Barriers to mental health service use among distressed family caregivers of lung cancer patients

Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services. This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients. Caregivers had not received mental health services during the patient's initial months of care at a comprehensive cancer centre in New York City. Thematic analysis of interview data was framed by Andersen's model of health service use and Corrigan's stigma theory. Results of our analysis expand Andersen's model by providing a description of need variables (e.g. psychiatric symptoms), enabling factors (e.g. finances), and psychosocial factors associated with caregivers' non-use of mental health services. Regarding psychosocial factors, caregivers expressed negative perceptions of mental health professionals and a desire for independent management of emotional concerns. Additionally, caregivers perceived a conflict between mental health service use and the caregiving role (e.g. prioritising the patient's needs). Although caregivers denied stigma associated with service use, their anticipated negative self-perceptions if they were to use services suggest that stigma may have influenced their decision to not seek services. Findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers

Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

<p>Abstract</p> <p>Background</p> <p>Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy.</p> <p>Methods/Design</p> <p>We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA) alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care.</p> <p>Discussion</p> <p>Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of chemotherapy without substantially increasing the cost of care.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00983892">NCT00983892</a></p

Spontaneous symmetry breaking: exact results for a biased random walk model of an exclusion process

It has been recently suggested that a totally asymmetric exclusion process with two species on an open chain could exhibit spontaneous symmetry breaking in some range of the parameters defining its dynamics. The symmetry breaking is manifested by the existence of a phase in which the densities of the two species are not equal. In order to provide a more rigorous basis to these observations we consider the limit of the process when the rate at which particles leave the system goes to zero. In this limit the process reduces to a biased random walk in the positive quarter plane, with specific boundary conditions. The stationary probability measure of the position of the walker in the plane is shown to be concentrated around two symmetrically located points, one on each axis, corresponding to the fact that the system is typically in one of the two states of broken symmetry in the exclusion process. We compute the average time for the walker to traverse the quarter plane from one axis to the other, which corresponds to the average time separating two flips between states of broken symmetry in the exclusion process. This time is shown to diverge exponentially with the size of the chain.Comment: 42 page

Wage losses in the year after breast cancer: Extent and determinants among Canadian women

This article is available open access through the publisher’s website at the link below. © The Author 2008.Background - Wage losses after breast cancer may result in considerable financial burden. Their assessment is made more urgent because more women now participate in the workforce and because breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated wage losses, their determinants, and the associations between wage losses and changes for the worse in the family's financial situation among Canadian women over the first 12 months after diagnosis of early breast cancer. Methods - We conducted a prospective cohort study among women with breast cancer from eight hospitals throughout the province of Quebec. Information that permitted the calculation of wage losses and information on potential determinants of wage losses were collected by three pretested telephone interviews conducted over the year following the start of treatment. Information on medical characteristics was obtained from medical records. The main outcome was the proportion of annual wages lost because of breast cancer. Multivariable analysis of variance using the general linear model was used to identify personal, medical, and employment characteristics associated with the proportion of wages lost. All statistical tests were two-sided. Results - Among 962 eligible breast cancer patients, 800 completed all three interviews. Of these, 459 had a paying job during the month before diagnosis. On average, these working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Multivariable analysis showed that a higher percentage of lost wages was statistically significantly associated with a lower level of education (Ptrend = .0018), living 50 km or more from the hospital where surgery was performed (P = .070), lower social support (P = .012), having invasive disease (P = .086), receipt of chemotherapy (P < .001), self-employment (P < .001), shorter tenure in the job (Ptrend < .001), and part-time work (P < .001). Conclusion - Wage losses and their effects on financial situation constitute an important adverse consequence of breast cancer in Canada.The Canadian Breast Cancer Research Alliance, Canadian Institutes of Health Research, and Fondation de l’Université Laval

Randomly Evolving Idiotypic Networks: Structural Properties and Architecture

We consider a minimalistic dynamic model of the idiotypic network of B-lymphocytes. A network node represents a population of B-lymphocytes of the same specificity (idiotype), which is encoded by a bitstring. The links of the network connect nodes with complementary and nearly complementary bitstrings, allowing for a few mismatches. A node is occupied if a lymphocyte clone of the corresponding idiotype exists, otherwise it is empty. There is a continuous influx of new B-lymphocytes of random idiotype from the bone marrow. B-lymphocytes are stimulated by cross-linking their receptors with complementary structures. If there are too many complementary structures, steric hindrance prevents cross-linking. Stimulated cells proliferate and secrete antibodies of the same idiotype as their receptors, unstimulated lymphocytes die. Depending on few parameters, the autonomous system evolves randomly towards patterns of highly organized architecture, where the nodes can be classified into groups according to their statistical properties. We observe and describe analytically the building principles of these patterns, which allow to calculate number and size of the node groups and the number of links between them. The architecture of all patterns observed so far in simulations can be explained this way. A tool for real-time pattern identification is proposed.Comment: 19 pages, 15 figures, 4 table

