The end of life: informal care for dying older people and its relationship to place of death

Objective: This study examined the features of informal end-of-life care of older people living in the community and the association between informal care characteristics and dying at home. Methods: Retrospective data were obtained from interviews and self-administered questionnaires of 56 persons who had been primary caregivers of older relatives in the last three months of their lives. Results: Results showed that informal caregivers of terminally ill older people living in the community provided a considerable amount of personal, household, and management care. Secondary informal caregivers and formal caregivers assisted resident primary caregivers less often than nonresident primary caregivers. Primary caregivers who felt less burdened, who gave personal care more intensively, and/or who were assisted by secondary caregivers, were more likely to provide informal end-of-life care at home until the time of death. Conclusions: Our study showed that informal care at the end of life of older people living in the community is complex, since the care required is considerable and highly varied, and involves assistance from secondary informal caregivers, formal home caregivers as well as institutional care. Burden of informal care is one of the most important factors associated with home death. More attention is needed to help ease the burden on informal caregivers, specifically with regard to resident caregivers and spouses. Since these resident caregivers were disadvantaged in several respects (i.e., health, income, assistance from other carers) compared to nonresident caregivers, interventions by formal caregivers should also be directed towards these persons, enabling them to bear the burden of end-of-life care. © Arnold 2004

Investigation of heavy metal pollution in eastern Aegean Sea coastal waters by using Cystoseira barbata, Patella caerulea, and Liza aurata as biological indicators

In order to have an extensive contamination profile of heavy metal levels (Cd, Cu, Fe, Mn, Ni, Pb, and Zn), seawater, sediment, Patella caerulea, Cystoseira barbata, and Liza aurata were investigated by using inductively coupled plasma-atomic emission spectrometry (ICP-AES). Samples were collected from five coastal stations along the eastern Aegean Sea coast (Turkey) on a monthly basis from July 2002 through May 2003. According to the results of this study, heavy metal levels were arranged in the following sequence: Fe > Pb > Zn > Mn > Ni > Cu > Cd for water, Fe > Cu > Mn > Ni > Zn > Pb > Cd for sediment, Fe > Zn > Mn > Pb > Ni > Cd > Cu for C. barbata, Fe > Zn > Mn > Ni > Pb > Cu > Cd for P. caerulea, and Fe > Zn > Mn > Cu > Ni > Pb > Cd for L. aurata. Moreover, positive relationships between Fe in water and Mn in water, Fe in sediment and Mn in sediment, Fe in C. barbata and Mn in C. barbata, Fe in P. caerulea and Mn in P. caerulea, and Fe in L. aurata and Mn in L. aurata may suggest that these metals could be originated from the same anthropogenic source. C. barbata represented with higher bioconcentration factor (BCF) values, especially for Fe, Mn, and Zn values. This observation may support that C. barbata can be used as an indicator species for the determinations of Fe, Mn, and Zn levels. Regarding Turkish Food Codex Regulation's residue limits, metal values in L. aurata were found to be lower than the maximum-permissible levels issued by Turkish legislation and also the recommended limits set by FAO/WHO guidelines. The results of the investigation indicated that P. caerulea, L. aurata, and especially C. barbata are quantitative water-quality bioindicators and biomonitoring subjects for biologically available metal accumulation for Aegean Sea coastal waters

Fatigue as a symptom or comorbidity of neurological diseases

Fatigue, best described as an overwhelming feeling of tiredness and exhaustion, occurs in the context of various neurological diseases. The high prevalence of fatigue as either a symptom or a comorbidity of neurological disease must be taken seriously, as fatigue interferes with patients' activities of daily living, has a remarkable negative impact on quality of life, and is a major reason for early retirement. The tremendous consequences of fatigue are consistent across neurological diseases, as is the uncertainty concerning its underlying pathophysiological mechanisms. Inconsistencies in defining fatigue contribute to the present situation, in which fatigue represents one of the least-studied and least- understood conditions. Tools for assessing fatigue abound, but few can be recommended for clinical or research use. To make matters worse, evidence-based pharmacological treatment options are scarce. However, non-pharmacological approaches are currently promising and likely to become of increasing importance. In sum, fatigue is challenging for both health-care professionals and patients. The present article aims to provide a comprehensive review of the literature on fatigue in neurological disease, and to reveal its complexity, as well as weaknesses in the concept of fatigue itself