Special Operations Cognitive Agility Training (SOCAT) for Special Operations Forces and spouses.

Increasingly complex and unpredictable personnel and operational demands require Special Operations Forces (SOF) members and their families to remain flexible, adaptive, and resilient within ever-changing circumstances. To mitigate the impact of these stressors on psychological health and fitness, researchers and educators at the Uniformed Services University of the Health Sciences (USUHS) developed Special Operations Cognitive Agility Training (SOCAT), a cognitive performance optimization program supported by the United States Special Operations Command (USSOCOM) Preservation of the Force and Family (POTFF). The goal of SOCAT is to enhance cognitive agility, defined as the ability to deliberately adapt cognitive processing strategies in accordance with dynamic shifts in situational and environmental demands, in order to facilitate decision making and adapt to change. Overall, SOCAT emphasizes optimal cognitive performance across different contexts - as well as across various stages of the military lifecycle - to serve as a buffer against biopsychosocial vulnerabilities, environmental and social stressors, military operational demands, and behavioral health problems, including suicide. This paper reviews foundational research behind SOCAT, mechanisms through which SOCAT is anticipated to build psychological resilience, and describes the process of developing and tailoring SOCAT for active duty SOF members and spouses. Limitations and future directions, including an ongoing, randomized controlled program evaluation, are discussed.

The effect of training the fathers to support their wives on stress and self-efficacy in mothers of premature newborns hospitalized in NICU: a quasi-experimental study.

BACKGROUND: The birth of premature newborns and their separation from family due to their hospitalization in the Neonatal Intensive Care Unit (NICU) cause stress in the parents, especially mothers. We conducted this study aimed to evaluate whether training the fathers to support their wives impacts premature newborn mothers' stress and self-efficacy or not? METHODS: A quasi-experimental (before-after study) including one experimental and control group was used. Data were collected from Seventy-five parents with newborns hospitalized in NICU (n = 30) in the intervention and (n = 45) in usual care groups. Settings were the NICUs of the two international, educational, specialty, and subspecialty Nemazee and Hafez hospitals of the Shiraz University of Medical Science. Fathers in the intervention group learned how to support their wives and provide care for their premature newborns. The control group received the usual care. Mother's stress and self-efficacy were measured using validated questionnaires. RESULTS: Data analysis showed that the mean scores of mothers' stress and self-efficacy from pre-intervention to post-intervention were significantly decreased and increased respectively in the intervention group (p <0.001). At the same time, there was no significant difference in the control group. CONCLUSION: When fathers are trained to support their wives and do so, it relieves the stress and improves the mothers' self-efficacy, and has a direct effect on providing care to their premature newborns. Therefore, it is recommended that measures should be taken so that the fathers be present, participate in providing care, and support their wives and newborns in NICU. TRIAL REGISTRATION: IRCT20171130037691N1 .

Comparing the effect of group- based training along with text messaging and compact disc- based training on men's knowledge and attitude about participation in perinatal care: a cluster randomized control trial.

BACKGROUND: Men's participation in perinatal care is one of the key factors in promoting maternal and neonatal health. The effects of various methods of training on men's knowledge and attitude about participation in perinatal care can be different. So, this study aimed to compare the effect of two methods of training on men's knowledge and attitude about participation in perinatal care. METHODS: This cluster randomized control trial was conducted in three midwifery clinics in Tabriz, Iran between May and August 2018. Each clinic was randomly assigned to intervention (group- based training along with text messaging and CD- based training) and control groups. Seventy-five men were enrolled in three groups and evaluated for their knowledge and attitude about participation in perinatal care. Before and 3 months after the intervention, a researcher-made questionnaire was completed by the participants. Data were analyzed using descriptive and inferential statistics (paired t-test, one-way ANOVA, ANCOVA, chi-square, Kruskal-Wallis and Fisher exact tests). RESULTS: The mean (SD) score of men, s knowledge and attitude about participation in perinatal care had a significant increase in group- based training along with text messaging after the intervention compared to the score of before the intervention (p < 0.001, p = 0.005, respectively), but the mean (SD) score of men, s knowledge and attitude had not a significant increase in CD- based training and control group after the intervention compared to the score of before the intervention. The mean (SD) score of men,s knowledge and attitude about participation in perinatal care in group- based training along with text messaging were significantly higher than in CD- based training (p < 0.001, p = 0.039, respectively) and control group (p = 0.001, p = 0.021, respectively) after the intervention, respectively. However, the mean (SD) score of men, s knowledge and attitude in CD- based training were not significantly different from the control group after the intervention. CONCLUSION: Group- based training along with text messaging was more effective in improving the knowledge and attitude of men about participation in perinatal care compared to CD- based training. So, its implication in educational programs for the men is recommended. TRIAL REGISTRATION: IRCT, IRCT20160224026756N4 . Registered 27 May 2018.

