Search

Children living in poverty are at an increased risk for maltreatment. Social safety net (SSN) programs with antipoverty objectives may reduce child maltreatment through pathways such as reduced food insecurity, lessened caregiver stress, and improved caregiving behaviors and ability to meet children's basic needs. The objective of this study is to conduct a systematic review of evidence on the ability of SSN programs to reduce child maltreatment in the United States (U.S.). This systematic review was conducted using PRISMA protocol. Among studies published between 1996–2022, the initial search returned 1,873 articles, and 27 papers were included in the final analysis. Abstracts were identified primarily on June 24th, 2022, and extraction and synthesis of data was conducted in 2022–2023. Of the 27 papers assessed, 16 studies found that SSN programs were protective against child maltreatment. Three of the reviewed studies found no effect of safety net programs, 4 studies presented mixed findings, and 4 studies found adverse impacts in terms of child maltreatment outcomes. When restricting to high-quality studies only, 10 out of 12 found protective impacts and none found adverse impacts on child maltreatment. SSNs are associated with protective effects against child maltreatment. Expansion of SSN programs would likely have positive benefits beyond poverty-related objectives, including reducing incidence of child maltreatment. [ABSTRACT FROM AUTHOR]

• Standard medical and behavioral treatment for encopresis is not always effective. • Some children resist toilet training due to fear of defecation outside a diaper. • A diaper fading protocol was used to train four children with toilet refusal. • The protocol flexibly adapted to individual patient needs. Childhood constipation and painful defecation is common, affecting 68% to 86% of children. Over 90% withhold stool, some only defecating in a diaper. Behavioral therapy is effective for encopresis, but there is minimal research on treating toilet avoidance. This study investigates a novel protocol to eliminate diapers in children with toilet avoidance. A diaper fading protocol was used with four children with toilet avoidance. Children were instructed to defecate in the bathroom, moving progressively closer to the toilet until they eventually sat on the toilet with the diaper. As needed, diapers were then faded by cutting increasingly wider slits in the base of the diaper so that stool could pass into the toilet. The cut widened until the diaper was eliminated entirely. Four children (three boys, average 5.22 years old) successfully completed toilet training using the diaper fading protocol in an average of 9.75 sessions. Delivery of treatment via telehealth was shown to be effective. The diaper fading protocol effectively and flexibly assisted toilet training in four children with stool withholding and toileting avoidance. Future work should investigate whether caregivers can utilize the protocol without ongoing support, or on a consultation basis only, to reduce the burden on health care workers with long waitlists. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the effects of an educational peer-group intervention on knowledge about dementia, perceived ability to talk about it, received support and self-perceived pressure from informal care among family caregivers with a Turkish or Moroccan immigrant background who cared for a person with dementia.Methods: This paper is based on a cluster randomised controlled trial with three measures, including participants who knew or cared for a person with dementia. For the purpose of this study, a selection was made of participants who cared for a person with dementia. Knowledge about dementia, perceived ability to talk about dementia, support received and self-perceived pressure from informal care were assessed inthe intervention and the control condition. Multi-level analyses were conducted to examine the effects.Results: Data for 386 participants was analysed. Improvement in knowledge about dementia over time was significantly greater in the intervention condition than in the control condition. In the intervention condition, there was also a significant increase over time in the support received from home-care staff, which was not found in the control condition. No effects were found on other types of support received, the ability to talk about dementia or the self-perceived pressure from informal care.Conclusion: Offering a culturally sensitive educational peer-group education intervention enhances knowledge about dementia and has a small but positive effect on the support received from home-care staff in these groups.Practice Implications: Offering peer-group-based education about dementia to family caregivers with Turkish or Moroccan immigrant backgrounds is important for multicultural dementia care. [ABSTRACT FROM AUTHOR]

Objectives: Current guidelines mandate organ donation to be financially neutral such that it neither rewards nor exploits donors. This systematic review was conducted to assess the magnitude and type of costs incurred by adult living kidney donors and to identify those at risk of financial hardship.Methods: We searched English-language journal articles and working papers assessing direct and indirect costs incurred by donors on PubMed, MEDLINE, Scopus, the National Institute for Health Research Economic Evaluation Database, Research Papers in Economics, and EconLit in 2005 and thereafter. Estimates of total costs, types of costs, and characteristics of donors who incurred the financial burden were extracted.Results: Sixteen studies were identified involving 6158 donors. Average donor-borne costs ranged from US$900 to US$19 900 (2019 values) over the period from predonation evaluation to the end of the first postoperative year. Less than half of donors sought financial assistance and 80% had financial loss. Out-of-pocket payments for travel and health services were the most reported items where lost income accounted for the largest proportion (23.2%-83.7%) of total costs. New indirect cost items were identified to be insurance difficulty, exercise impairment, and caregiver income loss. Donors from lower-income households and those who traveled long distances reported the greatest financial hardship.Conclusions: Most kidney donors are undercompensated. Our findings highlight gaps in donor compensation for predonation evaluation, long-distance donations, and lifetime insurance protection. Additional studies outside of North America are needed to gain a global prospective on how to provide for financial neutrality for kidney donors. [ABSTRACT FROM AUTHOR]

