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The simultaneous discovery of two corpses at the same scene obliges the forensic pathologist to consider many circumstances. First, the hypothesis of homicide/crime has to be investigated. However, when the circumstances, autopsy, histological data and toxicological and biochemical analyses suggest a natural cause of death, Philemon and Baucis syndrome should be considered. While a few cases of Philemon and Baucis deaths involving couples of spouses have been reported in the literature, only one paper describes the simultaneous deaths of two siblings. The case presented here concerns the death of two siblings who were found in an advanced stage of decomposition in their apartment, which had been allocated to them by social services. The victims were known to be living in conditions of social and economic deprivation and to be suffering from psychiatric disorders. The first suspected cause of death was malnutrition. However, this was excluded by complete autopsy, histological studies and, especially, biochemical investigations, which excluded starvation ketoacidosis. Moreover, no evidence of trauma or poisoning was found in either of the bodies. Despite the advanced stage of decomposition, one of the bodies presented with histological signs of myocardial sclerosis, left ventricular hypertrophy and contraction band necrosis, suggesting that the mechanism of death involved a fatal arrhythmia. The circumstances and the post-mortem findings were highly suggestive of Philemon and Baucis syndrome.

Background: Tobacco vaporizers are devices that heat tobacco without burning it. There is currently a scarcity of studies about the addictiveness of tobacco vaporizers or their effects on cigarette withdrawal symptoms. Goals: To assess the perceived dependence of users of tobacco vaporizers and the perceived effects of these products on cigarette withdrawal symptoms. Methods: Enrollment of participants through the internet from 2016 to 2018. Participants were self-selected visitors to an anti-addiction website, current and past users of tobacco vaporizers aged ≥18. Results: We included 139 users of IQOS tobacco vaporizers. All participants were current (49.6%) or former cigarette smokers at the time when they began to use the tobacco vaporizer. Among the 135 current users, the median dependence on vaporizers was 80 on a scale from 0-100 (25th and 75th percentiles: 50 and 90), and 63.6% reported being somewhat to totally afraid of becoming dependent on the vaporizer. Half (51%) reported that they were less dependent on vaporizers than on combustible cigarettes, 43.8% were equally dependent on both products and 5.2% were more dependent on vaporizers than on cigarettes. Only one cigarette withdrawal symptom was reported by participants, "craving" for combustible cigarettes, and among respondents who experienced craving, 83.9% found that the IQOS vaporizer relieved it "a lot" to "totally". Conclusions: In this self-selected online sample of IQOS users, the perceived dependence on this tobacco vaporizer was relatively high and almost two thirds of respondents were afraid of becoming dependent on IQOS. Most participants perceived that IQOS relieved the craving to smoke combustible cigarettes.

The smoking incentive in patients with schizophrenia (SCZ) depends on stimulation of nicotinic acetylcholine receptors (nAChRs) in the central nervous system. To detect potential predictor genes for nicotine responses in SCZ, we explored common factor using research data in human and animal samples. In lymphoblastoid cell lines from SCZ, the mRNA expression level of α7 nAChR subunit was decreased. In SCZ-like model mice of phencyclidine (PCP; 10 mg/kg/day, subcutaneously for 14 days)-administered mice, the mRNA expression level of α7 nAChR subunit and protein expression level of α7 or α4 nAChR subunit were significantly decreased in the prefrontal cortex during PCP withdrawal. Protein, but not mRNA, expression levels of α7, α4, and β2 nAChR subunits were significantly increased in the nucleus accumbens. Acute (-)-nicotine [(-)-NIC: 0.3 mg/kg, s.c.] treatment attenuated impairments of social behaviors and visual recognition memory. These effects of (-)-NIC were completely blocked by both methyllycaconitine, a selective α7 nAChR antagonist, and dihydro-β-erythroidine (DHβE), a selective α4β2 nAChR antagonist. (-)-NIC did not induce conditioned place preference, but enhanced sensitivity to methamphetamine-induced hyperactivity. These findings suggest that α7 nAChR is associated with development of disease and is implicated in the therapeutic effect of nicotine in SCZ. The smoking incentive in SCZ might be attributed to treat their own symptoms, rather than a result of (-)-NIC dependence, by stimulating α7 and/or α4β2 nAChRs.

Aside from depression and anxiety, less is known about the relationship of problematic smartphone use (PSU) to other psychopathology- related variables. The authors' aim was to test previously neglected variables in relation to PSU: rumination and excessive reassurance seeking behavior (ERSB). The authors recruited 295 college students for a web-based survey of smartphone use frequency, PSU, depression and anxiety, ruminative thinking, and ERSB. The authors tested linear regression and mediation models, assessing rumination and ERSB as mediating associations between depression/anxiety severity with PSU, adjusting for age, sex, and smartphone use frequency. Results demonstrate that ERSB was significantly related to PSU severity, and ERSB mediated the association between rumination and PSU. Furthermore, the combination of rumination and ERSB mediated relations between both depression and anxiety severity with PSU. Results provide evidence for ERSB as an important variable in understanding relationships between psychopathology symptoms and PSU severity among college students.

Whether the COVID-19 pandemic influences suicide rates in older adults is not yet known. However, the pandemic is likely to result in a confluence of the risk factors for suicidal behaviours (Reger et al., 2020) informing approaches to prevention. In this paper we examine the links between suicide in older people and the COVID-19 pandemic, provide the perspectives of psychiatrists from four regions (China, Hong Kong, Italy and Australia) facing different challenges and sociocultural contexts, and propose solutions to support older people.

