Effects of home-based specialized palliative care and dyadic psychological intervention on caregiver burden: results from a randomized controlled trial.

Background The Domus study, a randomized controlled trial (RCT), evaluated the effect of home-based specialized palliative care (SPC) reinforced with a psychological intervention for the patient-caregiver dyad on increasing advanced cancer patients' time spent at home, as opposed to hospitalized, and the number of home deaths. As palliative care extends to include support for patients' families and may thus assist caregivers and decrease demands on them, in this study we evaluated a secondary outcome, caregiver burden.Material and Methods Patients with incurable cancer and their caregivers were randomized (1:1) to care as usual or home-based SPC. Caregiver burden was assessed using the Zarit Burden Interview (ZBI) at baseline and 2, 4, 8 weeks and 6 months after randomization. Intervention effects were assessed in mixed effects models.Results A total of 258 caregivers were enrolled. Eleven per cent of informal caregivers experienced severe caregiver burden at baseline. Caregiver burden increased significantly over time in both groups (p = 0.0003), but no significant effect of the intervention was seen on overall caregiver burden (p = 0.5046) or burden subscales measuring role and personal strain.Conclusion In line with the majority of previous RCTs, the Domus intervention was not able to significantly reduce caregiver burden. Future interventions should consider targeting only caregivers reporting the greatest caregiver burden.

Deaf Identity, Social Relationships, and Social Support: Toward a Microsociological Perspective.

This study is the first to analyze data from a national survey to investigate the significance for deaf identity of the different forms of social and technological support that deaf people rely upon. Data were derived from a survey among 839 deaf people and were analyzed with regard to social identification as deaf, hearing, bicultural, and marginal. Findings showed connections between technology and identity, including the use of a range of technology to support being culturally deaf. Findings also showed that the deaf and hearing groups had strong homophilous social networks, while the bicultural group tended toward more mixed but equally strong social connectivity. The marginal group had a much thinner social connectivity and relied more upon institutional social support, findings that are in line with previous research revealing a sub-group struggling with social participation and well-being. Theoretically, the paper builds bridges between the fields of social identity and microsociology and shows how a microsociological perspective brings attention to the significance of reiterated social relations and practice for constructing social identity.

Couple similarity with respect to physical and mental disabilities.

AIMS: Existing research on relationships provides strong evidence of couple similarity on a wide range of variables including physical attributes, abilities, and attitudes. However, couple similarity with respect to disability has not been researched. This study investigated couple similarity with respect to both physical and mental disabilities, as well as associations with life satisfaction, among adult cohabiting couples in Denmark. METHODS: The study analysed data on self-reported mental and physical disabilities from a national survey involving 18,957 participants aged 16 to 65 years. RESULTS: The results showed that participants with a disability were more likely to have a partner with a disability. Further, results showed similarity by type and severity of disability as well as age of onset of disability. Having a partner with a disability was found to be associated with low life satisfaction among men with a disability. Results also showed an association among men with a disability between low life satisfaction and the onset of their disability after (as opposed to before) the start of their relationship. These associations were not found among women with a disability. CONCLUSIONS: The findings provide clear evidence for couple similarity with respect to disability. Findings on life satisfaction showed gender differences that might be explained by cultural gender norms that may play a particular role with respect to disability. Longitudinal research is required to research the factors that mediate how having or developing a disability affects relationships and wellbeing over time.

The Moderating Influence of School Achievement on Intelligence in Young Adulthood.

Education has been suggested to be possibly the most consistent, robust, and durable method available for raising intelligence, but little is known about the genetic and environmental interplay underlying this association. Therefore, we investigated how school achievement, as measured by grade point average in lower secondary school at 15 years of age, moderated intelligence variation in young adulthood. The sample consisted of all Danish male twin pairs who had left lower secondary school since 2002 and appeared, typically at age 18, before a draft board through 2015 (N = 2660). Shared environmental variance unique to intelligence (10% of total variance) was found to be greater among individuals with poor school achievement. However, school achievement did not moderate the genetic influences or the non-shared environmental influences on intelligence. We discuss the implications of this in light of the constraints imposed by the statistical models we used.

A Review of the Conversational Pragmatic Skills of Children With Cochlear Implants.