Background: Burn care is centralized in highly specialized burn centers in Europe. These centers are of limited capacity and may be overwhelmed by a sudden surge in case of a burn mass casualty incident. Prior incidents in Europe and abroad have sustained high standards of care through well-orchestrated responses to share the burden of care in several burn centers. A burn mass casualty incident in Romania in 2015 sparked an initiative to strengthen the existing EU mechanisms. This paper aims to provide insight into developing a response plan for burn mass casualties within the EU Civil Protection Mechanism.Methods: The European Burns Association drafted medical guidelines for burn mass casualty incidents based on a literature review and an in-depth analysis of the Romanian incident. An online questionnaire surveyed European burn centers and EU States for burn mass casualty preparedness.Results: The Romanian burn mass casualty in 2015 highlighted the lack of a burn-specific mechanism, leading to the late onset of international transfers. In Europe, 71% of respondents had existing mass casualty response plans, though only 35% reported having a burn-specific plan. A burns response plan for burn mass casualties was developed and adopted as a Commission staff working document in preparation for further implementation. The plan builds on the existing Union Civil Protection Mechanism framework and the standards of the WHO Emergency Medical Teams initiative to provide 1) burn assessment teams for specialized in-hospital triage of patients, 2) specialized burn care across European burn centers, and 3) medevac capacities from participating states.Conclusion: The European burn mass casualty response plan could enable the delivery of high-level burn care in the face of an overwhelming incident in an affected European country. Further steps for integration and implementation of the plan within the Union Civil Protection Mechanism framework are needed. [ABSTRACT FROM AUTHOR]

Background Having support from an informal carer is important for heart failure patients. Carers have the potential to improve patient self-care. At the same time, it should be acknowledged that caregiving could affect the carer negatively and cause emotional reactions of burden and stress. Dyadic (patient and informal carer) heart failure self-care interventions seek to improve patient self-care such as adherence to medical treatment, exercise training, symptom monitoring and symptom management when needed. Currently, no systematic assessment of dyadic interventions has been conducted with a focus on describing components, examining physical and delivery contexts, or determining the effect on patient and/or carer outcomes. Objective To examine the components, context, and outcomes of dyadic self-care interventions. Design A systematic review registered in PROSPERO, following PRISMA guidelines with a narrative analysis and realist synthesis. Data Sources: PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials were searched using MeSH, EMTREE terms, keywords, and keyword phrases for the following concepts: dyadic, carers, heart failure and intervention. Eligible studies were original research, written in English, on dyadic self-care interventions in adult samples. Review methods We used a two-tiered analytic approach including both completed studies with power to determine outcomes and ongoing studies including abstracts, small pilot studies and protocols to forecast future directions. Results Eighteen papers – 12 unique, completed intervention studies (two quasi- and ten experimental trials) from 2000 to 2016 were reviewed. Intervention components fell into three groups – education, support, and guidance. Interventions were implemented in 5 countries, across multiple settings of care, and involved 3 delivery modes – face to face, telephone or technology based. Dyadic intervention effects on cognitive, behavioral, affective and health services utilization outcomes were found within studies. However, findings across studies were inconclusive as some studies reported positive and some non-sustaining outcomes on the same variables. All the included papers had methodological limitations including insufficient sample size, mixed intervention effects and counter-intuitive outcomes. Conclusions We found that the evidence from dyadic interventions to promote heart failure self-care, while growing, is still very limited. Future research needs to involve advanced sample size justification, innovative solutions to increase and sustain behavior change, and use of mixed methods for capturing a more holistic picture of effects in clinical practice. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a major health care burden associated with significant morbidity and serious impact on the quality of life. Estimating blood glucose levels is the currently employed method for screening for DM. Due to the invasive nature of access to blood glucose; new methods are being suggested that depend upon different targets than blood or another biochemical pathway altogether. But these are not cost effective and have inherent limitations related to public screening. We hypothesize a simple, non invasive and cheap paper strip method to estimate tear film glucose levels for screening purposes at community level. We also discuss the ideal properties of such a paper strip and the process of validation the technique should undergo before being employed for mass usage. [ABSTRACT FROM AUTHOR]

Violence towards formal and informal caregivers is a frequently occurring and complex international hazard in healthcare that has a negative impact on the physical and psychological health states of caregivers. However, little is known about the prevalence and type of violence towards formal and informal caregivers by care recipients in the home care settings. The aim of this review is to obtain insight into the prevalence of violence by home care recipients against formal and informal caregivers in home care settings and the types and consequences of violence. A systematic review was conducted between March and May 2023 using the PubMed, EMBASE, CINAHL, and PsycINFO databases. A methodological quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Data collection was performed until May 2023. Out of 1087 screened articles, a total of 10 full texts were included after the screening process. Findings demonstrate that workplace violence is an understudied area of research. The few studies found in this review showed high prevalence rates of violence with risk for physical and mental injuries for formal caregivers. No information at all on violence against informal caregivers was available. Strategies for prevention and intervention against violence in the home care setting must be developed. To develop strategies, it is important to have more insight in the prevalence and types of violence. It is also important to explore violence against informal caregivers in research. Violence towards formal caregivers in home care settings is a common risk that negatively impacts the health status of caregivers. What is already known about the topic? • Workplace violence has a negative impact on the physical and psychological health state of formal caregivers. • There is a lack of knowledge on care recipient violence towards formal and informal caregivers in the home care setting. What this paper adds • No study was found that studied violence against informal caregivers; this review demonstrates the importance of exploring this topic. • In home care settings, formal caregivers are exposed to types of workplace violence that have little or no presence in the hospital setting • Sexual harassment and sexual aggression towards formal caregivers in the home care setting are underreported in the literature. [ABSTRACT FROM AUTHOR]