BackgroundThe aging population has led to a growing health expenditure burden. According to the National Bureau of Statistics of China, the old-age dependency ratio rose from 10.7% in 2003 to 17.8% in 2019, and health expenditure increased from 658.410 billion yuan in 2003 to 5812.191 billion yuan in 2019 in China.MethodsThis paper utilizes the quantile regression method to discuss the influencing factors of health expenditure in urban China based on the China Household Finance Survey (CHFS), especially dependency burden. Moreover, its regional heterogeneity is also compared.ResultsThe old-age dependency ratio, age, family size, self-rated health status, and income significantly impact the health expenditure of urban families in the quantile regression of the national sample. Dependency burden and other variables on urban household health expenditure have great regional heterogeneity. The relationship between urban health expenditure and residential areas in western China is more stable than that in eastern and central China.DiscussionGovernment should improve the healthcare system suitable for the older adult population as soon as possible. The government of western China should pay more attention to the introduction of professional medical talents and the configuration of precision medical equipment to improve the health system in western China.

Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self‐determination—a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical ‘problem frames’ for dependency and to increase our understanding of how dependency can be navigated in practices of long‐term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as ‘dependency work’, a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self‐determination, one of parity and one of self‐worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long‐term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work.

In this paper we study the statistical relations between three latent trait models for accuracies and response times: the hierarchical model (HM) of van der Linden (Psychometrika 72(3):287–308, 2007), the signed residual time model (SM) proposed by Maris and van der Maas (Psychometrika 77(4):615–633, 2012), and the drift diffusion model (DM) as proposed by Tuerlinckx and De Boeck (Psychometrika 70(4):629–650, 2005). One important distinction between these models is that the HM and the DM either assume or imply that accuracies and response times are independent given the latent trait variables, while the SM does not. In this paper we investigate the impact of this conditional independence property—or a lack thereof—on the manifest probability distribution for accuracies and response times. We will find that the manifest distributions of the latent trait models share several important features, such as the dependency between accuracy and response time, but we also find important differences, such as in what function of response time is being modeled. Our method for characterizing the manifest probability distributions is related to the Dutch identity (Holland in Psychometrika 55(6):5–18, 1990).

This study examined whether interpersonal dependency affects therapeutic outcome, using meta-analytic techniques to synthesize results from 31 studies (49 effect sizes; overall N = 3807). High levels of dependency were associated with more positive outcome in psychodynamic therapy (r = 0.11, p < 0.05), but not cognitive-behavioural therapy (r = -0.05, ns), and were associated with a less positive outcome in pharmacological treatment (r = -0.15, p < 0.001). Other predictors of outcome included patient diagnosis (high levels of dependency were linked with more positive outcome for patients with anxiety disorders but not those with depression), outcome measure (high levels of dependency were associated with significantly greater improvement in global functioning but not symptom reduction) and dependency measure (cognitive and cognitive-behavioural dependency scales yielded less positive results than other types of measures). These results contribute to a growing body of literature examining effects of personality on treatment process and outcome. © 2019 John Wiley & Sons, Ltd.

Background High levels of functional dependency appear to be deleterious to psychological and physical health. The goal of this research was to identify factors responsible for the association between functional dependency and negative health outcomes. Methods Self-report data were collected from 149 undergraduate students. Structural equation modeling was used to test a model in which functional dependency has indirect effects on three negative psychological outcomes (negative affect, functional impairment, and dissatisfaction with life) through two variables: lack of experiential awareness and diminished self-efficacy. Results The model provided a good fit to the data and five of the six indirect effects were statistically significant. Limitations Limitations include self-report and cross-sectional nature of the data. Conclusions These results help to shed light on the core pathology in functional dependency and implicate specific interventions in treating problems associated with this personality trait.

Background Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While there is growing understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these groups. Methods Q methodology was used to identify and describe the shared perspectives (‘subjectivities’) that exist on i) why health is worse in low-income communities (‘Causes’) and ii) the ways that health could be improved in these same communities (‘Solutions’). Purposively selected individuals (n = 53) from low-income communities (n = 25) and professional stakeholder groups (n = 28) ranked ordered sets of statements – 34 ‘Causes’ and 39 ‘Solutions’ – onto quasi-normal shaped grids according to their point of view. Factor analysis was used to identify shared points of view. ‘Causes’ and ‘Solutions’ were analysed independently, before examining correlations between perspectives on causes and perspectives on solutions. Results Analysis produced three factor solutions for both the ‘Causes’ and ‘Solutions’. Broadly summarised these accounts for ‘Causes’ are: i) ‘Unfair Society’, ii) ‘Dependent, workless and lazy’, iii) ‘Intergenerational hardships’ and for ‘Solutions’: i) ‘Empower communities’, ii) ‘Paternalism’, iii) ‘Redistribution’. No professionals defined (i.e. had a significant association with one factor only) the ‘Causes’ factor ‘Dependent, workless and lazy’ and the ‘Solutions’ factor ‘Paternalism’. No community participants defined the ‘Solutions’ factor ‘Redistribution’. The direction of correlations between the two sets of factor solutions – ‘Causes’ and ‘Solutions’ – appear to be intuitive, given the accounts identified. Conclusions Despite the plurality of views there was broad agreement across accounts about issues relating to money. This is important as it points a way forward for tackling health inequalities, highlighting areas for policy and future research to focus on. Electronic supplementary material The online version of this article (10.1186/s12913-019-3884-9) contains supplementary material, which is available to authorized users.

