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Despite changes in the structure of contemporary families, little is known about extended family members—siblings, grandchildren, nieces/nephews, stepkin—who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face. [ABSTRACT FROM AUTHOR]

Social cognition is a set of complex processes that mediate much of human behavior. The development of these skills is related to and interdependent on other cognitive processes, particularly inhibitory control. Brain regions associated with inhibitory control and social cognition overlap functionally and structurally, especially with respect to frontal brain areas. We proposed that the neural foundations of inhibitory control and social cognition are measurable in infancy. We used structural equation modeling and showed that 10-month frontotemporal neuroconnectivity measured using electroencephalogram coherence predicts social cognition at 9 years of age through age-4 inhibitory control. These findings provide insight into the neurodevelopmental trajectory of cognition and suggest that connectivity from frontal regions to other parts of the brain is a foundation for the development of these skills. [ABSTRACT FROM AUTHOR]

Background and Objectives Behavioral expressions of dementia are often stressful for family caregivers to manage as they strive to ensure their relative's needs are met. Guided by Lazarus and Folkman's Transactional Model of Stress and Coping, we identified specific behaviors that disrupt daily routines and challenge the achievement of caregiving goals, and the approaches and strategies caregivers employ to address them. Research Design and Methods We conducted semistructured interviews with 30 family caregivers in rural Appalachia caring for a relative living with dementia. Analysis involved use of open and focused coding processes to identify the ways caregivers managed behaviors and bar graphs to examine management approaches relative to categories of behaviors and caregiver demographic and emotional well-being variables. Results Analyses revealed 10 types of behavioral expressions of dementia associated with confusion, irritability, and resistance to engaging in necessary activities of daily living. Caregiver approaches to managing behaviors included gentle persuasion, being harsh by yelling or threatening, being persistent in expecting the person with dementia to complete the tasks at hand, disengaging by postponing the activity, and employing a combination of strategies. Approaches differed across types of behavior and caregiver demographics and had varying effects on caregiver well-being. Discussion and Implications Uncovering specific behaviors family caregivers of persons living with dementia found bothersome, caregivers' adaptive strategies for managing behaviors, and the impact of those approaches provides new information to inform training on effective dementia caregiving practices and development of targeted intervention programs for dementia care. [ABSTRACT FROM AUTHOR]

In custodial grandfamilies, grandchildren often provide critical support and assistance to their grandparents. Less is known about the extent to which grandchildren may serve as caregivers to their custodial grandparents and how providing care may impact their well-being. Informed by the stress process model, the purpose of this study was to examine the nature of adolescent grandchildren's caregiving to their custodial grandmothers and the relationship of providing this care to grandchildren's perceived caregiving interference and internalizing and externalizing behavior problems. A survey was administered to 81 adolescents, aged 12 to 18, and their custodial grandmothers. Results suggest that grandchildren provide assistance with both instrumental activities of daily living (IADLs; e.g., housework, cooking) and activities of daily living (ADLs; walking, dressing). Results of a path analysis revealed that grandchildren's assistance with ADLs was associated with greater perceptions of caregiving interference in social and academic arenas, which was associated with increased externalizing behavior problems. Implications for practice, which underscore the necessity of interventions to support grandchild caregivers, and directions for future research, are addressed. Highlights: Grandchildren assisting grandmothers with instrumental activities of daily living, including household chores, was common. Grandchildren assist custodial grandmothers with activities of daily living (e.g., transferring, using stairs, and walking). When grandchildren assist with more activities of daily living, they report greater perceptions of caregiving interference. Grandchildren with greater perceived caregiving interference experienced more externalizing behavior problems. [ABSTRACT FROM AUTHOR]

Objective: Despite overall improvements in the U.S. health care, older adults living in rural counties, such as Appalachian Virginia, continue to be underserved. Method: Multinomial regression models, including both individual and county data from 503 older adults aged 65+, were used to examine factors associated with informal and formal care use. Results: Older adults with stronger filial beliefs and less positive attitudes toward community services preferred informal help. If the county had more formal care services, however, older adults were more likely to use them, regardless of their filial beliefs. Disparities based on gender were observed, in that women who lived in counties with a higher percentage of older adults below the poverty line were more likely to receive no help than men. Discussion: Developing effective service promotion tactics, destigmatizing community services, and targeting services and support, especially to women, could decrease health disparities in rural Appalachia and similar geographic areas. [ABSTRACT FROM AUTHOR]

