This study evaluated caregiver burden in 92 informal caregivers of patients with dementia from memory centers in Lima, Peru. Three-quarters of caregivers scored above the cutoff for moderate to severe burden on the Zarit Burden Interview. Higher caregiver burden was associated with self-perception of worse health, greater impact on family finances, and longer time spent caregiving. The only consistent predictor of caregiver burden was symptoms of depression as measured by the Beck Depression Inventory. This study showed elevated burden in Peruvian informal dementia caregivers.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Study of Depression and Role of Support Groups in Its Management among HIV/AI...paperpublications3
Abstract: The acquired immuno-deficiency syndrome (AIDS) is one of the most dreaded entities that modern medicine has ever had to tackle. Depression is the most frequently observed psychiatric disorder among HIV/AIDS patients. It interferes with all aspects of living and may have a severe negative impact on quality of life. An HIV positive diagnosis is a life changing event and may induce shock, a sense of helplessness, denial, and occasional self blame. Belonging to a support group may be of assistance in preventing depression. PLWHA should be advised to belong to a support group. To improve the role of support groups their sizes should be limited.
Methodology: Aim of the Study: To determine the prevalence of depression among HIV positives and to find out the role Support group in reduction of depression.
Study Setting & Design: A tertiary care hospital, and Positive networks, Cross sectional study.
Sample Size: Study constituted of 100 HIV positive patients, depression was assessed using BDI, The data was collected using a pretested semi structured preformed, after obtaining written informed consent.
Sampling Method: Random Sample
Statistical analysis: Data was be analyzed using SPSS version 11.5, statistical test ANOVA and CHI-SQUARE will be used and P less than 0.05 taken as significant.
Exclusion criteria: people below the age of 18 years and above 65 years patients, who are not given consent.
Study Duration: 6 Months
Data Collection: The data was collected using a BDI –Beck Depression Inventory Scale (annexure 1) The HIV positive subjects were invited to participate in the interview and those who presented for treatment, People were invited to participate in the interview and after obtaining a written informed consent the subjects were recruited in the study. The study details were explained to them that this procedure would not affect the scheduled times of their consultation. The interviews were conducted in medical consultation rooms by the investigator. Each interview lasted an average of 1 hour.
Results: The result showed was that statistically significant (p=0.002) depression among urban area.69.5% were depressed among primary education, 59.4% were depressed among 8-12, 100% were depressed those who are education above 12 standard. There is no statistically significant in education and depression.
62% were depressed daily waged, 61.1% were depressed among salaried, 83.3% were depressed among business, 84.6% were depressed among unemployed
There is no statistically significant depression based on their education.
Unmarried 100% were depressed, 67.3% married were depressed, 100% depressed among divorced, 100%were depressed among spouse, 64.1% were depressed among widowed. There is no statistically significant between depression and marital status.
Presentation on palliative care given at the Caregiver's Conference for the Cystic Fibrosis Affiliate and Satellite Sites at Riley Children's Hospital.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Study of Depression and Role of Support Groups in Its Management among HIV/AI...paperpublications3
Abstract: The acquired immuno-deficiency syndrome (AIDS) is one of the most dreaded entities that modern medicine has ever had to tackle. Depression is the most frequently observed psychiatric disorder among HIV/AIDS patients. It interferes with all aspects of living and may have a severe negative impact on quality of life. An HIV positive diagnosis is a life changing event and may induce shock, a sense of helplessness, denial, and occasional self blame. Belonging to a support group may be of assistance in preventing depression. PLWHA should be advised to belong to a support group. To improve the role of support groups their sizes should be limited.
Methodology: Aim of the Study: To determine the prevalence of depression among HIV positives and to find out the role Support group in reduction of depression.
Study Setting & Design: A tertiary care hospital, and Positive networks, Cross sectional study.
Sample Size: Study constituted of 100 HIV positive patients, depression was assessed using BDI, The data was collected using a pretested semi structured preformed, after obtaining written informed consent.
Sampling Method: Random Sample
Statistical analysis: Data was be analyzed using SPSS version 11.5, statistical test ANOVA and CHI-SQUARE will be used and P less than 0.05 taken as significant.
Exclusion criteria: people below the age of 18 years and above 65 years patients, who are not given consent.
Study Duration: 6 Months
Data Collection: The data was collected using a BDI –Beck Depression Inventory Scale (annexure 1) The HIV positive subjects were invited to participate in the interview and those who presented for treatment, People were invited to participate in the interview and after obtaining a written informed consent the subjects were recruited in the study. The study details were explained to them that this procedure would not affect the scheduled times of their consultation. The interviews were conducted in medical consultation rooms by the investigator. Each interview lasted an average of 1 hour.
Results: The result showed was that statistically significant (p=0.002) depression among urban area.69.5% were depressed among primary education, 59.4% were depressed among 8-12, 100% were depressed those who are education above 12 standard. There is no statistically significant in education and depression.
62% were depressed daily waged, 61.1% were depressed among salaried, 83.3% were depressed among business, 84.6% were depressed among unemployed
There is no statistically significant depression based on their education.
Unmarried 100% were depressed, 67.3% married were depressed, 100% depressed among divorced, 100%were depressed among spouse, 64.1% were depressed among widowed. There is no statistically significant between depression and marital status.
Presentation on palliative care given at the Caregiver's Conference for the Cystic Fibrosis Affiliate and Satellite Sites at Riley Children's Hospital.
Consolidating, Improving, and Novel Palliative Care: Order SetsMike Aref
A selection of slides, taken from a series of presentations, showing the evolution of consolidating and developing order sets for delivery of primary palliative care in our healthcare system.
By Jason Vickers, occupational therapy student at the University of Salford, addressing What is Reflection? Reflective Practice Within Practice Education and the Reflective Cycle. COT Annual Conference 2010 (22-25 June 2010)
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.
The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the stability of the physician workforce.
