Existential behavioral therapy for informal caregivers of palliative patients: Barriers and promoters of support utilization

AbstractObjective:Several interventions have been developed during recent years to support informal caregivers of palliative patients. However, these trials reported low enrollment rates. Employing a newly developed group intervention, existential behavioral therapy (EBT), one study reported that only 13.6% of approached informal caregivers participated. The purpose of our present study was to identify the reasons for this low enrollment rate in order to improve future support designs.Method:All participants in the EBT trial (intervention vs. standard-care control group) as well as those who declined participation during a 4-month recruitment period were studied prospectively over 12 months. Andersen's behavioral model of healthcare service use was employed to identify group differences between acceptors and decliners: predisposing (age, gender, education, family status, relationship), enabling (social support, distance to hospital, caring vs. bereaved), and need factors (psychological distress, quality of life) were evaluated in a binary-logistic model.Results:Some 94 decliners were compared to 160 EBT participants (n = 81 intervention, n = 79 control). Caregivers who took part were significantly more distressed and suffered from a lower quality of life compared to decliners. Not only these need factors but also predisposing (age &lt;55 years) and enabling (use of social/professional support, familiarity with caregiving institution) factors were associated with EBT utilization. At the 12-month follow-up, EBT intervention participants reported greater quality of life improvements than decliners or controls (p = 0.05). While all groups had mean anxiety scores below the cutoff at 12-month follow-up, decliners showed better improvement in anxiety compared to EBT participants (intervention p = 0.04, controls p = 0.03).Significance of results:On average, decliners are less burdened: they may be more resilient, may have better coping strategies, or already have a sufficient support network in place. Screening caregivers with regard to their experienced quality of life and targeting those in need, especially younger caregivers with low levels of quality of life, may help to allocate resources more appropriately.</jats:sec

Individual meaning in life assessed with the Schedule for Meaning in Life Evaluation: toward a circumplex meaning model

AbstractObjective:The experience of “meaning in life” (MiL) is a major aspect of life satisfaction and psychological well-being. To assess this highly individual construct, idiographic measures with open-response formats have been developed. However, it can be challenging to categorize these individual experiences for interindividual comparisons. Our study aimed to derive MiL categories from individual listings and develop an integrative MiL model.Method:University students were asked to rate 58 MiL providing aspects recently found in a nationwide study using the Schedule for Meaning in Life Evaluation (SMiLE), an MiL instrument allowing for open responses. Pearson's correlations and factor analyses were used to test the unidimensionality of subsequently derived higher-order MiL categories. Multidimensional scaling, cluster analysis, and factor analysis were performed to further analyze a latent MiL structure.Results:A total of 340 students participated in the study. Some 11 unidimensional categories consisting of 34 meaning-providing aspects were summarized into a circumplex model with four MiL domains: leisure/health, work/finances, culture/spirituality, and relationships (family, partnership, social relations).Significance of results:This model seems to incorporate a major portion of individual respondent-generated MiL listings. It may be useful for future idiographic MiL studies to help organize individual experiences of MiL and allow for higher-level interindividual comparisons. Further studies including different samples are necessary to confirm this model or derive other MiL domains, for example, in palliative care patients or patients who are confronted with a loss of meaning.</jats:sec

Mindfulness in informal caregivers of palliative patients

AbstractObjectives:Mindfulness is a concept of growing impact on psychotherapy and has been shown to be effective for stress reduction and to improve psychological well-being. Existential Behavioural Therapy (EBT) was developed to support relatives of palliative care (PC) patients to cope with their situation during caregiving and bereavement. Mindfulness training was a core element of the intervention.We investigated the relationship between mindfulness, mental distress, and psychological well-being in informal caregivers, and evaluated if the effects of the intervention were mediated by mindfulness.Methods:Relatives of PC inpatients took part in a randomized-controlled EBT trial and completed the Cognitive and Affective Mindfulness Scale-Revised, items from the Five Facets of Mindfulness as well as the Brief Symptom Inventory, the Satisfaction with Life Scale, the WHOQOL-BREF, a numerical rating scale on quality of life (range 0–10), and the Schedule for Meaning in Life Evaluation at pre- and post-intervention, and a 3- and 12-months follow-up.Results:One-hundred-and-thirty carers were included, most of them (71.6%) recently being bereaved at the beginning of the intervention. High correlations between mindfulness and mental distress (r = −0.51, p &lt; 0.001) as well as life satisfaction (r = 0.52, p &lt; 0.001) were found. Mindfulness was a significant predictor of improvement in psychological distress, meaning in life and quality of life three months after the intervention. The EBT effects were partly mediated by mindfulness.Significance of results:Mindfulness seems to be a promising concept in supporting informal caregivers of PC patients. Further research is needed to identify the required format and intensity of mindfulness practice necessary for improvement.</jats:sec