Personally tailored activities for improving psychosocial outcomes for people with dementia in community settings.

BACKGROUND: People with dementia living in the community, that is in their own homes, are often not engaged in meaningful activities. Activities tailored to their individual interests and preferences might be one approach to improve quality of life and reduce challenging behaviour. OBJECTIVES: To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in the community and their caregivers. To describe the components of the interventions. To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS: We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 11 September 2019 using the terms: activity OR activities OR occupation* OR "psychosocial intervention" OR "non-pharmacological intervention" OR "personally-tailored" OR "individually-tailored" OR individual OR meaning OR involvement OR engagement OR occupational OR personhood OR "person-centred" OR identity OR Montessori OR community OR ambulatory OR "home care" OR "geriatric day hospital" OR "day care" OR "behavioural and psychological symptoms of dementia" OR "BPSD" OR "neuropsychiatric symptoms" OR "challenging behaviour" OR "quality of life" OR depression. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA: We included randomised controlled trials and quasi-experimental trials including a control group offering personally tailored activities. All interventions comprised an assessment of the participant's present or past interests in, or preferences for, particular activities for all participants as a basis for an individual activity plan. We did not include interventions offering a single activity (e.g. music or reminiscence) or activities that were not tailored to the individual's interests or preferences. Control groups received usual care or an active control intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently checked the articles for inclusion, extracted data, and assessed the methodological quality of all included studies. We assessed the risk of selection bias, performance bias, attrition bias, and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS: We included five randomised controlled trials (four parallel-group studies and one cross-over study), in which a total of 262 participants completed the studies. The number of participants ranged from 30 to 160. The mean age of the participants ranged from 71 to 83 years, and mean Mini-Mental State Examination (MMSE) scores ranged from 11 to 24. One study enrolled predominantly male veterans; in the other studies the proportion of female participants ranged from 40% to 60%. Informal caregivers were mainly spouses. In four studies family caregivers were trained to deliver personally tailored activities based on an individual assessment of interests and preferences of the people with dementia, and in one study such activities were offered directly to the participants. The selection of activities was performed with different methods. Two studies compared personally tailored activities with an attention control group, and three studies with usual care. Duration of follow-up ranged from two weeks to four months. We found low-certainty evidence indicating that personally tailored activities may reduce challenging behaviour (standardised mean difference (SMD) -0.44, 95% confidence interval (CI) -0.77 to -0.10; I2 = 44%; 4 studies; 305 participants) and may slightly improve quality of life (based on the rating of family caregivers). For the secondary outcomes depression (two studies), affect (one study), passivity (one study), and engagement (two studies), we found low-certainty evidence that personally tailored activities may have little or no effect. We found low-certainty evidence that personally tailored activities may slightly improve caregiver distress (two studies) and may have little or no effect on caregiver burden (MD -0.62, 95% CI -3.08 to 1.83; I2 = 0%; 3 studies; 246 participants), caregivers' quality of life, and caregiver depression. None of the studies assessed adverse effects, and no information about adverse effects was reported in any study. AUTHORS' CONCLUSIONS: Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities.

Association of husbands' education status with unintended pregnancy in their wives in southern Ethiopia: A cross-sectional study.

