In-home online music-based intervention for stress, coping, and depression among family caregivers of persons with dementia: A pilot study.

Little is known about how music affects family caregivers who provide care to persons with dementia at home. We examined the effects of an 8-week online music-based intervention on self-reported stress, coping, and depression among dementia family caregivers. Mann-Whitney U test and Wilcoxon signed-ranked tests were performed to examine between- and within-group differences between intervention (n = 24) and comparison (n = 11) groups from baseline to post-test. The coping subscale yielded a significant difference between the groups at post-test (U=76.50, Z=-1.978, p=0.048), indicating the intervention group had better coping than the comparison group at post-test. Significant within-group differences in overall stress (Z=-2.200, p=0.028) and coping subscale (Z=-1.997, p=0.046) in the comparison group at post-test suggest that overall stress and coping were maintained throughout the study in the intervention group, whereas the comparison group had higher overall stress and lower coping at post-test. Our in-home music-based intervention showed potential benefits for dementia family caregivers.

Academic Leadership Roles and the Promotion of Research, Education, and Practices That Reframe Aging.

Healthy aging represents an aspect of nursing science where there is accelerating academic interest in a topic that is of great public interest. Thus, an opportunity presents to consider how best to leverage academic leadership roles to assure a forward-looking curriculum, foster relevant research, and communicate results to the public. There are many roles that academic nursing leaders can play in advancing transformational ideas such as healthy aging, including acting as incubator and resource, hub and bridge, educational futurist, and public advocate. Nursing brings to this transformational task knowledge of the need for evidence-based research to guide policy and decision making as it relates to aging, clinical experience, and an ability to convey to a non-professional audience the clinical experience and research results. [Journal of Gerontological Nursing, 45(12), 28-32.].

Silicon-photonic PTAT temperature sensor for micro-ring resonator thermal stabilization.

We present a scheme for thermal stabilization of micro-ring resonator modulators through direct measurement of ring temperature using a monolithic PTAT temperature sensor. The measured temperature is used in a feedback loop to adjust the thermal tuner of the ring. The closed-loop feedback system is demonstrated to operate in presence of thermal perturbations at 20Gb/s.

Strategies for recreating normal life: Iranian coronary heart disease patients' perspectives on coping strategies.

AIMS AND OBJECTIVES: To identify coping strategies used by Iranian patients with coronary heart disease. BACKGROUND: One of the most important nursing interventions is facilitating adjustment for patients. A deeper understanding of patients' coping strategies for controlling illness and its consequences is needed. DESIGN: A qualitative design. METHODS: Participants were hospitalised patients diagnosed with coronary heart disease, based on documented angiographic results. A qualitative study using semi-structured interviews was conducted, and purposive sampling was performed. The qualitative content analysis determined categories and subcategories for describing and understanding coping strategies. RESULTS: The term 'coping strategies' refers to the strategies used by participants living with coronary heart disease as they attempt to understand and control their chronic condition and return to a social and physical state as similar to their predisease condition as possible. During the data analysis, six strategies emerged: searching for meaning and information; trying to achieve comfort and control; resting more, doing less and slowing down; motivating, prioritising and caring for self; turning to religion and spirituality; and expectations and receiving assistance and support. CONCLUSIONS: This qualitative study describes the coping strategies of Iranian patients with coronary heart disease and the commonalities with strategies for others dealing with chronic illnesses in Iran. The patients were found to use a variety of coping strategies to deal with their illness and its impacts on their lives. RELEVANCE TO CLINICAL PRACTICE: This study contributes to the existing body of knowledge about optimal nursing care strategies for patients with coronary heart disease. Through increasing awareness of coping strategies, nurses can help their patients employ the most effective tools and reinforce constructive successful coping styles for patients who are dealing with coronary heart disease.

Coronary heart disease patients transitioning to a normal life: perspectives and stages identified through a grounded theory approach.

