Psychological Interventions for Dementia Caregivers:What We Have Achieved, What We Have Learned

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver’s ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts have received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined

Time domain simulation of electromagnetic cloaking structures with TLM method

This paper was published in Optic Express and is made available as an electronic reprint with the permission of OSA. The paper can be found at the following URL on the OSA website: http://dx.doi.org/10.1364/OE.16.006461The increasing interest in invisible cloaks has been prompted in part by the availability of powerful computational resources which permit numerical studies of such a phenomenon. These are usually carried out with commercial software. We report here a full time domain simulation of cloaking structures with the Transmission Line Modeling (TLM) method. We first develop a new condensed TLM node to model metamaterials in two dimensional situations; various results are then presented, with special emphasis on what is not easily achievable using commercial software.This work has been supported in part by the “Ministerio de Educación y Ciencia” of Spain under research projects No. FIS2004-03273 and FIS2007-63293 cofinanced with FEDER funds of the European Union

Telephone-based behavioral activation intervention for dementia family caregivers: Outcomes and mediation effect of a randomized controlled trial

Objectives:  The study examined the effects of a telephone-administered psycho-education with behavioral activation intervention (TBA) for family caregivers of person’s with Alzheimer’s dementia to reduce levels of depressive symptoms and burden and to enhance relationship satisfaction with the care-recipient Methods:  A double-blinded randomized trial compared TBA with telephone-based psycho-education with general monitoring (TGM). Ninety-six dementia caregivers were randomized. Both conditions received four weekly psycho-education sessions led by a social worker. TBA participants then received eight bi-weekly behavioral activation practice sessions delivered by paraprofessionals. TGM participants received eight bi-weekly monitoring sessions by paraprofessionals. Results:  As compared to TGM, TBA participants reported significantly larger reductions in depressive symptoms and burden and larger improvement in relationship satisfaction. Self-efficacy for controlling upsetting thoughts was found to have a partial meditation effect between TBA and the reduction of depressive symptoms. Qualitative feedback suggested that TBA participants expressed unique gains in awareness and developing new ways of reappraising the caregiving situation. Conclusion:  TBA was an effective intervention to reduce depressive symptoms and burden as well as to enhance relationship satisfaction in dementia caregivers

A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats

Lymphatic filariasis and onchocerciasis are neglected tropical diseases (NTDs) targeted for elimination by mass (antifilarial) drug administration. These drugs are predominantly active against the microfilarial progeny of adult worms. New drugs or combinations are needed to improve patient therapy and to enhance the effectiveness of interventions in persistent hotspots of transmission. Several therapies and regimens are currently in (pre-)clinical testing. Clinical trial simulators (CTSs) project patient outcomes to inform the design of clinical trials but have not been widely applied to NTDs, where their resource-saving payoffs could be highly beneficial. We demonstrate the utility of CTSs using our individual-based onchocerciasis transmission model (EPIONCHO-IBM) that projects trial outcomes of a hypothetical macrofilaricidal drug. We identify key design decisions that influence the power of clinical trials, including participant eligibility criteria and post-treatment follow-up times for measuring infection indicators. We discuss how CTSs help to inform target product profiles

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Validating the Revised Scale for Caregiving Self-Efficacy: A Cross-National Review

Background and Objectives This article reviews an instrument used in cross-national research with dementia family caregivers—the Revised Scale for Caregiving Self-Efficacy (RSCSE). Although the RSCSE has been translated into multiple languages, few studies have examined scale performance across samples. We examine congruence of psychometric, reliability, and validity data to inform research and practice. Methods We conducted citation searches using Scopus, Google Scholar, Web of Science, and PsycINFO. Identified dementia caregiving studies cited the original RSCSE article and described results of English and/or non-English translations of the scale. Results Peer-reviewed published studies (N = 58) of dementia family caregivers included data for Arabic, Chinese, English, French, Italian, and Spanish translations of the RSCSE; the majority (72%) reported use of non-English translations. Studies utilizing confirmatory factor analytic approaches reported findings consistent with the original development study. Internal consistency, convergent/discriminant validity, and criterion validity indices were congruent across diverse cross-national caregiving samples assessed with different translations. Data supported the RSCSE’s sensitivity to change following specific psychosocial caregiving interventions. Discussion The reliability and validity of different translations of the RSCSE support continued use with cross-national samples of dementia family caregivers. Limitations of the scale point to the need for further self-efficacy measurement development within caregiving domains. Consistent with Bandura’s discussion of social cognitive theory in cultural contexts, personal agency for caregiving challenges remains generalizable to cross-national populations. This review discusses the implications for cross-cultural research and practice.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEpu

Cien días vistos por CINEP/PPP (no. 69 may 2010). Tema: Elecciones 2010

La edición virtual número 69 de la revista Cien Días vistos por CINEP/PPP presenta a sus lectores un análisis de las propuestas de los candidatos a la presidencia en materia de salud, seguridad, economía y justicia desde la identificación de los aciertos, pero ante todo los errores del actual Gobierno y los retos para el entrante. A su vez, las elecciones legislativas son analizadas desde la lupa de la distribución de las fuerzas políticas en el Congreso, la reforma de 2003, la vinculación de algunos congresistas al paramilitarismo, la nacionalización de los partidos y la representación de las organizaciones sindicales. También se evidencia la corrupción en esas elecciones y la posibilidad o no de que se pueda dar un fraude en las presidenciales. Encuentre además: un estudio sobre el permanente conflicto entre el gobierno Uribe y Chávez, desde la perspectiva venezolana, y un análisis sobre cómo, aparentemente, el Estado de opinión instaurado en la era Uribe, tan ajeno y contrapuesto a la academia, parece estarse disolviendo para dar paso al voto de opinión.I. Editorial Un respiro democrático Por Mauricio García Durán S.J II. Seguridad El embrujo del mago o Uribe en cuerpo ajeno Por Teófilo Vásquez Los límites de la seguridad democrática Por Diego Quiroga III. Justicia La justa Cenicienta Por Camilo Borrero IV. Derechos Humanos Los derechos humanos en la era Uribe Vélez Por el equipo del Banco de Datos de Derechos Humanos y Violencia Política del CINEP/PPP V. Economía ¿Le llegó la hora al empleo? Por Lucía Camargo Rojas VI. Salud La salud en el debate electoral Por Luis Alejandro Delgado y Natalia Paredes VII. Internacional Colombia y Venezuela. Un conflicto binacional de carácter irregular Por Alfredo Infante Silvera S.J VIII. Política Del Estado de opinión al voto de opinión Por Ana María Restrepo Un análisis de las elecciones legislativas Por Maria Clara Torres ¿Perdió el voto amarrado? Por Álvaro Delgado Nacionalización de los partidos políticos y democracia en Colombia Por Andrés Yepes y Víctor Barrera "Por primera vez observamos unas elecciones en las que no hay un favorito": MOE Por Lucía Camargo Roja