BACKGROUND: Unintended pregnancy rates are substantially higher in developing regions, have significant health consequences, and disproportionately affect subgroups with socio-economic disadvantage. We aimed to examine whether there is an association between husbands' education status and their wives unintended pregnancy in southern Ethiopia. METHODS: The data source for this study was from a cross-sectional study on iron-folate supplementation and compliance in Wolaita, South Ethiopia. Data were collected from October to November 2015 in 627 married pregnant women regarding their husbands' education status, socio-demographic characteristics, and if they wanted to become pregnant at the time of survey using an interviewer administered questionnaire. Logistic regression was used to estimate Odds Ratios (ORs) with associated z-tests and 95% Confidence Intervals (95% CI) for variables associated with unintended pregnancy. RESULTS: The proportion of unintended pregnancy in this sample was 20.6%. Husbands' education status, age, residence, and using family planning methods were associated with unintended pregnancy (all P-values < 0.05). Multivariable models consistently showed that being married to a husband with at least some college or university education was associated with a decreased OR for unintended pregnancy after controlling for age and use of family planning at conception period (OR 0.36 [95%CI: 0.17, 0.82]) and age and rural residence (OR 0.40 [95%CI: 0.18, 0.90]). CONCLUSION: Unintended pregnancy among Ethiopian woman was consistently associated with being married to least educated husbands in southern Ethiopia. Increasing age and living in a rural vs urban area were also independently associated with unintended pregnancy. Strategies for addressing family planning needs of women with poorly educated husbands should be the subject of future research.

El efecto del entrenamiento grupal en asertividad sexual sobre la asertividad sexual de las alumnas: Un estudio cuasi-experimental / The Effect of Group sexual assertiveness training on Sexual assertiveness of Female Students: A quasi-experimental study

Sexual relation is a very important part of the marital relationship. Any problem in the marital relationship affects the family and society cohesion. This study aim to determine the effect of Group sexual assertiveness training on Sexual assertiveness of Female Students. This quasi-experimental pre and posttest study was conducted on 80 married female students of Sistan and Baluchestan University (southeast of Iran), from 1 July 2018 to 30 March 2019.Students were selected and randomly allocated in the two intervention and control groups. The intervention group received group sexual assertiveness training in the 4 two-hourly sessions over a period of two weeks. The control group did not receive any training. The data were collected before and 12 weeks after the intervention by Hurlbert's sexual assertiveness questionnaire, and then were analyzed. After the implementation of group sexual assertiveness training, the mean score of sexual assertiveness significantly increased in the intervention group compared to the control group (p=0.01). It is recommended to add sexual assertive training to the pre-marriage education, especially in cultures in which women have a low level of sexual assertiveness

Efficacy and cost-utility of the eHealth self-management application 'Oncokompas', helping partners of patients with incurable cancer to identify their unmet supportive care needs and to take actions to meet their needs: a study protocol of a randomized controlled trial.

BACKGROUND: Incurable cancer does not only affect patients, it also affects the lives of their partners. Many partners take on caregiving responsibilities. The burden of these caregiving tasks are often associated with physical, psychological, and social difficulties and many partners have unmet supportive care needs. Oncokompas is an eHealth self-management application to support partners in finding and obtaining optimal supportive care, tailored to their quality of life and personal preferences. A randomized controlled trial will be carried out to determine the efficacy and cost-utility of Oncokompas. METHODS: A total of 136 adult partners of patients with incurable cancer will be included. Partners will be randomly assigned to the intervention group, which directly gets access to Oncokompas, or the waiting-list control group, which gets access to Oncokompas after three months. The primary outcome measure is caregiver burden. Secondary outcome measures comprise self-efficacy, health-related quality of life, and costs. Measures will be assessed at baseline, two weeks after randomization, and three months after the baseline measurement. DISCUSSION: This study will result in evidence on the efficacy and cost-utility of Oncokompas among partners of patients with incurable cancer, which might lead to implementation of Oncokompas as a health service for partners of patients with incurable cancer. TRIAL REGISTRATION: Netherlands Trial Register, NTR 7636. Registered on 23 November 2018.

Effects of psychoeducation on the mental health and relationships of pregnant couples: A systemic review and meta-analysis.