There has been a major decrease in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. This trend, coupled with attrition among currently practicing physicians, have already had a significant effect on patient access to primary care services.
Replacing physicians who leave practice is expensive:
estimates are $250 000 or more per physician. Even though the problem of burnout in physicians has been recognized for years, there
have been few programs targeting burnout before it leads to personal or professional impairment and very little data exist about their effectiveness.
METHODS
Study Population
All primary care physicians in the Greater Rochester, New York, community
(N=871) were invited to participate in the program through a series of mailed and electronic communications from the Monroe County Medical Society to individual physicians and local health care organizations, with follow-up telephone calls from the investigators.
This Hospital Skills Program (HSP) module has been developed to support the professional development of doctors working in a hospital generalist role in NSW hospitals.
Doctors participating in the HSP will have at least two years of clinical postgraduate experience and not be currently participating in a specialist vocational training program.
This HSP module has been developed by CETI on behalf of NSW Health as part of the Hospital Skills Program for generalist doctors. It aims to guide doctors, their employers and educators with regard to learning and professional development needs, workplace responsibilities and clinical tasks.
This module is one of several that have been developed by CETI to support the implementation of the HSP.
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
Assessing the Quality of End of-Life Care for Older Persons with Advanced Dem...mjbinstitute
Dementia is one of the most devastating illnesses affecting older persons. According to a survey from the Myers-JDC-Brookdale Institute, approximately 5% of Israeli elderly living in the community have advanced dementia.
This first study of the care of older people with advanced dementia in Israel reveals a wide range of unmet health and social service needs. It points to the need for a comprehensive policy for developing services to improve the quality of care and reduce the burden on the families.
The findings are contributing to the implementation of the national strategic plan for addressing the challenges of dementia, currently being implemented by the Ministry of Health, and to a new national program for palliative care for people with terminal illnesses, which is in the planning stages as a joint initiative of the Ministry of Health, JDC-ESHEL, and MJB.
The study was funded with the assistance of the Helen Daniels Bader Fund of Bader Philanthropies of Milwaukee, Wisconsin.
En Perú, los costos de un paciente con demencia son equivalentes a los previamente publicados. Un paciente con demencia fronto-temporal representa costos más elevados que un paciente con enfermedad de Alzheimer.
Module 3 Assignment: Pinch Table Template
PINCH Table
Research Problem (identify a gap in the literature): Postpartum depression is a major concern that can sometimes be overlooked. Finding new ways to reach out to patients should be considered and investigated. Low-income patients may not have access to transportation, or they may have other reasons for not coming into their doctor appointments. “Low income and minority women are at particularly high risk for unrecognized and untreated postpartum depression” (Kim, Geppert, Quan, Bracha, Lupo, & Cutt, 2012, p. 123). There should be further research and alternatives studied to help provide options and interventions for patients in need of further assistance.
Author
Study Purpose
Sample (N=xx) and
Demographics
Study Design type (describe in detail)
& Variables (List variables and label as Research, IV, DV)
Measurement methods of variables (tools, surveys or scales)
Major Study Findings / Results
(include some statistics and whether they are significant or not)
Notes
Study: Screening for Postpartum Depression Among Low-Income Mothers Using an Interactive Voice Response System
H. G. Kim was a part of the Department of Psychiatry, Hennepin Women’s Mental Health Program, Hennepin County Medical Center, Minneapolis,
J. Geppert, T. Quan D. B. Cutts- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA
Y. Bracha- Center for Urban Health, Hennepin County Medical Center, Minneapolis, MN, USA
V. Lupo-Department of Obstetrics/Gynecology, Hennepin County Medical Center, Minneapolis, MN, USA
“The purpose of this current study was to test the feasibility of using an automated phone screen for postpartum depression that low income mothers access remotely outside their clinic visits” (Kim, Geppert, Quan, Bracha, Lupo, & Cutt, 2012, p. 922).
Postpartum depression can affect 7-25% of new mothers within the first year after delivery of their baby (Kim et. al, 2012).
1,591 patients who recently delivered at Hennepin County Medical Center (HCMC) were approached.
1,013 (63.7%) signed consent to participate and completed the basic baseline demographic questionnaire. For initial sample, 70 mothers who were native-born Africans were not included in study due to lack of knowledge regarding their English literacy skills. 105 were also not included due to having private insurance. The final number of participants was 838, this included patients on Medical Assistance or who had no insurance. 324 study subjects used the automated phone screening system (Kim et. al., 2012).
The study was considered to be racially and ethnically diverse. -The study consisted of 26% African American, 51% Latina, 15% Caucasian, and 8% other.
-85% were >20 years old
-64% married
-50% had at least a high school diploma or GED
-38% were first time moms
-Most of the study participants were low-income: 74% were unemployed (Kim et. al., 2012).
-61 people out of 838 participated in the 3 month follow up s ...
Prevalence and Determinants of Distress Among Residents During COVID Crisispateldrona
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and Determinants of Distress Among Residents During COVID Crisisclinicsoncology
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and Determinants of Distress Among Residents During COVID Crisisgeorgemarini
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Consolidating, Improving, and Novel Palliative Care: Order SetsMike Aref
A selection of slides, taken from a series of presentations, showing the evolution of consolidating and developing order sets for delivery of primary palliative care in our healthcare system.
By Jason Vickers, occupational therapy student at the University of Salford, addressing What is Reflection? Reflective Practice Within Practice Education and the Reflective Cycle. COT Annual Conference 2010 (22-25 June 2010)
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians.
The consequences of burnout among practicing physicians include not only poorer quality of life and lower quality of care but also a decline in the stability of the physician workforce.
There has been a major decrease in the percentage of graduates entering careers in primary care in the last 20 years, with reasons related to burnout and poor quality of life. This trend, coupled with attrition among currently practicing physicians, have already had a significant effect on patient access to primary care services.
Replacing physicians who leave practice is expensive:
estimates are $250 000 or more per physician. Even though the problem of burnout in physicians has been recognized for years, there
have been few programs targeting burnout before it leads to personal or professional impairment and very little data exist about their effectiveness.