Objectives To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. Methods Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year. Results A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28–28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37–41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis. Conclusions Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.

Philosophers and scientists have long debated the nature of human social interactions and the prevalence of mutual dependence, conflict of interests, and power asymmetry in social situations. Yet, there is surprisingly little empirical work documenting the patterns of interdependence that people experience in daily life. We use experience sampling to study how people think about 3 dimensions of interdependence in daily life and how these dimensions relate to cooperation. In Study 1, 139 romantic couples (n = 278) reported on situations experienced with their partner (k = 6,766); in Study 2, individuals (n = 284) reported on situations experienced with any other person (k = 7,248), over the course of 1 week. Across both samples, we found that most social interactions were perceived as containing moderate mutual dependence, equal power, and corresponding interests. When couples reported on the same situation (Study 1), they largely agreed on their experienced interdependence and cooperation, suggesting that their reports reflect an underlying shared reality. In daily interactions across both samples, higher mutual dependence and lower conflict of interests were associated with more cooperation, whereas relative power was not directly related to cooperation. These associations replicated in laboratory experiments (Study 2). In daily life, high mutual dependence and high relative power exacerbated the negative relation between conflict of interests and cooperation. Finally, prevalent patterns of interdependence and the experience of specific interdependent situations affected multiple relationship outcomes. Our findings stress the importance of studying a diverse array of interdependent situations—and especially situations with corresponding interests—to better understand cooperation in daily life. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

We examined the development of sharing behavior of children (aged 6 to 12) within the unique, minority population of Christian Arab children in Israel (N = 319). Children had the opportunity to share candy with a needy or non-needy recipient. Parents' level of religiosity was assessed using the Duke University Religion Index questionnaire (DUREL). Results replicate previous research that focused primarily on the majority populations of the societies in question, by demonstrating an overall increase in the incidence of sharing with age. Furthermore-as previously found among the majority of Jewish children in Israel-the recipient's neediness moderated the association between household religiosity and sharing, such that religiosity predicted greater levels of sharing only when the recipient was described as "poor" (a child whose parents have little money), not when the prospective recipient was not specified as such. Finally, the neediness of the recipient increased the incidence of sharing regardless of age, suggesting that in this unique minority population, sensitivity to the recipient's neediness emerges already at the age of 6. We discuss possible mechanisms behind this developmental pattern. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The relationships between dimensions of personality (sociotropy and autonomy), coping strategies (rumination: brooding and reflection subtypes, and immature defenses) and symptoms of depression and anxiety were explored in patients with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). A total of 279 patients completed questionnaires including measures of personality dimensions, rumination, immature defenses, depression and anxiety. Our findings suggested that sociotropy and autonomy may be associated with both depressive and anxious symptoms in patients with MDD and with GAD. Multiple mediation analyses indicated that brooding always acted as a mediating link between personality vulnerabilities (sociotropy and autonomy) and depressive and anxiety symptoms, independently of the patient group. In addition, in patients with MDD and those with GAD, brooding and immature defenses functioned together by linking sociotropy and autonomy, respectively, with depressive symptoms. Our results also showed that, in patients with GAD, both types of rumination explained the relationship between sociotropy and autonomy and anxiety symptoms. Overall, our findings provided evidence of the transdiagnostic role of the brooding, linking the vulnerability of personality dimensions and emotional symptoms. They also indicated that reflection and immature defenses can operate in conjunction with brooding, depending on the type of vulnerability and emotional context.

Emotional dependency in a partner implies an excessive permanent affectional bonding to the other individual that is dysfunctional, associated with low self-esteem and conceals a lack of affection. Emotional dependency generates a series of negative emotional consequences: symptoms of anxiety and depression, obsessive thoughts, sleep disorders and abandonment of social relations and leisure. In recent decades several tools have been developed to measure emotional dependency, but they are more focused on measuring dependent personality disorder, centered on an exclusively young population or are not validated in the Spanish population. The aim of this research is to design and validate a new scale to overcome these limitations.The sample population included 166 adults (53 men and 113 women) from the general population, to whom a new scale was applied (partner#8217;s emotional dependency scale, SED), as well as the CDE (Emotional Dependency Questionnaire).The scale has a unidimensional structure, showing good internal consistency (Cronbach#8217;s alpha = .90) and a high convergent validity with the CDE (r = .86). There is no difference between men and women with regarding emotional dependency. Some cut-off points have been established based on the degree of emotional dependency (low, moderate, high and extreme).The SED is a brief assessment tool, simple to conduct and allows the degree of emotional dependency to be assessed unidimensionally with regard to a stable intimate relationship (current or past) in a normative population.