AIMS AND OBJECTIVES: To explore how Iranian patients with coronary heart disease experience their lives. BACKGROUND: Coronary heart disease is a leading cause of death in Iran and worldwide. Understanding qualitatively how patients experience the acute and postacute stages of this chronic condition is essential knowledge for minimising the negative consequences of coronary heart disease. DESIGN: Qualitative study using grounded theory for the data analysis. METHODS: Data for this study were collected through individual qualitative interviews with 24 patients with coronary heart disease, conducted between January 2009 and January 2011. Patients with angina pectoris were selected for participation through purposive sampling, and sample size was determined by data saturation. Data analysis began with initial coding and continued with focused coding. Categories were determined, and the core category was subsequently developed and finalised. RESULTS: The main categories of the transition from acute phase to a modified or 'new normal' life were: (1) Loss of normal life. Experiencing emotions and consequences of illness; (2) Coming to terms. Using coping strategies; (3) Recreating normal life. Healthcare providers must correctly recognise the stages of transition patients navigate while coping with coronary heart disease to support and educate them appropriately throughout these stages. CONCLUSION: Patients with coronary heart disease lose their normal lives and must work towards recreating a revised life using coping strategies that enable them to come to terms with their situations. RELEVANCE TO CLINICAL PRACTICE: By understanding Iranian patients' experiences, healthcare providers and especially nurses can use the information to support and educate patients with coronary heart disease on how to more effectively deal with their illness and its consequences.

Intersectional perspectives on family involvement in nursing home care: rethinking relatives' position as a betweenship.

This study seeks to understand, in the context of intersectional theory, the roles of family members in nursing home care. The unique social locus at which each person sits is the result of the intersection of gender, status, ethnicity and class; it is situational, shifting with the context of every encounter. A content analysis of 15 qualitative interviews with relatives of nursing home residents in Sweden was used to gain a perspective on the relationships between relatives and residents, relatives and the nursing home as an institution, and relatives and the nursing home staff. We sought to understand these relationships in terms of gendered notions of the family and the residents, which are handed down from generation to generation and thus condition who and how relatives should be involved in care, and the ways in which relationships change as care moves from home to nursing home. It requires knowledge and awareness that the nursing home culture is based on intersectional power structures in order for relatives to be involved in nursing home care in alternative and individual ways.

Characteristics and Correlates of Perceived Physical and Psychological Health Among Family Caregivers Living With Persons With Advanced Dementia.

BACKGROUND: Various factors drive a care setting shift from institutional to home settings for dementia care until the latest stage of the disease, suggesting the critical role of family caregivers living with persons with dementia. OBJECTIVES: This study explored the characteristics and correlates of self-reported overall physical and psychological (ie, depressive symptoms and stress) health among family caregivers living with persons with dementia in Sweden. METHODS: This cross-sectional, descriptive study used baseline data from an existing music-based intervention study of persons with dementia and their family caregivers (N = 76). Multivariable linear regression analyses were performed. RESULTS: On average, caregivers (n = 38; mean age: 74.8 years) were slightly younger than persons with dementia (n = 38; mean age: 78.6 years). Most caregivers were female (n = 24; 63.2%) and spouses or partners of persons with dementia (n = 37; 97.4%). Caregivers' perceived relationship with their family members with dementia was the only factor associated with caregivers' self-reported overall physical health (b = -0.655, p = .046). This suggests caregivers' more frequent feeling of a good relationship with the persons with dementia was linked to better self-rated physical health among family caregivers living with persons with dementia. CONCLUSIONS: This study highlights the importance of family caregivers' perceived relationship with persons with dementia in the context of caregivers' self-reported physical health. Future research is needed to explore the perceived relationship from the perspectives of persons with dementia and the determinants of caregiving dyads' (persons with dementia and family caregivers) perceived relationship with each other.

Day-to-day variability of stress biomarkers during a music intervention in people living with dementia and their family caregivers.

Examination of the variability of stress biomarkers among people living with dementia and their family caregivers can provide evidence of stress reactions and corresponding self-regulation capacities, but no such research has been conducted to date. The aim of this study was to examine day-to-day variability patterns of salivary biomarkers in dyads of people living with dementia and their family caregivers and to investigate differences in variability patterns between music intervention and control groups. This study involved secondary analysis of data collected during a two-group, non-randomized open trial examining the effects of an 8-week music intervention on physiological stress markers. A total of 5791 salivary samples from 34 dyads were used to analyze the variability of morning and evening cortisol and of morning dehydroepiandrosterone sulfate (DHEA-S). The variability indices employed were the intra- and inter-individual standard deviation, coefficient of variation, and intra-class correlation coefficient. We found that family caregivers in the music intervention group had significantly greater coefficients of variation for all three biomarker endpoints than those in the control group. Our findings provide evidence that stress biomarkers in family caregivers with functional self-regulation capacities may be more likely to respond to music intervention. However, stress biomarkers in people living with dementia may not be responsive to music intervention, possibly due to their dysfunctional self-regulation capacities. Future stress biomarker studies involving dyads of people living with dementia and family caregivers should consider biomarker variability patterns in determining the effectiveness of behavioral interventions.