METHODS
Study Population
All primary care physicians in the Greater Rochester, New York, community
(N=871) were invited to participate in the program through a series of mailed and electronic communications from the Monroe County Medical Society to individual physicians and local health care organizations, with follow-up telephone calls from the investigators.
This Hospital Skills Program (HSP) module has been developed to support the professional development of doctors working in a hospital generalist role in NSW hospitals.
Doctors participating in the HSP will have at least two years of clinical postgraduate experience and not be currently participating in a specialist vocational training program.
This HSP module has been developed by CETI on behalf of NSW Health as part of the Hospital Skills Program for generalist doctors. It aims to guide doctors, their employers and educators with regard to learning and professional development needs, workplace responsibilities and clinical tasks.
This module is one of several that have been developed by CETI to support the implementation of the HSP.
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
Assessing the Quality of End of-Life Care for Older Persons with Advanced Dem...mjbinstitute
Dementia is one of the most devastating illnesses affecting older persons. According to a survey from the Myers-JDC-Brookdale Institute, approximately 5% of Israeli elderly living in the community have advanced dementia.
This first study of the care of older people with advanced dementia in Israel reveals a wide range of unmet health and social service needs. It points to the need for a comprehensive policy for developing services to improve the quality of care and reduce the burden on the families.
The findings are contributing to the implementation of the national strategic plan for addressing the challenges of dementia, currently being implemented by the Ministry of Health, and to a new national program for palliative care for people with terminal illnesses, which is in the planning stages as a joint initiative of the Ministry of Health, JDC-ESHEL, and MJB.
The study was funded with the assistance of the Helen Daniels Bader Fund of Bader Philanthropies of Milwaukee, Wisconsin.
En Perú, los costos de un paciente con demencia son equivalentes a los previamente publicados. Un paciente con demencia fronto-temporal representa costos más elevados que un paciente con enfermedad de Alzheimer.
Module 3 Assignment: Pinch Table Template
PINCH Table
Research Problem (identify a gap in the literature): Postpartum depression is a major concern that can sometimes be overlooked. Finding new ways to reach out to patients should be considered and investigated. Low-income patients may not have access to transportation, or they may have other reasons for not coming into their doctor appointments. “Low income and minority women are at particularly high risk for unrecognized and untreated postpartum depression” (Kim, Geppert, Quan, Bracha, Lupo, & Cutt, 2012, p. 123). There should be further research and alternatives studied to help provide options and interventions for patients in need of further assistance.
Author
Study Purpose
Sample (N=xx) and
Demographics
Study Design type (describe in detail)
& Variables (List variables and label as Research, IV, DV)
Measurement methods of variables (tools, surveys or scales)
Major Study Findings / Results
(include some statistics and whether they are significant or not)
Notes
Study: Screening for Postpartum Depression Among Low-Income Mothers Using an Interactive Voice Response System
H. G. Kim was a part of the Department of Psychiatry, Hennepin Women’s Mental Health Program, Hennepin County Medical Center, Minneapolis,
J. Geppert, T. Quan D. B. Cutts- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, USA
Y. Bracha- Center for Urban Health, Hennepin County Medical Center, Minneapolis, MN, USA
V. Lupo-Department of Obstetrics/Gynecology, Hennepin County Medical Center, Minneapolis, MN, USA
“The purpose of this current study was to test the feasibility of using an automated phone screen for postpartum depression that low income mothers access remotely outside their clinic visits” (Kim, Geppert, Quan, Bracha, Lupo, & Cutt, 2012, p. 922).
Postpartum depression can affect 7-25% of new mothers within the first year after delivery of their baby (Kim et. al, 2012).
1,591 patients who recently delivered at Hennepin County Medical Center (HCMC) were approached.
1,013 (63.7%) signed consent to participate and completed the basic baseline demographic questionnaire. For initial sample, 70 mothers who were native-born Africans were not included in study due to lack of knowledge regarding their English literacy skills. 105 were also not included due to having private insurance. The final number of participants was 838, this included patients on Medical Assistance or who had no insurance. 324 study subjects used the automated phone screening system (Kim et. al., 2012).
The study was considered to be racially and ethnically diverse. -The study consisted of 26% African American, 51% Latina, 15% Caucasian, and 8% other.
-85% were >20 years old
-64% married
-50% had at least a high school diploma or GED
-38% were first time moms
-Most of the study participants were low-income: 74% were unemployed (Kim et. al., 2012).
-61 people out of 838 participated in the 3 month follow up s ...
Prevalence and Determinants of Distress Among Residents During COVID Crisispateldrona
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and Determinants of Distress Among Residents During COVID Crisisclinicsoncology
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and Determinants of Distress Among Residents During COVID Crisisgeorgemarini
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and determinants of distress among residents during COVID crisiskomalicarol
Residents completed an online survey assessing the sociodemographic characteristics, the workload, the work environment, the
burden, and the psychological impact of the pandemic. Wellbeing, burnout, and depression were assessed using respectively the
Residents and fellows’ wellbeing index (RSWBI), the abbreviated
Maslach Burnout Inventory (aMBI) and the PHQ-9 questionnaire.
Analysis was done on SPSS 25. Variables were significantly
associated with the outcomes if p value ≤ 0.05.
Epidemiology and Social demographics of Mental disorders.pptSonamManoj1
Epidemiology in teh context of mental disorders refers to the study of the distribution of mental conditions within specific populations. This ppt covers the data on India.