Affective variability is a defining feature of borderline personality disorder (BPD). We hypothesize that patients with BPD who score higher on self-criticism and/or dependency-patients with a relative emphasis on self-definition and interpersonal relatedness, respectively-are characterized by more affective variability in positive and negative emotions. To examine this hypothesis, a sample of 32 patients with BPD reported their momentary feelings of anger, depression, anxiety, cheerfulness, and relaxation in an experience sampling study with 10 random signals scheduled per day for 8 days. Using heterogeneous linear mixed models, results indicate that patients with BPD who score higher on self-criticism show more within-person variance (WPV) in anger, depression, anxiety, cheerfulness, and feeling relaxed, whereas patients who score higher on dependency show more WPV in anger but less WPV in anxiety and feeling relaxed. Consequently, individual differences in affective variability in BPD are, after adjustment for the confounding between the mean and WPV of affect, related to personality vulnerabilities like self-criticism and dependency. These results add evidence to two-polarities models of personality and the existing view that there is substantial heterogeneity in BPD. (PsycInfo Database Record (c) 2020 APA, all rights reserved). ispartof: Personality Disorders-Theory Research And Treatment vol:11 issue:4 pages:270-279 ispartof: location:United States status: published

This study examined the effects of systemic administration of the TrkB receptor antagonist (ANA-12) during induction of morphine dependence on the severity of physical and psychological dependence and the cerebrospinal fluid (CSF) BDNF levels in morphine-dependent and withdrawn rats. Rats became morphine-dependent by increasing daily doses of morphine for 7 days, along with ANA-12 injection. Then, rats were tested for the severity of physical dependence on morphine (spontaneous withdrawal signs), anxiety-like (the elevated plus maze), depressive-like (sucrose preference test) behaviors after spontaneous morphine withdrawal. Also, the CSF BDNF levels were assessed 2 h after the last dose of morphine and day 13 after morphine withdrawal in morphine-dependent and withdrawn rats. We found that the morphine withdrawal signs were significantly higher in morphine dependent rats receiving ANA-12 on days of 5–7 after morphine withdrawal, also ANA-12 exacerbated overall dependence severity. While, the percentage of time spent in the open arms and sucrose preference were higher in morphine-dependent rats receiving ANA-12 than morphine-dependent rats receiving saline. Also, the ANA-12 injection decreased the CSF BDNF levels following morphine dependence, while increased it after morphine withdrawal. We conclude that the ANA-12 exacerbated the severity of physical morphine dependence but attenuated the anxiety/depressive-like behaviors in morphine-dependent and withdrawn rats. Also, ANA-12 injection was able to reverse the changes in the CSF BDNF levels. Therefore, ANA-12 is not more likely to complete treatment for opiate addiction.

Objective: To investigate the association of goal attainment scaling outcomes with change in the Func-tional Independence Measure, and the association between the perceived importance, difficulty and degree of achievement of individual goals in general inpatient rehabilitation. Design: Prospective cohort study. Participants: A total of 208 participants admitted to inpatient rehabilitation in a metropolitan tertiary referral hospital in Melbourne, Australia. Methods: Participants determined the nature of the goals and their importance, and therapists determined the difficulty of the goals. The associations were investigated using median regression and random effect ordinal regression. Results: An increase of each point in the goal attainment scaling score was associated with an adjusted median increase of 0.34 points (95% confidence interval (CI): 0.18–0.5, p

Despite knowing that the practice of physical activity can positively influence the health of older people, there are variables such as the risk of dependency and the level of self-esteem that can mediate people´s quality of life. The objective of this study was to know the relationship between the risk of dependence and level of self-esteem in older people.515 seniors between 60 and 90 years old were interviewed. A single measurement was made, using different scales and validated questionnaires (Rosenberg personal self-esteem scale, Barber test and Modified Baecke PAQ questionnaire). Statistical analyzes (with the SPSS v. 23.0 program) descriptive, ANOVA, linear regression analysis and correlations were performed.89.1% had dependency risk, 32.6% were physically active and 43.3% had low self-esteem. The level of physical activity practice showed significant differences (p0.001) favorable to active people, who had a lower risk of dependence, better self-esteem and lower consumption of medications than sedentary ones.The practice of physical activity helps reduce drug consumption, which improves the self-esteem of the elderly and decreases the risk of dependence.A pesar de saberse que la práctica de actividad física puede influir positivamente sobre la salud de las personas mayores, existen variables como el riesgo de dependencia y el nivel de autoestima que pueden mediar en la calidad de vida de las personas. El objetivo del presente estudio fue conocer la relación existente entre el riesgo de dependencia y el nivel de autoestima en las personas mayores.Se entrevistaron 515 personas mayores, de entre 60 y 90 años de edad. Se realizó una única medición, utilizando diferentes escalas y cuestionarios validados (Escala de autoestima personal de Rosenberg, test de Barber y cuestionario Modificado Baecke PAQ). Se realizaron análisis estadísticos (con el programa SPSS v. 23.0) descriptivos, ANOVA, análisis de regresión lineal y correlaciones.El 89,1% presentó riesgo de dependencia, el 32,6% eran activos físicamente y el 43,3% tenían autoestima baja. El nivel de práctica de actividad física evidenció diferencias significativas (p0,001) favorables para las personas activas, las cuales presentaban menor riesgo de dependencia, mejor autoestima y menor consumo de medicamentos que las sedentarias.La práctica de actividad física ayuda a la reducción del consumo farmacológico, lo cual mejora la autoestima de las personas mayores y disminuye el riesgo de dependencia.

