobability sample of 330 family caregivers of children with cancer hospitalized at the National Institute of Health in Mexico City. The participants responded to a sociodemographic variables questionnaire, the Mexican Measurement Scale of Resilience RESI-M, and five other assessment scales. Results Overall internal consistency was very high (ordinal alpha = .976). The confirmatory factor analysis demonstrated that the five-factor model had a close fit to the data: NFI = .970, CFI = .997, SRMR = .055, and RMSEA = .019. The distributions of the RESI-M total score followed a normal distribution. The RESI-M total score correlated positively with psychological well-being and negatively with depression, parental stress and anxiety. The overall RESI-M total score also correlated positively with age, but there was no difference in means between women and men. Resilience was independent of social desirability. Conclusions The RESI-M shows reliability and construct validity in family caregivers of children with cancer and does not show a bias in relation to social desirability.
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Jalil YF, Villarroel GS, Silva AA, Briceño LS, Ormeño VP, Ibáñez NS, Méndez PA, Canales CF, Méndez MA. Reliability and validity of the revised impact on family scale (RIOFS) in the hospital context. J Patient Rep Outcomes 2019; 3:28. [PMID: 31089824 PMCID: PMC6517451 DOI: 10.1186/s41687-019-0118-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lack of formal instruments to measure Burden in primary caregivers of Children in a hospital context is limited because mostly of published instruments are related to cancer survivors, ambulatory environment or general context for children with chronic conditions, but none of them adapted property to prolonged hospitalization context. This leaves the rising population of hospitalized chronic children's caregivers without a proper assessment. The aim of this study was to develop a version of the Revised Impact on Family Scale adapted to primary caregivers of chronic hospitalized children. A cross-sectional study with two main stages was conducted. The first one describes the linguistic and contextual adaptation process of the instrument, and the second refers to the psychometric testing and analysis.. RESULTS Less than 15% of the participants expressed problems with some adapted items in the scale. Eighty-six caregivers were evaluated at Josefina Martinez Hospital, mostly female (34.2 ± 11.6 years old). Majority of participants were graduated from high school, salaried employee and mothers of the chronic child. The scale exhibits a high level of internal consistency (Cronbach's alpha 0.73), excellent intra-observer reliability (Intraclass Correlation Coefficient 0.9), acceptable empirical evaluation of content validity and low and negative construct validity (Pearson's correlation coefficient - 0.23). CONCLUSIONS This adapted version of the Revised Impact on Family Scale to the hospital context is a reliable, valid, self-administered and simple instrument to implement in order to assess the burden of primary caregivers with chronic hospitalized children.
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Affiliation(s)
- Yorschua F. Jalil
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
- Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Santiago, Chile
- Master of Science, Clinic Epidemiology, Universidad de la Frontera, Temuco, Chile
| | - Gregory S. Villarroel
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Adjunct Instructor, Kinesiology Career, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra A. Silva
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
| | - Lilian S. Briceño
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
| | - Vanessa Perez Ormeño
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
| | - Nicolas S. Ibáñez
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
| | - Paulina A. Méndez
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
| | - Cristina F. Canales
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
| | - Mireya A. Méndez
- Department of Kinesiology and Respiratory Rehabilitation, Hospital Josefina Martínez, Avenida Camilo Henríquez 3691, Puente Alto, Santiago, Chile
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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