Exposure to violence in relation to personality traits, coping abilities, and burnout among caregivers in nursing homes: a case-control study

Background: Although violence toward caregivers occurs often and caregivers’ ability to interact and deal with difficult situations is relevant in preventing such violence, few studies have been conducted that focus on caregivers’ characteristics. Aim: This study explores the relationship between perceived exposure to violence and demographical factors, parental rearing, personality traits including coping abilities, defence styles, and burnout among caregivers working in nursing homes. Method: A total of 196 caregivers working in nursing homes were included. They were asked to complete questionnaires concerning demographical factors and exposure to violence. One group of female caregivers reporting no exposure to violence (n = 20) was matched with one group of exposed to violence (n = 20). Both groups were asked to complete questionnaires concerning parental rearing, personality traits, coping abilities, and burnout. Result: Around 68.4% of the caregivers had been exposed to violence during the previous year and 22.4% several times a week. Caregivers 50 years of age or younger and employed in geriatric care for more than 3 years were more frequently exposed to violence. Inter‐group differences were found regarding ‘maternal rejection’ and ‘burnout’. No statistical differences could be found concerning defence styles, coping ability, temperament, or character aspects. Conclusion: Violence toward caregivers occurs frequently and appears to be influenced by several factors. ‘Maternal rejection’ and ‘burnout’ among caregivers exposed to violence might influence the communication between caregivers and residents, rendering more violence. However, personality traits among caregivers do not seem to be associated with exposure to violence.     

Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition

PURPOSE: To analyze ligament innervation and the structural composition of wrist ligaments to investigate the potential differences in sensory and biomechanical functions. METHODS: The ligaments analyzed were the dorsal radiocarpal, dorsal intercarpal, scaphotriquetral, dorsal scapholunate interosseous, scaphotrapeziotrapezoid, radioscaphoid, scaphocapitate, radioscaphocapitate, long radiolunate, short radiolunate, ulnolunate, palmar lunotriquetral interosseous, triquetrocapitate, and triquetrohamate ligaments. The ligaments were harvested from 5 cadaveric, fresh-frozen specimens. By using the immunohistochemical markers p75, Protein Gene Product 9.5, and S-100 protein, the mechanoreceptors and nerve fibers could be identified. RESULTS: The innervation pattern in the ligaments was found to vary distinctly, with a pronounced innervation in the dorsal wrist ligaments (dorsal radiocarpal, dorsal intercarpal, scaphotriquetral, dorsal scapholunate interosseous), an intermediate innervation in the volar triquetral ligaments (palmar lunotriquetral interosseous, triquetrocapitate, triquetrohamate), and only limited/occasional innervation in the remaining volar wrist ligaments. The innervation pattern also was reflected in the structural differences between the ligaments. When present, mechanoreceptors and nerve fibers were consistently found in the loose connective tissue in the outer region (epifascicular region) of the ligament. Hence, ligaments with abundant innervation had a large epifascicular region, as compared with the ligaments with limited innervation, which consisted mostly of densely packed collagen fibers. CONCLUSIONS: The results of our study suggest that wrist ligaments vary with regard to sensory and biomechanical functions. Rather, based on the differences found in structural composition and innervation, wrist ligaments are regarded as either mechanically important ligaments or sensory important ligaments. The mechanically important ligaments are ligaments with densely packed collagen bundles and limited innervation. They are located primarily in the radial, force-bearing column of the wrist. The sensory important ligaments, by contrast, are richly innervated although less dense in connective tissue composition and are related to the triquetrum. The triquetrum and its ligamentous attachments are regarded as key elements in the generation of the proprioceptive information necessary for adequate neuromuscular wrist stabilization.     

Alpha-radioimmunotherapy of intraperitoneally growing OVCAR-3 tumors of variable dimensions: Outcome related to measured tumor size and mean absorbed dose.

The purpose of this work was to (a) investigate the efficacy of radioimmunotherapy using 211At-MX35 F(ab')2 or 211At-Rituximab F(ab')2 (nonspecific antibody) against differently advanced ovarian cancer in mice; (b) image the tumor growth on the peritoneum; and (c) calculate the specific energy and mean absorbed dose to tumors and critical organs. METHODS: Two experiments with 5-wk-old nude mice (n = 100 + 93), intraperitoneally inoculated with approximately 1 x 10(7) NIH:OVCAR-3 cells, were done. At either 1, 3, 4, 5, or 7 wk after inoculation animals were intraperitoneally treated with approximately 400 kBq 211At-MX35 F(ab')2 (n = 50 + 45), approximately 400 kBq 211At-Rituximab F(ab')2 (n = 25 + 24), or unlabeled Rituximab F(ab')2 (n = 25 + 24). At the time of treatment 29 animals were sacrificed and biopsies were taken for determination of tumor sizes using scanning electron microscopy (SEM). Eight weeks after each treatment the animals were sacrificed and the presence of macro- and microscopic tumors and ascites was determined. The specific energy and mean absorbed dose to tumors were calculated. The activity concentration was measured in critical organs and abdominal fluid. RESULTS: When given treatment 1, 3, 4, 5, or 7 wk after cell inoculation the tumor-free fraction (TFF) was 95%, 68%, 58%, 47%, 26%, and 100%, 80%, 20%, 20%, and 0% when treated with 211At-MX35 F(ab')2 or 211At-Rituximab F(ab')2, respectively. The SEM images revealed maximum tumor radius of approximately 30 mum 1 wk after cell inoculation, increasing to approximately 340 mum at 7 wk. Specific energy to cell nuclei varied between 0 and approximately 540 Gy, depending on assumptions regarding activity distribution and tumor size. The mean absorbed dose to thyroid, kidneys, and bone marrow was approximately 35, approximately 4, and approximately 0.3 Gy, respectively. CONCLUSION: Treatment with 211At-MX35 F(ab')2 or 211At-Rituximab F(ab')2 resulted in a TFF of 95%-100% when the tumor radius was < or =30 microm. The TFF was decreased (TFF < or = 20%) for 211At-Rituximab F(ab')2 when the tumor radius exceeded the range of the alpha-particles. The specific antibody gave for these tumor sizes a significantly better TFF, explained by a high mean absorbed dose (>22 Gy) from the activity bound to the tumor surface and probably some contribution from penetrating activity.     

