Exploring Feelings of Pleasure and Purpose Associated With Older People's Activities Using Ecological Momentary Analysis: An Observational Study.

Momentary feelings of pleasure and purpose can be sources of intrinsic motivation, but momentary purpose is rarely studied. Activities, contexts, and feelings of retired/semiretired adults (n = 67, aged 50-78 years) were captured using ecological momentary assessment. Participants provided 2,065 valid responses to six daily smartphone surveys for 7 days. Physical activity was measured by waist-worn ActiGraph accelerometer. Pleasure (measured by affective happiness) and purpose outcomes were regressed on activities, context, and potential confounding variables. Interactions between activities and contexts were explored. Participants were highly active: 98.5% met physical activity guidelines. Sedentary activities were negatively associated with sense of purpose, especially when indoors. However, social sedentary activities were positively associated with feelings of happiness. Active, social outdoor activities were positively associated with both outcomes. Less sedentary participants experienced greater happiness and purpose during all their activities. Context matters: active, social, and outdoor activities seem to be more appealing to older adults.

Acceptance and Commitment Therapy versus Cognitive Behavior Therapy for Children With Anxiety: Outcomes of a Randomized Controlled Trial.

Acceptance and Commitment Therapy (ACT) has a growing empirical base in the treatment of anxiety among adults and children with other concerns. This study reports on the main outcomes of a randomized controlled trial of ACT and traditional cognitive behavioral therapy (CBT) in children with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety disorder. Participants were 193 children from urban Sydney, Australia, who were block-randomized to a 10-week group-based program of ACT or CBT or a 10-week waitlist control (WLC). Completers included 157 children (ACT = 54, CBT = 57, WLC = 46; M = 11 years, SD = 2.76; 78% Caucasian, 58% female). Pretreatment, posttreatment, and 3 months posttreatment assessments included clinician/self/parent-reported measures of anxiety, quality of life (QOL; anxiety interference, psychosocial and physical health-related QOL), and acceptance/defusion outcomes. Completer and intention-to-treat analyses revealed that ACT and CBT were both superior to WLC across outcomes, reflecting statistically and clinically significant differences, with gains maintained at 3 months posttreatment. Both completer and intention-to-treat analyses found ACT and CBT to produce similar outcomes. There was some support for ACT having greater effect sizes for QOL outcomes but not for avoidance/fusion. Although this study does not suggest that ACT is equivalent to CBT or should be adopted in its place, it does provide evidence that ACT might be another empirically supported treatment option for anxious youth. Further research is needed to replicate these findings.

Review: Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: a meta-analysis.

BACKGROUND: Mindfulness-based interventions (MBIs) are increasingly used in the management of various mental health disorders in children and adolescents. However, there is limited evidence about the efficacy of various interventions used. METHOD: A systematic review was performed to examine the effects of different MBIs on mental health symptoms and quality of life in both clinical and nonclinical samples of children and adolescents using data from only randomized control trials. The studies were also assessed for quality. Based on the type of MBI, study population, and control arm we had three comparisons for meta-analyses. RESULTS: Fifteen studies were included in the qualitative analysis but only 11 trials with comparable interventions and controls were included for meta-analyses. Mindfulness-based stress reduction/mindfulness-based cognitive therapy arm was more effective than nonactive control in the nonclinical populations. Acceptance commitment therapy was comparable to active treatments in patients in the clinical range. Other MBIs were also effective improving anxiety and stress but not depression in nonclinical populations compared to nonactive control. CONCLUSIONS: Mindfulness-based interventions can be effective in children and adolescents with mental health symptoms. As there were significant limitations these results must be interpreted with caution.

Community palliative care nurse experiences and perceptions of follow-up bereavement support visits to carers.

Community (district) nurses (CNs) are well positioned to provide follow-up home visits to bereaved families and carers of their recently deceased palliative clients. An Australian survey of CN's (n = 58, response rate 29%) described their experiences of bereavement support visits, perceptions of their role in bereavement care and their professional support needs. Although positive experiences were commonly reported, with 95% of participants considering bereavement follow-up visits as consistent with their role, 53% found the visits difficult for reasons such as the nurse or client not understanding the purpose, the CN's excessive personal identification with the client's situation, the emotional intensity of visits, and lack of confidence or skills despite prior training. The nature and quality of the CN's prior relationship with the bereaved family was an important determinant of the visits' success. Results highlight the value of bereavement support visits, while identifying professional development needs. Managing emotionally intense episodes should receive priority in preparing CN's for this challenging role.

