Atención recibida al final de la vida en los servicios de urgencias desde la perspectiva de los cuidadores: estudio cualitativo

Objective

To discover the experiences of end-of-life patients attended by the emergency services, through the discourse of the family caregivers who accompanied the family member in this care transit.

The opportunity costs of caring for people with dementia in Southern Spain

Objective

The aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced.

Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine

BackgroundAs the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers’ and infant caregivers’ attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia.MethodsWe conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4 months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4 month immunization visit were surveyed.FindingsPrior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed.ConclusionHealthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.     

精神分裂症患者及家属、医生对知情同意具体程序态度的初步分析

目的分析精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度，以指导今后知情同意的实施。方法所有样本均来自中南大学湘雅二医院，共计55名患者，46名家属，61名医生。采用知情同意态度问卷，来调查精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度。结果患者、家属、精神科医生非参数检验结果表明，共计有17项条目存在显著性差异。比如条目4“签写一份接受医疗服务的知情同意书，其目的是”，67．4％的家属，59．2％的患者，90．2％的医生选择第3项“既保护医生又保护患者”，仅21．7％的家属，26．5％的患者，1．6％的医生选择第2项“保护患者”。结论目前精神分裂症患者、家属以及精神科医生对知情同意具体程序的态度存在明显差异。     

Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trial

ObjectivesTo compare online cognitive-behavioral therapy (CBT) with and without telephone support respectively to online psychoeducation in a randomized controlled trial (RCT) in caregivers of people with dementia with mild anxiety or depression.DesignThree-arm parallel-group RCT comparing online CBT with and without telephone support respectively to online psychoeducation.Setting and ParticipantsOnline study with caregivers of people with dementia.MeasuresThe primary outcome measure was mental health measured by General Health Questionnaire–12 (GHQ-12) at 26 weeks. Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS); the Relative Stress Scale (RSS) and the Short Sense of Competency Questionnaire. The primary analysis focused on people completing GHQ-12 at both baseline and 26 weeks, evaluated using analysis of covariance.Results638 people were randomized to the 3 treatment arms, of whom 208 were included in the analysis population. There were significant improvements in GHQ-12 in all treatment arms compared to baseline (P < .001 for all interventions), but neither CBT with nor without telephone support conferred any significant advantage compared to psychoeducation. For the secondary outcomes, there were no significant differences between CBT with telephone support and psychoeducation, but CBT without telephone support was less effective than psychoeducation with respect to HADS depression subscale [mean difference 1.86, 95% confidence interval (CI) 0.61, 3.11; P = .004] and caregiver stress (RSS mean difference 3.11, 95% CI 0.13, 6.09; P = .04). Good safety was achieved in all 3 treatment arms, with no deaths or serious adverse events.Conclusions and ImplicationsOnline CBT with telephone support and psychoeducation both achieved significant benefits over 26 weeks compared with baseline in mental health and mood, but there were no advantages for CBT compared with the psychoeducation intervention. CBT without telephone support was less effective with respect to mood outcomes than psychoeducation and should not be recommended based on current evidence.     

Looking ahead: Caregivers’ COVID-19 vaccination intention for children 5 years old and younger using the health belief model

COVID-19 vaccine hesitancy is a significant public health issue. While vaccines are not yet available for children, clinical trials are underway, and children will likely be an important factor in the U.S. reaching herd immunity. However, little research has been conducted to examine parents’ intention to vaccinate their young children for COVID-19.MethodAn online survey with a national U.S. sample of 682 primary caregivers of children under age six assessed variables associated with intention to accept the COVID-19 vaccine for their children from November 13, 2020, to December 8, 2020.ResultsCaregivers whose child received a recent influenza vaccine, as well as those with previous experience COVID-19, were more likely to express COVID-19 vaccination intention for their young child. Identifying as female was associated with lower COVID-19 vaccination intention, while identifying as Hispanic or Latino was associated with higher intention. Health Belief Model variables of perceived severity of COVID-19 for their child, as well as vaccine confidence, were positive predictors of COVID-19 vaccine intention and mediated the relationship between prior behavior, demographic variables, and intention.ConclusionsThe findings highlight the importance of early, proactive COVID-19 vaccination education efforts directed at caregivers, including those with young children. Vaccines for young children will likely become a necessary part of ending the pandemic’s impact in school settings. Operationally, COVID-19 vaccination may also become a part of childhood vaccination schedules. Understanding the beliefs and intentions of caregivers of young children before vaccinations are recommended for children will enable public health officials and medical practitioners to prepare in advance.     

Caregiver distress: what nurses in rural settings can do to help

Caregivers in rural settings experience unmet needs. Some family caregivers in rural areas, either willingly or grudgingly, take on the role of caregiving as one of many responsibilities. A review of the literature reveals that the burden of the added responsibility results in physiological and psychological caregiver distress. The authors suggest some strategies to meet caregiver needs and outline areas where research is needed.     

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial

BackgroundEmpowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.AimsTo evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.DesignA randomized control trial.MethodsSixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.ResultsThe family empowerment program decreased parental stress (F = 13.993, p < .0001) and increased family function (cohesion, expression, conflict solving, and independence) (F = 19.848, p < .0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F = 26.483, p < .0001) and forced expiratory volume in first second (FEV1) (F = 7.381, p = .001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.ConclusionWe empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families’ life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.