I-labelling of an internally Se-labelled monoclonal antibody—Biodistribution in tumour-bearing nude mice

A monoclonal antibody, C215, was first internally labelled with ⁷⁵Se-methionine and then labelled with ¹²⁵I. The biodistribution of the dual-labelled [¹²⁵I][⁷⁵Se]C215 was studied in tumour-bearing nude mice killed 3 days after injection. The biodistribution of the dual-labelled [¹²⁵I][⁷⁵Se]C215 was compared with the biodistribution of single-labelled [¹³¹I]C215 and [⁷⁵Se]C215. Iodine-labelled antibodies seem to be damaged during iodination, affecting the disappearance rate and tumour uptake. There were no signs of dehalogenation of circulating antibodies or antibodies taken up in the tumour.     

Do daughters of female alcoholics have more problems during childhood and adolescence than sons?

171 female alcoholic inpatients living in Stockholm were examined and found to fulfil the alcoholism criteria of DSM-III-R. They comprised 171 women consecutively admitted to the Karolinska Alcohol Clinic and staying at least one week for treatment. The examination included a general medical examination, a psychiatric and social history, blood tests and ECG. The subjects' and their families' possibilities of creating a good upbringing environment for their children and their own childhood were studied.

The alcoholics and their offspring were followed from the registers of the child welfare committees, temperance boards, social service departments, the Social Insurance Office and the Medical Information System of the Medical Services Board of Stockholm County Council.

The children of the female alcoholics had, during their childhood, often had contact with an educational welfare officer, a psychologist or a physician for various problems and were also registered in the children's welfare committee registers. 29% of the female alcoholics themselves had been fostered by their biological mother alone or by grandparents until 16 years of age. 51% of the women had an alcohol-abusing mother and father during childhood. Signs of social maladjustment and having been under the care of a child welfare committee were recorded in 20% and 12% of the women.

Among the children, we found that the boys were more vulnerable during their adolescence than the girls and that there were also major similarities in the social situation for these children of alcoholic women. The indications were that there is also a vulnerable group among girls who develop high consumption of alcohol and simultaneous drug abuse during their teens. Forty five per cent of the girls and 60% of the boys among the female alcoholics' children had school problems and were also in contact with an educational welfare officer, psychologist or physician for various problems. Scrutiny of the Children's Welfare Committee Register showed 60% of the sons and 40% of the daughters were registered. Forty five per cent of the boys and 30% of the girls were registered by the Temperance Board. Forty per cent of the boys and 25% of the girls were registered in the Criminal Offenders Register. Forty five per cent of the boys and 30% of the girls had had hospital treatment on at least one occasion for underlying physical illness or injury. The most common reason for establishing contact with children's psychiatric outpatient clinics or counselling clinics was recommendation and investigation necessitated by supportive measures and school adjustment problems.

It is concluded that female alcoholics resemble male alcoholics and that these females have a disturbed childhood and often have an alcohol and drug-abusing parent, nervous problems in the parents, attempted suicide by a parent and serious schisms in the family and that especially the boys from these female alcoholics' families are extremely vulnerable and they have a more traumatic childhood than the girls, but both of them fare ill.     

The View of Caring among Patients and Personnel

All patients in hospital care and primary health care in the county of Västerbotten, Sweden (n = 5158) were asked to express their level of satisfaction with the quality of care. The study was carried out on one specific day. All personnel on duty that day (n = 2824) were also included and asked to give their interpretations of their patients' experiences. A questionnaire containing positive and negative statements concerning both the relationship and the task aspects of care was used. The results showed that the youngest and oldest patients expressed the highest degree of satisfaction, while young and middle-aged patients expressed a more restrained view. The least satisfactory aspects concerned the opportunities to express criticism and the possibilities of receiving information about access to help outside the health care organization. The personnel's responses agreed with those of the patients, but fewer personnel thought that their patients were satisfied than was in fact the case.     