Terminally ill patients experience high symptom burden at the end of life (EoL), even when receiving hospice care. In the U.S., family caregivers play a critical role in managing symptoms experienced by patients receiving home hospice services. Yet, most caregivers don't receive sufficient support or formal training in symptom management. Therefore, providing additional visits and education to caregivers could potentially improve outcomes for both patient and caregiver. In response, we developed the Improving Home hospice Management of End-of-life issues through technology (I-HoME) intervention, a program designed for family caregivers of home hospice patients. This paper describes the intervention, study design, and protocol used to evaluate the intervention. The I-HoME study is a pilot randomized controlled trial aimed at reducing patient symptom burden through weekly tele-visits and education videos to benefit the patient's family caregiver. One hundred caregivers will be randomized to hospice care with (n = 50) or without (n = 50) the I-HoME intervention. Primary outcomes include intervention feasibility (e.g., accrual, attrition, use of the intervention) and acceptability (e.g., caregivers' comfort accessing the tele-visits and satisfaction). We will also examine preliminary efficacy using validated patient symptom burden and caregiver outcome measures (i.e., burden, depression, anxiety, satisfaction). The trial is evaluating a novel symptom management intervention that supports caregivers of patients receiving home hospice services. The intervention employs a multi-pronged approach that provides needed services at a time when close contact and support is crucial. This research could lead to advances in how care gets delivered in the home hospice setting. • Home hospice caregivers play a critical role in managing symptoms at the EoL. • I-HoME is a novel symptom management intervention aimed at reducing symptoms. • The intervention employs a multi-pronged approach to support caregivers in hospice. [ABSTRACT FROM AUTHOR]

Children with Developmental Coordination Disorder (DCD) are at high risk for mental health disorders, stemming from challenges participating in motor activities. Parents of children with DCD report increased caregiver burden exacerbated by insufficient support and services for their child. A paucity of literature exists on parent and child mental health associated with a DCD diagnosis. To explore parent perceptions of their child's mental health, and the impact of DCD on family and parental mental health. Implementation of a secondary analysis using the impACT for DCD, a cross-sectional online survey of parents of children with self-reported suspected or confirmed diagnosis of DCD living in British Columbia, Canada. Data analysis included descriptive and inferential statistics and content analysis. Of the 237 participants, more than one third of parents (36%) rated their own mental health to be fair or poor, and the majority (90%) expressed concern for their child's mental health. Themes emerged on the impact of DCD on child, parent, and family, influenced by access to resources. Standard of care for DCD needs to include services and supports that address caregiver burden and mental health of children with DCD and their families. This paper explores parent perceptions of their child(ren)'s and their own mental health when raising a child with DCD in British Columbia (BC). In BC, there is a lack of research on the mental health challenges families face when their child has a diagnosis of DCD. Amongst health care providers, there tends to be a focus on DCD as a motor disorder, with limited understanding and acknowledgement of the mental health component for children and their families. Thus, this study will inform health-care providers, parents, educators, and policy makers on parent-identified mental health needs and the essential services and supports. Unique to this study was the inclusion of a descriptive and exploratory content analysis, providing a holistic understanding of parents' perceptions regarding the impact of DCD on their children and themselves. Our results revealed that parents perceive significant inter-connected impacts of DCD on the child, parents, and family, leading to poor mental health for parents and their child(ren). Limited access to resources and supports results in a negative trajectory for family mental health and well-being. Study results indicate the critical importance of addressing mental health, in addition to motor challenges. Healthcare providers need to adopt a family-centred approach to address the physical and psychosocial impairments associated with DCD, ensuring positive outcomes for children and their families. • Children with DCD and their families experience mental health challenges. • Interventions should address both motor and psychological functions linked to DCD. • Family-centred care needs to address parental mental health and caregiver burden. • A standard of care is crucial to address the needs of children & families with DCD. [ABSTRACT FROM AUTHOR]

Objective: This paper seeks to explore the impact of training, a handout, and patients' questions on pharmacists' comfort and satisfaction in discussing opioid risks with pediatric caregivers.Methods: In a mixed methods intervention study in a children's hospital outpatient pharmacy, 2 practicing pharmacists and 1 student pharmacist counseled 100 caregivers using their standard practices (not telling a caregiver the pain medicine was an opioid or informing them about opioid risks). After the training, the same 2 pharmacists and another student pharmacist counseled 97 caregivers about opioid-risk by assessing their beliefs, explaining that the medication was an "opioid," and integrating a safety handout into the consult. The pharmacists completed short surveys after each consult in both phases and were interviewed. Qualitative data were coded using NVivo version 12 (QSR International). Descriptive statistics and multivariate regression analyses were performed on the data collected from the surveys.Results: During the preintervention phase, opioid risks were not discussed; no pharmacist described the pain medication as an opioid. The pharmacists reported that they needed training and resources to assist opioid counseling. In the postintervention phase, the pharmacists indicated that the medication was an opioid in all consults. The pharmacists' comfort increased significantly over time and decreased with caregivers' concerns at posttest (adjusted R2 = 0.40). The pharmacists' satisfaction increased with time and caregiver questions (adjusted R2 = 0.15). The pharmacists reported that the training and handout facilitated opioid-risk and safety discussions.Conclusion: The intervention positively affected pharmacists' comfort and satisfaction. It should be evaluated in different settings and populations. [ABSTRACT FROM AUTHOR]

Background: Carers experience significant physical and psychological burden and are at increased risk of experiencing clinical depression. Although several psychological treatments have been shown to be effective for preventing and treating depression in carers, most are complex, costly, and not easily accessible to family carers. In this paper, we review evidence of effectiveness of Behavioural Activation (BA) for depressive symptoms in informal caregivers and report on its quality.Methods: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Online trial registers for randomised controlled clinical trials of BA for carers.Results: Twelve trials met inclusion criteria and eleven were included in the meta-analyses. BA reduced depressive symptoms for carers (standardised mean difference (SMD) -0.68; confidence interval (CI) -1.14 to -0.22) at post intervention (4-14 weeks) and in the long term (l year; SMD -0.99; CI -1.26 to -0.71). BA decreased risk of a diagnosis of major depression (Odds Ratio 0.35; CI 0.19 to 0.67), and reduced negative affect (SMD -0.53; 95% CI -0.83 to -0.23), and caregiver burden (SMD -0.32; CI -0.55 to -0.09) at post-treatment. Quality of evidence was moderate and there was no evidence of publication bias.Limitations: There was high heterogeneity in the studies included.Conclusion: BA is effective in reducing depressive symptoms post-treatment and long-term (1 year) and decreases odds of a diagnosis of major depression in informal caregivers. Our review provides further evidence that BA is an effective psychological intervention, which is potentially highly scalable across many settings, populations and cultures (Registration: PROSPERO-CRD42019138860). [ABSTRACT FROM AUTHOR]

Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age < 65 versus ≥ 65 years. PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age ≥ 65), and 2 on caregiver burden (1 study with mean age ≥ 65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences. VSN has a negative impact not only on patients' independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice. PROSPERPO Registration No. CRD42018087483. [ABSTRACT FROM AUTHOR]

• To date very few QoL measures have been specifically developed for SMA. • There is an increased need to explore the impact of new drugs on QoL. • The existing scales provide useful information not related to functional changes. • The use of these tools may help the discussion on costs of the new therapies. • Combining existing tools will strengthen the perspective of patients and carers'. The positive outcome of different therapeutic approaches for spinal muscular atrophy (SMA) in clinical trials and in clinical practice have highlighted the need to establish if functional changes are associated with possible changes of patient health-related quality of life or have an effect on activities of daily living and caregiver burden. The aim of this paper is to provide a critical review of the tools previously or currently used to measure quality of life, activity of daily living, and caregiver burden in SMA. We identified 36 measures. Only 6 tools were specifically developed for SMA while the others had been used and at least partially validated in wider groups of neuromuscular disorders including SMA. Twelve of the 36 focused on health-related quality of life, 5 on activities of daily living and 9 on caregiver burden. Ten included a combination of items. The review provides a roadmap of the different tools indicating their suitability for different SMA types or age groups. Scales assessing activities of daily living and care burden can provide patients and carers perspective on functional changes over time that should be added to the observer rated scales used in clinic. [ABSTRACT FROM AUTHOR]

• More than 20% of dependent older people have joint contractures or acquired deforming hypertonia. • Mobility limitation, whatever the cause, constitutes the "primum movens" of joint contractures. • Histological, cellular and molecular changes are involved in joint contractures. Joint contractures and acquired deforming hypertonia are frequent in dependent older people. The consequences of these conditions can be significant for activities of daily living as well as comfort and quality of life. They can also negatively affect the burden of care and care costs. However, etiological factors and pathophysiologic mechanisms remain only partly understood. As a result, preventive interventions and treatments focus entirely on controlling symptoms rather than the causes. Moreover, the effectiveness of these interventions remains to be validated. The purpose of this position paper is to present current data on etiological factors contributing to the development of joint contractures and acquired deforming hypertonia in older people. The pathophysiologic mechanisms of joint contractures in animal models are also presented. [ABSTRACT FROM AUTHOR]

Background: Family carers provide strong support for many older adults, often enabling older adults to remain at home. Little is known about the care recipients' perspectives of the role and contributions of family carers, particularly when hospital admissions occur as part of end of life care. Aim: This paper explores the meanings of family caring for care recipients by drawing on older adults' perspectives about the impact of hospital admission on established family caring relationships. Design: Exploratory semi-structured qualitative interviews. Key findings reported in this paper emerged from within the inductive research design. Setting: Interviews were conducted in older adults' place of residence in northwest England between June 2009 and July 2010. Participants: Participants were 27 older adults living with heart failure (n = 13) or lung cancer (n = 14), aged 69-89 years (mean 79 4.3 years) and considered by their health professionals to be in their last year of life. In 12 of the interviews, a family carer was also present and made contributions. Findings: For community-dwelling older adults, family carers are conceptualised as 'conductors'; making strong contributions to maintaining the rhythm of good care throughout the illness trajectory. Following older adults' hospital admission, family carers find themselves in the role of 'second fiddle', their ability to work with the individual and to make or influence decisions vastly reduced. Despite this, carers continue to invest considerable effort in maintaining continuity in the carer relationship to maximise the individual's wellbeing by identifying needs, filling gaps in provision and advocating on patients' behalf. Family carers act flexibly to provide continuity, support and take responsibility for older adults' wellbeing across settings. Conclusions: Nurses and family carers working together, and greater appreciation of the contribution and role of family carers by health professionals may contribute to improving the quality and continuity of care for older adults. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Bipolar depression poses a great burden on patients and their families due to its duration, associated functional impairment, and limited treatment options. Given the complexity of the disorder and the advances in treatment, a number of clinical guidelines, consensus statements and expert opinions were developed with the aim to standardize treatment and provide clinicians with treatment algorithms for every-day clinical practice. Unfortunately, they often led to conflicting conclusions and recommendations due to limitations of the available literature. As findings emerge from research literature, guidelines quickly become obsolete and need to be updated or revised. Many guidelines have been updated in the last 5years, after the last review of bipolar disorder (BD) treatment guidelines. Objective: The purpose of this work is to systematically review guidelines, consensus meetings and treatment algorithms on the acute treatment of bipolar depression updated or published since 2005, to critically underline common and critical points, highlight limits and strengths, and provide a starting point for future research Materials and methods: The MEDLINe/PubMed/Index Medicus, PsycINFO/PsycLIT, Excerpta Medica/EMBASE, databases were searched using “depression”, “bipolar”, “manic-depression”, “manic-depressive” and “treatment guidelines” as key words Results: The search returned 204 articles. Amongst them, there were 28 papers concerning structured treatment algorithms and/or guidelines suggested by official panels. After excluding those guidelines that were not performed by scientific societies or international groups and those published before 2005, the final selection yielded 7 papers When looking into guidelines content, the results indicate a trend to the gradual acceptance of the use of the atypical antipsychotic quetiapine as monotherapy as first-line treatment. Antidepressant monotherapy is discouraged in most of them, although some support the use of antidepressants in combination with antimanic agents for a limited period of time. Lamotrigine has become a highly controversial option. Conclusion: The management of bipolar depression is complex and should be differentiated from management of unipolar depression. Guidelines may be useful instruments for helping clinicians to choose and plan bipolar depression treatment by integrating the more updated scientific knowledge with every-day clinical practice and patient-specific factors; however, a further effort is needed in order to improve guidelines implementation in clinical practice. The latest updates on treatment guidelines for bipolar depression give priority to novel treatment approaches, such as quetiapine, over more traditional ones, such as lithium or antidepressants. Lamotrigine is a controversial option. [Copyright &y& Elsevier]