Hostile sexism expresses derogation of women’s competence and emphasizes that women will exploit men’s relational dependence. Men who endorse hostile sexism perceive their female partners more negatively, but do these negative perceptions stem from motives for dominance or insecurities about dependence? We tested both perspectives by assessing bias in perceptions of partners’ behaviors that challenge dominance (criticism, instruction, taking over) versus affirm partners are dependable (love, care, availability). Both members of 100 heterosexual couples reported how much they received and enacted these behaviors in (a) a lab-based discussion and (b) six monthly retrospective reports about an ongoing important goal. In both support contexts, men’s hostile sexism was associated with underestimating dependability-relevant support, particularly when partners reported providing low support. This pattern did not emerge for dominance-relevant behaviors. These results indicate that men’s hostile sexism involves insecurities about dependence, producing perceptions that female partners are less dependable than they actually are.

Background: Heart failure (HF) is a progressive and debilitating condition that represents an ever-growing problem for health systems worldwide. HF patients feel that they are a burden on their families, they feel socially isolated and have a low perception of their health. Accordingly, the objectives of this study were to: (1) to explore the profile of care dependency in a representative sample of Spanish HF patients through the Care Dependency Scale (CDS), and (2) to identify correlates of care dependency in this population. Material and Methods: We performed a cross-sectional study of 187 patients admitted for HF decompensation to the Hospital Clínico of Zaragoza (Spain). Results: Only 15% of our sample was highly or completely dependent on care from others. More specifically, our results indicate that HF patients felt a greater level of dependency on care from others when it comes to moving, getting dressed and undressed, maintaining good personal hygiene, participating in daily and recreational activities and being continent. Conclusions: We find association between the CDS categories that present a low score for care dependency in HF patients and the patients’ physical deterioration.

Objective: Considering that unknown psychopathology might play a role in the management of pediatric asthma, this study examines how self-esteem and psychosocial family environment (child-raising a...

Aim Frailty is a predictor of several adverse health outcomes in older adults. However, the relationship between preadmission frailty status and the incidence of dependency after discharge in hospitalized older patients remains unclear. The aim of the present study was to determine whether preadmission frailty status can predict dependency after discharge among hospitalized older patients. Methods We analyzed the cohort data for hospitalized older patients (aged ≥65 years) with internal medical problems obtained from a prospective study. The main outcome was the incidence of dependency from admission to a month after discharge. The frailty status was assessed using the Kihon Checklist. We defined scores of ≥8 as frail, 4-7 as pre-frail and 0-3 as robust. The Cox proportional hazards regression model was used to estimate the hazard ratios and confidence intervals of the relationships between preadmission frailty status and the incidence of dependency. Results A total of 151 participants who completed follow ups were analyzed (mean age 77.2 years [SD 6.9 years]). The prevalence of frailty, pre-frailty and robust was 22.5%, 37.8% and 39.7%, respectively. During the follow-up period, 39 participants (25.8%) had an incidence of dependency. Participants with frailty (adjusted hazard ratio 4.29, 95% confidence interval 1.72-10.69) had a significantly elevated incidence of dependency compared with that of robust participants. Participants with pre-frailty (adjusted hazard ratio 1.27, 95% confidence interval 0.51-10.69) had no significantly elevated incidence of dependency compared with robust participants. Conclusions The preadmission frailty status using the Kihon Checklist can predict the incidence of dependency after discharge among hospitalized older patients. Geriatr Gerontol Int 2018; 18: 1609-1613.

Understanding how the brain forms representations of structured information distributed in time is a challenging endeavour for the neuroscientific community, requiring computationally and neurobiologically informed approaches. The neural mechanisms for segmenting continuous streams of sensory input and establishing representations of dependencies remain largely unknown, as do the transformations and computations occurring between the brain regions involved in these aspects of sequence processing. We propose a blueprint for a neurobiologically informed and informing computational model of sequence processing (entitled: Vector-symbolic Sequencing of Binding INstantiating Dependencies, or VS-BIND). This model is designed to support the transformation of serially ordered elements in sensory sequences into structured representations of bound dependencies, readily operates on multiple timescales, and encodes or decodes sequences with respect to chunked items wherever dependencies occur in time. The model integrates established vector symbolic additive and conjunctive binding operators with neurobiologically plausible oscillatory dynamics, and is compatible with modern spiking neural network simulation methods. We show that the model is capable of simulating previous findings from structured sequence processing tasks that engage fronto-temporal regions, specifying mechanistic roles for regions such as prefrontal areas 44/45 and the frontal operculum during interactions with sensory representations in temporal cortex. Finally, we are able to make predictions based on the configuration of the model alone that underscore the importance of serial position information, which requires input from time-sensitive cells, known to reside in the hippocampus and dorsolateral prefrontal cortex.This article is part of the theme issue ‘Towards mechanistic models of meaning composition’.

While the malignant self-regard construct and a corresponding questionnaire, the Malignant Self-Regard Questionnaire (MSRQ; Huprich, 2011) have been empirically evaluated in several non-clinical samples, it has yet to be evaluated in a clinical population. In this study, 139 outpatients in the Departments of Psychiatry and Behavioral Sciences (n = 83) and Internal Medicine (n = 57) were administered the MSRQ and a number other measures to assess its construct and incremental validity. The MSRQ was internally consistent in both samples, and was positively correlated with four dimensions of levels of personality functioning, DSM-5 personality trait domains, overdependence, detachment, insecure attachment, and general perceptions of physical and mental well-being. Furthermore, the MSRQ incrementally predicated variance in levels of personality functioning, interpersonal dependency, and general perceptions of physical and mental well-being above and beyond DSM-5 traits and (where appropriate) levels of personality functioning. These findings converge with studies of the MSRQ in nonclinical samples and support the clinical utility and validity of the MSRQ for further use.