ABSTRACT- Background: The occurrence of psychiatric disorders is more in the prisoners than in general population. Co-morbidity is seen to be an important and complex entity in clinical assessment of mental state competence (diminished mental capacity, temporary insanity and insanity) in the offenders at the time of the offence. It has a great role in determining all possible options in future treatment of violent offenders. Aim: This research article is focused on the co-morbid psychiatric diagnoses and the treatment outcomes in the mentally ill prisoners referred to the tertiary care mental health facility. Materials and Method: Total 100 mentally ill prisoners referred to the tertiary care psychiatric hospital during the study period (Jan 2015 - Dec 2015) was the sample size. It was a prospective study and the sampling method was of the purposive type. Results: Besides their primary diagnosis, the referred prisoners had more than one co-morbid psychiatric diagnosis in 46% of the cases. The most frequent co-occurring conditions were learning disabilities, personality disorders, and substance use disorders. The outcomes for the psychiatric conditions were positive as patients responded well to the line of management. Conclusion: The study provides valuable data to understand the mental health needs and the treatment gaps in this population so as to plan adequate services to tackle these issues. Key-words- Mentally ill prisoners, Psychiatric co-morbidities, Treatment outcomes, Substance use disorders, Personality disorders
Perceived Stress, Ways of Coping and Care Giving Burden among Family Caregive...iosrjce
Addressing perceived stress, ways of coping and care giving burden among family caregivers are
highly relevant in the current scenario in terms of prevention of mental illness and promotion of mental health of
people engaged in the care of their family member with schizophrenia. A community prevalence study
conducted by the IMHANS, Kerala estimated that 3.2 lakh people in the State suffer from schizophrenia (THE
HINDU, May 25, 2006).
Un acercamiento al diagnóstico oportuno de demencia, basado en pruebas cognitivas breves validadas para Perú; y pautas del manejo de síntomas cognitivos, psicológicos y conductuales, con particular énfasis en enfermedad de Alzheimer.
Los cuidadores de pacientes con enfermedad de Alzheimer en Perú generalmente son mujeres (esposas o hijas), o los cónyuges, que tienen elevada carga de enfermedad y presentan elevados índices de depresión.
Enfermedad de Alzheimer. Conociendo la enfermedad que llegó para quedarse.Capítulo de Demencia
El libro trata sobre de la realidad del Alzheimer en el Perú y el mundo; así como las preguntas frecuentes acerca de esta enfermedad que fueron elaboradas a lo largo de varios años de investigación junto a pacientes y cuidadores
Autores:
Nilton Custodio - Especialista en Neurología
Rosa Montesinos - Especialista en Medicina de Rehabilitación
Puede descargarlo gratuitamente en el siguiente enlace: goo.gl/wKOvEd
Una propuesta de la experiencia de trabajo en la unidad de diagnóstico de deterioro cognitivo y prevención de demencia en Lima, basado en las validaciones realizadas por nuestro equipo de trabajo.
Una revisión de la historia natural de la enfermedad de Parkinson, y el rol de rasagilina, un inhibidor de la monoamino-oxidasa B en las disitintas etapas de la enfermedad de Parkinson.
Abordaje fisioterapéutico de pacientes con fibromialgia, con especial énfasis en programas de ejercicios aeróbicos, pautas ergonómicas y para higiene del sueño.
Detallada información de la rehabilitación del lenguaje y la deglución en el paciente con enfermedad de Parkinson. Incluye tratamiento en musculatura oro-facial, articulación de la palabra y deglución.
Conferencia para sensibilizar a la comunidad acerca de la enfermedad de Parkinson: Llamamos la atención: temblor no es el único síntoma, existen síntomas no motores, escasamente reconocidos.
El rol de la lesión de sustancia blanca en la etiología de demencia, sobre todo demencia vascular. Prevención primaria, con adecuado manejo de hipertensión arterial es una válida opción.
Tanto depresión como demencia, disminuyen la calidad de vida e incrementan el deterioro de actividades de vida
diaria de individuos de la tercera edad. Los estudios de seguimiento longitudinal y de caso-control reportan una
estrecha asociación entre depresión de inicio tardío y deterioro cognitivo progresivo, pues se ha demostrado riesgo de incremento en 2 a 5 veces para desarrollar demencia en pacientes con depresión de inicio tardío. Por otro lado, la depresión de inicio precoz ha demostrado en forma consistente ser también un factor de riesgo para demencia, y escasas probabilidades de ser pródromo de demencia.La naturaleza de la asociación (si depresión es un pródromo o consecuencia de demencia, o un factor de riesgo para desarrollar demencia) permanece aún sin ser esclarecida. Independiente de ello, las estrategias para tratar depresión podrían alterar el riesgo de desarrollar demencia.
Evaluación de una prueba cognitiva breve para discriminar individuos sanos de pacientes con deterioro cognitivo leve y enfermedad de Alzheimer en estadios iniciales en Lima, Perú.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
1. Dement Neuropsychol 2014 December;8(4):376-383
376
Original Article
The informal caregiver burden in Peru Custodio N, et al.
Informal caregiver burden in
middle-income countries
Results from Memory Centers in Lima – Peru
Nilton Custodio1,2,3
, David Lira1,2,3
, Eder Herrera-Perez3,4,5
, Liza Nuñez del Prado3,6
, José Parodi7
,
Erik Guevara-Silva8
, Sheila Castro-Suarez3,9
, Marcela Mar3
, Rosa Montesinos2,3,10
, Patricia Cortijo3
ABSTRACT. Objective: The aim of this study was to evaluate caregiver burden based on Zarit Burden Interview (ZBI) and
depression in caregivers on the Beck Depression Inventory-II (BDI-II). Methods: Literate individuals, 18 years or older, who
spoke Spanish as their native language were included. Demographic characteristics: Age, sex, education, relationship to
person with dementia, length of time caregiving, other sources of help for caring, impact on the household economy, family
support, and perception of impaired health; and Clinical data on care-recipients: type of dementia, time since diagnosis,
treatment, and Global Deterioration Scale (GDS); the ZBI and BDI-II. Descriptive and analytical statistics were employed
to assess caregiver burden and predictors of higher burden in caregivers. Results: A total of 92 informal caregivers were
evaluated. Regarding care-recipients, 75% were 69 years old or over, 75% had at least one year since diagnosis, 73.9%
had Alzheimer’s disease, 84.8% received treatment, 75% scored 5 or over on the GDS. For caregivers, 75% were 55.5
years old or over, predominantly female (81.5%), married (83.7%), the spouse of care-recipients (60.87%), had at least 10
years of education (75.0%) and one year of caregiving (75%), reduced entertainment time (90.2%) and self-perception of
impaired health (83.7%). Median score on the ZBI was 37.5 (minimum value = 3; and maximum value = 74). The coefficient
of BDI was 1.38 (p-value <0.001). Conclusion: This sample of Peruvian informal caregivers showed elevated ZBI values.