BACKGROUND: Previous studies suggest that psychoeducational interventions for pregnant and postpartum couples can improve perinatal mental health outcomes and promote couples' relationships. However, most studies conducted to date have focused only on maternal depression, with few studies addressing the needs of fathers, or the effects of paternal participation on the mental health/relationship of both partners. OBJECTIVES: This study aimed to systematically examine the effects of perinatal couples' psychoeducation on parental mental health and their relationship. DESIGN: A systematic review and meta-analysis were conducted. DATA SOURCES: Six electronic databases were searched, including Embase, MEDLINE, Web of Science, the Cochrane Library, CINAHL, and PubMed. REVIEW METHODS: The authors independently extracted data from journals written in English or Korean, published between January 2000 and August 2017. Randomized controlled trials (RCTs) that reported psycho-emotional symptoms and couples' relationship outcomes were screened. Of the 11 studies that systematically reviewed couples' mental health and relationship problems, seven RCTs, with data available to pool for quantitative analysis, were reviewed. The total number of participants from all studies was 7119, and the number of participant couples ranged from 15 to 869. RESULTS: Psychoeducational interventions had a small effect size in promoting maternal mental health (SMD = -0.307; 95% CI: -0.47 to -0.14). However, there was evidence of heterogeneity for the overall outcome, with I2 of 16% and p = .27. Paternal mental health also improved, but with a small effect size (SMD = -0.296; 95% CI: -0.53 to -0.05). The pooled results of four studies showed that interventions had very small effect sizes for improving maternal perception of the couple's relationship (SMD = 0.125; 95% CI: -0.05 to 0.30). There was evidence of heterogeneity for the overall outcome, with I2 of 7% and p = .36. Psychoeducational interventions with fathers showed a medium effect size for improving paternal perception of the couple's relationship (SMD = 0.348; 95% CI: 0.16 to 0.52); heterogeneity was I2 of 0% and p = .68. CONCLUSION: This study was meaningful as it revealed evidence from published trials regarding the effectiveness of psychoeducational programs that target both pregnant women and their partners. Results indicate that psychoeducational interventions can reduce maternal postpartum depression and ameliorate paternal negative affect, as well as provide overall improvement in the couples' relationship satisfaction. However, further studies on physiological indicators and/or clinical symptoms of postpartum depression are needed to better understand the practical significance of psychoeducational intervention.

The Association Between Spousal Education and Cognitive Ability Among Older Mexican Adults.

OBJECTIVES: Education and cognition are closely associated, yet the role of spousal education is not well understood. We estimate the independent effects of own and spousal education on cognitive ability in late-life in Mexico, a developing country experiencing rapid aging. METHOD: We analyzed 4,017 married dyads (age 50+) from the 2012 Mexican Health and Aging Study. Cognitive ability for married adults was a factor score from a single factor model. Using seemingly unrelated regression, we test whether spousal education influences older adults' cognitive ability, whether associations are explained by couple-level socioeconomic position, health and health behaviors, and social support, and whether associations differed by gender. RESULTS: Education and cognitive ability were correlated within couples. Higher spousal education was associated with better cognitive ability. Associations between spousal education and cognitive ability were independent of own education, did not differ by gender, and remained significant even after adjustment for couple-level socioeconomic position, health and health behaviors, and perceived social support. DISCUSSION: In addition to own education, spousal education was associated with better cognitive ability, even at relatively low levels of education. We discuss the possibility that spousal education may improve cognition via transmission of knowledge and mutually reinforcing cognitively stimulating environments.

A Qualitative Study About How Nurses in Belgium Offer Relationship Support to Couples in Palliative Care.

Although palliative care nurses are identified as key players in supporting couples during advanced illness, there is a lack of evidence about their knowledge and experiences with this particular role. The aim of the study was to explore palliative care nurses' attitudes, roles, and experiences in addressing relationship functioning of couples in daily practice. A qualitative study was conducted using in-depth interviews, observational research, and peer debriefing groups with palliative care nurses in Flanders, Belgium. Nurses support relationship functioning by creating a couple-positive care environment, by being present/acknowledging feelings, and by rectifying imbalances between couples. They do so in a proactive way, backed up by team support. Nurses hesitate toward explicitly unraveling and intervening in relationship problems, in favor of providing comfort or offering a strengths-based approach. The findings offer an urgent call to enhance the educational programs for palliative care nurses by integrating the theories and practice frameworks that guide relational assessment and intervention, which are being used in family nursing.