Many children who use cochlear implants (CI) have strong skills in many aspects of spoken language; however, limited information is available about their mastery of the pragmatic skills required to participate in conversation. This study reviewed published literature describing the pragmatic skills of children who use CIs in conversational contexts. Twenty-five studies met the inclusion criteria, and data were extracted describing participant characteristics, methodology, data type, outcomes, and factors associated with outcomes. Pragmatic skills were described in three broad categories: speech acts, turns, and breakdowns and repairs. Participants showed heterogeneity in age, age at implantation, duration of implant use, and languages used. Studies employed a variety of methodologies, used a range of different sample types and coding strategies, and considered different factors associated that might be associated with children's pragmatic skills. Across studies, children with CIs were reported to have a range of pragmatic skills in conversational contexts, from few to severe difficulties. The body of literature on this topic is small and considered heterogeneous children with CIs with a wide range of skills. Further research is needed to understand the pragmatics language skills of children with CIs and the factors influencing the diversity in skills observed.

Changes in personality traits among candidates for special operations forces.

This study examines the personality traits of 32 male candidates (Age: M = 27.2, SD = 4.2) who completed an eight-month intensive training program to become operators in the Danish Naval Special Warfare Group (also known as Frogmen). The Frogmen candidates completed the Big Five Inventory (BFI) the day before the start of (T1) and at the end (T2) of the training program. For comparison, first year students from the Danish Technical University 2013 (N = 192) completed the BFI at enrollment of study (T1) and one year later (T2). The results showed that Frogman candidates at T1 had significantly higher levels of Conscientiousness and Agreeableness than the university students. Relative to the university students, the Frogmen showed higher scores in Extraversion and lower scores in Neuroticism at T2 compared to T1.

An explorative study of the individual differences associated with consumer stockpiling during the early stages of the 2020 Coronavirus outbreak in Europe.

There is little existing research on why some people stockpile goods and others do not at a time of crisis. More research on this phenomenon and the individual differences associated with it is needed in order to gain a better understanding of what is a potentially economically and socially disruptive behavior. In this study, 175 adult participants from Denmark and 90 from the United Kingdom responded to a survey about the activity of extra shopping (stockpiling) during the first weeks of the Coronavirus outbreak. Questions exploring the "big five" personality traits, Social Dominance Orientation, Health Literacy, and attitudes to the governmental response to the crisis were included in the survey. The explorative analysis showed that stockpiling was associated with high scores on Extraversion and Neuroticism, and low scores on Conscientiousness and Openness to Experience. Stockpiling was also associated with the view that the government should be doing more to stop the Coronavirus epidemic. An explorative factor analysis of reasons for stockpiling identified the two factors "Panic" and "Action".

Vicarious traumatisation in lawyers working with traumatised asylum seekers: a pilot study.

Although vicarious traumatisation has been documented in numerous professional groups, the research on asylum lawyers is sparse. This pilot study aimed to explore whether asylum lawyers are affected by their work with traumatised clients. Seventy asylum lawyers completed a pilot survey consisting of the Trauma and Attachment Belief Scale; Impact of Event Scale-Revised; Depression, Anxiety and Stress Scales; and a work-characteristics questionnaire. The results included significant association between higher contacts with trauma-exposed clients and anxiety; higher weekly work hours and fewer years of experience in asylum law with more stress; fewer years of experience with general trauma scores and intrusion symptoms; and more clients per week with cognitive changes regarding trust in others. The findings highlight the potentially detrimental impact on asylum lawyers of working with traumatised clients and the need for further investigation.

Work and Employment Characteristics of Deaf and Hard-of-Hearing Adults.

Studies have reported a higher level of unemployment among deaf and hard-of-hearing (DHH) adults compared to adults without hearing loss. However, little is known about factors explaining success in the labor market. This study presents the analysis of two data sets. The first was drawn from a survey of 804 DHH adults in Denmark. The second was a survey completed by 190 DHH adults with post-secondary qualification in the United States. In the Danish sample, among the spoken language users, higher ages, higher level of educational attainment, and no additional disabilities were associated with having a job. Among the sign language users, higher ages, higher level of educational attainment, earlier ages at hearing loss diagnosis, and not using cochlear implants were associated with having a job. In the US sample, male gender and better sign language skills were associated with having a job.

A national survey on violence and discrimination among people with disabilities.

BACKGROUND: The aim of the study was to quantify levels of violence and discrimination among people with disabilities and analyze the effects of gender and the type and degree of disability. METHODS: The study analyzed data on self-reported violence and discrimination from a Danish national survey of 18,019 citizens, of whom 4519 reported a physical disability and 1398 reported a mental disability. RESULTS: Individuals with disabilities reported significantly higher levels of violence than those without. Specifically, individuals reporting a mental disability reported higher levels of violence and discrimination. Significant gender differences were found with regard to type of violence: while men with disabilities were more likely to report physical violence, women with disabilities were more likely to report major sexual violence, humiliation and discrimination. Neither severity nor visibility of disability was found to be a significant factor for risk of violence. CONCLUSIONS: This large-scale study lends support to existing research showing that people with disabilities are at greater risk of violence than people without disabilities. Further, the study found that people with mental disabilities were significantly more likely to report all types of violence and discrimination than those with physical disabilities. The findings also show that gender is significant in explaining the type of violence experienced and the experience of discrimination.

