A validation of the Croatian version of Zarit Burden Interview and clinical predictors of caregiver burden in informal caregivers of patients with dementia: a cross-sectional study

AimTo validate the Croatian version of the Zarit Burden Interview (ZBI) and to investigate the predictors of perceived burden.MethodsThis cross-sectional study involved 131 dyads of one informal caregiver family member and one patient with dementia visiting primary care practices (Health Care Center Zagreb-West; 10/2017-9/2018). Patient-related data were collected with the Mini-Mental-State-Examination, Barthel-index, and Neuropsychiatric-Inventory-Questionnaire (NPI-Q); caregiver-related data with the ZBI, and general information on caregivers and patients with a structured questionnaire. Principal-axis-factoring with varimax-rotation was used for factor analysis.ResultsThe caregivers'' mean age was 62.1 ± 13 years. They were mostly women (67.9%) and patients'' children (51.1%). Four dimensions of ZBI corresponding to personal strain, frustration, embarrassment, and guilt were assessed and explained 56% variance of burden. Internal consistency of ZBI (α = 0.87) and its dimensions (α₁ = 0.88, α₂ = 0.83, α₃ = 0.72, α₄ = 0.75) was good. Stronger cognitive and functional impairment of patients was associated only with personal strain, whereas more pronounced neuropsychiatric symptoms and the need for daily care were associated with more dimensions. Longer caregiver education suppressed embarrassment and promoted guilt. Guilt was higher in younger caregivers, caregivers of female patients, patients'' children, and non-retired caregivers. In multivariate analysis significant predictors of higher overall burden were male sex of the patient, higher NPI-Q, the need for daily-care services, shorter duration of caregiving, non-spouse relationship, higher number of hours caring per-week, and anxious-depressive symptoms in a caregiver.ConclusionThe Croatian version of ZBI is reliable and valid. Our data confirm that ZBI is a multidimensional construct. Caregivers may benefit from individually tailored interventions.

Dementia is an increasing health care problem associated with population aging (1-3). There are 8.9 million persons worldwide caring for patients with dementia older than 50 years (4). Caregiving for a family member with dementia substantially affects all aspects of informal caregivers'' lives and demands lifestyle reorganization and adaptation. Usually, one family member becomes a dominant caregiver, devoting three quarters of a day to caregiving tasks, an amount of time that increases with disease progression (5). Caregivers often neglect their own needs and health problems and become increasingly exposed to physical, emotional, financial, and other loads, all of which can be assembled under the term caregiver burden (6). Patients with dementia frequently experience neuropsychiatric symptoms, which become an increasingly difficult problem, often worse than cognitive deterioration itself (7-9). These symptoms can lead to an inability of the informal caregivers to care for patients within her or his own family and increase the perceived caregiving burden.The most commonly used tool for the assessment of caregiver burden is the Zarit Burden Interview (ZBI) (10). The original 29-item version was shortened to a 22-item version, which is currently the most widely used interview form. Several author groups showed that ZBI was a multidimensional construct, and that caregivers with the same total score might be differently affected by different aspects of burden (11-13). In addition, different burden dimensions might be differently affected by caregiver-related factors such as age, socio-economic factors, family relationship, availability of social support, etc (14-16). The most notable patient-related factors that affect caregiver burden are the presence of neuropsychiatric symptoms (especially irritability, agitation, sleep disorders, anxiousness, apathy, and delusions) and loss of cognitive function (17-20). These considerations have important implications for the planning of appropriate caregiver-oriented interventions.The number of patients with dementia in Croatia ranges from 67 000 (21) to 85 000 (22) (estimates from 2013 and 2010, respectively), approximately 15 000 out of whom reside in the wider Zagreb area. Due to population aging and migrations, these numbers are probably increasing. However, there is currently no official registry of patients with dementia or informal caregivers in Croatia that would provide a direct insight into the real magnitude of the problem. The population of informal caregivers of patients with dementia in Croatia has not been extensively studied so far. It was shown that a high proportion of caregivers suffer from anxious and depressive symptoms (23). In addition, in comparison with professionals, informal caregivers were more anxious and depressive, especially if they were of older age and lived in the same household with the patient (24). Caregiving burden was identified as a contributor to the satisfaction with social support (25).There is currently no version of ZBI questionnaire validated for the Croatian population. Thus, the aims of our study were to validate the Croatian version of the ZBI, to evaluate the validity and internal consistency of the questionnaire, and to assess the relationship of caregivers’ and patients’ characteristics with total and different aspects of caregiver burden.     

