The CAREPAL-8: a short screening tool for multidimensional family caregiver burden in palliative care.

BACKGROUND: Family caregivers of terminally ill and dying people do not only experience varying levels but also different dimensions of caregiver-related strain and burden. The aim of the study was to develop a short multidimensional screening tool for the detection of burden in family caregivers in palliative care. METHODS: Family caregivers of cancer patients newly admitted to specialist inpatient palliative care (N = 232) completed questionnaires on psychological burden, quality of life, social support and need fulfillment. A latent class mixture model was used to identify discrete classes of family caregivers related to their multidimensional caregiver burden. Multinomial logistic regression analyses were performed to identify the most predictive items from a set of established questionnaires. RESULTS: Four latent classes of family caregivers were identified: Currently stable caregivers (37%), Caregivers with unmet needs (20%), Psychologically burdened caregivers (30%), and High-risk caregivers (13%). Each of these classes describes a different risk profile of multidimensional family caregiver burden, although family caregivers exhibit high levels of distress across all classes. From a set of 48 items, we identified eight items that predicted the class membership best. These items represent the items of the novel multidimensional screening tool: The 8-item Screening Tool for Family Caregiver Burden in Palliative Care (CAREPAL-8). Except for social support, the items maintained fidelity to the conceptualization of multidimensional caregiver burden used in this study. A preliminary classification system was developed, which has yet to be validated. CONCLUSIONS: This study represents the first step in the establishment of a practical, self-administered screening tool that might help healthcare providers to tailor caregiver care according to their burden in daily practice. Brevity of the 8-item tool might facilitate its use in routine clinical care.

Supportive care needs and service use during palliative care in family caregivers of patients with advanced cancer: a prospective longitudinal study.

PURPOSE: This study aimed to investigate the supportive care needs of family caregivers (FCs) of advanced cancer patients and their support service use at the beginning of specialist inpatient palliative care (SIPC), near the patient's death, and during bereavement. METHODS: FCs reported their needs using the Family Inventory of Needs (FIN), along with their utilization of psychosocial and bereavement support services at the beginning (N = 232) and 6-9 months after SIPC (N = 160). RESULTS: At the beginning of SIPC, mean of 16.9 of 20 needs were reported to be highly important, and 12.2 were reported to be met. At the time of the patient's death, 16.8 needs were highly important, and 13.8 were met. At both time points, the highest ranked need was related to information about changes in the patient's condition (100% vs. 99%), and the most frequently unmet need was related to feeling hope (73% vs. 71%). Multivariate linear regression analysis revealed a low education level to be consistently related to a greater number of highly important needs. Higher satisfaction with care and better social support was related to a greater number of met needs. Twenty-five percent of FCs had accessed at least one psychosocial support service prior to SIPC, and 30% had done so during bereavement. Among non-users of support services, > 75% indicated sufficient informal support as a barrier to service use. CONCLUSIONS: The findings offer a useful guide for adequately addressing FCs' needs in an effort to optimize FC support. However, only a subgroup of the FCs used support services. Better information and provision of tailored services might improve FCs' situations in the future.

Psychological burden in family caregivers of patients with advanced cancer at initiation of specialist inpatient palliative care.

BACKGROUND: This study prospectively evaluated distress, depressive and anxiety symptoms as well as associated factors in family caregivers (FC) of advanced cancer patients at initiation of specialist inpatient palliative care. METHODS: Within 72 h after the patient's first admission, FCs were asked to complete German versions of the Distress Thermometer, Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire depression module 9-item scale (PHQ-9) for outcome measure. Multivariate logistic regression analyses were used to identify associated factors. RESULTS: In 232 FCs (62% spouses/partners), mean level of distress was 7.9 (SD 1.8; range, 2-10) with 95% presenting clinically relevant distress levels. Most frequent problems were sadness (91%), sorrows (90%), anxiety (78%), exhaustion (77%) and sleep disturbances (73%). Prevalence rates of moderate to severe anxiety and depressive symptoms were 47 and 39%, respectively. Only 25% of FCs had used at least one source of support previously. In multivariate regression analysis, being female (OR 2.525), spouse/partner (OR 2.714), exhaustion (OR 10.267), and worse palliative care outcome ratings (OR 1.084) increased the likelihood for moderate to severe anxiety symptom levels. Being female (OR 3.302), low socio-economic status (OR 6.772), prior patient care other than home-based care (OR 0.399), exhaustion (OR 3.068), sleep disturbances (OR 4.183), and worse palliative care outcome ratings (OR 1.100) were associated with moderate to severe depressive symptom levels. CONCLUSIONS: FCs of patients presenting with indication for specialist palliative care suffer from high distress and relevant depressive and anxiety symptoms, indicating the high need of psychological support not only for patients, but also their FCs. Several socio-demographic and care-related risk-factors influence mental burden of FCs and should be in professional caregivers' focus in daily clinical practice.

Glycine betaine metabolism in the acetogenic bacterium Acetobacterium woodii.