Risk factors for self-harm in children and adolescents admitted to a mental health inpatient unit.

OBJECTIVE: The aim of this study was to identify risk factors for self-harm for children and adolescents in a mental health inpatient unit. METHODS: A retrospective file audit of patient files over three years (2006-2009) was conducted to determine risk factors associated with self-harm in children and adolescents admitted to a mental health unit. A checklist of potential factors was based on risk factors found in a review of the literature including demographic information, diagnosis, home situation, environmental stressors, childhood trauma and previous mental health care. The study compared those who self-harmed with a control group who did not self-harm. RESULTS: There were 150 patients who self-harmed (mean age 14 years) and 56 patients who did not self-harm with a mean age of 13 years. Several factors were identified that increased the likelihood of self-harm, including a diagnosis of depression, female gender, increasing age, being Australian-born, living with a step parent, not having received previous mental health care, having a history of trauma, and having other stressors including problems within the family. CONCLUSIONS: While increasing age, female gender, a history of trauma and a diagnosis of depression are well known as risk factors for self-harm, this study confirms that family factors, in particular living with a step parent, significantly add to the risk. Child and adolescent services should be aware of the increased risk of self-harm in young people with mental health problems who live in blended families. Treatment approaches need to involve parents as well as the child or young person.

Temporal trends in self harm and aggression on a paediatric mental health ward.

OBJECTIVE: The aim of this paper is to describe trends in aggression and self harm on a mental health inpatient unit for children and adolescents between January 2006 and August 2009. Various ward interventions and the ward milieu were evaluated as possible explanatory factors for trends. METHOD: This was a retrospective study whereby incidents of aggression, self harm and seclusion were obtained from a computerized Incident Information Management System (IIMS) database. Trends in incidents were analysed using linear regression analyses. RESULTS: Over a 44-month period, 292 incidents of aggression and 139 incidents of self harm were reported. The use of seclusion and the number of aggressive incidents both significantly decreased over time. Trends suggested a positive relationship between the introduction of restraint training, changes in leadership and full staff complement, and a reduction in aggression and seclusion. CONCLUSIONS: Although the findings are limited by their retrospective nature and reliance on formal records, this study suggests that different factors can contribute to decrease the incidence of adverse events on a psychiatric ward. Future prospective research is needed to assess the effectiveness of different interventions in both the prevention and management of self harm, aggression and seclusion in child and adolescent inpatient units.

Evaluation of an information booklet for caregivers of people with dementia: an Australian perspective.

The need for improved communication around end-of-life issues has been identified in cancer care. However, caregivers assisting those with dementia have been given scant attention. This study investigated the application of a new dementia information booklet for family caregivers, accessing those that were both community-based and linked to a residential aged-care facility through the distribution of 672 information booklets. This occurred via 14 dementia advisory services and 48 residential aged-care facilities throughout New South Wales, Australia. A total of 233 carers (33%) completed the booklet questionnaire evaluation. The descriptive statistics indicated that most carers found the booklet useful and thought that the booklet should be freely available to them. Almost half of the carers said that they wanted to receive the information at the time of, or soon after, the diagnosis of dementia. Only a small group of respondents considered the information to be confronting. The reported anxiety was thought to be part of a larger issue of dementia education and dealing with loss and not specifically related to the booklet itself.

Genistein decreases androgen biosynthesis in rat Leydig cells by interference with luteinizing hormone-dependent signaling.

