Følelser i sundhed og sygdom - genbesøgt

Er mennesket grundlæggende styret af fornuft eller følelse? Det ældgamle spørgsmål: Er følelser konstruktive størrelser eller uhensigtsmæssige forstyrrelser i et menneskeliv? Hvordan beriger følelserne vores liv, og spiller de en rolle i vores sundhed og sygdom? . I Jane Austens roman Fornuft og følelse, som finder sted i den engelske overklasse i forrige århundrede, udspilles et drama om betydningen af fornuft og følelse i tilgangen til livet og kærligheden. Dilemmaet mellem fornuft eller følelse illustreres ved at portrættere storesøsteren Elinor Dashwood, som lader sig lede af fornuften og lillesøsteren Marianne Dashwood, som er impulsiv og i sine følelsers vold. I lyset af dette dilemma udspindes en kærlighedshistorie om kvindernes tilgang til livet og deres relationer, og det giver brændstof til handlingen, at netop følelserne enten får overtaget eller bliver behersket og undertrykt.Det grundlæggende spørgsmål om fornuft og følelse har dannet baggrund for dette temanummer, og en række professionelle og forskere med forskellige disciplinære baggrunde belyser med deres bidrag en række dimensioner og aspekter af emotioner eller her benævnt følelser; deres rolle i nutiden og i forhold til individ, relationer, sygdom og samfund

Effect of the Carer Support Needs Assessment Tool intervention (CSNAT-I) in the Danish specialised palliative care setting: a stepped-wedge cluster randomised controlled trial

Background: The Carer Support Needs Assessment Tool intervention (CSNAT-I) has been shown to improve end-of-life care support for informal caregivers. This study investigated the impact of the CSNAT-I on caregivers of patients recently enrolled in specialised palliative care (SPC) at home in Denmark. Methods: A stepped-wedge cluster randomised controlled trial with nine clusters (ie, SPC teams). Outcome measures were collected using caregiver questionnaires at baseline (T0) and 2-week (T1) and 4-week (T2) follow-up. Results: A total of 437 caregivers were enrolled (control group, n=255; intervention group, n=182). No intervention effect was found on the primary outcome, caregiver strain at T1 (p=0.1865). However, positive effects were found at T1 and T2 on attention to caregivers’ well-being (p<0.0001), quality of information and communication (p<0.0001), amount of information (T1: p=0.0002; T2: p<0.0001), involvement (T1: p=0.0045; T2: p<0.0001), talking about greatest burdens (p<0.0001) and assistance in managing greatest burdens (p<0.0001). The effect sizes of these differences were medium or large and seemed to increase from T1 to T2. At T1, positive effects were found on distress (p=0.0178) and home care responsibility (p=0.0024). No effect was found on the remaining outcomes. Conclusion: Although no effect was found on caregiver strain, the CSNAT-I showed positive effects on caregiver distress, home care responsibility and key outcomes regarding caregivers’ experience of the interaction with healthcare professionals. Trial registration number: NCT03466580

Identifying bereaved subjects at risk of complicated grief: Predictive value of questionnaire items in a cohort study

<p>Abstract</p> <p>Background</p> <p>Bereavement is a condition which most people experience several times during their lives. A small but noteworthy proportion of bereaved individuals experience a syndrome of prolonged psychological distress in relation to bereavement. The aim of the study was to develop a clinical tool to identify bereaved individuals who had a prognosis of complicated grief and to propose a model for a screening tool to identify those at risk of complicated grief applicable among bereaved patients in general practice and palliative care.</p> <p>Methods</p> <p>We examined the responses of 276 newly bereaved individuals to a variety of standardised and ad hoc questionnaire items eight weeks post loss. Inventory of Complicated Grief (ICG-R) was used as a gold standard of distress at six months after bereavement. Receiver operating characteristic (ROC) curves analysis was performed for all scales and items regarding ICG-R score. Sensitivity, specificity and area under curve (AUC) were calculated for scales and items with the most promising ROC curve analyses.</p> <p>Results</p> <p>Beck's Depression Inventory (BDI) was the scale with the highest AUC (0.83) and adding a single item question ('Even while my relative was dying, I felt a sense of purpose in my life') gave a sensitivity of 80% and specificity of 75%. The positive/negative predictive values for this combination of questions were 70% and 85%, respectively. With this screening tool bereaved people could be categorized into three groups where group 1 had 7%, group 2 had 23% and group 3 had 64% propensity of suffering from complicated grief six months post loss.</p> <p>Conclusions</p> <p>This study shows that the BDI in combination with a single item question eight weeks post loss may be used for clinical screening for risk of developing complicated grief after six months. The feasibility and clinical implications of the screening tool has to be tested in a clinical setting.</p

De store teoriers fald - Træk af sorgteori gennem tiden

Sorg er et eksistentielt livsvilk&aring;r de fleste mennesker gennemlever flere gange i deres liv. I de fleste tilf&aelig;lde er sorg pinefuld om end ikke udtryk for psykopatologi. Teoretikere har besk&aelig;ftiget sig med f&aelig;nomenet sorg gennem det seneste &aring;rhundrede. Teorierne handler om beskrivelsen af sorgreaktionen, hvordan forskellige personligheder h&aring;ndterer sorgen samt hvilke interventionsformer der er hensigtsm&aelig;ssige. Klassisk freudiansk sorgteori har haft en gennemgribende indflydelse p&aring; forst&aring;elsen af sorg og f&oslash;rst indenfor de seneste &aring;r, er de tidlige sorgteorier for alvor blevet revideret. Tr&aelig;k af sorgteori gennem tiden gennemg&aring;s og udviklingen af teorierne diskuteres i lyset af den metodem&aelig;ssige udvikling omr&aring;det har gennemg&aring;et fra kliniske observationer til systematiske kvantitative metoder i postmodernismens tidsalder