A relationship-focused investigation of spousal psychological adjustment to dual-sensory loss.

OBJECTIVES: The relationship intimacy model of psychosocial adjustment to illness indicates that a patient's willingness to communicate about their illness, as perceived by the spouse, is a strong predictor of spouse relational and psychological well-being. Inspired by the relationship intimacy model, the current study examined the psychological adjustment of spouses of individuals with dual-sensory loss (DSL), a disability where interpersonal communication is of particular concern. METHOD: Surveys were sent to all known individuals and their partners who were 50 years of age or older and were enrolled in services for acquired DSL in Denmark. A total of 65 spouses met the inclusion criteria of which 45 (69%) returned a partner survey. RESULTS: Results showed a significant association between couples' sensory loss-related communication, relationship satisfaction, perceived support and psychological well-being. Perceived support significantly mediated the association between couples' sensory loss communication and spouse psychological well-being. CONCLUSION: The current study's findings provide support for a relationship-focused perspective of spousal psychological adjustment in the context of DSL. Further, couples' sensory loss-related communication is presented as a potential intervention target to enhance spouse perceived support and psychological well-being.

Personality Traits, Self-Efficacy, and Cochlear Implant Use Among Deaf Young Adults.

A variety of studies have examined ways in which cognitive and social-emotional factors may be linked to and affected by hearing loss, use of cochlear implants (CIs), and sign language. A related domain that largely has been overlooked, however, is personality. This paper reports a study of personality traits and self-efficacy among deaf and hard-of-hearing (DHH; n = 223) college students, with and without CIs, as compared to hearing peers (n = 106). All participants completed (HEXACO) personality trait and self-efficacy inventories; DHH participants also completed a communication questionnaire. Hearing participants scored higher on the personality trait Conscientiousness than both DHH CI users and non-CI users, as well as higher on Openness to Experience compared to DHH CI users. Hearing participants also scored higher on self-efficacy compared to DHH non-CI users. Among DHH non-CI users, greater self-rated sign language skills were associated with higher Extraversion and Agreeableness scores. Among the DHH CI users, earlier sign language acquisition was associated with higher Openness to Experience scores, and earlier cochlear implantation was associated with greater Emotionality scores. Self-efficacy was associated with both better self-rated spoken language skills and a stronger preference for spoken language over sign language use among DHH CI users.

Prevalence and characteristics of self-reported physical and mental disorders among adults with hearing loss in Denmark: a national survey.

PURPOSE: Existing research shows that people with hearing loss have a high risk of additional physical and mental disorders. However, only a few population-based studies have been conducted. This study assesses the prevalence and characteristics of additional disorders among adults with hearing loss in Denmark and thereby contributes a population-based study to this area of research. METHOD: Data on self-reported physical and mental disorders from a national survey of 772 adults with hearing loss were compared to corresponding data from a national survey of 18,017 adults from the general population. RESULTS: People with hearing loss reported more physical and mental disorders than the general population. Specifically, they reported higher incidences of visual impairment, cerebral palsy, intellectual impairment, and "other mental disorders". CONCLUSION: Adults with hearing loss have a greater risk of additional physical and mental disorders. It is important for clinicians to have some understanding of the communication needs and characteristics of deaf and hard-of-hearing patients, so that they can recognize and treat symptoms and provide appropriate support.

Sensory loss and its consequences for couples' psychosocial and relational wellbeing: an integrative review.

OBJECTIVES: Previous research has shown that marital communication is key to couples' successful illness adjustment. However, little is known about couples' experiences of health conditions characterised by communication difficulties such as acquired hearing, vision, and dual-sensory loss. The aim of this review was to identify the effect of sensory loss, and associated communication difficulties, on couples' relational and psychosocial adjustment. METHOD: A systematic search was conducted to identify studies investigating the social, psychological, and relational impact of sensory loss on couples. RESULTS: Twenty-four articles met the criteria for inclusion in the review. Significant heterogeneity in the measurements and design of the quantitative studies prevented statistical data synthesis. All but two studies reported some effect of sensory loss on couples' psychosocial or relational wellbeing. Higher levels of marital satisfaction were found to buffer against adverse psychological outcomes. Results of quantitative and qualitative studies were synthesised to form an integrative model illustrating the associations between sensory loss and couples' relational and psychosocial wellbeing. CONCLUSIONS: Although this review reports an association between sensory loss and couples' relational and psychosocial wellbeing, the results should be viewed with caution given that relatively few studies on couples' experiences of acquired sensory loss exist, and many have methodological limitations.