Testicular Leydig cells express estrogen receptors and are the predominant source of the male sex steroid hormone testosterone (T). Previous studies demonstrated that genistein acts through estrogen receptors in Leydig cells. In the present study, pre-treatment of Leydig cells isolated from 35 day-old male Long Evans rats with the epidermal growth factor receptor (EGFR) kinase inhibitor AG 1478 abrogated genistein inhibition of T biosynthesis. Also, incubation of Leydig cells in culture medium containing epidermal growth factor (EGF) decreased T secretion (control: 255+/-16; EGF: 190+/-17ng/10(6) cells, 24h) (P<0.05). However, T secretion by genistein-treated Leydig cells (0.1nM, 10muM; 24h) was rescued by post-treatment incubation with forskolin (control: 275+/-28 versus 325+/-35; 780+/-85; ng/10(6) cells, 3h) and dibutyryl cyclic adenosine 3'-5'-monophosphate (dbcAMP) (control: 370+/-65 versus 580+/-75; 2500+/-200; ng/10(6) cells, 3h) (P>0.05). Furthermore, post-treatment incubation with cholera toxin, an activator of G proteins, caused genistein-treated Leydig cells to produce similar T amounts as untreated control (control: 55+/-5 versus 52+/-2 and 47+/-4; ng/10(6) cells, 3h) (P>0.05). These observations imply that genistein action interferes with coupling of transmembrane luteinizing hormone receptors (LHR) with G proteins. Uncoupling of LHR from G proteins adversely affects adenylate cyclase function and impacts LH-dependent stimulation of Leydig cells. These findings have implications for testicular steroidogenesis in individuals exposed to genistein and soy-based products.

Challenges for professional care of advanced dementia.

Qualitative methodology based on action research identified challenges when caring for persons with advanced dementia, as perceived by key professional providers. Data collection was via five focus groups (total n = 24) and 20 follow-up individual interviews. Participants included palliative care, aged care and dementia specialist nurses, medical specialists from an area health service, residential aged care staff and general medical practitioners. Responses emphasized the need for improved knowledge and skills, and clearer policy. Concerns included accurate assessment, especially of pain, owing to the inability of people with advanced dementia to communicate their symptoms. Assessment, managing physical and behavioural symptoms, and communicating with family presented as further challenges. Conclusions are that the need for a palliative approach to care in advanced dementia should be recognized. Aged care staff can deliver palliative care to people with advanced dementia only if the staff receive relevant education and training beyond their generalist competencies.

Drug Recovery and Copay Assistance Program in a Community Cancer Center: Charity and Challenges.

PURPOSE: The cost of cancer care is escalating dramatically, in part because of the rising expense of systemic cancer therapy. This creates financial dilemmas for patients and insurers and potential economic disruption for institutions attempting to provide cancer care to the underserved. Our institution initiated a drug recovery and copay assistance program (DRCAP) to mitigate the impact of the rising cost of parenteral medications. METHODS: We performed a 3-year review of our strategies to mitigate financial burden of parenteral therapeutics and supportive care medicines. Financial metrics were established and analyzed before and after implementing DRCAP. Medication encounters and associated costs were stratified by adolescents and young adults (15 to 39 years of age), and adults 40 years of age and older and were annualized from 2016 to 2018. RESULTS: The DRCAP resulted in a total of nearly $3.5 million worth of drugs replaced or copay assistance yearly in 2017 and 2018. This accounted for approximately 10% of our pharmacy budget for parenteral medications in each of these years. The vast majority was received in the form of drug replacement. The DRCAP resulted in assistance to 173 and 256 patients in 2017 and 2018, respectively. CONCLUSION: A DRCAP increased availability of otherwise unaffordable parenteral oncolytics and resulted in cost savings for our institution. Adolescents and young adults were disproportionately represented because of inadequate or no insurance. Despite the salutary benefits, such programs likely inflate the overall cost of cancer care. Cancer care providers participating in a DRCAP will remain in this conundrum until market forces can affect the cost of oncology therapeutics.

Sustaining hope when communicating with terminally ill patients and their families: a systematic review.