Abstract: As the age of the general population increases, the number of elderly people who need care is increasing. It has been suggested that rural carers may be disadvantaged compared to urban carers, but it is not clear what affect geographic location has on carers. This paper presents a systematic review of the literature on urban–rural comparisons on various outcomes for informal carers who provide care for elderly people in the community. Of 150 articles that were reviewed, eight articles were included with three themes in the outcomes for carers: service use, health promotion behaviors and psychological health (such as carer stress, burden or depressive symptoms). Overall, there were few consistent or statistically significant differences between urban and rural carers. Many of the differences observed were explained by other factors, such as carer or care recipient characteristics. The literature search was limited to papers in the English language, involving quantitative methods and published in peer-reviewed journals. There were not enough studies found to examine other outcomes or to pool data across studies. There is too little evidence comparing urban and rural carers to inform clinicians and policy makers. More good-quality research is urgently needed. [Copyright &y& Elsevier]

The Internet of Health Things (technologies for exchanging data) is crucial in helping promote health and wellbeing. Family caregivers of people with Alzheimer's can significantly benefit from the Internet of Health Things by enabling caregivers to participate in programs from home to help manage their stress and distress in their caregiver role. This paper reports the results of a techno-economic analysis and a life cycle assessment comparing a video-communication delivered intervention designed to decrease the stress and distress of caregivers of people with Alzheimer's and related dementias to a hypothetical in-person delivery of the same intervention. Results indicated that the virtual intervention, compared to the hypothetical in-person intervention, was associated with lower participant costs yet, potentially more expensive from an organizational/provider perspective. Environmentally, the virtual intervention had lower carbon emissions than the hypothetical in-person delivery of the intervention. Furthermore, video-communication delivery of the intervention has the potential to reduce some of the hassles of looking for respite to attend caregiving interventions and allow caregivers to join from their preferred location across the country. [ABSTRACT FROM AUTHOR]

• Care needs across countries depend on fertility rates, aging of the population, and the prevalence and causes of morbidity. • A care dependency ratio measures future care needs relative to the potential future supply of caregivers. • Time-use survey data indicate that future unpaid caregivers will be equivalent to one- to two-fifths of the labor force. • Unless the gender division of family care work changes, women and girls will be providing four-fifths of future unpaid caregiving. • To lessen the family's care burden, governments should invest in care programs, basic infrastructure, and measures to protect caregivers and recipients. The COVID-19 pandemic has caused millions of infections and deaths worldwide, forced schools to suspend classes, workers to work from home, many to lose their livelihoods, and countless businesses to close. Throughout this crisis, families have had to protect, comfort and care for their children, their elderly and other members. While the pandemic has greatly intensified family care responsibilities for families, unpaid care work has been a primary activity of families even in normal times. This paper estimates the future global need for caregiving, and the burden of that need that typically falls on families, especially women. It takes into account projected demographic shifts, health transitions, and economic changes in order to obtain an aggregate picture of the care need relative to the potential supply of caregiving in low-, middle- and high-income countries. This extensive margin of the future care burden, however, does not capture the weight of that burden unless the quantity and quality of care time per caregiver are taken into account. Adjusting for care time given per caregiver, the paper incorporates data from time-use surveys, illustrating this intensive margin of the care burden in three countries that have very different family and economic contexts—Ghana, Mongolia, and South Korea. Time-use surveys typically do not provide time data for paid care services, so the estimates depend only on the time intensity of family care. With this caveat, the paper estimates that the care need in 2030 would require the equivalent of one-fifth to two-fifths of the paid labor force, assuming 40 weekly workhours. Using the projected 2030 mean wage for care and social service workers to estimate the hypothetical wage bill for these unpaid caregivers if they were paid, we obtain a value equivalent to 16 to 32 percent of GDP in the three countries. [ABSTRACT FROM AUTHOR]

Given the social burden and significant cost of dementia care in Australia, finding evidence-based approaches that improve outcomes, maintain independence, and reduce the impact on patients and families is essential. Finding effective ways to train and assist the healthcare staff who support these individuals is also critical, as they are considered to be at risk of workplace stress, burnout, and other psychological disturbances which negatively affects standards of care. The current paper describes a protocol for evaluating the effects of a Montessori-based approach to dementia care, in non-residential respite centres. An 18 month prospective observational, cohort controlled design is suggested that will compare participants from a community respite service that has undergone a Montessori-based workplace culture change and those from a service that provides a person-centred ‘care as usual’ approach. To achieve this, the protocol includes the assessment of participants across multiple variables on a monthly basis including the cognitive, behavioural, and emotional functioning of clients with dementia, levels of caregiver burden experienced by informal carers, and burnout, compassion satisfaction and workplace engagement among respite staff. The protocol also employs a qualitative evaluation of program fidelity. This approach will provide further insight into the potential benefits of early intervention with Montessori approaches for persons living with dementia in the community, their caregivers, and the staff and volunteers who assist them. [ABSTRACT FROM AUTHOR]

