Palliative caregivers who would not take on the caring role again

ContextHealth and social services rely heavily on family and friends for caregiving at the end of life.ObjectivesThis study sought to determine the prevalence and factors associated with an unwillingness to take on the caregiving role again by interviewing former caregivers of palliative care patients.MethodsThe setting for this study was South Australia, with a population of 1.6 million people (7% of the Australian population) and used the South Australian Health Omnibus, an annual, face-to-face, cross-sectional, whole-of-population, multistage, systematic area sampling survey, which seeks a minimum of 3000 respondents each year statewide. One interview was conducted per household with the person over the age of 15 who most recently had a birthday. Using two years of data (n = 8377; 65.4% participation rate), comparisons between those who definitely would care again and those who would not was undertaken.ResultsOne in 10 people across the community provided hands-on care for someone close to them dying an expected death in the five years before being interviewed. One in 13 (7.4%) former caregivers indicated that they would not provide such care again irrespective of time since the person’s death and despite no reported differences identified in unmet needs between those who would and would not care again. A further one in six (16.5%) would only “probably care again.” The regression model identified that increasing age lessens the willingness to care again (odds ratio [OR] 3.94; 95% confidence interval [CI] 1.56, 9.95) and so does lower levels of education (OR 0.413; 95% CI 0.18, 0.96) controlling for spousal relationship.ConclusionThese data suggest that assessment of willingness to care needs to be considered by clinical teams, especially in the elderly. Despite most active caregivers being willing to provide care again, a proportion would not.     

Exploratory study of the psychopathological profiles of adolescent cannabis users

Although adolescent cannabis users have been reported not to be a homogeneous group, they are few typological studies and only one based on psychopathological variables. A better knowledge of the typology of cannabis users might contribute to the identification of specific needs concerning prevention or treatment. Among 199 adolescents using cannabis at least monthly during the last six month, cluster analysis yielded three clusters based on depressive symptoms, social anxiety, borderline personality traits, and psychopathic traits (impulsivity and callous-unemotional traits). The largest cluster, called 'ordinary' was well below the mean on all measures. Another cluster, labeled 'borderline' was distinguished by high levels of borderline traits, depressed mood, and social anxiety. The smallest cluster, called 'impulsive' was well above the mean in impulsivity and callous traits but low on all other measures. Frequency of cannabis use was higher in the borderline and impulsive clusters than in the ordinary cluster. Multiple regression analyses suggested that the contributions of psychopathological variables to cannabis use varied across clusters.     

Reducing 'swine flu': the midwife's role

With 70 per cent of pregnant women remaining unvaccinated in January 2011, the Department of Health (DOH) and the Royal College of Obstetricians and Gynaecologists (RCOG) provided further updated advice for providers of maternity services in February 2011, stressing that pregnant women should be included in the 'at risk' groups for GPs' seasonal flu vaccine, which would also reduce the incidence of H1N1 virus in newborns (DOH and RCOG 2011). The launch of the 'NHS Flu Fighter' this autumn is expected to increase the uptake of NHS staff being vaccinated, further reducing transmission to this vulnerable group.     

Higher rate of bronchoalveolar lavage culture positivity in children with nonacid reflux and respiratory disorders

The aim of the study was to determine if children with chronic cough or wheezing and with more full-column, nonacid reflux have a higher likelihood of a positive bronchoalveolar lavage fluid culture. In a prospective study of 46 children with cough who were undergoing endoscopy, multichannel intraluminal impedance testing, and bronchoscopy, we found that patients who had a positive culture had significantly more full-column, nonacid gastroesophageal reflux than those who had a negative culture.     

Once initiated,viral encephalitis-induced seizures are consistent no matter the treatment or lack of interleukin-6

Theiler’s murine encephalomyelitis virus infection of C57BL/6 mice results in acute behavioral seizures in 50% of the mice. Treatment of infected mice with minocycline or infection of interleukin (IL)-6-deficient chimeric mice results in a significant decrease in the number of mice developing seizures. However, in those mice that do develop seizures, the pathological changes (neuronal cell loss, inflammation [perivascular cuffing, gliosis, activated microglia/macrophages]), and the numbers of virus infected cells in minocycline-treated or IL-6-deficient chimeric mice are very similar. Therefore, once seizures develop, the pathological changes are consistent regardless of the treatment or genetic background.     

Parents' experiences of newborn screening for genetic susceptibility to type 1 diabetes

Advances in genomic medicine have lead to debate about the potential inclusion of genetic tests for susceptibility to common complex disorders in newborn screening programmes. Empirical evidence concerning psychosocial reactions to genetic testing is a crucial component of both ethical debate and policy development, but while there has been much speculation concerning the possible psychosocial impact of screening newborns for genetic susceptibilities, there remains a paucity of data. The aim of the study reported here is to provide some of this missing empirical evidence, using type 1 diabetes as an example of a common disorder with multiple significant genetic contributors to its aetiology. Semi-structured interviews were conducted with 11 parents of babies who had received increased risk results in a study that involved newborn screening for genetic susceptibility to type 1 diabetes. Interpretative phenomenological analysis was used to evaluate the data. The interview data suggest that the probabilistic nature of results of genetic susceptibility tests impacts upon all aspects of parents' psychosocial reactions, resulting in a complex and dynamic process quite different to that described in relation to current newborn screening programmes. While parents generally reported fairly minor levels of concern in response to news of their child's increased genetic risk, these worries frequently recurred, and perception of risk also varied and fluctuated over time. Both individual and contextual factors appeared to interact with the inherent uncertainty of the test result to contribute to the dynamic nature of parental reactions, and their behavioural responses. The implications of these findings for future research and for the debate concerning potential expansion of newborn screening are discussed.