Patterned thin film enzyme electrodes via spincoating and glutaraldehyde vapor crosslinking: towards scalable fabrication of integrated sensor-on-CMOS devices.

Effective continuous glucose monitoring solutions require consistent sensor performance over the lifetime of the device, a manageable variance between devices, and the capability of high volume, low cost production. Here we present a novel and microfabrication-compatible method of depositing and stabilizing enzyme layers on top of planar electrodes that can aid in the mass production of sensors while also improving their consistency. This work is focused on the fragile biorecognition layer as that has been a critical difficulty in the development of microfabricated sensors. We test this approach with glucose oxidase (GOx) and evaluate the sensor performance with amperometric measurements of in vitro glucose concentrations. Spincoating was used to deposit a uniform enzyme layer across a wafer, which was subsequently immobilized via glutaraldehyde vapor crosslinking and patterned via liftoff. This yielded an approximately 300 nm thick sensing layer which was applied to arrays of microfabricated platinum electrodes built on blank wafers. Taking advantage of their planar array format, measurements were then performed in high-throughput parallel instrumentation. Due to their thin structure, the coated electrodes exhibited subsecond stabilization times after the bias potential was applied. The deposited enzyme layers were measured to provide a sensitivity of 2.3 ± 0.2 µA mM-1 mm-2 with suitable saturation behavior and minimal performance shift observed over extended use. The same methodology was then demonstrated directly on top of wireless CMOS potentiostats to build a monolithic sensor with similar measured performance. This work demonstrates the effectiveness of the combination of spincoating and vapor stabilization processes for wafer scale enzymatic sensor functionalization and the potential for scalable fabrication of monolithic sensor-on-CMOS devices.

Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions.

BACKGROUND: To develop a healthcare environment that is congruent with diversity among care providers and care recipients and to eliminate ethnic discrimination, it's important to map out and assess caregivers' awareness and acceptance of diversity. Because of a lack of standardized questionnaires in the Swedish context, this study designed and standardized a questionnaire: the Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD, for short). METHOD: The questionnaire was developed in four phases: a comprehensive literature review, face and content validity, construct validity by factor analysis, and a reliability test by internal consistency and stability assessments. RESULTS: Results of different validity and reliability analyses suggest high face, content, and construct validity as well as good reliability in internal consistency (Cronbach's alpha: 0.68 to 0.8) and stability (test-retest: Spearman rank correlation coefficient: 0.60 to 0.76). The result of the factor analysis identified six dimensions in the questionnaire: 1) Attitude toward discrimination, 2) Interaction between staff, 3) Stereotypic attitude toward working with a person with a Swedish background, 4) Attitude toward working with a patient with a different background, 5) Attitude toward communication with persons with different backgrounds, 6) Attitude toward interaction between patients and staff. CONCLUSION: This study introduces a newly developed questionnaire with good reliability and validity values that can assess healthcare workers' awareness and acceptance of diversity in the healthcare environment and healthcare delivery.

Being perceived as a 'visitor' in the nursing staff's working arena--the involvement of relatives in daily caring activities in nursing homes in an urban community in Sweden.

BACKGROUND: It is both complex and difficult for relatives when a loved one moves into a nursing home and many relatives are not prepared for the realities these new situations entail. Little attention has been paid to scrutinising the involvement of relatives in patient care, particularly in relation to the structures and routines of nursing homes or to the staff's reasoning concerning their involvement. AIM: To describe, from a gender perspective, how nursing staff's routines and reasoning act to condition the involvement of relatives in nursing homes. METHODS: Focused ethnographic fieldwork was conducted in a medium-sized urban community in central Sweden in three different nursing homes. RESULTS: The nursing staff assigns a certain code of conduct to all relatives they perceived as 'visitors' in their working arena. This code of conduct was related to the routines and subcultures existing among the nursing staff and stemmed from a division of labour; the underlying concept of 'visitor' predetermined the potential for relatives' involvement. This involvement is explicitly related to the general gendered characteristics that exist in the nursing staff's perception of the relatives. DISCUSSION: The study's limitations are primarily concerned with shortcomings associated with a research presence during the fieldwork. The discussion focuses on the dimensions of power structures observed in the nursing home routines and the staff's reasoning based on their gendered assumptions. We argue that it is important to develop mechanisms that provide opportunities for nursing staff in elderly care to reflect on these structures without downplaying the excellent care they provide. We stress the importance of further exploring these issues concerning relatives and their involvement in nursing homes to facilitate the transition from informal caregiver to 'visitor'.