Background Emerging evidence suggests a possible etiologic role of certain personality traits (not necessary dysfunctional) in the risk of depression, but the longitudinal long-term available evidence is currently scarce. We longitudinally assessed whether 3 common personality traits (competitiveness, tension and dependency) were associated with the risk of depression after a maximum follow-up of 15 years. Methods We assessed 15,604 university graduates free of depression at baseline through a self-administered questionnaire including personality traits. Simple, Likert-type, questions with 11 possible answers ranging from 0 to 10 were used at baseline to assess the 3 personality traits. We compared participants with high scores (7–10) versus those with low scores (0–4). New medical diagnoses of depression during follow-up were used as the outcome. Results During a median follow-up of 10.1 y, we prospectively identified 902 new medical diagnoses of depression. The multivariable-adjusted hazard ratios (95% confidence intervals) for depression were 1.85 (1.52–2.24) for participants with higher baseline tension (7–10 versus 0 to 4), P-trend

The aim of the present study was to test whether the maladaptive personality traits of self-criticism and neediness predict suicide ideation when controlling for general distress. Further, potential interactive effects on suicide ideation of the two traits and distress were also evaluated. Two studies with nonclinical samples were conducted. The first investigation was cross-sectional and involved a final sample of 202 community adults while the second study was longitudinal with a final sample of 207 college students. Results of Study 1 demonstrated that self-criticism, but not neediness, associated with suicide ideation and, in doing so, also interacted with distress. Neediness also tended to interact with self-criticism in the prediction of suicide ideation. Results from Study 2 were similar and confirmed the Study 1 results. Changes in self-criticism, but not changes in neediness, predicted changes in suicide ideation after statistically controlling for changes in distress. Changes in the interaction between self-criticism and distress predicted changes in suicide ideation and changes in the interaction between self-criticism and neediness tended to predict changes in suicide ideation. Results are discussed with regard to their implications for psychological intervention.

Background Family members who care for patients with severe mental illness experience emotional distress and report a higher incidence of mental illness than those in the general population. They report feeling inadequately prepared to provide the necessary practical and emotional support for these patients. The MAT training, an Interaction-Skills Training program (IST) for caregivers, was developed to meet those needs. This study used a single-arm pretest-posttest design to examine the impact of the training on caregivers’ sense of competence (self-efficacy) and burden. Methods One hundred family caregivers recruited from three mental health institutions participated in the training. Burden was assessed using the Involvement Evaluation Questionnaire, and self-efficacy using the Self-Efficacy Questionnaire. Analysis of variance with repeated measures was used to investigate whether participation in the training changed the level of family caregivers’ burden and self-efficacy. Pearson’s correlation was used to examine the relationships between self-efficacy and burden. Results Our results indicate that, after the training, self-efficacy increased significantly over time (p

Background Recovery outlooks of physical functioning and quality of life after hip fracture have not changed significantly over the past 25 years. Previous research has mainly dealt with causalities and acute treatment, while the recovery process from the patients’ perspective has been less comprehensively described. Expanded knowledge of what the patients consider important in their recovery process may have important consequences for how these patients are treated in the future and thereby on future patient outcomes. The aim presently is therefore to explore how elderly patients with hip fracture enrolled in an ongoing RCT have experienced their recovery process. Method The study was qualitative in design. Eight frail elderly in recovery after hip fracture (aged 69–91) were interviewed in their home four months after their fracture. The interviews covered issues related to their experiences of facilitators and barriers throughout the different stages in the recovery process. The patients were already enrolled in an ongoing randomized controlled trial, examining the effects of habitual functional training during their short term stays at nursing homes. The patients were chosen strategically according to age, gender, and participation in rehabilitation. The interviews were recorded, transcribed and subjected to a method of systematic text condensation inspired by Giorgi’s phenomenological method. Results The results revealed that the patients’ experiences of the recovery process fell into three main themes: “Feeling vulnerable”, “A span between self-reliance and dependency” and “Disruption from a normal life”. The feeling of gloominess and vulnerability persisted throughout. Being in recovery was also experienced as a tension between self-reliance and dependency; a disrupted life where loss of mobility and the impact of age was profoundly present. Conclusion Being in recovery after hip fracture was experienced as a life breaking event. Based on these findings, increased focus on individualized treatment to each patient through each stage of the recovery process should be emphasized.