The quarternary, trimethylated amine glycine betaine (GB) is widespread in nature but its fate under anoxic conditions remains elusive. It can be used by some acetogenic bacteria as carbon and energy source but the pathway of GB metabolism has not been elucidated. We have identified a gene cluster involved in GB metabolism and studied acetogenesis from GB in the model acetogen Acetobacterium woodii. GB is taken up by a secondary active, Na+ coupled transporter of the betaine-choline-carnitine (BCC) family. GB is demethylated to dimethylglycine, the end product of the reaction, by a methyltransferase system. Further conversion of the methyl group requires CO2 as well as Na+ indicating that GB metabolism involves the Wood-Ljungdahl pathway. These studies culminate in a model for the path of carbon and electrons during acetogenensis from GB and a model for the bioenergetics of acetogenesis from GB.

[Prevalence of symptoms of posttraumatic stress disease in police officers in relation to job-specific requirements]. / Prävalenz von Symptomen einer Posttraumatischen Belastungsstörung bei Polizeibeamten in Bezug auf dienstspezifische Anforderungen.

The professional activity of policemen is connected to psychological and physical stress. The aim of this study was to identify the work specific requirements and stress as well as to deter-mine the exact circumstances of the experience of traumatic events and their coping. Additionally the occurrence of potentially traumatising situations during operations and the prevalence of PTSD symptoms were investigated in detail using questionnaires. As traumatising events severe traffic accidents, use of firearms, but also non-specific operations resulting in death, e. g. the killing of a child, were listed by the policemen. The knowledge of the psychological stress and its sources as well as the analysis of the exact circumstances of traumatic events are helpful in preventing PTSDs more efficiently, e. g. by special trainings for coping with stress and conflicts, in faster identification and treatment using professional support.

Prevalence and Predictors of Distress, Anxiety, Depression, and Quality of Life in Bereaved Family Caregivers of Patients With Advanced Cancer.

OBJECTIVE: To investigate prevalence and predictors of postloss distress, depressive and anxiety symptoms, and quality of life among bereaved family caregivers of patients with advanced cancer. METHODS: Prospective multicenter study. Family caregivers (N = 160, mean age 56.8 years, 66% female) completed validated outcome measures (Distress Thermometer, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire depression module 9-item scale, SF-8 Health Survey Questionnaire) 6 months after patient's discharge or death at specialist inpatient palliative care ward. RESULTS: Clinically relevant distress was observed in 82% with sadness (89%), exhaustion (74%), sleeping problems (68%), loneliness (53%), and sorrows (52%) being the most common distress-causing problems. Moderate/severe anxiety and depressive symptoms were observed in 27% and 35%, respectively. Compared to an adjusted norm sample, quality of life was significantly impaired with exception of "bodily pain" and physical component score. Preloss caregiving (odds ratio [OR] 2.195) and higher preloss distress (OR 1.345) predicted high postloss distress. Utilization of psychosocial support services (OR 2.936) and higher preloss anxiety symptoms (OR 1.292) predicted moderate/severe anxiety symptoms, lower preloss physical quality of life (OR 0.952), and higher preloss depressive symptoms (OR 1.115) predicted moderate/severe depressive symptoms. CONCLUSION: Preloss mental burden showed to be a consistent predictor for postloss burden and should be addressed during palliative care. Future research should examine specific caregiver-directed interventions during specialist palliative care.

Personal and contextual predictors for adolescent dating violence perpetration / Variables personales y contextuares predictivas de perpetración de violencia en el noviazgo en la adolescencia / Variáveis pessoais e contextuais preditoras de perpetração de violência no namoro na adolescência

Abstract Previous studies indicate that being a victim of child maltreatment and witnessing parental violence are predictors of dating violence in adolescence. The influence of the peer group, alcohol use and being female also increase the risk for dating violence, although they are still poorly researched variables. Thus, this descriptive cross-sectional study investigated personal and contextual variables associated with the perpetration of dating violence in 403 adolescents, aged 14-19, from public and private schools in the Metropolitan Region of Porto Alegre, Brazil. A multivariate logistic regression analysis indicated that having suffered psychological maltreatment in childhood increases 5.37 (95% IC = 2.30-12.57) the likelihood of an adolescent being a perpetrator of verbal/emotional dating violence. Other predictive variables (witnessing parental violence, peer group influence, alcohol use and being female) were not significant. This study gathers evidence of intergenerational aspects of dating violence and indicates the need for preventive work with adolescents.

Resumen Los estudios previos sobre el tema indican que ser víctima de malos tratos en la infancia y ser testigo de violencia conyugal en los padres son variables predictoras de la violencia en el noviazgo entre adolescentes; así como que la influencia del grupo de pares, el uso del alcohol y el sexo femenino aumentan el riesgo para la violencia en el noviazgo, aunque estas son variables todavía poco investigadas. Teniendo esto en cuenta, con el presente estudio transversal y descriptivo se investigó respecto a las variables personales y contextuales asociadas a la perpetración de violencia en el noviazgo en 403 adolescentes, de 14 a 19 años, de escuelas públicas y privadas en la Región Metropolitana de Porto Alegre, Brasil. Como resultados, una regresión logística multivariada indicó que haber sufrido maltrato psicológico en la infancia aumenta 5.37 veces (95 % IC = 2.30-12.57) la probabilidad de que un adolescente sea perpetrador de violencia verbal-emocional en el noviazgo. Otras variables, como ser testigo de violencia conyugal, la influencia del grupo de pares, el consumo de alcohol y el sexo femenino, no se mostraron significativas. Este estudio recoge evidencia de aspectos intergeneracionales de la violencia en el noviazgo e indica la necesidad de programas de prevención e intervención con los adolescentes.