The aim of this systematic review was to examine studies that have investigated sustaining hope during prognostic and end-of-life issues discussions with terminally ill patients and their families. A comprehensive search of databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Central Register of Controlled Trials) and handsearching, from 1985 to June 2006, identified 27 studies. This review suggests that the issues surrounding hope in this context are complex. Despite the lack of unanimity among researchers regarding the definition of hope, findings suggest that balancing hope with honesty is an important skill for health professionals (HPs). Many patients seem to be able to maintain a sense of hope despite acknowledging the terminal nature of their illness. Patients and caregivers mostly preferred honest and accurate information, provided with empathy and understanding. Many different sources of hope were identified in this context in broad aspects of life, not just the medical situation. HPs need to recognize this spectrum of hope and appreciate that patients may simultaneously hope for 'cure' while acknowledging the terminal nature of their illness. HPs may help patients to cope with their terminal prognosis by exploring and fostering realistic forms of hope that are meaningful for the particular patient and their family.

A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease.

BACKGROUND AND AIMS: Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men. Women also have lower participation rates than men in cardiac rehabilitation. This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs. METHODS: The Heart Awareness for Women program (HAFW) commenced in 2003 with phase I involving development of program elements and seeking validation through consumers and clinical experts. The program was then trialed in an 8-week program in a convenience sample of 6 women. Phase II applied the revised program using action research principles focusing on enabling clinical staff to implement the ongoing program. A total of 54 women participated in this phase, 48 of whom completed baseline questionnaires. A mixed-method evaluation, using questionnaires, interviews, and observation, assessed the impact of the intervention on psychological and social aspects of women's recovery following an acute coronary event. RESULTS: Women welcomed the opportunity to discuss their individual stories, fears, and challenges and to derive support from contact with other women. Via health professional facilitation, women were able to develop strategies collectively to address risk factor modification and achieve optimal cardiovascular health. No statistically significant changes in depression, anxiety, stress, cardiac control, role integration, or perceived social support were found; however, descriptive and qualitative findings revealed decreases in anxiety and an increased sense of social support. CONCLUSIONS: On the basis of this study, a cardiac rehabilitation program tailored to the needs of women appears to be feasible and acceptable. The efficacy of this intervention to improve health-related outcomes needs to be tested in a randomized, controlled trial.

Exposure to phytoestrogens in the perinatal period affects androgen secretion by testicular Leydig cells in the adult rat.

The use of soy-based products in the diet of infants has raised concerns regarding the reproductive toxicity of genistein and daidzein, the predominant isoflavones in soybeans with estrogenic activity. Time-bred Long-Evans dams were fed diets containing 0, 5, 50, 500, or 1000 ppm of soy isoflavones from gestational d 12 until weaning at d 21 postpartum. Male rats in all groups were fed soy-free diets from postnatal d 21 until 90 d of age. The mean +/- SD concentration of unconjugated (i.e. biologically active) genistein and daidzein in serum from the group of dams maintained on the diet containing the highest amount of isoflavones (1000 ppm) were 17 +/- 27 and 56 +/- 30 nM, respectively, at d 21 postpartum. The concentrations were considerably greater in male offspring (genistein: 73 +/- 46 nM; daidzein: 106 +/- 53 nM). Although steroidogenesis was decreased in individual Leydig cells, male rats from the highest exposure group (1000 ppm diet) exhibited elevated serum levels of the sex steroid hormones androsterone at 21 d (control: 15 +/- 1.5 vs.28 +/- 3.5 ng/ml; P < 0.05) and testosterone at 90 d of age (control: 7.5 +/- 1 vs.17 +/- 2 ng/ml; P < 0.05). Testosterone secretion by immature Leydig cells, isolated from 35-d-old male rats, decreased on exposure to 0.1 nm genistein in vitro (control: 175 +/- 5 vs. 117 +/- 3 ng/10(6) cells per 24 h; P < 0.05), indicative of direct phytoestrogen action. Thus, phytoestrogens have the ability to regulate Leydig cells, and additional studies to assess potential adverse effects of dietary soy-based products on reproductive tract development in neonates are warranted.

Discrepant perceptions about end-of-life communication: a systematic review.