Developing a toolkit for patients with COPD or chronic heart failure and their informal caregivers to improve person-centredness in conversations with healthcare professionals: A Design Thinking approach

BackgroundThe perspective of patients and informal caregivers is often not expressed in conversations with healthcare professionals which can have a negative impact on quality of care and quality of life.ObjectiveDescribe the development of a toolkit for patients with COPD or chronic heart failure and their informal caregivers enabling them to explore and express their perspective in conversations with healthcare professionals.Patient involvement: Patients, informal caregivers and healthcare professionals were involved in the design process from problem definition to solution development.MethodDesign Thinking Approach using eight co-creation sessions and qualitative data-collection methods. Nineteen patients, ten informal caregivers and thirteen healthcare professionals participated in one or more co-creation sessions. Homogenous subgroups of participants were used in session 1, 2 and 4 and mixed groups were used in session 3, 5 and 6. Session 7 and 8 were used to test prototype toolkits.ResultsThree challenges to expressing the personal perspective to healthcare professionals, four statements defining the desired situation for conversations, eleven design criteria for the toolkit and ten selection criteria for tools were identified. This information was used to develop a prototype toolkit.DiscussionMost patients and informal caregivers had moderate to high levels of education and all participating healthcare professionals were female with a majority of nurses and only three physicians. It is possible that this has influenced the design of the toolkit.Practical valueThe toolkit can support patients and informal caregivers in exploring and expressing their perspective in conversations with healthcare professionals. Feasibility of the toolkit and implications for healthcare professionals will be examined in a pilot implementation study.     

Sleep–wake fluctuations and respiratory events during Cheyne–Stokes respiration in patients with heart failure

Fluctuations in sleep–wake state are thought to contribute to the respiratory instability of Cheyne–Stokes respiration in patients with heart failure by promoting the rhythmic occurrence of central apnea and ventilatory overshoot. There are no data, however, on the relationship between vigilance state and respiratory events. In this study we used a novel method to detect the occurrence of state transitions (time resolution: 0.25 s, minimum duration of state changes: 2 s) and to assess their time relationship with apnoeic events. We also evaluated whether end‐apnoeic arousals are associated with a ventilatory overshoot. A polysomnographic, daytime laboratory recording (25 min) was performed during Cheyne–Stokes respiration in 16 patients with heart failure. Automatic state classification included wakefulness and non‐rapid eye movement sleep stages 1–2. As a rule, wakefulness occurred during hyperpnoeic phases, and non‐rapid eye movement sleep occurred during apnoeic events. Ninety‐two percent of the observed central apneas (N = 272) were associated with a concurrent wakefulness → non‐rapid eye movement sleep → wakefulness transition. The delay between wakefulness → non‐rapid eye movement sleep transitions and apnea onset was ?0.3 [?3.1, 3.0] s [median (lower quartile, upper quartile); P = 0.99 testing the null hypothesis: median delay = 0], and the delay between non‐rapid eye movement sleep → wakefulness transitions and apnea termination was 0.2 [?0.5, 1.2] s (P = 0.7). A positive/negative delay indicates that the state transition occurred before/after the onset or termination of apnea. Non‐rapid eye movement sleep → wakefulness transitions synchronous with apnea termination were associated with a threefold increase in tidal volume and a twofold increase in ventilation (all P < 0.001), indicating ventilatory overshoot. These findings highlight that wakefulness → non‐rapid eye movement sleep → wakefulness transitions parallel apnoeic events during Cheyne–Stokes respiration in patients with heart failure. The relationships between state changes and respiratory events are consistent with the notion that state fluctuations promote ventilatory instability.     