External forcing of earthquake swarms at Alpine regions: example from a seismic meteorological network at Mt. Hochstaufen SE-Bavaria

In the last few years, it has been shown that above-average rainfall and the following diffusion of excess water into subsurface structures is able to trigger earthquake swarms in the uppermost brittle portion of the Earth's crust. However, there is still an ongoing debate on whether the crust already needs to be in a critical-to-failure state or whether it is sufficient that water is transported rapidly within channels and veins of karst or similar geological formations to the underlying, earthquake-generating layers. Also unknown is the role of other forcing mechanisms, possible co-variables and probably necessary tectonic loading in the triggering process of earthquakes. Because of these problems, we do not use an explicit physical model but instead analyze the meteorological and geophysical data via sophisticated statistical models. ewline We are interested in the influence of a more complete set of possible forcing parameters, including the influence of synthetic earth tides, on the occurrence of earthquake swarms. In this context, regression models are the adequate tool, since the calculation of simple correlations can be confounded by the other variables. Since our outcome variable (the number of quakes) is a count, we use Poisson regression models that include the plausible assumption of a Poisson distribution for the counts. For this study, we use nearly continuous recordings of a seismic and meteorological network in the years 2002–2008 at Mt. Hochstaufen in SE-Bavaria. Our non-linear regression model reveals correlations between external forces and the triggering of earthquakes. In addition to the still dominant influence of rainfall, theoretical estimated tidal tilt show some weak influence on the swarm generation. However, the influence of the modeled trend functions shows that rain is by far not the most important forcing mechanism present in the data

An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty

Background: In contrast to infection or mechanical issues joint replacement failure following inflammatory adverse reactions is poorly understood. Objective: To assess the association of IL-1β polymorphisms and history of allergy with aseptic non-mechanical complications following arthroplasty. Methods: In 102 patients with aseptic non-mechanically caused symptomatic knee or hip arthroplasty (SA) and 93 patients with asymptomatic arthroplasty (AA) questionnaire-based history, patch test with at least standard series, lymphocyte transformation test (LTT) with nickel, cobalt and chromium and interleukin-1 polymorphism analysis were done. Three polymorphisms of the IL1B gene [IL-1b -3954 (rs1143634), IL-1b -511 (rs16944) and IL-1b -31 (rs1143627)] and one polymorphism of the IL1RN gene [IL1RN intron 2, variable number of tandem repeats, VNTR (rs2234663)] were assessed by PCR and gel electrophoresis. Results: We found no significant difference in smoking history and atopy but 25% versus 10% of self-reported metal allergy in SA versus AA; the patch test (respective, LTT) for metal sensitivity was more often positive in SA patients. The allele 498 bp of the IL1RN polymorphism occurred significantly more often in the SA group (37% versus 11%; p < 0.0001). Upon additional presence of atopy, the difference was even greater (60% vs 10%) (p < 0.000001). There was no association of IL-1 polymorphisms with metal allergy. Conclusion: The IL1RN VNTR allele 498 bp was strongly associated with SA. In patients with a history of atopy, presence of the IL1RN VNTR allele 498 bp led to a four-fold higher SA prevalence compared to patients without this allele

A reward self-bias leads to more optimal foraging for ourselves than others

People are self-biased for rewards. We place a higher value on rewards if we receive them than if other people do. However, existing work has ignored one of the most powerful theorems from behavioural ecology of how animals seek resources in everyday life, the Marginal Value Theorem (MVT), which accounts for optimal behaviour for maximising resources intake rate. Does this self-bias help humans maximise rewards when foraging for their own benefit compared to foraging for the benefit of others? Participants had to decide when to leave patches where reward intake was gradually depleting, in environments with different average reward rates. Half of the time participants foraged for themselves, and in the other half they collected rewards for an anonymous stranger. The optimal MVT derived solution states people should leave when the instantaneous reward intake in a patch equals the average rate in an environment. Across two studies, people were more optimal when foraging for self, showing a reduced sensitivity to instantaneous rewards when foraging for other. Autistic traits were linked to reduced sensitivity to reward rates when foraging for self but not for other. These results highlight that the self-bias may be adaptive, helping people maximise reward intake