Self-perception of worsened health, repercussion on the family economy and time caregiving were the main determinants
of ZBI, although only BDI was a consistent predictor of ZBI.
Key words: dementia, caregiver, burden, Peru.
SOBRECARGA DO CUIDADOR INFORMAL DE PAÍSES DE RENDA MÉDIA: RESULTADOS DE CENTROS DE MEMÓRIA EM LIMA - PERU
RESUMO. Objetivo: Avaliar a sobrecarga do cuidador baseada na entrevista de Zarit (ZBI). Métodos: Nós incluímos
cuidadores com 18 anos ou mais de idade, língua espanhola como nativa, alfabetizados. Foram avaliadas características
demográficas: idade, gênero, educação, relação com o paciente com demência, extensão do cuidado, outras fontes de ajuda
para os cuidados, impacto na economia doméstica, suporte familiar e percepção do comprometimento de saúde; e dados
clínicos de saúde dos pacientes: tipo de demência, tempo desde o diagnóstico, tratamento e escala de deterioração global
(GDS); ZBI e BDI-II. Resultados: Avaliamos 92 cuidadores informais. Os pacientes tinham 69 anos ou mais, 75% tinha pelo
menos um ano do diagnóstico, 73,9% com doença de Alzheimer, 84,8% recebia algum tratamento, 75% tiveram GDS de
5 ou mais. Quanto aos cuidadores: 75% tinham 55 anos ou mais, mulheres (81,5%), casados (83,7%), cônjuge (60,9%),
com pelo menos 10 anos de educação (75%) e um ano de cuidado (75%), tempo reduzido de entretenimento (90,2%) e
autopercepção de comprometimento da saúde (83,7%). A mediana da ZBI foi 38 (mínimo: 3 e máximo: 74). O coeficiente
de BDI foi 1,38 (p<0,001). Conclusão: Nossa amostra de cuidadores informais peruanos mostram valores consideráveis
na ZBI. A autopercepção de piora de saúde, repercussão na economia familiar e tempo de cuidado foram os principais
determinantes da ZBI, embora somente a BDI foi um preditor consistente de ZBI.
Palavras-chave: demência, cuidador, sobrecarga, Peru.
1
Servicio de Neurología, Clínica Internacional, Lima, Peru; 2
Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima,
Peru; 3
Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru; 4
Unidad de Diseño y Elaboración de Proyectos de Investigación, Lima, Peru; 5
Centro
de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru. 6
Servicio de Neurología. Clínica Maisson de
Sante, Lima, Peru; 7
Centro de Investigación del Envejecimiento, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru; 8
Departamento de
Medicina, Hospital de Chancay, Lima, Peru; 9
Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; 10
Servicio de Medicina
Física y Rehabilitación, Clínica Internacional, Lima, Peru.
Nilton Custodio. Instituto Peruano de Neurociencias – Bartolomé Herrera 161, Lince – Lima – Perú. E-mail: ncustodio@ipn.pe
Disclosure: The authors report no conflicts of interest.
Received September 10, 2014. Accepted in final form November 17, 2014.
2. Dement Neuropsychol 2014 December;8(4):376-383
377Custodio N, et al. The informal caregiver burden in Peru
INTRODUCTION
Providing care to a relative with functional or cogni-
tive needs is associated with negative consequences
for the caregiver, especially if the care-recipient has de-
mentia.1-4
Furthermore, these negative consequences
for caregivers indirectly impact the health of care-recipi-
ents. Thus, the caregiver’s status should be measured in
all intervention studies of dementia, including clinical
drug trials.5
Several measures have been used for assessing the
consequences of caregiving, such as socioeconomic im-
pact, health status, quality of life, and, ultimately, bur-
den.6-10
Burden has been conceptualized as the set of
objective and subjective problems that may be experi-
enced by a caregiver.11
The objective problems include
activities (time and care tasks), facts (effects on physical
and psychological health), and events (social, economic,
and occupational impacts). The attitudes and emotional
reactions of caregivers (guilt, stress and concerns) are
the subjective problems associated to the experience of
care.12
The majority of the tools for measuring caregiv-
ing focus only on the subjective dimension of burden.
Currently, there are several tools for assessing care-
giver burden,13-22
but their utility is variable because
their conceptualization is heterogeneous.23
Zarit de-
veloped a scale for assessing the subjective burden as-
sociated with functional and cognitive impairment of
demented patients living in the community.22
The Za-
rit Burden Interview (ZBI), a brief and simple scale, is
the most used tool for measuring the global status of
informal caregivers, identifying critical areas, and evalu-
ating the efficacy of applied interventions.23
This scale
has been validated for various languages, including
Spanish.2,24-29
The aim of the study was to assess the burden in Pe-
ruvian informal caregivers of patients with dementia.
METHODS
Study design. This was a cross-sectional study in a sample
of caregivers from private memory centers.
Population and sample.Participants were informal caregiv-
ers of patients with an established diagnosis of demen-
tia. Caregivers 18 years or older, who spoke Spanish as
their native language, were literate, consecutively en-
rolled during the period spanning from June to August
2014, were included. Three recruitment centers were
involved: [1] Instituto Peruano de Neurociencias; [2]
Clínica Internacional – Lima; and 3) Clínica Internacio-
nal – San Borja.