Use of technological aids and interpretation services among children and adults with hearing loss.

OBJECTIVES: The technological development of communication aids for people with hearing loss has progressed rapidly over the last decades. Quality has improved and the number of different types of aids has increased. However, few studies have examined the prevalence of technology use and interpreting services use among people with hearing loss as they relate to demographic characteristics of this population. DESIGN: This study reports from national surveys of children and adults with hearing loss. Use of hearing aids, cochlear implants, other aids and interpreting services were analysed with regard to gender, age, degree of hearing loss, mode of communication, having an additional disability, level of educational achievement among adults, and whether or not children lived together with both of their parents. STUDY SAMPLE: 269 children (0-15 years of age) and 839 adults (16-65 years of age). RESULTS: Differences in technology and service use were associated with age, degree of hearing loss, and mode of communication among children and adults, and gender and level of educational achievement among adults. CONCLUSION: Individual and social factors have an impact on technological hearing aid and interpreter use. More research about individual differences and clinical implications of support services is needed.

The Significance of Deaf Identity for Psychological Well-Being.

Research has paid attention to how deaf identity affects life outcomes such as psychological well-being. However, studies are often carried out with small samples and without controlling for other variables. This study examined how different forms of identity-deaf, hearing, bicultural (deaf and hearing), and marginal (neither deaf nor hearing)-were associated with levels of psychological well-being and a number of other variables. The sample was 742 adults with hearing loss in Denmark. The study found that those with a deaf, hearing or bicultural identity had significantly higher levels of psychological well-being than those with a marginal identity. Further, it found that additional disability, educational level, and feeling discriminated against significantly and independently explained the degree of psychological well-being. Results are discussed here with respect to social identity theory and current deaf identity themes.

Social Dominance Orientation, Language Orientation, and Deaf Identity.

The notion of the Deaf community as a linguistic-cultural minority has been increasingly recognized and studied over the last two decades. However, significant differences of opinion and perspective within that population typically have been neglected in the literature. Social dominance orientation (SDO), a theoretical construct, typically focusing on intergroup perceptions and relations, is one aspect that has been left unexplored and might prove particularly enlightening. The present study investigated SDO among 119 deaf and 49 hearing young adults through a standardized SDO questionnaire. SDO was examined with regard to cultural identities (deaf, hearing, bicultural, and marginal), cochlear implant use, and language orientation (sign language or spoken language). The deaf participants were found to be more egalitarian than hearing individuals overall. Deaf individuals who held the strongest deaf identities, those who were sign language oriented, and not cochlear implant users, were the most egalitarian.

Achievement, Language, and Technology Use Among College-Bound Deaf Learners.

Deaf learners are a highly heterogeneous group who demonstrate varied levels of academic achievement and attainment. Most prior research involving this population has focused on factors facilitating academic success in young deaf children, with less attention paid to older learners. Recent studies, however, have suggested that while factors such as early cochlear implantation and early sign language fluency are positively associated with academic achievement in younger deaf children, they no longer predict achievement once children reach high school age. This study, involving data from 980 college-bound high school students with hearing loss, examined relations between academic achievement, communication variables (audiological, language), and use of assistive technologies (e.g., cochlear implants [CIs], FM systems) and other support services (e.g., interpreting, real-time text) in the classroom. Spoken language skills were positively related to achievement in some domains, while better sign language skills were related to poorer achievement in others. Among these college-bound students, use of CIs and academic support services in high school accounted for little variability in their college entrance examination scores.

Level of Educational Attainment Among Deaf Adults Who Attended Bilingual-Bicultural Programs.

In Scandinavia and some other countries, a bilingual-bicultural approach to deaf education was celebrated in national programs from the mid-1980s until the broad popularity of cochlear implantation in middle 2000s created a shift back to an emphasis on spoken language for many deaf children. At the same time, only a few studies evaluated the long-term outcomes of bilingual-bicultural education, and several of their findings have raised questions about benefits of the approach. This study examined the level of educational attainment of 408 deaf individuals who attended primary school either before or during the period of bilingual-bicultural education in Denmark, both relative to a comparable hearing cohort. Beyond group comparisons, three logistic regression models were created to evaluate the prediction of educational attainment by a number of relevant variables. Compared to the hearing population, the deaf population had a significantly lower level of educational attainment both before and after the introduction of bilingual-bicultural education. Signed language and spoken language abilities, the kind of school attended, degree of hearing loss, parental hearing loss, and gender were found significantly to explain levels of educational attainment in the deaf population.