Assessing stress using repeated saliva concentration of steroid hormones in dementia care dyads: results from a controlled pilot care music intervention.

Background: Stress-related biomarkers have the potential to provide objective measures of whether interventions directed at people with dementia (PWD) and their family caregivers (FCG) are successful. The use of such biomarkers has been limited by logistical barriers to sample collection. Objective: Explore saliva concentration of steroid hormones in dementia care dyads during a music intervention. Methods: Consecutive PWD attending a memory evaluation center and their FCG were allocated to either an intervention-with-music or a non-intervention control group. All were living at home. Stress biomarkers, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) samples were collected by the PWD and their FCG, in the morning and evening, 5 days a week, for 8 consecutive weeks. Biomarker concentrations of the intervention and the control groups were compared at week 8, in an intention-to-treat approach with adjustment for baseline value. Results: Twenty-four PWD in the intervention group and 10 in the control group, and their FCG were included in the analyses. The mean number of morning saliva collections was similar in the intervention and the control groups, ranging from 4.3 to 4.9 per participant weekly during the first 7 weeks, declining to 3.3 during week 8. Median log morning cortisol (pg/mL) among caregivers was lower in the intervention group than in the control group (8.09 vs. 8.57, P = 0.0133). Conclusion: This study demonstrates that music intervention was associated with lower morning saliva cortisol concentrations for FCGs.

Location-aware ingestible microdevices for wireless monitoring of gastrointestinal dynamics.

Localization and tracking of ingestible microdevices in the gastrointestinal (GI) tract is valuable for the diagnosis and treatment of GI disorders. Such systems require a large field-of-view of tracking, high spatiotemporal resolution, wirelessly operated microdevices and a non-obstructive field generator that is safe to use in practical settings. However, the capabilities of current systems remain limited. Here, we report three dimensional (3D) localization and tracking of wireless ingestible microdevices in the GI tract of large animals in real time and with millimetre-scale resolution. This is achieved by generating 3D magnetic field gradients in the GI field-of-view using high-efficiency planar electromagnetic coils that encode each spatial point with a distinct magnetic field magnitude. The field magnitude is measured and transmitted by the miniaturized, low-power and wireless microdevices to decode their location as they travel through the GI tract. This system could be useful for quantitative assessment of the GI transit-time, precision targeting of therapeutic interventions and minimally invasive procedures.

The Feasibility and Acceptability of In-Home Saliva Collection for Stress in Persons With Dementia and Their Family Caregivers.

BACKGROUND: Although increasing attention is being paid to cortisol and the sulfated form of dehydroepiandrosterone (DHEA-S) as stress biomarkers, the feasibility of saliva collection of such biomarkers has yet to be investigated among dementia care dyads (persons with dementia [PWD] and family caregivers) living in a home setting. We explored the feasibility and acceptability of in-home saliva collection for cortisol and DHEA-S as stress biomarkers among dementia care dyads. METHODS: Dementia care dyads were recruited from a memory evaluation center. After pre-evaluation and education sessions, participants collected their saliva 3 times a day, 5 days a week, for 8 consecutive weeks. We calculated frequency counts and percentages to assess enrollment rate, retention rate, the completion rate of saliva collection, and valid samples of cortisol and DHEA-S. Independent samples t-tests were performed to compare mean differences in the total number of collected samples and valid samples between PWD and family caregivers at each time point of saliva collection. RESULTS: A total of 46 dyads were referred to this study; 32 dyads (69.6%) agreed to participate, and 26 started collecting saliva. Twenty-four dyads (75%) completed 8 weeks of saliva collection. There were no significant differences (p > 0.05) in the number of collected samples and valid samples between PWD and caregiver participants. CONCLUSION: This study supports the feasibility of in-home saliva collection for stress biomarker assay and the need for further investigation into self-administered collection of stress biomarkers with a particular focus on dementia care dyads living at home.