Resumo Estudos prévios indicam que ser vítima de maus-tratos na infância e testemunhar a violência conjugal dos pais são preditores da violência no namoro na adolescência. A influência do grupo de pares, o uso de álcool e ser do sexo feminino igualmente aumentam o risco para a violência no namoro, embora ainda sejam variáveis pouco investigadas. Dessa forma, este estudo transversal descritivo investigou variáveis pessoais e contextuais associadas à perpetração de violência no namoro em 403 adolescentes, de 14 a 19 anos, de escolas públicas e privadas da Região Metropolitana de Porto Alegre, Brasil. Uma análise de regressão logística multivariada indicou que ter sofrido maus-tratos psicológicos na infância aumenta em 5,37 (IC 95 % = 2,30-12,57) a probabilidade de um adolescente ser perpetrador de violência verbal ou emocional no namoro. Demais variáveis preditoras (testemunhar violência parental, influência do grupo de pares, uso de álcool e ser do sexo feminino) não se mostraram significativas. Este estudo reúne evidências de aspectos intergeracionais da violência no namoro e indica a necessidade de programas de prevenção com adolescentes.

Bem-estar subjetivo, violência e sintomas de depressão, ansiedade e estresse em adolescentes / Subjective well-being, violence and symptoms of depression, anxiety and stress in adolescents / Bienestar subjetivo, violencia y síntomas de depresión, ansiedad y estrés en los adolescentes

Este estudo investigou relações entre exposição à violência direta (VD) e violência indireta (VI), Bem-Estar Subjetivo (BES) e sintomas de depressão, ansiedade e estresse em 426 adolescentes de 12 a 18 anos (M=14,91; DP=1,66). Foram utilizados os instrumentos Triagem da Exposição de Crianças à Violência na Comunidade, Escala de Depressão, Ansiedade e Estresse para Adolescentes (EDAE-A), Escala de Afetos Positivos (AP) e Afetos Negativos (AN) e Escala Multidimensional de Satisfação de Vida para Adolescentes (EMSVA). A Regressão Linear Múltipla indicou um modelo em que ser exposto à VD e VI, ser do sexo feminino, ter maior nível de AN e menores níveis de SVA explicaram 47% da variação nos escores da EDAE-A. Depressão e VD explicaram 39% na variação nos escores do BES. A exposição à VD e VI foi associada a sintomas de ansiedade, depressão e estresse, demonstrando que se constitui num fator de risco ao desenvolvimento emocional. (AU)

This study investigated the relationship between exposure to direct violence (DV) and indirect violence (IV), subjective well-being (SWB) and symptoms of depression, anxiety and stress in 426 adolescents aged 12 to 18 years (M=14.91; SD=1.66). The instruments used were the Screening for Children's Exposure to Violence in the Community; Depression, Anxiety and Stress Scale for Adolescents (DASS-A); Positive Affects Scale (PA) and Negative Affects (NA) Scale; and the Multidimensional Scale of Life Satisfaction for Adolescents (MSLSA). Multiple Linear Regression indicated a model in which being exposed to DV and IV, being female, having a higher level of NA and lower levels of SVA, explained 47% of the variation in DASS-A scores. Depression and DV explained 39% of the variation in SWB scores. Exposure to DV and IV was associated with symptoms of anxiety, depression and stress, demonstrating that it constitutes a risk factor for emotional development. (AU)

Este estudio investigó las relaciones entre exposición a violencia directa (VD), violencia indirecta (VI), Bienestar Subjetivo (BES) y síntomas de depresión, ansiedad y estrés en 426 adolescentes de 12 a 18 años (M=14,91; DP=1,66). Los instrumentos utilizados fueron Proyección de Exposición de Niños a Violencia en la Comunidad; Escala de Depresión, Ansiedad y Estrés para adolescentes (EDAE-A); Escala de Afectos Positivos (AP) y Afectos Negativos (AN) y Escala Multidimensional de Satisfacción de Vida para adolescentes (EMSVA). La regresión lineal múltiple indicó un modelo, en que estar expuesto a VD y VI, ser de sexo femenino, tener mayor nivel de AN y niveles menores de SVA explica el 47% de variación en los puntajes de EDAE-A. Depresión y VD explicaron el 39% de variación en los puntajes del BES. La exposición a VD y VI se ha asociado con síntomas de ansiedad, depresión y estrés, demostrando que se constituye en un factor de riesgo para el desarrollo emocional. (AU)