Little research has compared the perceptions of health professionals (HPs), patients, and caregivers about the communication of prognostic information. The objectives of this literature review were to determine 1) patient and caregiver perceptions of levels of information received about prognosis and end-of-life (EoL) issues regarding a life-limiting illness; 2) patient perceptions of and factors related to their understanding and awareness of prognosis; 3) HPs' perceptions of patients' wishes about disclosure of prognosis and factors related to their decision whether to disclose; and 4) concordance between HPs and patients/caregivers regarding the information given by HPs about prognostic and EoL issues. Relevant studies meeting the inclusion criteria were identified by searching computerized databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Cochrane Register of Controlled Trials [Central]) up to November 2004. The reference lists of identified studies were hand searched for further relevant studies. Inclusion criteria were studies of any design evaluating communication of prognostic information that included adult patients with an advanced, life-limiting illness; their caregivers; and qualified HPs. Fifty-one studies were identified. There was a large discrepancy between patients/caregivers and HPs regarding the amount of information they believed had been given. Patients' understanding and awareness of information received conflicted with the HPs' perceptions of patients' understanding and awareness of the information that had been given. HPs tended to underestimate patients' need for information and overestimate patients' understanding and awareness of their prognosis and EoL issues. HPs need to repeatedly check patients' understanding and preferences for information.

A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information.

Evidence-based recommendations concerning how to discuss dying, life expectancy, and likely future symptoms with patients with a limited life expectancy and their families are lacking. The aim of this systematic review was to review studies regarding prognostic/end-of-life communication with adult patients in the advanced stages of a life-limiting illness and their caregivers. Relevant studies meeting the inclusion criteria were identified by searching computerized databases up to November 2004. One hundred twenty-three studies met the criteria for the full review, and 46 articles reported on patient/caregiver preferences for content, style, and timing of information. The majority of the research was descriptive. Although there were individual differences, patients/caregivers in general had high levels of information need at all stages of the disease process regarding the illness itself, likely future symptoms and their management, and life expectancy and information about clinical treatment options. Patient and caregiver information needs showed a tendency to diverge as the illness progressed, with caregivers needing more and patients wanting less information. Patients and caregivers preferred a trusted health professional who showed empathy and honesty, encouraged questions, and clarified each individual's information needs and level of understanding. In general, most patients/caregivers wanted at least some discussion of these topics at the time of diagnosis of an advanced, progressive, life-limiting illness, or shortly after. However, they wanted to negotiate the content and extent of this information.

Outcomes of acutely ill older hospitalized patients following implementation of tailored models of care: a repeated measures (pre- and post-intervention) design.

BACKGROUND: There is a lack of research investigating models of nursing care for older hospitalised patients that address the nursing needs of this group. OBJECTIVES: The objective of this study is to evaluate the efficacy of models of care for acutely older patients tailored to two contexts: an aged care specific ward and a medical ward. DESIGN: This is a repeated measures design. Efficacy of the models was evaluated in terms of: patient and nurses' satisfaction with care provided; increased activities of daily living; reduced unplanned hospital readmissions; and medication knowledge. SETTINGS: An aged care specific ward and a medical ward in two Sydney teaching hospitals. PARTICIPANTS: There were two groups of patients aged 65 years or older who were admitted to hospital for an acute illness: those admitted prior to model implementation (n=232) and those admitted during model implementation (n=116). Patients with moderate or severe dementia were excluded. The two groups of nurses were the pre-model group (n=90) who were working on the medical and aged care wards for the study prior to model implementation, and the post-model group (n=22), who were the nurses working on the wards during model implementation. METHODS: Action research was used to develop the models of care in two wards: one for an aged care specific ward and another for a general medical ward where older patients were admitted. The models developed were based on empirical data gathered in an earlier phase of this study. RESULTS: The models were successful in both wards in terms of increasing satisfaction levels in patients and nurses (p<0.001), increasing functional independence as measured by activities of daily living (p<0.01), and increasing medication knowledge (p<0.001). CONCLUSIONS: Findings indicate that models of care developed by nurses using an evidence-based action research strategy can enhance both satisfaction and health outcomes in older patients.

The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses.