The impact of caregivers' singing on expressions of emotion and resistance during morning care situations in persons with dementia: an intervention in dementia care.

AIMS AND OBJECTIVES: The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC). BACKGROUND: Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD. DESIGN: This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for. METHOD: The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis. RESULTS: Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions. CONCLUSIONS: MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions. RELEVANCE TO CLINICAL PRACTICE: MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.

Breast cancer risk perception, benefits of and barriers to mammography adherence among a group of Iranian women.

The study aimed to assess associations between Health Belief Model variables, stages of change, and participation in mammography for early detection of breast cancer in a sample of Iranian women. A total of 414 women, aged 40 to 73 years, were recruited by random sampling. The study took place in the winter of 2007, using a self-report questionnaire and structured interviews, designed to measure the five Health Belief Model constructs and stages of adoption for mammography. The study indicated that 45.8% of the women were in the pre-contemplation and contemplation stages of a mammogram, and 29% of participants reported having had at least one mammogram. Screening behavior was associated with older age, familial history of breast cancer, history of breast disease, health insurance coverage, and living in an urban area. Furthermore, the perceived susceptibility to breast cancer, perceived benefits and barriers for mammography, and cues to action variables defined by the Health Belief Model were four factors related to having a mammogram. The study concludes that health care professionals must provide women with more fear appeals that outline vulnerability to developing breast cancer, remove cognitive barriers to seeking mammography, and apply effective guidance on the participation of women in breast cancer screening programs.

Care providers' perceptions of the importance of oral care and its performance within everyday caregiving for nursing home residents with dementia.

BACKGROUND: The oral caregiving in nursing homes for persons with dementia often becomes complicated due to the patients' lack of compliance, which in turn can result in giving oral care a low priority in daily care. Furthermore, directives for responsibilities are unclear. OBJECTIVE: The aim of this article was to describe care providers' perception of and reasoning for the oral care for nursing home residents with dementia and to describe registered nurses' reasoning in relation to their responsibility for monitoring oral care interventions within the regular caregiving routines for nursing home residents with dementia. METHODS: Two sub-studies were carried out; focus group discussions with nine care providers and interviews with four nurses. All participants were staff in nursing home units specialized in dementia. RESULTS: The focus group discussion revealed three themes: Art of caregiving, Barriers and Treatment strategies. Themes related to the nurses' statements about oral hygiene within caregiving were Care, Responsibility for care and Information. CONCLUSION: Three main findings from the study are discussed: Unclear responsibilities of different staff members related to daily oral care for the nursing home patients; a lack of guidelines and routines for oral hygiene and a lack of guidelines for sharing information between the different professional groups.

Communicating through caregiver singing during morning care situations in dementia care.

It is well known that persons with dementia (PWD) have problems expressing and interpreting communication, making interaction with others difficult. Interaction between PWD and their caregivers is crucial, and several strategies have been investigated to facilitate communication during caregiving. Music therapeutic caregiving (MTC)--when caregivers sing for or together with PWD during caregiving activities--has been shown to enhance communication for PWD, evoking more vitality and positive emotions. The aim of this study was to describe how PWD and their caregivers express verbal and nonverbal communication and make eye contact during the care activity 'getting dressed', during morning care situations without and with MTC. Findings revealed that during the situations without MTC, the caregivers led the dressing procedure with verbal instructions and body movements and seldom invited the PWD to communicate or participate in getting dressed. Patterns in responses to caregivers' instructions included both active and compliant responses and reactions that were resistant and aggressive, confused, and disruptive. In contrast to the 'ordinary' morning care situation, during MTC, the caregivers seemed interested in communicating with the PWD and solicited their mutual engagement. Although verbal communication consisted of singing about things other than getting dressed, e.g. dancing, love, sailing, God, the PWD mostly responded to caregivers in a composed manner, by being active, compliant, and relaxed, though some were also resistant or incongruent. The authors conclude that MTC could be a way for PWD and their caregivers to successfully interact and co-operate during caring situations, as it seems to evoke enhanced communication for both partners in this context.