Spousal Education and Cognitive Functioning in Later Life.

OBJECTIVES: Numerous studies have documented the relationship between education and cognitive functioning at the individual level. Yet few studies have examined whether a spouse's education spills over to influence the other spouse's cognitive functioning. This study, therefore, investigates the association between spousal education and cognitive functioning, the pathways that may account for this association, and gender differences in this association. METHOD: Growth curve models were analyzed by using longitudinal couple data from the Health and Retirement Study (N = 5,846 individuals). RESULTS: More years of spousal education are associated with higher level of cognitive functioning at age 65 (γ000 = 0.0532, 95% confidence interval [CI] = 0.0163-0.0901) and slower decline in cognitive functioning in later adulthood (γ100 = 0.0054, 95% CI = 0.0026-0.0082). The positive association between spousal education and the level of cognitive functioning at age 65 is fully explained by economic resources. The association of spousal education with the rate of change in cognitive functioning decreases but remains significant after controlling for economic resources and health behaviors (γ100 = 0.0043, 95% CI = 0.0014-0.0072). The association between spousal education and cognitive functioning is similar for men and women. DISCUSSION: Findings suggest that more years of spousal education may slow decline in cognitive functioning for men and women in later life.

What Do Women Want? Looking Beyond Patient Satisfaction.

OBJECTIVE: To hear the voices of women, their partners, and nurses about expectations and priorities during the postpartum hospitalization. DESIGN: Focus groups using semistructured interview questions. SETTING: A 12-bed labor-delivery-recovery-postpartum unit at a small urban hospital in the U.S. Northeast. PARTICIPANTS: Women who planned to or had given birth, their partners, and the maternity nurses who cared for them. MEASUREMENTS: Qualitative thematic analysis of focus group transcripts. RESULTS: Thematic analysis produced the following themes for women's priorities: Need for individualized attention to maternal physical and emotional care; Fear of providing inadequate care for the newborn, including establishing infant feeding; and Transitioning to parenting as a new mother versus as an experienced mother. Themes for nurses' priorities included Safety issues around sleep and breastfeeding, Transitioning to parenting with an emphasis on maternal self-care, and Addressing barriers to effective discharge education. Response comparisons between the women/partners and nurses suggest that there is a disconnection between women's and nurses' priorities and expectations for care during the postpartum period. CONCLUSION: Women and nurses identified unmet needs in the postpartum period, consistent with the current literature. Providing standardized education during the transitional period around discharge from the hospital to home may not be optimal and may even detract from meeting the needs for rest and connection with family and the health care team. Nursing care that extends beyond the maternity hospitalization may be needed to individualize care and meet previously unmet needs.

Family-friendly for her, longer hours for him: Actor-partner model linking work-family environment to work-family interference.

Supportive work-family environments are associated with lower levels of perceived work-to-family interference (WFI; Kelly et al., 2014), but we know little about the mechanisms underlying this linkage. Nor is much known about the larger family contexts within which these processes take place, including crossover effects of spouses' work on one another's WFI (Westman, 2001). This study utilized longitudinal data collected in home interviews with dual-earner couples to examine mechanisms through which a supportive work-family environment has implications for employees' and their spouses' WFI-with a focus on work demands, specifically hours and pressure, as potential mediators. Participants were married heterosexual couples (N = 194 dyads) with at least two children living at home; reflecting the demographics of their communities, they were almost all white and working/middle class. In separate home interviews wives and husbands reported on their work-family environment, work demands (work hours; work pressure) and their work-to-family interference one year later. Results of an Actor-Partner Interdependence Mediation Model revealed that more supportive work-family environments predicted less WFI for both employees and their spouses. The mechanisms underlying this association, however, differed by employee gender and type of effect (spillover to the employee or crossover to the spouse). Work demands served as a mediator for wives' (but not husbands') spillover (but not crossover). Wives' supportive work-family environments, however, were associated with husbands working longer hours. Results suggest that supportive work-family environments may be particularly beneficial for dual-earner families. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An educational intervention to men for reducing environmental tobacco smoke exposure in their pregnant wives.