1. Describe the current prevalence and involvement of caregivers in community-based palliative care randomized controlled trials (RCTs) 2. Identify caregiver outcomes assessed in RCTs that engaged caregivers The growing movement toward the provision of health services in community settings expands opportunities for over 47 million American caregivers to more closely engage with their adult care recipients. Community-based palliative care (CBPC) interventions offer potentially effective responses to the need for accessible, affordable palliative care delivery in communities. However, no comprehensive review of the literature has been identified that evaluates how CBPC randomized controlled trials (RCTs) involve caregivers in their interventions. The aims of this systematic review are to evaluate the prevalence and involvement of caregiver engagement in CBPC RCTs and to describe the caregiver outcomes measured in RCTs that engage caregivers. A search of Embase, PubMed, CINAHL, and PsychInfo databases was completed in July 2021 using caregiving and CBPC search terms. Inclusion was limited to CBPC RCTs conducted in at least one US site. Quality assessment was completed using the Cochrane Risk of Bias Tool for Randomized Controlled Trials. This systematic review integrated a narrative synthesis to describe the review's findings. Twenty-six published papers describing 22 RCTs met inclusion criteria. In the five studies that reported caregiver data, caregiver burden and quality of life were the most frequently evaluated outcomes. Of the studies involving caregivers, the trials provided highly heterogeneous definitions of caregiving, and the involvement of caregivers in interventions varied widely across studies. Interventions provided verbal education, coaching, or support to caregivers. Only one study explicitly identified the caregiver as a member of the intervention's interdisciplinary team. This systematic review highlights the wide variability in CBPC RCT interventions and limited assessment of caregiver outcomes. As patient care is increasingly provided through community- and home-based services, this review underscores the need for more comprehensive research related to caregiver involvement and outcomes in CBPC interventions. [ABSTRACT FROM AUTHOR]

The unique demands of the foster carer role are associated with high levels of self-reported stress among foster carers. The current study examines the amount of carer stress that can be attributed to certain role specific challenges and how stress from these challenges varies between carers and placements. As a secondary aim the study examines carer perceptions on current organisational support and training. Participants were sourced from a national fostering agency with branches in the local area. Carers were eligible to participate in the study if they were caring full time for at least one foster child. Eligible carers completed an identical online or paper survey including measures of general stress and parenting stress as well as study specific measures regarding satisfaction with organisational training and support. Results demonstrated that challenging behaviours are the most stressful unique role demand for foster carers and the largest predictor of carer stress levels. Overwhelmingly carers reported a desire for additional training in order to support them in their role. The results support previous research outlining the difficulties faced by foster carers and the need to improve support and training to ensure good placement outcomes including placement stability and reduced carer attrition. [ABSTRACT FROM AUTHOR]

Introduction Alzheimer's Disease and Related Diseases (ADRD) are associated with a caregiver burden that increases with the progression of the disease. Psychosocial interventions reported a moderate improvement on caregivers' burden. Patients with ADRD and their older caregivers are also exposed to a higher risk of developing drug-related problems. The main objective of the PHARMAID study is to measure the impact of personalized pharmaceutical collaborative care integrated to a multidisciplinary psychosocial program on the burden of caregivers. Methods The PHARMAID study is a 18-month randomized controlled trial that started in September 2016. This paper describes the study protocol. PHARMAID plans to enroll 240 dyads, i.e. ADRD patients and caregivers, whose inclusion criteria are: outpatient with mild or major neurocognitive disorders due to ADRD, living at home, receiving support from a family caregiver. Three parallel groups will compare a control group with two experimental groups: psychosocial intervention and integrated pharmaceutical care at a psychosocial intervention. The main outcome is the caregiver's burden assessed by the Zarit Burden Index at 6, 12 and 18 months. Discussion This is the first trial designed to assess the specific impact of the integration of pharmaceutical care in a multidisciplinary psychosocial program on the caregiver's burden. The results will inform policymakers on strategies to implement in the near future. Trial Registration number: [ ClinicalTrials.gov : NCT02802371 ] Registered in June 2016. [ABSTRACT FROM AUTHOR]

Background Many of the health behaviors known to contribute to cardiometabolic risk and disease (CMRD), including physical activity, diet, sleep, and screen time, begin during childhood. Given the population-wide burden of CMRD, novel ways of assessing risk and providing feedback to support behavior change are needed. Purpose This paper describes the design and rationale for the Study for using Technology to Reach Individual Excellence (STRIVE), a randomized controlled trial testing the use of an integrated, closed-loop feedback system that incorporates longitudinal, patient-generated, mobile health technology (mHealth) data on health behaviors and provides clinical recommendations to help manage CMRD among at-risk families. Methods STRIVE is a 6-month trial among 68 children, ages 6–12 year olds with a body mass index ≥ 85th percentile from Massachusetts with at least one parent with CMRD. Data on several health behaviors will be collected daily over 6 months. Children and parents will each wear wristbands that collect objective physical activity, sleep, and screen time data via accelerometry, noise, and infrared detection. Sugar sweetened beverage consumption will be assessed by self-report via a smartphone application. Weight will be collected using a wireless scale. Intervention group parents receive feedback on their child's health behaviors and personalized CMRD counseling via mobile messaging. Control parents receive standard of care recommendations and weekly health behavior reports for self-guided care. Conclusion The STRIVE trial will test the use of mHealth and closed-loop feedback systems to improve health behaviors among families at-risk for or with established CMRD. [ABSTRACT FROM AUTHOR]

Injuries at work have a substantial economic and societal burden. Often groups of labour market participants, such as young workers, recent immigrants or temporary workers are labelled as being “vulnerable” to work injury. However, defining groups in this way does little to enable a better understanding of the broader factors that place workers at increased risk of injury. In this paper we describe the development of a new measure of occupational health and safety (OH&S) vulnerability. The purpose of this measure was to allow the identification of workers at increased risk of injury, and to enable the monitoring and surveillance of OH&S vulnerability in the labour market. The development included a systematic literature search, and conducting focus groups with a variety of stakeholder groups, to generate a pool of potential items, followed by a series of steps to reduce these items to a more manageable pool. The final measure is 29-item instrument that captures information on four related, but distinct dimensions, thought to be associated with increased risk of injury. These dimensions are: hazard exposure; occupational health and safety policies and procedures; OH&S awareness; and empowerment to participate in injury prevention. In a large sample of employees in Ontario and British Columbia the final measure displayed minimal missing responses, reasonably good distributions across response categories, and strong factorial validity. This new measure of OH&S vulnerability can identify workers who are at risk of injury and provide information on the dimensions of work that may increase this risk. This measurement could be undertaken at one point in time to compare vulnerability across groups, or be undertaken at multiple time points to examine changes in dimensions of OH&S vulnerability, for example, in response to a primary prevention intervention. [ABSTRACT FROM AUTHOR]