Based on previous studies, informal caregiver was
defined as the person who identified themselves as the
primary unpaid caregiver for the person with demen-
tia. The person with dementia lived in the community,
and caregivers reported that more than 1 hour of their
day was devoted to caregiving duties, and that they had
been providing care for more than three consecutive
months.13,14
Procedures. The authors extended the invitations to
participate. All the caregivers were evaluated using the
same instruments (questionnaire and tests). The clinical
data of patients were verified from medical records.
Test of interest. The ZBI is a screening test for assessing
caregiver burden, which has been specially designed to
reflect the burden experienced by caregivers of demen-
tia patients. It can be completed by caregivers them-
selves or as part of an interview. Caregivers are asked to
answer a series of 22 questions about the impact of the
patient’s disabilities on their life. For each item, caregiv-
ers have to indicate how often they felt this way (never,
rarely,sometimes,quitefrequently,ornearlyalways).22,30
The ZBI include three subtests: [1] Consequences
of care on caregiver; [2] Beliefs and expectations about
ability to care; and [3] Relationship between caregiver
and patient. This test is scored by adding the numbered
responses of the individual items. For each option men-
tioned “(never, rarely, sometimes, quite frequently,
nearly always)”, a score is assigned in the 0-4 range and
maximum score is 88. Higher scores indicate greater
caregiver burden. Additionally, estimates of the degree
of burden can be made as following: [1] Little or no bur-
den if ZBI ≤ 20; [2] Mild to moderate burden if ZBI > 20
and ZBI ≤ 40; [3] Moderate to severe burden if ZBI > 40
and ZBI ≤ 60; and [4] Severe burden if ZBI > 60.22,30,31
Other measures and tests. Demographic characteristics. The
following characteristics were assessed: age (persons
with dementia and caregivers), sex, education, relation-
ship to person with dementia, length of time caregiving,
andexistenceofothersourcesofhelpforcaring(caregiv-
ers). Additionally, caregivers were asked to report work-
ing status, impact on the household economy, existence
of family support, and perception of impaired health.
Depression in caregivers. Depressive symptomatol-
ogy was measured by the Beck Depression Inventory-
II (BDI-II) test, a widely used self-report measure for
assessing this problem in community samples.32
The
BDI-II has shown high performance in discriminating
between depressed and non-depressed subjects among
older adults.33,34
The instrument validity appears to be
3. Dement Neuropsychol 2014 December;8(4):376-383
378 The informal caregiver burden in Peru Custodio N, et al.
independent of language.35
The scale contains 20 items,
andyieldsascorebetween0and60,wherehigherscores
indicates higher levels of depressive symptoms. A score
of 16 or greater is used as the cut-off to indicate high
levels of depressive symptoms.36
Clinical data of patients. Information about type of
dementia, time since diagnosis of dementia, treatment
for dementia, and Global Deterioration Scale (GDS)
score were collected.
Professionals involved. Data collection was carried out by
neurologists suitably trained and experienced in the
tests applied.
Statistical methods. Descriptive statistics was performed
using proportions for categorical variables. The skew-
ness and kurtosis test (sktest) was used to assess the
normality of the distributions. Therefore, numerical
variables were summarized as median, minimum and
maximumvalues.Theseresultsareshowedstratifiedinto
four groups according to severity of burden: little or no
burden (Group 1), mild to moderate burden (Group 2),
moderatetosevereburden(Group3),andsevereburden
(Group 4).
Chi-Square and Mann-Whitney tests for pairs of
groups were used to compare demographic, medical and
other characteristics between groups (Group 1 versus all
others, Group 2 versus Groups 3 and 4, Group 3 versus
Group 4). Scatter plots were employed to graphically
display the variability of caregiver burden according to
time since diagnosis, GDS, and time caregiving, by type
of dementia.
The predictive value of the measured variables was
studied by multiple regression analysis. For this pur-
pose, the hierarchical forward stepwise technique was
applied to identify the best model to explain the vari-
ability of ZBI value. All analyses were performed with a
confidence level of 0.95 using STATA 12.0 (Stata Corpo-
ration, College Station, Texas) software.
Ethical aspects.This study was authorized by the research
office of Clínica Internacional. The present study was
approved by the Research Ethics Committee of the Uni-
versidad Privada San Martin de Porres. All participants
gave their informed consent to participate in the study.
RESULTS
Descriptive statistics.Participants in the study included 92
informalcaregivers,comprising39fromClínicaInterna-
cional – Lima, 33 from Instituto Peruano de Neurocien-
cias and 20 from Clínica Internacional – San Borja. The
caregivers had elevated ZBI scores (median = 37.5; mini-
mum value = 3; and maximum value = 74). Care-recipi-
entswerepredominantly69yearsoldorover(75%),with
at least one year since diagnosis (75%), a medical diag-
nosisofAlzheimer’sdisease(73.9%),receivedtreatment
(84.8%), and obtained a GDS score of 5 or more (75%).
The majority of caregivers were 55.5 years old or
over (75%), female (81.5%), married (83.7%), spouse of
care-recipients (60.87%), with at least 10 years of educa-
tion (75.0%) and one year as caregiver (75%). Addition-
ally, caregivers reported reduced entertainment time
(90.2%) and self-perception of impaired health (83.7%).
Finally, many caregivers reported working (37.0%), re-
duced working time (44.6%), external support for car-
ing (39.1%), and impact on the household economy
(47.8%). However, 62.0% of caregivers had the support
of a second caregiver. Detailed information by severity
of burden is shown in Tables 1 and 2.
The scatter plot showed no clear tendency of caregiv-
er burden according to time since diagnosis (Figure 1),
GDS (Figure 2), or time caregiving (Figure 3), particu-
larly for Alzheimer’s and mixed dementia sub-types.
Analytical statistics. Neither demographic nor clinical
characteristics of patients with dementia were clearly
associated with caregiver burden. Only time since di-
agnosis and GDS were significantly higher in caregivers
with moderate severity burden or greater than in care-
givers with little or no burden (Table 1).