OBJECTIVE: To determine the effect of education based on health belief model (HBM) on the level of their pregnant wives' environmental tobacco smoke exposure (ETSE). METHODS: This interventional randomized study was conducted on 60 cigarette smoking men who have exposed their pregnant wives to smoke during of their pregnancy. The HBM constructs and weekly ETSE were evaluated by using questionnaire. The intervention group received education with emphasis on the risks of cigarette's smoke on the pregnancy. Then right after the training and 6 weeks after that, HBM constructs and 6 weeks after the training the weekly ETSE were evaluated again. RESULTS: Results showed a significant difference between the mean of perceived susceptibility, perceived benefits and barriers at intake and 6 weeks after the intervention in the intervention group. Also, the level of perceived susceptibility/severity and perceived barriers in both groups were significantly different 6 weeks after the intervention compared to intake time. The ETSE was significantly lower in the intervention group 6 weeks after the intervention in comparison to before the intervention and also to the control group. CONCLUSIONS: This study showed that education husbands would relatively improve their health beliefs and reduce the ETSE of their pregnant wives.

What Women Think Should Be Done to Stop Intimate Partner Violence in Ghana.

This aricle expands scholarship on intimate partner violence in Ghana by discussing what should be done to stop it, using data from the Northern region. The data came from 53 survey participants who provided useful responses to an open question: "what should we do to stop intimate partner violence"? The 53 respondents were part of 443 women non-randomly sampled at public health centers across the region to participate in a survey on intimate partner violence. Although the survey used a questionnaire, responses to the open question constituted qualitative data for this article. All 53 written responses were typed out verbatim into a Microsoft word document to generate a transcript for analysis. Responses entered in the transcript were numbered to distinguish one from another. Each numbered unit of text represented the complete response of a participant. Data were content-analyzed and reduced to five meaning categories for interpretation and conclusion-drawing. These are: provide behavior change support to couples; institute and enforce legal sanctions against perpetrators; empower women; provide public education for social change; and pray and preach against violence. Discussion of the findings is situated within discourse analysis and the article concludes with a note on implications for policy and practice.

Exploring antenatal education content for couples in Blantyre, Malawi.

BACKGROUND: Despite advocating for male involvement in antenatal education, there is unmet need for antenatal education information for expectant couples. The objective of this study was to gain a deeper understanding of the education content for couples during antenatal education sessions in Malawi. This is needed for the development of a tailor-made curriculum for couple antenatal education in the country, later to be tested for acceptability, feasibility and effectiveness. METHODS: An exploratory cross sectional descriptive study using a qualitative approach was conducted in semi-urban areas of Blantyre District in Malawi from February to August 2016. We conducted four focus group discussions (FGDs) among men and women independently. We also conducted one focus group discussion with nurses/ midwives, 13 key informant interviews whose participants were drawn from both health-related and non-health related institutions; 10 in-depth interviews with couples and 10 separate in-depth interviews with men who had attended antenatal clinics before with their spouses. All the interviews were audiotaped, transcribed verbatim and translated from Chichewa, the local language, into English. We managed data with NVivo 10.0 and used the thematic content approach as a guide for analysis. RESULTS: We identified one overarching theme: couple antenatal education information needs. The theme had three subthemes which were identified based on the three domains of the maternity cycle which are pregnancy, labour and delivery and postpartum period. Preferred topics were; description of pregnancy, care of pregnant women, role of men during perinatal period, family life birth preparedness and complication readiness plan, coitus during pregnancy and after delivery, childbirth and baby care. CONCLUSION: Antenatal education is a potential platform to disseminate information and discuss with male partners the childbearing period and early parenting. Hence, if both men and women were to participate in antenatal education, their information needs should be prioritized. Men and women had similar choices of topics to be taught during couple antenatal education, with some minor variations.

The effect of an educational intervention in early pregnancy with spouse's participation on optimal gestational weight gain in pregnancy: a randomized controlled trial.