Background 'Open Dialogue' is a social network model of crisis and continuing mental healthcare which involves elements of service delivery such as immediate response and a style of therapeutic meeting called network meetings. Although there are indications from non-randomised studies that it may help people in their recovery from severe mental health crises and improve long-term outcomes, this has yet to be tested in a randomised controlled trial. Methods This paper outlines the protocol for a multi-site cluster-randomised control trial assessing the clinical and cost-effectiveness of Open Dialogue compared to treatment as usual (TAU) for individuals presenting in crisis to six mental health services in England. The primary outcome is time to relapse, with secondary outcomes including measures of recovery and service use. Participants will be followed-up for two years, with data collected from electronic medical records and researcher-led interviews. The analysis will compare outcomes between treatment groups as well as investigating potential mediators of effect: shared decision-making and social network quality and size. Carers of a subsample of participants will be asked about their experiences of shared decision-making, carer burden, and satisfaction. Discussion This trial will provide evidence of whether Open Dialogue services implemented in the English mental health system is an effective alternative to current care and may have important implications for the organization of community mental health services. Trial registration : retrospectively registered (108 participants recruited of 570 target) on 20/12/2019, ISRCTN52653325. [ABSTRACT FROM AUTHOR]

Currently, 15%, 12.8% and 17.1% of the Canadian, American and European populations, respectively, are 65 years or older. Due to aging-related disabilities, elderly individuals will require support from family members while in the community. Annually, family caregivers save the Canadian and American healthcare systems $25 billion and $350 billion, respectively. However, to maintain the important role they play, caregivers' experiences must be investigated in order to provide appropriate support. Despite the fact that 'caregiver burden' is preponderantly used as an indicator of the caregiving experience, much disagreement remains on what the term entails and how it should be utilized. This paper endeavors to critically discuss the concept of 'caregiver burden', its use in the literature and the implications this has for future research and clinical practice. The vagueness derived from the various 'caregiver burden' definitions limits the term's relevance to policy-making and clinical practice. Additionally, much of the literature on 'caregiver burden' is not theoretically framed, which reduces the conceptual clarity of the term. Quantitative measures are largely used to investigate 'caregiver burden', which can sometimes fail to capture contextual features that are relevant to caregiving outcomes (e.g., culture). Stress theory and role theory are recommended as guiding frameworks for future research that investigates 'caregiver burden'. Future research on 'caregiver burden' would also benefit from integrating qualitative and quantitative approaches into mixed method designs in order to gain a holistic understanding of the concept. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previous research identifies positive and negative effects of being a sibling in a family which includes a disabled child. Short break services (also known as respite) provide families with a break from caring and offer disabled children the chance to participate in various activities. This paper investigates the effects that these short breaks have on siblings. Methods: The research consists of a qualitative analysis of data collected as part of a survey of families using short break services. Data from 239 parent–carers (mostly biological parents) and 84 siblings are included in the analysis. Data are written responses to open questions about use of services and the effects they have. Results: The effects of short breaks on siblings are described as being mostly positive. Short breaks have the potential to ameliorate some of the negative impacts of being a sibling in a family with a disabled child whilst also promoting the positive impacts of having a disabled brother or sister. However, some siblings also report some adverse effects of short breaks. Conclusion: Short breaks have a significant role to play in promoting the wellbeing of siblings; however, their role currently seems to be largely unrecognised and consequently undervalued. [Copyright &y& Elsevier]

Abstract: Caregiving research has rarely examined the nature and impact of care provision at night. This paper analyses indepth interviews with 24 older people in England whose sleep had been adversely affected by providing care at night. A framework is proposed that illustrates how six aspects of caregiving can disrupt carers'' sleep quality: first, attending to the night-time physical needs of the care recipient; second, anticipation of their night-time care needs; third, ‘monitoring’ their relative at night; fourth, disruption from relatives who are awake for long periods at night, wandering or shouting; fifth, undertaking emotional support, and worries or anxieties related to their relative; and finally, the legacy of caregiving may continue to disrupt sleep after caring ceases, because of painful images of their relative''s suffering or feelings of guilt. Adverse effects on carers'' sleep are greatest for co-resident carers, especially when caring for a spouse or relative with a life-limiting illness or dementia. [Copyright &y& Elsevier]

Abstract: Informal caregiving is a complex concept, and inconsistencies are found in the literature regarding how to measure it. The differences in tasks included in the definition of caregiving, as well as the different methods used to measure caregiving time may explain the huge variations in results found in the literature. The current paper aimed to lay out the challenges of how to calculate the time spent by informal caregivers on providing care and assistance to an ill person at home. It also proposes a method for measuring informal caregiving time, which attempts to distinguish between “normal” activities and “caregiving” activities. The proposed measurement method is then applied to a cohort of informal caregivers of palliative care patients. The illustration study revealed that this method brought advantages comparatively to other methods, and that persisting challenges remain in measuring informal caregiving time. We conclude that, the estimate of time spent caregiving for palliative care patients may be useful in guiding support programs for the families taking care of a loved one at home during the palliative phase of care. [Copyright &y& Elsevier]

