Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers

Purpose: We sought to identify indicators associated with the quality of life (QoL) of stroke patients and caregivers. Methods: The cross-sectional study was conducted at nine Dutch stroke service facilities involving 251 stroke patients and their caregivers. We used the EuroQol (EQ-5D) and Satisfaction with Stroke Care questionnaires, and included the variables (1) disability at hospital admission, (2) length of hospital stay, (3) demographic data, and (4) caregivers' relationship with stroke patients. The Actor-Partner (patient-caregiver) Interdependence Model (APIM) was used to examine dependence between patients' and caregivers' QoL scores through dyad membership. Results: Patients' age was significantly related to their QoL, and caregivers' age and educational level were significantly related to their QoL. Patients' disability on hospital admission and length of stay were associated with patients' QoL, and their disability on admission was related to caregivers' QoL. No relationship was found between length of stay and caregivers' QoL. Satisfaction with care was associated with both patients' and caregivers' QoL. Conclusions: The APIM distinguished the different roles of patients and caregivers while acknowledging the interdependence of their QoL scores. Satisfaction with care was identified as important indicator of stroke patients' and caregivers' QoL

Defensive coping and health-related quality of life in chronic kidney disease: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Coping with the stresses of chronic disease is considered as a key factor in the perceived impairment of health related quality of life (HRQL). Little is known though about these associations in chronic kidney disease (CKD). The present study aimed to investigate the relationship of defensive coping and HRQL among patients in different CKD stages, after adjusting for psychological distress, sociodemographic and disease-related variables.</p> <p>Methods</p> <p>The sample consisted of 98 CKD patients, attending a university nephrology department. Seventy-nine (79) pre-dialysis patients of disease stages 3 to 4 and 19 dialysis patients were included. HRQL was assessed by the 36-item Short-Form health survey (SF-36), defensive coping by the Rationality/Emotional Defensiveness (R/ED) scale of the Lifestyle Defense Mechanism Inventory (LDMI) and psychological distress by the depression and anxiety scales of the revised Hopkins Symptom CheckList (SCL-90-R). Regression analyses were carried out to examine the association between SF-36 dimensions and defensive coping style.</p> <p>Results</p> <p>Patients on dialysis had worse scores on SF-36 scales measuring physical aspects of HRQL. In the fully adjusted analysis, a higher defensive coping score was significantly associated with a lower score on the mental component summary (MCS) scale of the SF-36 (worse mental health). In contrast, a higher defensive score showed a small positive association with the physical component summary (PCS) scale of the SF-36 (better health), but this was marginally significant.</p> <p>Conclusions</p> <p>The results provided evidence that emotional defensiveness as a coping style tends to differentially affect the mental and the physical component of HRQL in CKD. Clinicians should be aware of the effects of long-term denial and could examine the possibility of screening for defensive coping and depression in recently diagnosed CKD patients with the aim to improve both physical and mental health.</p

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

___Key messages___ The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer

Meaning-making in a context of climate change : Supporting agency and political engagement

Responding effectively to climate change requires an understanding of what shapes people’s individual and collective sense of agency and responsibility towards the future. It also requires transforming this understanding into political engagement to support systems change. Based on a national representative survey in Sweden (N = 1,237), this research uses the novel SenseMaker methodology to look into these matters. More specifically, in order to understand the social and institutional prerequisites that must be in place to develop inclusive climate responses, we investigate how citizens perceive their everyday life and future, and the implications for their sense of responsibility, agency, and political engagement. Our research findings show how citizens perceive and act on climate change (individually, cooperatively, and by supporting others), their underlying values, beliefs, emotions and paradigms, inter-group variations, and obstacles and enablers for change. The findings reveal that, in general, individual and public climate action is perceived as leading to improved (rather than reduced) wellbeing and welfare. At the same time, climate anxiety and frustration about structural and governance constraints limit agency, whilst positive emotions and inner qualities, such as human–nature connections, support both political engagement and wellbeing. Our results shed light on individual, collective, and structural capacities that must be supported to address climate change. They draw attention to the need to develop new forms of citizen involvement and of policy that can explicitly address these human interactions, inner dimensions of thinking about and acting on climate change, and the underlying social paradigms. We conclude with further research needs and policy recommendations

Meaning-making in a context of climate change: supporting agency and political engagement