To explore the psychometric properties of the full 22-item English (UK and US) version of the Zarit Caregiver Burden Interview administered to caregivers to patients with Duchenne muscular dystrophy.Caregivers to patients with Duchenne muscular dystrophy from the United Kingdom and the United States, recruited through the TREAT-NMD network, completed the Zarit Caregiver Burden Interview online. The psychometric properties of the Zarit Caregiver Burden Interview were examined using Rasch analysis.A total of 475 caregivers completed the Zarit Caregiver Burden Interview. Model misfit was identified for 9 of 22 items (mean item fit residual 0.061, SD: 2.736) and 13 of 22 items displayed disordered thresholds. The overall item-trait interaction chi-square value was 499 (198 degrees of freedom, p 0.001). The mean person fit residual was estimated at -0.213 (SD: 1.235). The Person Separation Index and Cronbach's α were estimated at 0.902 and 0.914, respectively. Item dependency was low and we found no significant differential item functioning by country or sex.Our Rasch analysis shows that the Zarit Caregiver Burden Interview fails to fully operationalize a quantitative conceptualization of caregiver burden among caregivers to patients with Duchenne muscular dystrophy from the United Kingdom and the United States. Further research is needed to understand the psychometric properties of the Zarit Caregiver Burden Interview in other populations and settings. Implications for Rehabilitation Duchenne muscular dystrophy is a terminal disease characterized by progressive muscle degeneration resulting in substantial disability and a significant burden on family caregivers. The Zarit Caregiver Burden Interview is one of the most widely applied measures of caregiver burden. Our Rasch analysis suggests that the Zarit Caregiver Burden Interview is not fit for purpose to measure burden in UK and US caregivers to patients with Duchenne muscular dystrophy. Clinicians and decision-makers should interpret Zarit Caregiver Burden Interview data from these populations with caution.

This section features original work on pathographies—i.e., (auto)biographical accounts of disease, illness, and disability—that provide narrative inquiry relating to the personal, existential, psychological, social, cultural, spiritual, political, and moral meanings of individual experience. Editors are: Nathan Carlin and Therese Jones. For submissions, contact Nathan Carlin at: Nathan.Carlin@uth.tmc.edu.

There is substantial evidence that personality traits, such as self-criticism and dependency, predict the development of depression and anxiety symptoms, as well as depressive episodes. However, it is unknown whether self-criticism and dependency predict the first onset of depressive and anxiety disorders, and unclear how to characterize dynamic mechanisms by which these traits, stressful life events, and psychopathology influence one another over time. In this study, 550 female adolescents were assessed at baseline, 528 and 513 of whom were assessed again at Waves 2 and 3, respectively, over the course of 18 months. Self-criticism and dependency were assessed with self-report inventories, depressive and anxiety disorders were assessed with diagnostic interviews, and stressful life events were assessed via semistructured interview. Logistic regression analyses showed that self-criticism and dependency significantly predicted the first onset of nearly all depressive and anxiety disorders (significant polychoric rs ranged from .15-.42). Subsequent path analyses focused on prediction of depression, and supported several conceptual models of personality-stress-psychopathology relationships. In particular, Personality × Stress interactions were evident for both dependency and self-criticism. These interactions took the form of dual vulnerability, such that stressful life events predicted an increased probability of a later depressive disorder only at low levels of each trait. Results suggest the traits of self-criticism and dependency are important to consider in understanding who is at risk for depressive and anxiety disorders. (PsycINFO Database Record

Purpose The purpose of the study was to examine the psychometric properties of the Persian version of the Care Dependency Scale (CDS) in nursing homes. Design Instrument development. Methods The English version of the CDS was translated into Persian. A convenient sample of 140 (100 older people without dementia and 40 patients with dementia) Persian speaking people were selected from the nursing homes in Ahvaz, Iran. Cronbach's alpha, discriminant validity, and construct validity (exploratory factor analysis) were examined. Findings Exploratory factor analysis indicated that the CDS has two factors, including psycho-social and somatic factors. Discriminant validity showed that the CDS can differentiate patients with dementia from the older adults without dementia. Conclusions The results of the study showed that the Persian CDS is a reliable and valid scale when used in nursing homes. Clinical Relevance The Persian version of the CDS can help clinicians and nurses to assess patients’ need and the degree of care dependency among older adults in Persian-speaking areas.

What causes some marriages to stand the test of time while others fail? Marital commitment is the key force underlying the stability, quality, and longevity of the romantic relationship. Commitment is strengthened in the presence of marital satisfaction, the absence of alternative attractions, and steady investments made in the relationship. Commitment is also a consequence of increasing dependence. When partners are emotionally engaged with their virtual connections, their dependence on the significant other decreases. On the contrary, dependence on the partner increases when people feel satisfied with their relationship, think unfavorably about the quality of available alternatives, and feel that they have made great investments in their relationship. Technological advancements of the present era have spawned a wide array of social networking sites (SNSs) that display boastfully curated profiles of virtual connections. These overly glossed profiles may lead social media users to feel deficient in their lives. Previous research has shown that Facebook use can reduce relationship satisfaction by providing potential romantic alternatives and deflecting time and emotional investments away from the committed relationship. This article examines the commitment literature and discusses how commitment is undermined in the contemporary era. Finally, marital therapy is addressed with suggestions for future areas of exploration.

Betrayal trauma theory proposes a relation between intimate partner violence (IPV) and dissociation, suggesting that dissociation among victims of IPV may function to restrict awareness of abuse in order to preserve attachments perceived as vital. We investigated two factors that may moderate the relation between IPV and dissociation-childhood sexual abuse (CSA) severity and fear of abandonment-among 348 women currently in a relationship. The relation between frequency of IPV (sexual and physical) and dissociation (amnesia and depersonalization) was moderated by CSA severity and fear of abandonment. Specifically, among women with clinically relevant fear of abandonment, the strength of the relation between IPV and dissociation became stronger as CSA severity increased. This study is the first to demonstrate the moderating roles of fear of abandonment and CSA history in the relation between IPV and dissociation among women. Findings suggest that it may be important to target fear of abandonment in interventions with IPV victims who have a CSA history. Results suggest that fear of abandonment warrants greater attention in research on IPV revictimization.