Objectives:Exposure to suffering of a relative or friend increases the risk for psychological and physical morbidity. However, little is known about the mechanisms that account for this effect. We test a theoretical model that identifies intrusive thoughts as a mediator of the relation between perceived physical and psychological suffering of the care recipient and caregiver depression. We also assess the role of compassion as a moderator of the relation between perceived suffering and intrusive thoughts. Methods:Hispanic and African American caregivers (N= 108) of persons with dementia were assessed three times within a one-year period. Using multilevel modeling, we assessed the mediating role of intrusive thoughts in the relation between perceived physical and psychological suffering and CG depression, and we tested moderated mediation to assess the role of caregiver compassion in the relation between perceived suffering and intrusive thoughts. Results:The effects of perceived physical suffering on depression were completely mediated through intrusive thoughts, and compassion moderated the relation between physical suffering and intrusive thoughts. Caregivers who had greater compassion reported more intrusive thoughts even when perceived physical suffering of the CR was low. For perceived psychological suffering, the effects of suffering on depression were partially mediated through intrusive thoughts. Discussion:Understanding the role of intrusive thoughts and compassion in familial relationships provides new insights into mechanisms driving caregiver well-being and presents new opportunities for intervention. [ABSTRACT FROM AUTHOR]

Parental incarceration is often an adverse childhood experience that has been characterized as an enduring trauma that involves ongoing and repeated stressors. In this study we focus on the role of parental incarceration in predicting child trauma symptomology as well as key mediating family processes such as visitation and children's caregiving arrangement. We utilize a comparison group design of single caregiver and child dyads (N = 45) among similarly disadvantaged single caregiver families to first determine mean differences in child trauma symptomology. Findings revealed that both child and caregiver reports of child trauma symptomology were significantly higher in single caregiver families impacted by parental incarceration and these levels were in the clinical range (parent reports) or approached the clinical range (child reports). We then tested a mediational model examining family processes linked to child trauma symptomology. Parental incarceration was associated with more serious visitation problems (than other contexts of visitation to a nonresident parent) and children being raised by someone other than a biological parent. Parental incarceration also significantly predicted parent and child reports of child trauma symptoms. The effect of parental incarceration on parent reports of child trauma symptomology was fully mediated by the quality of children's visitation suggesting the importance of developing interventions aimed at alleviating child distress during visits in correctional settings. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Energy-containing beverages, specifically sugar-sweetened beverages, may contribute to weight gain and obesity development. Yet, no rapid assessment tools are available which quantify habitual beverage intake (grams, energy) in adults. Objective: Determine the factorial validity of a newly developed beverage intake questionnaire (BEVQ) and identify potential to reduce items. Methods: Participants from varying economic and educational backgrounds (n=1,596, age 43±12 years, body mass index [calculated as kg/m2] 31.5±0.2) completed a 19-item BEVQ (BEVQ-19). Beverages that contributed <10% to total beverage, or sugar-sweetened beverages, energy and grams were identified for potential removal. Factor analyses identified beverage categories that could potentially be combined. Regression analyses compared BEVQ-19 outcomes with the reduced version''s (BEVQ-15) variables. Inter-item reliability was assessed using Cronbach''s α. Following BEVQ-15 development, a subsequent study (n=70, age 37±2 years; body mass index 24.5±0.4) evaluated the relative validity of the BEVQ-15 through comparison of three 24-hour dietary recalls'' beverage intake. Results: Three beverage items were identified for elimination (vegetable juice, meal replacement drinks, and mixed alcoholic drinks); beer and light beer were combined into one category. Regression models using BEVQ-15 variables explained 91% to 99% of variance in the four major outcomes of the BEVQ-19 (all P<0.001). Cronbach''s α ranged .97 to .99 for all outcomes. In the follow-up study, BEVQ-15 and three 24-hour dietary recalls'' variables were significantly correlated with the exception of whole milk; BEVQ-15 sugar-sweetened beverages (R 2=0.69), and total beverage energy (R 2=0.59) were more highly correlated with three 24-hour dietary recalls'' than previously reported for the BEVQ-19. The BEVQ-15 produced a lower readability score of 4.8, which is appropriate for individuals with a fourth-grade education or greater. Conclusions: The BEVQ-19 can be reduced to a 15-item questionnaire. This brief dietary assessment tool will enable researchers and practitioners to rapidly (administration time of ∼2 minutes) assess habitual beverage intake, and to determine possible associations of beverage consumption with health-related outcomes, such as weight status. [Copyright &y& Elsevier]

