Does a Family Meetings Intervention Prevent Depression and Anxiety in Family Caregivers of Dementia Patients? A Randomized Trial

Family caregivers of dementia patients are at increased risk of developing depression or anxiety. A multi-component program designed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers. However, the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated. This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients.A randomized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients. Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline. Participants were randomized to the family meetings intervention (n = 96) or usual care (n = 96) condition. The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year. Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms (primary outcomes), caregiver burden and quality of life (secondary outcomes). Intention-to-treat as well as per protocol analyses were performed.A substantial number of caregivers (72/192) developed a depressive or anxiety disorder within 12 months. The intervention was not superior to usual care either in reducing the risk of disorder onset (adjusted IRR 0.98; 95% CI 0.69 to 1.38) or in reducing depressive (randomization-by-time interaction coefficient = -1.40; 95% CI -3.91 to 1.10) or anxiety symptoms (randomization-by-time interaction coefficient = -0.55; 95% CI -1.59 to 0.49). The intervention did not reduce caregiver burden or their health related quality of life.This study did not demonstrate preventive effects of family meetings on the mental health of family caregivers. Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose, when applied for therapeutic purposes or targeted towards subgroups of caregivers.Controlled-Trials.com ISRCTN90163486

Identifying work ability promoting factors for home care aides and assistant nurses

<p>Abstract</p> <p>Background</p> <p>In workplace health promotion, all potential resources needs to be taken into consideration, not only factors relating to the absence of injury and the physical health of the workers, but also psychological aspects. A dynamic balance between the resources of the individual employees and the demands of work is an important prerequisite. In the home care services, there is a noticeable trend towards increased psychosocial strain on employees at work. There are a high frequency of work-related musculoskeletal disorders and injuries, and a low prevalence of sustainable work ability. The aim of this research was to identify factors promoting work ability and self-efficacy in care aides and assistant nurses within home care services.</p> <p>Methods</p> <p>This study is based on cross-sectional data collected in a municipality in northern Sweden. Care aides (n = 58) and assistant nurses (n = 79) replied to a self-administered questionnaire (response rate 46%). Hierarchical multiple regression analyses were performed to assess the influence of several independent variables on self-efficacy (model 1) and work ability (model 2) for care aides and assistant nurses separately.</p> <p>Results</p> <p>Perceptions of personal safety, self-efficacy and musculoskeletal wellbeing contributed to work ability for assistant nurses (R²adj of 0.36, <it>p </it>< 0.001), while for care aides, the safety climate, seniority and age contributed to work ability (R²adj of 0.29, <it>p </it>= 0.001). Self-efficacy was associated with the safety climate and the physical demands of the job in both professions (R²adj of 0.24, <it>p </it>= 0.003 for care aides), and also by sex and age for the assistant nurses (R²adj of 0.31, <it>p </it>< 0.001).</p> <p>Conclusions</p> <p>The intermediate factors contributed differently to work ability in the two professions. Self-efficacy, personal safety and musculoskeletal wellbeing were important for the assistant nurses, while the work ability of the care aides was associated with the safety climate, but also with the non-changeable factors age and seniority. All these factors are important to acknowledge in practice and in further research. Proactive workplace interventions need to focus on potentially modifiable factors such as self-efficacy, safety climate, physical job demands and musculoskeletal wellbeing.</p

Immunity Traits in Pigs: Substantial Genetic Variation and Limited Covariation

BACKGROUND: Increasing robustness via improvement of resistance to pathogens is a major selection objective in livestock breeding. As resistance traits are difficult or impossible to measure directly, potential indirect criteria are measures of immune traits (ITs). Our underlying hypothesis is that levels of ITs with no focus on specific pathogens define an individual's immunocompetence and thus predict response to pathogens in general. Since variation in ITs depends on genetic, environmental and probably epigenetic factors, our aim was to estimate the relative importance of genetics. In this report, we present a large genetic survey of innate and adaptive ITs in pig families bred in the same environment. METHODOLOGY/PRINCIPAL FINDINGS: Fifty four ITs were studied on 443 Large White pigs vaccinated against Mycoplasma hyopneumoniae and analyzed by combining a principal component analysis (PCA) and genetic parameter estimation. ITs include specific and non specific antibodies, seric inflammatory proteins, cell subsets by hemogram and flow cytometry, ex vivo production of cytokines (IFNα, TNFα, IL6, IL8, IL12, IFNγ, IL2, IL4, IL10), phagocytosis and lymphocyte proliferation. While six ITs had heritabilities that were weak or not significantly different from zero, 18 and 30 ITs had moderate (0.1<h2≤0.4) or high (h2>0.4) heritability values, respectively. Phenotypic and genetic correlations between ITs were weak except for a few traits that mostly include cell subsets. PCA revealed no cluster of innate or adaptive ITs. CONCLUSIONS/SIGNIFICANCE: Our results demonstrate that variation in many innate and adaptive ITs is genetically controlled in swine, as already reported for a smaller number of traits by other laboratories. A limited redundancy of the traits was also observed confirming the high degree of complementarity between innate and adaptive ITs. Our data provide a genetic framework for choosing ITs to be included as selection criteria in multitrait selection programmes that aim to improve both production and health traits