Baroreflex control of the circulation in patients with congestive heart failure

Vagal and glossopharyngeal afferents from cardiopulmonary and arterial baroreceptors exert supraspinal tonic restraint on sympathetic efferent outflow. The baroreceptor inhibitory influence is directly related to physiological changes in cardiac filling and arterial pressures. Increased cardiac pressures and dimensions during CHF may provide chronic stimulation that reduces responsiveness of these receptors and thereby influence the neurohumoral control of the circulation. Patients with chronic and severe CHF of ischemic cause were compared with control subjects whose ischemic heart disease did not affect cardiac performance. Orthostatic pooling of blood with use of upright tilt (45 degree), provided an apparently sufficient stimulus to unload baroreceptors in patients like controls. In contrast to peripheral vasoconstriction in controls, the patients dilated their resistance vessels during upright tilt. This abnormal vasodilation was systemic and uniform in skeletal muscle and subcutaneous tissue of the forearm remaining at heart level. Such an inability to vasoconstrict in the patients, could not be attributed to depression of local vasoconstrictor reflex or autoregulatory responsiveness of forearm vascular beds. Neural blockade carried out separately or in combination with blockades of forearm vascular effector receptors revealed; increased neural efferent activity to the forearm during tilting the patients which mediated beta-adrenergic vasodilation in both vascular beds. The patients had augmented circulating catecholamine levels, those for epinephrine increased in venous effluents but were maintained in brachial arterial inflow, and those for norepinephrine increased in arterial rather than venous plasma in the forearm. Following the patients during a course of therapy with a selective vasodilator calcium antagonist, the beta-adrenergic reflex vasodilation became substantially attenuated but was preserved during a placebo course of therapy. The beta-adrenergic reflex effect evidenced in the studied patients is most probably a manifestation of reduced baroreceptor afferent restraint and it could subsequently relate to the severity of depression of baroreceptor sensitivity during the course of CHF.     

长沙市唐氏综合征患者经济负担及女性照护者心理与社会歧视评估

目的:对长沙市的唐氏综合征(Down syndrome,DS)疾病负担进行估算,从女性角度对DS患者主要照护者的心理负担及受社会歧视程度进行评估。方法:2020年3月,对居住在长沙地区且志愿参与的DS患者家庭进行深度访谈及问卷调查。DS的经济负担测算包括直接成本、间接成本和福利保障性收入。使用斯坦福心理幸福感(Psyc...     

The effects of job demands and low job control on work–family conflict: the role of fairness in decision making and management

The present study examined whether perceptions of organizational fairness (the procedural and interactional components) were able to diminish the negative effects of high job demands and low job control on the balance between work and family. The study participants were 713 women working in long‐term care for elderly people in Finland. The results showed that high job demands, low job control, and unfair decision making were associated with high levels of time‐based work interference with family (WIF). Perceptions of organizational fairness were found to partially mediate the association between job control and WIF. In addition, fair treatment and management protected against WIF when demands were low but were unable to buffer against the negative effects of high job demands. © 2008 Wiley Periodicals, Inc.     

Low levels of B-type natriuretic peptide predict poor clinical outcomes in patients with chronic and advanced heart failure

B-type natriuretic peptide (BNP) is a neurohormone produced mainly by ventricular myocytes in response to increased left ventricular end-diastolic pressure. Patients with acute decompensated heart failure often have elevated plasma BNP. However, recent clinical observations have demonstrated that in patients with advanced heart failure, the plasma level of BNP is lower than those with acute heart failure. We hypothesized that a lower circulating BNP level in patients with chronic and advanced heart failure is due to the exhaustion of the biosynthesis mechanisms and is associated with a poor outcome in these patients.     

Using the IPQ and PMDI to predict regular diabetes care‐seeking among patients with Type 1 diabetes

Objectives: The objectives were, first, to identify factors associated with regular diabetes care‐seeking and, second, to compare the performance of the Illness Perception Questionnaire (IPQ) and a modified version of the Personal Models of Diabetes Interview (PMDI) in predicting care‐seeking. Method: This was a cross‐sectional study involving 42 patients who had not attended hospital diabetes clinic for a period of 18 months or more and 42 matched controls receiving specialist care. Differences in illness representations between clinic attenders and non‐attenders were examined. Due to the variability in care‐seeking between non‐attenders (ranging from no contact with health professionals to regular general practitioners care), participants were then reclassified for further analyses into those receiving regular care from either hospital diabetes clinic or general practice (n = 52) and those receiving no regular care (n = 32). Results: Patients not seeking regular care held more negative views of the control, course and consequences of diabetes than those who received regular care. Regression analyses showed that the most important construct was treatment effectiveness. Treatment effectiveness (PMDI) and control (IPQ) dimensions were associated with clinic attendance. PMDI constructs of treatment effectiveness, threat and worries were associated with regular care‐seeking. Conclusions: IPQ and PMDI results were generally consistent. In order to understand diabetes care‐seeking behaviour it is important to measure beliefs about the benefits of treatment recommendations in addition to those of the disease itself. Emotional and cognitive responses to diabetes should be assessed.     

