Measuring pain in aphasia: validity and reliability of the PACSLAC-D

Background: Post-stroke pain in patients with an inability to communicate is not systematically assessed and therefore not sufficiently treated. This stresses the need to study pain assessment instruments that do not require good communication skills. Aim: To examine the validity and reliability of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Dutch version (PACSLAC-D) in stroke patients with aphasia. Method: Sixty stroke patients (mean age 79.3 years, standard deviation [SD] 8.0), of whom 27 had aphasia were observed during rest, activities of daily living (ADL), and physiotherapy using the Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Dutch version (PACSLAC-D). The observations were repeated after two weeks. To examine convergent validity, correlations between the PACSLAC-D, self-report pain scales, and the clinical judgment of a health care professional (pain present yes/no) were used. To examine discriminative validity, differences in pain were investigated between rest and ADL, in patients who use pain medication and those who do not, and in patients with and without aphasia. Internal consistency and test-retest reliability were assessed to determine reliability. Results: Convergent validity failed to meet the acceptable threshold during rest but was adequate during ADL and physiotherapy. Discriminative validity was only adequate during ADL. The internal consistency was 0.33 during rest, 0.71 during ADL, and 0.65 during physiotherapy. Test-retest reliability varied from poor during rest (intraclass correlation coefficient [ICC] = 0.07; 95% confidence interval [CI]: -0.40-0.51) to excellent during physiotherapy (ICC = 0.95; 95% CI: 0.83-0.98). Conclusions: The PACSLAC-D captures pain in patients with aphasia who are unable to self-report, during ADL and physiotherapy, but may be less accurate during rest. & COPY; 2023 Published by Elsevier Inc. on behalf of American Society for Pain Management Nursing.Geriatrics in primary carePublic Health and primary car

Measuring positive caregiving experiences in family caregivers of nursing home residents: a comparison of the Positive Experiences Scale, Gain in Alzheimer Care INstrument, and Positive Aspects of Caregiving questionnaire

Aim To compare the Positive Experiences Scale (PES), Gain in Alzheimer Care INstrument (GAIN) and Positive Aspects of Caregiving (PAC) in assessing positive caregiving experiences among caregivers of nursing home residents with dementia, and to explore which caregiver and care recipient characteristics relate to positive caregiving experiences.Methods A total of 63 caregivers (mean age 59.2 years; SD 11.8) of nursing home residents with dementia from four Dutch nursing homes participated in this cross-sectional observational study. Internal consistency, convergent validity and user-friendliness (i.e. perception of item relevance and comprehensibility, ease of use, missing items, and user preference) were examined using Cronbach's alpha's, correlation coefficients and descriptive statistics, respectively.Results The Cronbach's alpha for the GAIN, PAC and PES was 0.90, 0.94 and 0.68, respectively. The sum score of the PES showed a ceiling effect. Convergent validity was confirmed for all three instruments. The PES had the least missing data (mean number of missing items 0.2, SD 0.5) and was preferred by 40% of the caregivers, followed by the GAIN (mean number of missing items 0.6, SD 1.7, preferred by 11%). Positive caregiving experiences were negatively associated with educational level (range -0.28 to -0.35). Only the PES correlated positively with caregiver age (r = 0.25).Conclusions All three questionnaires can be used to assess positive caregiving experiences, but the GAIN might be the most suitable questionnaire for caregivers of nursing home residents with dementia. Further research is necessary to examine generalizability of the findings. Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.Geriatrics in primary carePublic Health and primary car

Family involvement in the Namaste Care Family program for dementia: A qualitative study on experiences of family, nursing home staff, and volunteers

Public Health and primary careGeriatrics in primary car

Prenatal reflective functioning and development of aggression in infancy: The roles of maternal intrusiveness and sensitivity

Development Psychopathology in context: clinical setting

Cost-effectiveness of the Namaste care family program for nursing home residents with advanced dementia in comparison with usual care: a cluster-randomized controlled trial