None of the demographic characteristics of caregiv-
ers or existence of family support was associated with
burden severity. Median time caregiving was signifi-
cantly higher in caregivers with moderate burden sever-
ity or greater. The proportion of caregivers reporting re-
duced entertainment time and perception of impaired
health was found to increase directly with burden sever-
ity (Table 2).
Working status (currently working and reduced
working time), availability of a second caregiver and
impact on household economy exhibited a significant,
linear, positive association with burden severity in care-
givers. External support in caring showed a significant,
linear negative association with burden severity. Sub-
tests of the ZBI were linearly positively associated with
burden severity in caregivers (Table 2).
Finally, a multivariate model was built to predict ZBI
values. According to statistical procedures, this hierar-
chical model (Adjusted R-squared = 0.7421) included
the following variables (sorted by relevance for higher
burden severity): [1] self-perception of impaired health
(β=7.16); 2) time caregiving (β3=5.69; β2= –1.43; and
4. Dement Neuropsychol 2014 December;8(4):376-383
379Custodio N, et al. The informal caregiver burden in Peru
Table 1. Characteristics and test scores by severity of caregiver burden in 92 patients with dementia attended at the neurology consultancy of three memory
centers.
Degree of severity
Little or no
burden (n=26)
n (%)
Mild to moderate
burden (n=23)
n (%)
Moderate to severe
burden (n=24)
n (%)
Severe burden
(n=19)
n (%)
Age of patient, years§
75 (57-88) 76 (60-92) 76 (40-89) 73 (56-84)
Time since diagnosis, years§
1 (0-3) 2 (1-3)* 2 (1-3)* 2 (0-3)*
Dementia sub-type
Alzheimer’s dementiaz 18 (69.2%) 16 (69.6%) 21 (87.5%) 13 (68.4%)
Vascular dementia 4 (15.4%) 4 (17.4%) 2 (8.3%) 3 (15.8%)
Frontotemporal dementia 1 (3.9%) 1 (4.4%) 1 (4.2%) 3 (15.8%)
Mixed dementia 3 (11.5%) 2 (8.7%) 0 (0.0%) 0 (0.0%)
Treatment, type
None 2 (7.7%) 4 (17.4%) 5 (20.8%) 3 (15.8%)
Cholinesterase inhibitors 19 (73.1%) 8 (34.8%) 6 (25.0%) 6 (31.6%)
Memantine 2 (7.7%) 4 (17.8%) 1 (4.8%) 2 (10.5%)
Cholinesterase inhibitors plus memantine 3 (11.5%) 7 (30.4%) 12 (50.0%) 8 (42.1%)
Global Dementia Scale, points§
4 (3-6) 5 (3-5)* 5 (3-6)* 5 (3-6)*
§
Data are expressed as median (minimum and maximum values); *p-value for the comparison with the little or no burden group; **p-value for the comparison with the mild to moderate burden group;
***p-value for the comparison with the moderate to severe burden group.
Table 2.Characteristics and test scores by severity of burden in 92 caregivers of patients with dementia attended at the neurology consultancy of three memory
centers.
Degree of severity
Little or no
burden (n=26)
Mild to moderate
burden (n=23)
Moderate to severe
burden (n=24)
Severe burden
(n=19)
Sex of caregiver: female 23 (88.5%) 21 (91.3%) 18 (75.0%) 13 (68.4%)
Age of caregiver, years§
68 (43-80) 65 (38-76) 56 (36-76) 57 (50-76)
Civil status of caregiver: married 25 (96.2%) 16 (69.6%)* 18 (75.0%)* 18 (94.7%)
Education of caregiver, years§
11 (5-16) 14 (6-16) 10 (5-18) 10 (5-16)
Relationship with patient
Spouse 19 (73.1%) 14 (60.9%) 9 (37.5%) 14 (73.7%)
Son or daughter 7 (26.9%) 7 (30.4%) 11 (45.8%) 2 (10.5%)
Other 0 (0.0%) 2 (8.7%) 4 (16.7%) 3 (15.8%)
Time caregiving, years§
1 (0-2) 1 (0-3) 1 (1-3)* 2 (0-3)*
Currently working 4 (15.4%) 6 (26.1%)* 12 (50.0%)* ** 12 (63.2%)* ** ***
Reduced working time 3 (11.5%) 12 (52.1%)* 14 (58.3%)* ** 12 (63.2%)* ** ***
Impact on the household economy 4 (15.4%) 12 (52.2%)* 15 (62.5%)* ** 13 (68.4%)* ** ***
Family support 7 (26.9%) 6 (26.1%) 11 (45.8%)* 4 (21.1%)
External support for caring 14 (53.89%) 11 (47.8%) * 7 (29.2%)* ** 4 (21.1%)* ** ***
Reduced entertainment time 18 (69.3%) 23 (100.0%)* 23 (95.8%)* 19 (100.0%)*
Self-perception of impaired health 13 (50.0%) 21 (91.3%)* 24 (100.0%)* 19 (100.0%)*
Availability of second caregiver 5 (19.2%) 14 (60.9%)* 21 (87.5%)* ** 17 (89.5%)* ** ***
Beck Depression Index, points§
8 (4-19) 19 (7-25)* 29 (9-39)* ** 34 (21-41)* **
Consequences of care on caregiver (S1), points 6 (0-14) 16 (10-30)* 27 (18-36)* ** 33 (28-37)* ** ***
Beliefs and expectations about ability to care (S2), points 4 (0-9) 8 (0-14)* 15.5 (8-21)* ** 21 (16-24)* ** ***
Relationship between caregiver and patient (S3), points 2 (0-5) 6 (4-11)* 10 (5-15)* ** 13 (10-16)* ** ***
§
Data are expressed as median (minimum and maximum values); *p-value for the comparison with the little or no burden group; **p-value for the comparison with the mild to moderate burden group; ***p-
value for the comparison with the moderate to severe burden group; S1-S3: Sub-tests of the Zarit test.