Cluster Monte Carlo study of multi-component fluids of the Stillinger-Helfand and Widom-Rowlinson type

Phase transitions of fluid mixtures of the type introduced by Stillinger and Helfand are studied using a continuum version of the invaded cluster algorithm. Particles of the same species do not interact, but particles of different types interact with each other via a repulsive potential. Examples of interactions include the Gaussian molecule potential and a repulsive step potential. Accurate values of the critical density, fugacity and magnetic exponent are found in two and three dimensions for the two-species model. The effect of varying the number of species and of introducing quenched impurities is also investigated. In all the cases studied, mixtures of $q$-species are found to have properties similar to $q$-state Potts models.Comment: 25 pages, 5 figure

Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography

BACKGROUND: Spontaneous carotid artery dissections have been rarely reported in children. Diagnosis has traditionally been confirmed by catheter arteriography. More recently diagnosis has been made by magnetic resonance imaging and magnetic resonance angiography; however the sensitivity of these techniques has yet to be determined. The authors are unaware of reports of carotid dissection confirmed by dynamic computed tomography (computerized tomographic arteriography) in the young. CASE PRESENTATION: We recently evaluated a fourteen year-old male following the development of transient neurologic symptoms. There was no antecedent illness or trauma. Dynamic computed tomography revealed an intracranial dissection involving the supraclinoid segment of the left internal carotid artery (confirmed by catheter arteriography). Studies for vasculitis, pro-thrombotic states, and defects of collagen were negative. CONCLUSION: Spontaneous carotid artery dissection is a potential cause of transient neurological symptoms and ischemic stroke in the pediatric population. Dynamic computed tomography appears to be a reliable diagnostic tool which can lead to early diagnosis

Self-Reported Health-Promoting Behaviors of Black and White Caregivers

The purpose of this study was to describe the behaviors that caregivers report carrying out to maintain their own health, and to compare the health-promoting behaviors of Black and White caregivers. Although many studies have examined health-promoting behaviors, few have examined health promotion among caregivers. Reported studies of caregivers’ health-promoting behaviors have not compared cultural groups. The sample for this study was selected by random digit dialing, and included 136 Black and 257 White caregivers of frail elders. Content analysis of respondents’ answers to the open-ended question, “In general, what do you do to stay healthy?” was used to address the research questions. Most caregivers reported specific behaviors they engaged in for the purpose of staying healthy. Although most of their behaviors addressed physical health, caregivers also mentioned behaviors that contribute to mental and spiritual health. Both differences and similarities were found in Black and White caregivers’ self-reported health behaviors, which have important implications for nursing practice and research in the future.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69087/2/10.1177_01939459922044027.pd

Uplifting and Inflation with D3 Branes

Back-reaction effects can modify the dynamics of mobile D3 branes moving within type IIB vacua, in a way which has recently become calculable. We identify some of the ways these effects can alter inflationary scenarios, with the following three results: (1) By examining how the forces on the brane due to moduli-stabilizing interactions modify the angular motion of D3 branes moving in Klebanov-Strassler type throats, we show how previous slow-roll analyses can remain unchanged for some brane trajectories, while being modified for other trajectories. These forces cause the D3 brane to sink to the bottom of the throat except in a narrow region close to the D7 brane, and do not ameliorate the \eta-problem of slow roll inflation in these throats; (2) We argue that a recently-proposed back-reaction on the dilaton field can be used to provide an alternative way of uplifting these compactifications to Minkowski or De Sitter vacua, without the need for a supersymmetry-breaking anti-D3 brane; and (3) by including also the D-term forces which arise when supersymmetry-breaking fluxes are included on D7 branes we identify the 4D supergravity interactions which capture the dynamics of D3 motion in D3/D7 inflationary scenarios. The form of these potentials sheds some light on recent discussions of how symmetries constrain D term interactions in the low-energy theory.Comment: JHEP.cls, 35 pages, 3 .eps figure