Background: Dementia is a progressive disease that decreases quality of life of persons with dementia and is associated with high societal costs. The burden of caring for persons with dementia also decreases the quality of life of family caregivers. The objective of this study was to assess the societal cost-effectiveness of Namaste Care Family program in comparison with usual care in nursing home residents with advanced dementia.Methods: Nursing homes were randomized to either Namaste Care Family program or usual care. Outcome measures of the cluster-randomized trial in 231 residents included Quality of Life in Late-Stage Dementia (QUALID) and the Gain in Alzheimer Care Instrument (GAIN) for family caregivers over 12 months of follow-up. Health states were measured using the EQ-5D-3L questionnaire which were translated into utilities. QALYs were calculated by multiplying the amount of time a participant spent in a specific health state with the utility score associated with that health state. Healthcare utilization costs were estimated using standard unit costs, while intervention costs were estimated using a bottom-up approach. Missing cost and effect data were imputed using multiple imputation. Bootstrapped multilevel models were used after multiple imputation. Cost-effectiveness acceptability curves were estimated.Results: The Namaste Care Family program was more effective than usual care in terms of QUALID (- 0.062, 95%CI: - 0.40 to 0.28), QALY (0.0017, 95%CI: - 0.059 to 0.063) and GAIN (0.075, 95%CI: - 0.20 to 0.35). Total societal costs were lower for the Namaste Care Family program as compared to usual care (- 552 euro, 95%CI: - 2920 to 1903). However, these differences were not statistically significant. The probability of cost-effectiveness at a ceiling ratio of 0 euro/unit of effect extra was 0.70 for the QUALID, QALY and GAIN.Conclusions: The Namaste Care Family program is dominant over usual care and, thus, cost-effective, although statistical uncertainty was considerable.Public Health and primary careGeriatrics in primary car

The relationship between guilt feelings, conflicts with staff and satisfaction with care in relatives of nursing home residents with dementia: a longitudinal analysis

Introduction: Family caregivers often experience guilt after nursing home placement. The aim of the present study was to describe family caregivers’ guilt over time and assess the impact of conflicts with staff and satisfaction with care on guilt. Method: Data of 222 family caregivers at three assessments during one-year follow-up were used. In addition to caregivers’ guilt and the variables conflicts with staff and satisfaction with the care, potential confounders were measured: sociodemographic data, clinical characteristics of the person with dementia, and caregiver burden. Linear mixed model analyses were performed to examine the longitudinal relationships between variables. Results: Guilt remained stable over time. Unadjusted models showed that conflicts with staff were positively associated with guilt (β = 0.11; p Geriatrics in primary carePublic Health and primary car

Infant autonomic nervous system response and recovery: Associations with maternal risk status and infant emotion regulation

Development Psychopathology in context: clinical setting

COVID-19 management in nursing homes by outbreak teams (MINUTES) - study description and data characteristics: a qualitative study

Objectives Nursing homes are hit relatively hard by the COVID-19 pandemic. Dutch long-term care (LTC) organisations installed outbreak teams (OTs) to coordinate COVID-19 infection prevention and control. LTC organisations and relevant national policy organisations expressed the need to share experiences from these OTs that can be applied directly in COVID-19 policy. The aim of the 'COVID-19 management in nursing homes by outbreak teams' (MINUTES) study is to describe the challenges, responses and the impact of the COVID-19 pandemic in Dutch nursing homes. In this first article, we describe the MINUTES Study and present data characteristics. Design This large-scale multicentre study has a qualitative design using manifest content analysis. The participating organisations shared their OT minutes and other meeting documents on a weekly basis. Data from week 16 (April) to week 53 (December) 2020 included the first two waves of COVID-19. Setting National study with 41 large Dutch LTC organisations. Participants The LTC organisations represented 563 nursing home locations and almost 43 000 residents. Results At least 36 of the 41 organisations had one or more SARS-CoV-2 infections among their residents. Most OTs were composed of management, medical staff, support services staff, policy advisors and communication specialists. Topics that emerged from the documents were: crisis management, isolation of residents, personal protective equipment and hygiene, staff, residents' well-being, visitor policies, testing and vaccination. Conclusions OT meeting minutes are a valuable data source to monitor the impact of and responses to COVID-19 in nursing homes. Depending on the course of the COVID-19 pandemic, data collection and analysis will continue until November 2021. The results are used directly in national and organisational COVID-19 policy.Public Health and primary careGeriatrics in primary car