A comparison between the care of vocally disruptive patients and that of other residents at psychogeriatric wards

This study aimed at examining the relationship between the occurrence of vocally disruptive behaviour and the care of demented patients. The results presented here focus on the contents of the patient's daily life provided by the staff. In all the psychogeriatric wards within one county council, having patients identified as vocally disruptive, 37 patients exhibiting this behaviour and 37 controls were studied. Semistructured continuous observations for 15 hours per patient (7.00 a.m.-10.00 p.m.) were made. Data from a previous report revealed that the vocally disruptive patients were more physically dependent on the staff as compared to controls. However, the physical care provided did not differ significantly. The patients spent 21% of the observed time in caring activities, mainly physical care, 18% of the time they were sleeping or dozing, and 71% of the observed time they were left to themselves and reduced to inactivity and solitude. Regression analysis disclosed that only the amount of activating care in a group was significantly related to the vocally disruptive behaviour. Hence the data support the idea that understimulation is present in the demented patient's life but it can hardly be the cause of the behaviour. However, the environment might contribute to the occurrence and maintenance of vocally disruptive behaviour.     

Incidence of violence towards staff caring for the elderly

A survey study concerning violence was conducted among staff (n=506) working with the elderly in residential settings and ordinary homes. The major aim of the study was to investigate the incidence of violence directed towards staff by elderly people living in residential settings. Furthermore, associations between the number of violent incidents and gender, age, year in service, year at present place of work, education of the staff, type of setting, the frequency and type of violence as well as the emotional reactions expressed by the staff should be examined. Forty percent of the staff was exposed to violence during the preceding year and 18% noted incidents of violence daily. A significantly larger proportion of staff working in nursing homes registered violence compared with those working in other types of settings. Physical violence was the most common (76%) type of violence. Powerlessness, sadness, anger and feelings of insufficiency were the most dominant feelings among staff facing by violent situations. Our results point to the necessity to further study caregivers' perception of patient violence and its impact on the quality of care.     

Comparison of therapeutic efficacy and biodistribution of 213Bi- and 211At-labeled monoclonal antibody MX35 in an ovarian cancer model

IntroductionThe purpose of this study was to compare the therapeutic efficacy and biodistribution of the monoclonal antibody MX35 labeled with either ²¹³Bi or ²¹¹At, both α-emitters, in an ovarian cancer model.MethodsOne hundred female nude BALB/c (nu/nu) mice were inoculated intraperitoneally with human ovarian cancer cells (OVCAR-3). Two weeks later, 40 of these mice were injected intraperitoneally with ～2.7 MBq of ²¹³Bi-MX35 (n=20) or ～0.44 MBq of ²¹¹At-MX35 (n=20). Four weeks after inoculation, 40 new OVCAR-3-inoculated mice were injected with the same activities of ²¹³Bi-MX35 (n=20) or ²¹¹At-MX35 (n=20). Presence of tumors and ascites was investigated 8 weeks after therapy. Biodistributions of intraperitoneally injected ²¹³Bi-MX35 and ²¹¹At-MX35 were studied in tumor-free nude BALB/c (nu/nu) mice (n=16).ResultsThe animals injected with ²¹³Bi-MX35 or ²¹¹At-MX35 2 weeks after cell inoculation had tumor-free fractions (TFFs) of 0.60 and 0.90, respectively. The untreated reference group had a TFF of 0.20. The groups treated with ²¹³Bi-MX35 or ²¹¹At-MX35 4 weeks after inoculation both had TFFs of 0.25, and the reference animals all exhibited evidence of disease. The biodistributions of ²¹³Bi-MX35 and ²¹¹At-MX35 were very similar to each other and displayed no alarming activity levels in the investigated organs.ConclusionsMicrometastatic growth of an ovarian cancer cell line was reduced in nude mice after treatment with ²¹³Bi-MX35or ²¹¹At-MX35. Treatment with ²¹¹At-MX35 provided a non-significantly better result for the chosen activity levels. The radiolabeled MX35 did not accumulate to a high extent in the investigated organs. No considerable signs of toxicity were observed.     

Irradiation Induces Marked Immunohistochemical Expression of Vasoactive Intestinal Peptide in Colonic Mucosa of Man

Vasoactive intestinal peptide (VIP) is known tomodulate inflammatory reactions, to have trophiceffects, and to contribute to diarrhea and has beenimplicated as an important factor in severalinflammatory conditions in the human gut. The aim of thepresent study was to investigate the effects ofirradiation on the expression of VIP in the colon ofpatients operated on for adenocarcinoma. Some of thepatients had received preoperative irradiation (25 Gy)within one week before the operation. Specimens ofsigmoideum, 10 cm cranial to the margin of the cancer,were examined, by using antiserum against VIP and immunohistochemistry. There were numerous nervefibers showing VIP-like immunoreactivity in the damagedmucosa, including the regions showing ulcerations. Therewas a higher degree of expression of VIP in the ganglion cells in the submucous plexusesin irradiated than nonirradiated patients. The studyshows that there is a marked immunohistochemicalexpression of VIP concomitant with the occurrence of inflammatory and repair processes in theirradiationdamaged human colonic mucosa.