Intimate partner violence (IPV) is prevalent among romantic dyads. While rates decline as couples age, a significant number of couples continue to experience IPV. Given the detrimental effect of IPV on intrapersonal and interpersonal functioning, the current systematic review aimed to identify risk factors among older adult couples. Further, this paper aimed to apply a well-validated framework for understanding marital quality and IPV, the Vulnerability Stress Adaptation (VSA) model, to aggression among older adults. Using preferred reporting items for systematic reviews and meta-analyses standards, results demonstrated that low socioeconomic status, cognitive impairment, caregiver burden, psychological distress, and social isolation are key risk factors IPV among older adults. These, and other risk factors, are conceptualized using the VSA model. • Intimate partner violence (IPV) continues in later life. • Risk factors for IPV may differ among older adults. • The Vulnerability Stress Adaptation model can be used to model IPV risk factors among older adults. [ABSTRACT FROM AUTHOR]

• Explore the effect of work-family conflict on parenting stress for ADHD families. • Identify work-family conflict as a potent contributor to parenting stress. • Non-working parents have higher parenting stress than employed parents do. • Chinese mothers experience higher parenting stress than fathers do. • More research is needed given the absence of work and parenting stress research. This paper reports the results of a one-time survey among Chinese families of children with attention-deficit/hyperactivity disorder (ADHD) (n = 314) and families with typically developing (TD) children (n = 308) in mainland China, which aimed to examine the effects of the parenting role, work-family conflict, child ADHD symptoms, parental depression, anxiety, and somatization, parenting alliance, and social support on parenting stress. The results of the study have shown that (i) parents of children with ADHD experienced significantly higher levels of parenting stress than did parents of TD children; Chinese mothers experienced significantly higher parenting stress than fathers did; (ii) mothers of children with ADHD had more work-family conflict than mothers of TD children did; (iii) non-working parents had higher levels of parenting stress than the employed parents did; (iv) work-family conflict, depression, anxiety, and somatization, child ADHD symptoms, parenting role, and social support accounted for 40.9% of the variance in parenting stress; parenting alliances did not approach significance in the regression. Implications for social work practice and service development are discussed. [ABSTRACT FROM AUTHOR]

Variance decomposition is an effective sensitivity analysis method to screen the key parameters influencing passive safety system operation based on the uncertainties of thermal-hydraulic (T-H) model inputs. However, such method needs a large number of samples gained from T-H model running with the inputs sampled randomly from their probabilistic distributions, and the T-H model always takes quite long time to run once, then it will be a heavy calculation burden to do the analysis. In this paper, we propose a method to improve the analyzing efficient: based on the system T-H characteristics, the system behavior in a short time after an accident happening can represent the system T-H performance and be used to do the sensitivity analysis. Passive Containment Cooling System (PCCS) in AP1000 is used as a case study in our analysis, by which the heat produced in the containment can be transferred to the atmosphere through natural circulations. After steam line break (SLB) accident, the peak value of pressure in the containment appears within 1000s, we do the sensitivity analysis to screen key parameters in two ways: firstly, we screen the key inputs with variance decomposition method directly, 100 samples are gained from T-H model simulating 1000s, the inputs are sampled based on their probabilistic distributions, and the results show that air pressure is the most important parameter and the others don't have enough differentiation degrees. Then we get more 100 samples under the condition that air pressure is supposed as 0.1 MPa, here air temperature and steam mass flow are important ones besides air pressure. In another way, we analyze the correlation between pressure in the containment in a short time after SLB and the peak value according to the system T-H behavior, and get 600 samples from T-H model simulating 50s, the results are in accordance with that from T-H model simulating 1000s, air pressure, air temperature and steam mass flow are important parameters, and it just needs 1.55 h to calculate the important factor for one input. • Fluid state at short term after accident can represent the system T-H behavior. • Important inputs affecting peak pressure is screened by variance decomposition. • The pressure at short term is used instead of peak value in the method. • Shorter simulation time can be evaluated according to T-H Characteristics. • Shorter simulating time and more samples can improve the analyzing efficiency. [ABSTRACT FROM AUTHOR]

• Precompression total strain mainly affects EPS' compressive properties. • Precompression plastic strain mainly affects EPS' rheological properties. • Short-term loads are helpful in attenuating the creep of EPS. • Suggestions for using recycled EPS are provided. This paper investigates the effect of stress history on the compressive and rheological behaviors of EPS geofoam. Short-time, constant-load and constant-strain precompression loadings were applied to impose different types of stress history on EPS samples. These samples were thereafter subjected to rapid compression, creep and stress relaxation tests to reveal their compressive (i.e. stress-strain relationship) and rheological (i.e. creep and stress relaxation) behaviors. Test results showed that (i) the yield strain of EPS increases as the maximum past strain level (precompression strain) increases and the stress-strain behavior of the EPS in the post-yielding range is not affected by its stress history; and (ii) the accumulated plastic strain during precompression decreases the rate of creep and stress relaxation. Based on the observed influence of stress history on the EPS, suggestions on the use of pre-loaded EPS were provided in this study. [ABSTRACT FROM AUTHOR]

Children in therapeutic foster care (TFC) are more likely to have complex emotional and behavioral needs that require skilled parenting, but TFC foster parents do not always receive the training and support they need to provide these children with stable, supportive and therapeutic care, resulting in high levels of placement disruptions. As the broader foster care system moves away from relying on residential programs for children with emotional and behavioral needs and in turn places more of these high-need children in home-based settings, better understanding the unique needs of TFC foster parents is critical. Drawing from focus groups with TFC foster parents, this paper explores different aspects of their experiences, identifies multiple ways in which they need support, and provides recommendations for foster care agencies looking to retain skilled foster parents and increase the quality and stability of children's experience in TFC programs. • Therapeutic foster parents do not always receive the support they need. • FFPSA-related system changes will lead to more reliance on therapeutic foster care. • Support needed by therapeutic foster parents is multi-dimensional. • Many sources of therapeutic foster parent stress could be proactively addressed. • To better provide therapeutic services agencies should partner with foster parents. [ABSTRACT FROM AUTHOR]