Interpretation of genotypic resistance to predict darunavir/ritonavir failure in antiretroviral experienced patients

From the Italian Antiretroviral Resistance Cohort Analysis database, 1104 patients starting ritonavir-boosted darunavir-containing regimen were included as follows: 118 subsequently failed treatment at a median of 11 months (interquartile range: 5-20); 3 years failure proportion: 24.6%. HIV Drug Resistance Database and ANRS interpretation algorithms were associated with a progressive risk prediction of virological failure at adjusted Cox. In contrast, Rega algorithm allows to identify a higher number of patients at risk of failure, without losing statistical significance. Four mutations (V32I, I50V, L76V, I84V) were predictive of failure, the hazard ratio progressively increased by detecting 1 (hazard ratio: 2.0, 95% confidence interval: 1.3 to 3.0), 2 (3.6, 2.0 to 6.6), or 3 of them (9.7, 2.8 to 33.5).     

煤炭企业员工的职业使命感与工作负荷、工作满意度的关系

目的:考察煤炭企业员工的职业使命感与工作负荷、工作满意度的关系以及工作负荷在职业使命感与工作满意度之间的调节作用。方法:在以煤炭为主营业务的某矿业集团中选取员工404人,采用使命感问卷(SCQ)、工作负荷问卷(WQ)与总体员工满意度问卷(GESQ)进行调查。结果:煤炭企业员工的SCQ得分与WQ、GESQ得分均呈正相关(r=0.13、0.57,均P0.05),WQ得分与GESQ得分呈正相关(r=0.12,P0.05);SCQ得分正向预测WQ工作步调负荷得分和GESQ得分(β=0.15、0.51,均P0.01);工作负荷在使命感与工作满意度之间的调节效应无统计学意义。结论:煤炭企业员工的职业使命感会给他们带来较高的工作负荷和工作满意度,工作负荷的高低可能不会改变使命感与工作满意度之间的关系。     

Intention to serve the same company for long years and job satisfaction in Japanese workers

The purpose of this study was to investigate the relation between intention to serve the same company for long years and job satisfaction in Japanese workers. Four hundred eighteen Japanese workers completed a questionnaire to assess intention to serve for long years and job satisfaction. Job satisfaction was measured by two scales. One scale was consisted of the items which were deviced in the preliminary study concerning satisfaction with the company, and the other was consisted of the items based on the Minnesota Satisfaction Questionnaire. A factor analysis on the former scale yielded four factors: fosterage by company, order in company, company's name recognition, and expansibility of company. A factor analysis on the latter yielded four factors: contribution and activity, recognition and benefits, supervision, and discretion on job. The multiple regression analysis showed that "expansibility of company" was the most important predictor of intention to serve for long years.     

Diabetes mellitus and congestive heart failure: the prevalence of congestive heart failure in patients with and without diabetes in Poland

IntroductionDiabetes mellitus is a systemic disease and has a negative effect on the cardiovascular system. This paper aimed to present a retrospective analysis of morbidity associated with heart failure in subgroups of patients with and without diabetes in Poland in 2012.Material and methodsData from the National Health Fund were used for the study. In general, 656,937 patients with heart failure, including 281,538 males and 375,354 females, were studied. In this population, additionally, 201,043 patients with heart failure (main diagnosis) and diabetes were studied, including 82,117 males and 118,926 females.ResultsThe mean index of morbidity associated with heart failure in the whole subpopulation of diabetes patients was 9.03%; 8.42% for males and 9.50% for females. Morbidity associated with heart failure in the population of patients diagnosed with diabetes in Poland in 2012 was seven times higher compared to morbidity associated with heart failure in non-diabetes patients. Morbidity associated with heart failure in females was significantly higher compared to morbidity in males in the whole population, in both the subpopulations of patients with and without diabetes.ConclusionsDiabetes mellitus significantly increases risk of heart failure in both women and men. The risk is significantly high after the age of 60 years and higher in females.     

Use of a comprehensive numerical model to improve biventricular pacemaker temporization in patients affected by heart failure undergoing to CRT-D therapy

Cardiac resynchronization therapy by biventricular pacemaker/ICD implantation is a validated therapy for patients affected by heart failure with asynchrony of ventricular contraction. Considering the large number of parameters which play a role in cardiac resynchronization therapy, a comprehensive numerical model of cardiocirculatory system could be a useful tool to support clinical decisions. A variable elastance model of ventricles was updated to model the interventricular septum and to simulate the interventricular and the intraventricular desynchrony, and the effect of the biventricular stimulation. In addition, a numerical model of the biventricular pacemaker, which drives the beginning of the heart chambers and interventricular septum contraction, was also developed. In order to validate the model,