Caregiver forgiveness is associated with less burden and potentially harmful Behaviors

Objectives: This study investigated whether caregiver forgiveness of care recipient's (CR's) upsetting behaviors is associated with less burden and potentially harmful behaviors (PHB) by the caregiver.

Method: Seventy-six family caregivers of persons with dementia were recruited by means of convenience sampling through two local dementia service centers in Hong Kong. Caregivers were asked to complete an anonymous questionnaire that assessed CR behavior problems and caregiver burden, PHB and forgiveness.

Results: Results showed that forgiveness partially mediated the associations between CR disruptive behaviors and caregiver burden, and between CR depression and caregiver burden. At the same time, burden partially mediated the relationship between forgiveness and PHB.

Conclusion: The associations between certain behavioral problems and burden were mediated by caregiver forgiveness. Forgiveness also predicted harmful behaviors, both directly and indirectly through burden. Future research should investigate the basis of forgiveness in dementia caregivers and whether forgiveness may constitute another dimension in caregiver interventions.     

东莞市2004至2007年脑卒中发病率趋势及住院直接经济负担调查

目的了解东莞地区2004～2007年脑卒中流行病学发病趋势及住院直接经济负担。方法监测东莞地区2004至2007年脑卒中的发病情况、住院相关经济指标及影响因素。结果东莞地区脑卒中的平均发病密度为142．5／10万人年,4年来脑卒中的标准化发病率有逐年升高趋势,平均每年增长7．9％。脑卒中患者平均住院日16．6d,平均住院费用为11715．5元,脑卒中亚型（P〈0．001）、平均住院时间（P〈0．001）和预后（P〈0．001）是影响平均住院费用的主要因素。结论东莞市脑卒中发病率有逐年上升的趋势,缩短住院时间可能是减轻住院经济负担的合理途径。     

湛江市遂溪县曲水村人体寄生虫分布与危害调查

目的了解广东省湛江市遂溪县洋青镇曲水村人体寄生虫病流行与危害情况。方法采用生理盐水直接涂片法、饱和盐水浮聚法、改良加藤厚涂片法和试管滤纸钩蚴培养法检查人体寄生虫感染情况。采用询问登记、填写调查表方式,了解寄生虫病的危害情况。解剖检查褐家鼠、福寿螺广州管圆线虫感染情况。结果检出钩虫、蛔虫、鞭虫、蛲虫和粗脚粉螨5种寄生虫,总感染率为10.75%。钩虫感染率为6.07%,蛔虫和鞭虫均为1.87%,蛲虫和粗脚粉螨均为0.47%。感染率男性高于女性,与职业和年龄分布无关。感染度多以轻度为主。钩虫感染者钩蚴性皮炎发生率为69.23%,虫种为美洲钩虫。鼠类、褐云玛瑙螺和福寿螺广州管圆线虫感染率分别为16.66%,13.04%和10.00%。结论遂溪县曲水村分布虫种主要为线虫,以钩虫为主;为广州管圆线虫病的自然疫源地。     

左心室瘢痕负荷SPECT相位分析法检测及其对心脏再同步治疗疗效的影响

目的 观察慢性心力衰竭患者心脏再同步治疗(CRT)后有反应和无反应者之间左心室瘢痕负荷的差异性,评价左心室瘢痕负荷对CRT疗效的影响.方法 对30例2006年至2010年因慢性心力衰竭在南京医科大学第一附属医院接受CRT的患者进行静息核素心肌显像检查,应用相位分析技术检测左心室瘢痕负荷、收缩期相位时间标准差( phase S D)和带宽(BW)并用来评价心脏同步性.以术后6个月超声心动图的检测结果及随访6个月内是否因心力衰竭住院作为分组标准,左心室射血分数(LVEF)提高≥0.05且无因心力衰竭住院的患者入选反应组,LVEF提高＜0.05或者入院1次以上的患者入选无反应组,观察两组之间左心室瘢痕负荷和同步性指标之间的差异.结果 30例患者中反应组19例(男8例),无反应组11例(男8例).两组之间术前临床资料相似,年龄、性别均差异无统计学意义;有反应组术前QRS时限显著大于无反应组[(163.0±7.7)ms对(134.6±11.8) ms,P＜0.05];两组术前LVEF差异无统计学意义,但术后有反应组显著高于无反应组(0.49±0.02对0.33±0.15,P＜0.01).两组患者左心室瘢痕负荷和CRT术后左心室同步性差异具有统计学意义,有反应组患者的左心室瘢痕负荷明显低于无反应组(24.6％±3.6％对36.5％±3.9％,P=0.022);有反应组左心室同步性较好,收缩期相位时间标准差明显小于无反应组(28.1°±4.4°对56.1°±6.9°,P＜0.01),收缩期带宽明显小于无反应组(88.0°±13.9°对170.1°±24.4°,P＜0.01).左心室瘢痕负荷和心脏同步性对CRT疗效具有明显的影响.结论 接受CRT的慢性心力衰竭患者,左心室瘢痕负荷和CRT术后心脏同步性与CRT疗效密切相关.     