Maternal reflective functioning: influence on parenting practices and the early development of externalizing behavior

Het terugdringen van agressie is in de afgelopen jaren in toenemende mate een maatschappelijke prioriteit geworden. Agressie in de vroege kindertijd vergroot de kans op latere agressieproblemen en antisociaal gedrag. In de peutertijd is er al een groep hoog-agressieve kinderen te identificeren die later in de ontwikkeling meer persistente, ernstigere vormen van agressie laat zien. Belangrijk is om veranderbare factoren te identificeren die samenhangen met het ontstaan en/of de instandhouding van het probleemgedrag. Het ouderlijk reflectief functioneren (RF) is in dat kader een interessant concept, aangezien deze vaardigheid te trainen is. In dit proefschrift is de invloed van het RF-vermogen van moeder op de ontwikkeling van (voorlopers van) gedragsproblemen in de vroege kindertijd, in het bijzonder fysieke agressie, bekeken. Geconcludeerd kan worden dat het RF-vermogen van de moeder een belangrijke rol speelt bij het ontwikkelen van (voorlopers van) gedragsproblemen. Over het algemeen genomen lijkt een beter prenataal RF-vermogen van de moeder samen te hangen met een kleinere kans op het ontwikkelen van vroege fysieke agressie. De bevindingen suggereren dat het bij de preventie en aanpak van vroege gedragsproblemen belangrijk is om te investeren in het verbeteren van het ouderlijk RF, bij voorkeur al tijdens de zwangerschap.This study is funded by the Netherlands Organization for Scientific Research (NWO), National Initiative Brain & Cognition, grant number: 056-23-001, awarded to prof. dr. Hanna Swaab and prof. dr. Stephanie van Goozen.Development Psychopathology in context: clinical setting

Maternal reflective functioning: influence on parenting practices and the early development of externalizing behavior

Het terugdringen van agressie is in de afgelopen jaren in toenemende mate een maatschappelijke prioriteit geworden. Agressie in de vroege kindertijd vergroot de kans op latere agressieproblemen en antisociaal gedrag. In de peutertijd is er al een groep hoog-agressieve kinderen te identificeren die later in de ontwikkeling meer persistente, ernstigere vormen van agressie laat zien. Belangrijk is om veranderbare factoren te identificeren die samenhangen met het ontstaan en/of de instandhouding van het probleemgedrag. Het ouderlijk reflectief functioneren (RF) is in dat kader een interessant concept, aangezien deze vaardigheid te trainen is. In dit proefschrift is de invloed van het RF-vermogen van moeder op de ontwikkeling van (voorlopers van) gedragsproblemen in de vroege kindertijd, in het bijzonder fysieke agressie, bekeken. Geconcludeerd kan worden dat het RF-vermogen van de moeder een belangrijke rol speelt bij het ontwikkelen van (voorlopers van) gedragsproblemen. Over het algemeen genomen lijkt een beter prenataal RF-vermogen van de moeder samen te hangen met een kleinere kans op het ontwikkelen van vroege fysieke agressie. De bevindingen suggereren dat het bij de preventie en aanpak van vroege gedragsproblemen belangrijk is om te investeren in het verbeteren van het ouderlijk RF, bij voorkeur al tijdens de zwangerschap.</p