Dementia Caregiver Burden: A Research Update and Critical Analysis

Purpose of Review: This article provides an updated review of the determinants of caregiver burden and depression, with a focus on care demands and especially the differential effects of various neuropsychiatric symptoms or symptom clusters. Moreover, studies on caregivers for frontotemporal and Lewy body dementias were referred to in order to identify differences and similarities with the mainstream literature based largely on Alzheimer caregivers. Recent Findings: As a group, neuropsychiatric symptoms are most predictive of caregiver burden and depression regardless of dementia diagnosis, but the effects appear to be driven primarily by disruptive behaviors (e.g., agitation, aggression, disinhibition), followed by delusions and mood disturbance. Disruptive behaviors are more disturbing partly because of the adverse impact on the emotional connection between the caregiver and the care-recipient and partly because they exacerbate difficulties in other domains (e.g., caring for activities of daily living). In behavioral variant frontotemporal dementia, not only are these disruptive behaviors more prominent but they are also more disturbing due to the care-recipient’s insensitivity to others’ feelings. In Lewy body dementia, visual hallucinations also appear to be distressing. Summary: The disturbing nature of disruptive behaviors cuts across dementia conditions, but the roles played by symptoms that are unique or particularly serious in a certain condition need to be explored further

Aanbevelingen voor de realisatie van een register Dementiezorg en Ondersteuning.

Vanuit het programma Dementiezorg voor Elkaar1 wordt het Register Dementiezorg en Ondersteuning opgezet (hierna ‘het Register’). Het betreft een integraal, sector overstijgend en toekomstbestendig Register (Rühl, 2016) met gegevens over het gebruik en de kwaliteit van zorg en ondersteuning voor mensen met dementie. Deze notitie is bedoeld om geïnteresseerden te informeren over de aanbevelingen op basis waarvan het Register momenteel wordt opgezet. De aanbevelingen in deze notitie dienen als uitgangspunt voor de projectgroep die vanuit Dementiezorg voor Elkaar verantwoordelijk is voor de opzet van het Register. Het Register dient drie doelen. Ten eerste om regionale dementienetwerken te voorzien van verbeterinformatie met betrekking tot de kwaliteit van zorg en ondersteuning en over het zorggebruik van mensen met dementie en mantelzorgers. Ten tweede dient het Register om ook op landelijk niveau de kwaliteit van zorg en ondersteuning én het zorggebruik van mensen met dementie en mantelzorgers te monitoren. Een derde doel is om gegevens uit het Register beschikbaar te stellen voor onderzoeksdoeleinden. Ten behoeve van deze doelen dienen gegevens zoveel mogelijk uit bestaande gegevensbronnen gehaald en aan elkaar gekoppeld te worden. Het gaat daarbij om gegevens over 1) het gebruik van zorg en ondersteuning door mensen met dementie en mantelzorgers en 2) de kwaliteit van die zorg en ondersteuning. Een wereldwijde overzichtsstudie laat zien dat het opzetten van een Register binnen de dementiezorg veel inspanning vergt (Krysinska e.a., 2013). Onder meer het krijgen van vertrouwen van relevante stakeholders in het nut en de werking van het Register is fundamenteel voor een toekomstbestendig en sector-overstijgend Register. De nu volgende aanbevelingen zijn relevant bij het opzetten van het Register. Deze hebben voornamelijk betrekking op het creëren van vertrouwen en draagvlak bij relevante stakeholders. De aanbevelingen zijn tot stand gekomen op basis van bestaande kennis en ervaringen. Hiervoor zijn schriftelijke bronnen geraadpleegd en zijn gesprekken gevoerd met relevante experts en professionals. (aut. ref.