Responding effectively to climate change requires an understanding of what shapes people’s individual and collective sense of agency and responsibility towards the future. It also requires transforming this understanding into political engagement to support systems change. Based on a national representative survey in Sweden (N = 1,237), this research uses the novel SenseMaker methodology to look into these matters. More specifically, in order to understand the social and institutional prerequisites that must be in place to develop inclusive climate responses, we investigate how citizens perceive their everyday life and future, and the implications for their sense of responsibility, agency, and political engagement. Our research findings show how citizens perceive and act on climate change (individually, cooperatively, and by supporting others), their underlying values, beliefs, emotions and paradigms, inter-group variations, and obstacles and enablers for change. The findings reveal that, in general, individual and public climate action is perceived as leading to improved (rather than reduced) wellbeing and welfare. At the same time, climate anxiety and frustration about structural and governance constraints limit agency, whilst positive emotions and inner qualities, such as human–nature connections, support both political engagement and wellbeing. Our results shed light on individual, collective, and structural capacities that must be supported to address climate change. They draw attention to the need to develop new forms of citizen involvement and of policy that can explicitly address these human interactions, inner dimensions of thinking about and acting on climate change, and the underlying social paradigms. We conclude with further research needs and policy recommendations. In general, citizens perceive increased individual and public climate action as leading to improved (rather than reduced) wellbeing and welfare.Effective responses to climate change require addressing underlying social paradigms (to complement predominant external, technological, and information-based approaches).Such responses include increasing policy support for: o learning environments and practices that can help individuals to discover internalized social patterns and increase their sense of agency and interconnection (to self, others, nature);o institutional and political mechanisms that support citizen engagement and the systematic consideration of human inner dimensions (values, beliefs, emotions and associated inner qualities/capacities) across all sectors of work, by systematically revising organizations’ vision statements, communication and project management tools, working structures, policies, regulations, human and financial resource allocation, and collaboration; ando nature-based solutions and other approaches to support the human–nature connection. In general, citizens perceive increased individual and public climate action as leading to improved (rather than reduced) wellbeing and welfare. Effective responses to climate change require addressing underlying social paradigms (to complement predominant external, technological, and information-based approaches). Such responses include increasing policy support for: o learning environments and practices that can help individuals to discover internalized social patterns and increase their sense of agency and interconnection (to self, others, nature);o institutional and political mechanisms that support citizen engagement and the systematic consideration of human inner dimensions (values, beliefs, emotions and associated inner qualities/capacities) across all sectors of work, by systematically revising organizations’ vision statements, communication and project management tools, working structures, policies, regulations, human and financial resource allocation, and collaboration; ando nature-based solutions and other approaches to support the human–nature connection. o learning environments and practices that can help individuals to discover internalized social patterns and increase their sense of agency and interconnection (to self, others, nature); o institutional and political mechanisms that support citizen engagement and the systematic consideration of human inner dimensions (values, beliefs, emotions and associated inner qualities/capacities) across all sectors of work, by systematically revising organizations’ vision statements, communication and project management tools, working structures, policies, regulations, human and financial resource allocation, and collaboration; and o nature-based solutions and other approaches to support the human–nature connection.</p

Examining Youth Perceptions and Social Contexts of Litter to Improve Marine Debris Environmental Education

Youth have astute observations about site-specific personal and environmental factors that contribute to littering and marine debris, and they have a strong potential to act as change agents in communities. Interactions with youth in Pinellas County Florida add insights into a growing body of research on environmental education and marine debris prevention. This study assessed perceptions of marine debris and littering behaviors through group discussions with middle school and high school students (N = ∼44), evaluations at summer camp programs (N = ∼31) and pre- and post-assessments of environmental field trips (pre-assessment N = ∼120; post-assessment N = ∼140). Youth showed high initial awareness of the effects of marine debris on the environment but showed less understanding about the role of watersheds and biodegradation in marine litter issues. A majority of youth attributed others’ littering behavior to dispositional factors, like laziness, while attributing their own littering to situational factors, like poorly placed bins. Student observations of educators and parents also influenced littering behaviors and willingness to act. To reduce littering, education and outreach programs need to (1) provide opportunities for ongoing assessment of complex marine debris topics, (2) align visual and written or verbal messages, (3) reduce actor/observer bias related to littering behaviors, and (4) support adult role models