Objectiveto profile the trajectory of, and risk factors for, functional decline in older patients in the 30 days following Emergency Department (ED) discharge.Methodsprospective cohort study of community-dwelling patients aged ≥65 years, discharged home from a metropolitan Melbourne ED, 31 July 2012 to 30 November 2013. The primary outcome was functional decline, comprising either increased dependency in personal activities of daily living (ADL) or in skills required for living independently instrumental ADL (IADL), deterioration in cognitive function, nursing home admission or death. Univariate analyses were used to select risk factors and logistic regression models constructed to predict functional decline.Resultsat 30 days, 34.4% experienced functional decline; with 16.7% becoming more dependent in personal ADL, 17.5% more dependant in IADL and 18.4% suffering deterioration in cognitive function. Factors independently associated with decline were functional impairment prior to the visit in personal ADL (Odds Ratio [OR] 3.21, 95% confidence interval [CI] 2.26–4.53) or in IADL (OR 6.69, 95% CI 4.31–10.38). The relative odds were less for patients with moderately impaired cognition relative to those with normal cognition (OR 0.38, 95% CI 0.19–0.75). There was a 68% decline in the relative odds of functional decline for those with any impairment in IADL who used an aid for mobility (OR 0.32, 95% CI 0.14–0.7).Conclusionolder people with pre-existing ADL impairment were at high risk of functional decline in the 30 days following ED presentation. This effect was largely mitigated for those who used a mobility aid. Early intervention with functional assessments and appropriate implementation of support services and mobility aids could reduce functional decline after discharge.

Independence was a core value of the movement for disability rights. People with disabilities did not have to be dependent, advocates claimed; they were robbed of autonomy by poverty, social prejudice, and architectural barriers. Recently, critics have noted that the emphasis on independence equates personhood with autonomy, reason, and self-awareness, thereby excluding those who are incapable of self-determination. The stigma of dependency is communicated to caregivers whose work is devalued and undercompensated. These values are echoed in the life writing of people with disabilities, which tends to present a singular narrative voice, even when the author requires assistance in the physical or intellectual work of composition. The 1979 Mexican memoir-testimonio Gaby Brimmer, collaboratively authored by the acclaimed journalist Elena Poniatowska, Brimmer, her mother, and her paid caregiver is a notable exception. Consisting of interwoven dialogue among its three informants, Gaby Brimmer enacts dependency at the level of form, while exploring the challenges and opportunities of interdependence in societies that devalue the giving and receiving of care.

When it comes to old age, we are witnessing almost revolutionary changes at the present time. After decades of ignorance and lack of public interest, old age has fundamentally been re-negotiated. A diverse range of authors have diagnosed the growing bifurcation of old age into a rather independent and capable Third Age and a deep old Fourth Age that is characterized by sickness, frailty and dependency. Against this backdrop, many gerontologists claim that the so-called young-old are praised and valued for their (ongoing) "sameness" in terms of midlife-norms and capabilities, whereas the oldest old are increasingly excluded from humanity by radical "othering". Taking up this diagnosis, the article elaborates on this growing polarization within later life: Based on empirical research on the re-negotiation of old age in Germany, this contribution argues that the juxtaposition of "sameness" and "otherness" obscures the true character of the polarization, particularly with regard to the social role of the Third Age. Instead of sameness and otherness, we rather witness different processes of othering, with the young-old being valued as the other and the oldest old being disdained as the other. Despite the existence of profound critical analyses of the abjection associated with the Fourth Age as well as a considerable amount of literature on old age activation and the new role of the young-old, the specific point of this article's concern-the othering of the Third Age-has been completely neglected. The article discusses the reasons for this gap in more detail and will indicate to what extent concepts from Postcolonial Studies may help us to understand the dual process of othering-glorification and abjection.

The rapid ageing of populations around the world and the associated shift in the burden of disease from infectious to chronic conditions are creating complex challenges for national governments. Addressing the needs of these older populations in a sustainable and equitable way, will be a fundamental pillar of socioeconomic development in the 21st Century. The World Health Organization (WHO) Global strategy and action plan on ageing and health, which was adopted by all the Organization's 194 Member states in 2016, provides a clear framework for global action. One critical priority is to establish sustainable and equitable long-term care systems in every country. WHO defines long-term care as "the activities undertaken by others to ensure that people with, or at risk of, a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity". These activities include both social care and health care, as well as contributions from other sectors, such as education or transport. And these activities need to be effectively coordinated if they are to efficiently, equitably and sustainably meet the needs of older people. This requires the stewardship of governments to ensure that: care is accessible and affordable; the rights of older people to lives of meaning and dignity are upheld regardless of their physical or mental capacity; services are oriented around the individual's specific needs; caregivers are supported; the workforce (both paid and unpaid) are treated fairly; and older people's intrinsic capacity is maintained for as long as possible. WHO has proposed three inter-related strategies to establish and sustain long-term care systems. System infrastructure needs to be developed and continually improved. The capacity of the workforce needs to be strengthened and families and communities must be supported. And the care and support provided needs to be more person-centred and integrated, underpinned by minimum standards and accreditation for care providers. This paper outlines some of the critical issues confronting governments in countries at all levels of development if this ambitious vision is to be achieved.