The economic burden of hypertension in rural south‐west China

Objective To estimate the economic burden of hypertension in a given year in rural Yunnan Province of China, including direct, indirect and intangible costs. Methods A prevalence‐based cost‐of‐illness method was used to estimate the economic burden of hypertension. Data on participants’ demographic characteristics, inpatient hospitalisation expenditures, outpatient visit expenditures, self‐medication costs and indirect costs related to hypertension were collected from a cross‐sectional health examination and questionnaire survey, involving 9396 consenting individuals aged ≥18 years and 3500 households. Blood pressure (BP) levels were determined from the average of three BP measurements. Years of life lost (YLL) because of hypertension was estimated using medical death certificates. Results The overall prevalence of and YLL/1000 population because of hypertension was 24.8% and 1.5 years for the survey population, respectively. Mean unit direct medical costs, direct non‐medical costs, morbidity costs, mortality costs, intangible costs and cost of illness were estimated to be $467.2, $20.1, $23.5, $8265.1, $417.4 and $9393.3, respectively. The total cost of hypertension was estimated to be $231.7 million. Direct costs represented the largest component of economic cost of hypertension. On average, males had higher overall direct, indirect and intangible costs of hypertension than females. Both indirect and intangible costs decreased with age, whereas direct costs increased with age. The incidence of household catastrophic health payment and household impoverishment because of hypertension was 8.9% and 4.1%, respectively. Conclusions Hypertension inflicts a considerable economic burden upon individual households and society as a whole in Yunnan Province, China.     

Caregiver burden and disability in somatization disorder

Objective

Authors assessed disability and caregiver burden in patients with somatization disorder (SOM-D), and compared it with that in patients with schizophrenia and chronic depression.

Methods

The sample consisted of 30 patients diagnosed as SOM-D as per ICD 10 Diagnostic Criteria for Research (ICD-10-DCR), and 30 age- and gender-matched patients each of schizophrenia and depression, who served as comparison groups. Disability and caregiver burden were assessed using WHO's Disability Assessment Schedule (WHO-DAS) and the Family Burden Assessment Schedule (FBAS) respectively. Functioning and severity of illness were assessed on the Global Assessment of Functioning scale (GAF) and Clinical Global Impression scale (CGI) respectively.

Results

Severity of illness in patients with SOM-D was comparable to that in the comparison groups. Patients with SOM-D scored higher on total disability on WHO-DAS than the patients with schizophrenia and depression, though scores on family burden were comparable. Disability in patients with SOM-D was more in females, less educated, older and those working at home, compared to the other demographic groups.

Conclusion

Patients with SOM-D suffer considerable disability due to illness and impose significant burden on their caregivers, comparable to that seen in severe mental illnesses like schizophrenia and chronic depression.     

Sustained outcomes of a peer‐taught family education program on mental illness

Objective: This study examines 6‐month follow‐up data from participants in a randomized trial of a peer‐driven 12‐session family support and education program, called family‐to‐family (FTF) and offered by the US National Alliance on Mental Illness, to determine whether improvements in distress, family functioning, coping and empowerment were sustained. Method: Individuals randomized to the FTF condition were assessed after program completion and then 3 months later on measures of distress, family functioning, coping, and empowerment. We used a multilevel regression model (sas proc mixed ) to test for significant changes over time (baseline, 3 and 9 months). Results: All significant benefits that FTF participants gained between baseline and immediately post‐FTF were sustained at 9 months including reduced anxiety, improved family problem‐solving, increased positive coping, and increased knowledge. Greater class attendance was associated with larger increases in empowerment and reductions in depression and displeasure with ill relative. Conclusion: Evidence suggests that benefits of the FTF program were sustained for at least 6 months without any additional boosters or supports. Peer‐based programs may produce sustained benefits for individuals seeking help in addressing challenges and stresses related to having a family member with a mental illness.     

Increased pulse wave velocity and carotid intima–media thickness in patients with carpal tunnel syndrome

Introduction: Carpal tunnel syndrome (CTS) is associated with cardiovascular risk factors. The aim of our study was to determine whether carotid intima–media thickness (CIMT) and carotid–femoral pulse wave velocity (cf-PWV), as surrogates of cardiovascular disease and arterial stiffness, are increased in patients with carpal tunnel syndrome. Methods: Forty patients with CTS and 40 gender- and age-matched controls underwent cf-PWV assessment, CIMT measurement, and nerve conduction study. Results: CIMT and cf-PWV were increased significantly in patients with CTS. They correlated positively with median sensory and motor nerve distal latency. Whereas both CIMT and PWV related to CTS, only CIMT independently predicted CTS. Conclusions: There is both increased pulse wave velocity and CIMT and a positive correlation between these parameters and median nerve sensory distal latency in patients with CTS. CTS appears to be associated with arterial stiffness and atherosclerotic burden, but the underlying mechanisms require further study. Muscle Nerve 47: 872–877, 2013