Objectives: This research documents spousal accounts of daily symptoms and behaviors of their husbands or wives with mild cognitive impairment (MCI) and assesses how MCI-related symptoms and care needs are associated with spouse care partners’ psychological well-being and biomarkers of physiological wear and tear. Method: Thirty spouse care partners participated in a 7-day diary study and reported on behavior problems associated with MCI as well as daily stressors and strains they experienced. They also provided saliva samples on 4 of the study days. Results: Multilevel models revealed daily variability and change in psychological affect and the diurnal cortisol rhythm. Daily primary stressors, everyday secondary strains, and marital interactions predicted these changes. Discussion: The findings document the negative physiological effects of having a spouse with MCI and provide new details on probable causes of psychological and biological distress. They shed light on MCI-specific interventions to address couples’ needs before severe disease progression occurs that could interfere with spouses’ ability to provide home-based care and support. [ABSTRACT FROM PUBLISHER]

The article discusses a study to determine if physician participation in a Web-based, American Board of Pediatrics-approved Maintenance of Certification (MOC) Part 4 activity increased rates of an important clinical outcome in their practice and identify particular practices that may predict increased rate of exclusive breastfeeding. Participants indicated that the Web-based format enabled them to work at their own pace using their own data and reinforced the importance of chart documentation.

The article offers information on interpersonal neurobiology, an interdisciplinary theory being used by couple and family therapists. Topics discussed include National Longitudinal Study of Adolescent to Adult Health (Add Health), attachment theory and the connections between experiences in relationships and brain development. Also mentioned are exploring couple relationship quality, self-acceptance and neuroticism, a personality trait characterized by emotional reactivity.

Abstract: Maintenance of weight loss remains a challenge for most individuals. Thus, practical and effective weight-loss maintenance (WTLM) strategies are needed. A two-group 12-month WTLM intervention trial was conducted from June 2007 to February 2010 to determine the feasibility and effectiveness of a WTLM intervention for older adults using daily self-monitoring of body weight, step count, fruit/vegetable (F/V) intake, and water consumption. Forty weight-reduced individuals (mean weight lost=6.7±0.6 kg; body mass index [calculated as kg/m2] 29.2±1.1), age 63±1 years, who had previously participated in a 12-week randomized controlled weight-loss intervention trial, were instructed to record daily body weight, step count, and F/V intake (WEV [defined as weight, exercise, and F/V]). Experimental group (WEV+) participants were also instructed to consume 16 fl oz of water before each main meal (ie, three times daily), and to record daily water intake. Outcome measures included weight change, diet/physical activity behaviors, theoretical constructs related to health behaviors, and other clinical measures. Statistical analyses included growth curve analyses and repeated measures analysis of variance. Over 12 months, there was a linear decrease in weight (β=−0.32, P<0.001) and a quadratic trend (β=0.02, P<0.01) over time, but no group difference (β=−0.23, P=0.08). Analysis of the 365 days of self-reported body weight for each participant determined that weight loss was greater over the study period in the WEV+ group than in the WEV group, corresponding to weight changes of −0.67 kg and 1.00 kg, respectively, and an 87% greater weight loss (β=−0.01, P<0.01). Overall compliance to daily tracking was 76%±5%. Daily self-monitoring of weight, physical activity, and F/V consumption is a feasible and effective approach for maintaining weight loss for 12 months, and daily self-monitoring of increased water consumption may provide additional WTLM benefits. [Copyright &y& Elsevier]

Objectives. This article examined exposure to and appraisal of care-related stressors associated with use of adult day services (ADS) by family caregivers of individuals with dementia. Methods. Using a within-person withdrawal design (A-B-A-B), we compared caregivers’ exposure to and appraisal of behavior problems on days their relative attended and did not attend ADS. Participants were 121 family caregivers enrolling a relative with dementia in an ADS program. Daily assessments were obtained prior to the person's attending ADS for the first time and after 1 and 2 months of attendance on days the person attended and did not attend ADS. Results. Total exposure to stressors and stress appraisals decreased significantly over time on ADS days compared with non-ADS days. Most of this difference was accounted by the time the person with dementia was away from the caregiver, but there were also significant reductions in behavioral problems during the evening and improved sleep immediately following ADS use. Discussion. ADS use lowered caregivers’ exposure to stressors and may improve behavior and sleep for people with dementia on days they have ADS. The study highlights how a within-person design can identify the effects of an intermittent intervention, such as ADS. [ABSTRACT FROM PUBLISHER]