5. Dement Neuropsychol 2014 December;8(4):376-383
380 The informal caregiver burden in Peru Custodio N, et al.
Figure 1. Zarit test scores according to time since diagnosis in
92 subjects attended at the neurology consultancy of the“Clínica
Internacional”, by dementia sub-type.
Figure 2. Zarit test scores according to global dementia scale
points in 92 subjects attended at the neurology consultancy of
“Clínica Internacional”, by dementia sub-type.
Figure 3. Zarit scores according to time caregiving in 92 sub-
jects attended at the neurology consultancy of the “Clínica Inter-
nacional”, by dementia sub-type.
6. Dement Neuropsychol 2014 December;8(4):376-383
381Custodio N, et al. The informal caregiver burden in Peru
β1=-3.04); [3] impact on family economy (β=4.71); GDS
(β=1.58); currently working (β=1.42); BDI (β=1.38); re-
duced entertainment time (β=0.75); reduced working
time (β= –0.18); family support (β= –2.39); and exis-
tence of other support (β= –5.41). However, only BDI
was statistically significant (p-value <0.001) (Table 3).
DISCUSSION
This study showed considerable levels of burden in a
sample of Peruvian informal caregivers, higher than lev-
els previously reported in other studies including Peru-
vian sub-samples.37
Additionally, we found that BDI-II
value was a consistent predictor of ZBI value. However,
self-perception of worsened health, repercussion on the
family economy and time caregiving proved stronger
determinants of ZBI than BDI-II value and caregiver
working status or patient deterioration status.
Subjective burden has been defined as the attitudes
and emotional reactions to the experience of caring and
relates to how the situation is perceived, including diffi-
culties and rewards. By contrast, objective burden refers
to the performance of the caregiver and determinants
of demands caring for patients, such as activities for car-
ing, time spent, physical burden, and exposure to stress-
ful situations related to caring needs.38,39
In our study,
we assessed the subjective and objective dimension of
the burden by means of the ZBI and questionnaire plus
BDI-II, respectively.
The informal caregivers showed impairments in
physical, psychological, and social performance,38,40
with
perception of poor health and development of several
medical problems and comorbidities.41
Furthermore, as
well as the social and financial implications, caregivers
suffer higher levels of depression and anxiety, greater
incidence of physical health problems, and shortened
life expectancy.46
A previous report highlighted that in-
formal care was associated with psychiatric conditions
(40% to 75%) such as depression (15% to 32%).47
In our
study, at least 75% of caregivers had depression accord-
ing to BDI values.
A recent systematic review suggested that caregiver
characteristics have a greater impact on perceived bur-
den,stress,anddepressionthantheintensivenessofthe
care needed.48
However, relevant characteristics such as
time caregiving or family support were not associated
with ZBI values in our sample. This result could be re-
lated to limitations in measuring these variables since,
among other factors, the commencement of caregiving
is hard to define because it evolves naturally from sup-
port given and received normally before the onset of de-
mentia and may precede or follow a formal diagnosis.49
We observed that the existence of several sources of
support (family support, external support, and avail-
ability of a second caregiver) were not sufficient to
counteract the burden of the caregiver. Similarly, previ-
ous studies have shown that caregiving usually does not
cease even after admission to a nursing home because
caregivers visiting their relatives are still involved in car-
ing. Thus, the burden may persist after nursing home
admission.50
Table 3. Multivariate model to predict ZBI values in 92 caregivers of patients with dementia attended at the neurology
consultancy of three memory centers.
Adjusted R-squared = 0.7421
β p-value
Self-perception of impaired health 7.156 0.086
Time caregiving§
Between 1 and 3 years –3.046 0.597
Between 3 and 6 years –1.425 0.813
Between 6 and 9 years 5.687 0.452
Impact on family economy 4.705 0.140
Currently working 1.582 0.667
Global Dementia Scale, points 1.425 0.375
Beck Depression Inventory, points 1.376 0.000
Reduced entertainment 0.747 0.874
Reduced working time –0.181 0.965
Family support –2.39 0.449
External support for caring –5.411 0.078
§
Less than 1 year as reference; β: coefficient of regression; p-value for Wald test in multiple regression model.
7. Dement Neuropsychol 2014 December;8(4):376-383
382 The informal caregiver burden in Peru Custodio N, et al.
A complete assessment of caregiver status should
include the caregiver (burden and impacts) and care-
recipients (health and non-health related problems).51
The relationship between informal caregivers and care-
recipients influences the perceived impact of caring48
and the family is the main source of caring for patients
with dementia.52
In our study, the majority of caregivers
were spouses and, secondarily, son or daughter.
We highlighted that self-perception of impaired
health, impact on the family economy and time caregiv-
ing care were the strongest determinants of caregiver
burden. These findings are preliminary and prospective
studiesassessingthedeterminantsofburdenincaregiv-
ers should be conducted.
Our study has some limitations. We did not pre-
viously investigate the validity of the ZBI. The ZBI
does not assess all measures of caregiver status, such
as quality of life and we did not apply tests for these
purposes.
We did not measure some variables such as living
together (living with care-recipients), overburden (ex-
istence of other care-recipients, including children), de-
tails of caring (average time spent caring each day, tech-
niques for caring, care training, living arrangements,
and co-existence of professional service or support) and
disease (perception of cognitive and behavioral impair-
ments by patient and caregiver, complete assessment of
the clinical status of patient and treatment compliance).
In summary, our sample of Peruvian informal care-
givers showed elevated ZBI scores. The self-perception
of worsened health, repercussion on family economy
and time caregiving were the main determinants of ZBI,
although only BDI was a consistent predictor of ZBI.
ZBI is an essential tool for measuring the burden of
informal caregivers that combines several aspects of the
impact on caregivers associated with the caring process.
Thus, its use in clinical practice is valuable.
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