Nursing is known to be stressful. Stress detrimentally can influence job satisfaction, psychological well-being, and physical health. There is a need for increased understanding of the stress that nurses experience and how best to manage it. Three hundred twenty Australian acute care public hospital nurses participated in a study by completing four questionnaires that examined (a) how various workplace stressors relate to ways of coping, demographic characteristics, and physical and mental health and (b) which workplace stressors, coping mechanisms, and demographic characteristics were the best predictors of physical and mental health. Significant correlations were found between stressors and physical and mental health. Multiple regression showed age to be the only significant predictor of physical health. The best coping predictors of mental health were escape-avoidance, distancing, and self-control. Other significant predictors of mental health were support in the workplace, the number of years worked in the unit, and workload. Mental health scores were higher for nurses working more years in the unit and for those who used distancing as a way of coping. Mental health scores were lower for nurses who used escape-avoidance, lacked workplace support, had high workload, and used self-control coping. The findings have implications for organizational management, particularly in terms of recommendations for stress management, social support, and workload reduction.

Palliative care for end-stage dementia: a discussion of the implications for education of health care professionals.

The increasing burden of chronic disease demands that palliative care clinicians address the needs of patients with non-malignant disease. This discussion document seeks to address some of the challenges to providing palliative care for end-stage dementia (ESD) and the need for skill enhancement in key providers of care. In spite of the intent, there is an apparent lack of appropriate, co-ordinated and comprehensive palliative care available for these individuals and their families. There is an absence of well-articulated models to assist health care providers of ESD clients. It would appear that the development and evaluation of guidelines, implementation of education programs and collaborative associations between palliative and aged-care providers of care are key strategies to facilitate palliative care for ESD clients.

Breast screening education at Australian and Thai worksites: a comparison of program effectiveness.

To determine whether a nurse-led breast screening educational program in the workplace improved the breast screening practices and attitudes of women. Worksites are potentially cost-effective and convenient for breast cancer screening education due to their ability to educate several women at one time. This was a collaborative study between industry, university and health services in Australia and Thailand. This was a pre post test group comparative design. Three worksites in Australia and three in Thailand were assigned to one of three groups: treatment (group education), pamphlet only, or control. All groups were assessed pre-education and again 3 months post-education on breast screening attitudes and practices using a mail-out self-report questionnaire. Women were significantly more likely to practice breast self-examination (BSE) following group education, and were more confident in their ability to detect a breast lump. There was a significant increase in breast screening discussion on the workplace for the Thai group following the group education program. An increase of 25% more women saw having a mammography as a priority. The Thai women had less access to free mammographic screening. They also had more negative attitudes and poorer knowledge regarding BSE and physical breast examination (PBE) than the Australian group, with the education program having a more positive impact on them than the Australian group. Relative breast screening attitudes and practices for the treatment, pamphlet and control groups are also presented. This study provides educators and health promotion professionals with further information on the beliefs and practices of women working in both Australian and Thai industries about breast screening. Education programs such as this one can have a positive impact on attitudes and practices including increased likelihood and confidence in practising BSE, promoting women to have a PBE, and promoting discussion of breast screening at the workplace. The findings suggest that Australian women have greater opportunities to ensure their breast health than Thai women, and that there may be a greater need for programs such as this in countries such as Thailand.

Anxiety levels in people who stutter: a randomized population study.

The question of whether people who stutter are generally more anxious than people who do not stutter has not yet been resolved. One major methodological barrier to determining whether differences exist has been the type of stuttering sample used. Studies investigating anxiety levels of those who stutter have mostly assessed people referred to stuttering therapy clinics, which is arguably a biased sample. To date, no studies have been published that have measured the anxiety levels of people who stutter in the community using random selection procedures. Such a sample is more likely to be representative of the population of people who stutter. The present study involved a random selection and telephone interview of people in 4,689 households. The telephone respondent was given a description of stuttering and asked if any person living in their household stuttered. If yes, a number of corroborative questions were asked, and permission was requested to tape the speech of the person believed to stutter over the telephone. A definite case of stuttering was based on (a) a positive detection of stuttering from the tape and (b) at least one of the corroborative questions supporting the diagnosis. A total of 87 people were identified as definite cases of stuttering across all ages, and 63 participants who were 15 years or older completed a trait anxiety questionnaire over the telephone. Mean trait anxiety levels were significantly higher than levels generally found in society, though differences were not large. Implications of these results are discussed.