Gaining weight above the Institute of Medicine recommended range contributes to the development of obesity, which increases risk for diseases. We evaluated the effectiveness of an educational program with the spouse's participation on the optimal gestational weight gain (GWG) in pregnancy. We conducted a randomized controlled trial on 128 nulliparous women attending Najmieh Hospital-Antenatal Clinic based in Tehran-Iran. Participants randomly allocated into two groups of interventions and one control group. In group A, the women received education with their spouse's participation. In group B, the women received education without the participation of the spouses. In the control group, women received only routine prenatal care. Data were analysed by the ANOVA and Chi-square coefficient. The mean of the total GWG in the groups A and B was significantly lower than the control group (13.50 ± 3.85, 13.55 ± 3.20 and 15.53 ± 4.20 kg, respectively, P > 0.05). The rate of optimal GWG in groups A and B was 1.97 and 1.77 times of the control group, respectively (P < 0.05). The percentage of non-optimal GWG significantly decreased (P < 0.05). Groups A and B were not significantly different indicating no effect of spousal presence.

Caregivers of Patients Considering a Destination Therapy Left Ventricular Assist Device and a Shared Decision-Making Intervention: The DECIDE-LVAD Trial.

OBJECTIVES: This study aims to characterize caregivers of patients considering destination therapy left ventricular assist device (DT-LVAD) and evaluate the effectiveness of a shared decision-making (SDM) intervention. BACKGROUND: Caregivers play an integral role in the care of patients with chronic illness. At the extreme, pursuing a DT-LVAD is a major preference-sensitive decision that requires high-level caregiver engagement. Yet, little is known about caregivers of patients considering DT-LVAD, and there is a paucity of research on the involvement of caregivers in medical decision-making. METHODS: A 6-center, stepped-wedge trial was conducted. After varying time in usual care (control), sites were transitioned to an SDM intervention consisting of staff education and pamphlet and video decision aids (DAs). The primary outcome was decision quality, measured by knowledge and values-choice concordance. RESULTS: From 2015 to 2017, 182 caregivers of patients considering DT-LVAD were enrolled (control group, n = 111; intervention group, n = 71). The median age was 61 years, 86.5% were female, and 75.8% were spouses. Caregiver knowledge (0% to 100%) improved from baseline to post-education in both groups: in the control group it improved from 64.2% to 73.3%; in the intervention group it improved from 62.6% to 76.4% (adjusted difference of difference: 4.8%; p = 0.08). At 1 month, correlation between stated values and caregiver-reported treatment choice was stronger in the intervention group (difference in Kendall's tau: 0.36, 95% confidence interval: 0.04 to 0.71; p = 0.03). Caregivers reported decisional conflict (0 to 100) at baseline (control group: 19.0 ± 2.1; intervention group: 21.4 ± 2.6), which decreased post-education more in the control group (control group: 9.0 ± 1.9, intervention group: 18.8 ± 2.4; p = 0.009). Caregivers in the control group were more likely to "definitely recommend" the educational materials than those in the intervention group (93.5% vs. 74.5%, respectively; p = 0.004). CONCLUSIONS: An SDM intervention improved concordance between caregiver values and treatment choice for their loved ones but did not significantly impact knowledge. Caregivers found the DAs less acceptable than more biased educational materials and exposure to DAs led to higher conflict initially. These findings highlight the complexity of SDM involving caregivers of patients with chronic illness. (PCORI-1310-06998 Trial of a Decision Support Intervention for Patients and Caregivers Offered Destination Therapy Heart Assist Device [DECIDE-LVAD]; NCT02344576).

The "more at home with dementia" program: a randomized controlled study protocol to determine how caregiver training affects the well-being of patients and caregivers.

BACKGROUND: Caring for people with dementia imposes heavy burdens on caregivers, especially spouses. This can lead to depression, anxiety, and physical symptoms in the caregiver, with early institutionalization for the patient. An Australian study reported that a residential caregiver training program delivered in medical settings could delay nursing home admission, lower mortality, reduce psychological morbidity in caregivers, and lower healthcare costs. In this replication study, we aim to determine the effectiveness of an adaptation of this program to non-medical settings in the Dutch health care system. METHODS: A randomized controlled study design will be used, comparing an intervention group with a control group. The intervention will last for five days and will be delivered in either a holiday park or a bed and breakfast setting. The control group will receive care as usual. Data will be collected at baseline and after 3 and 6 months, and outcomes will be assessed in the caregiver group and in the dementia group. The primary outcome will be caregiver-related quality of life after 3 months. The main secondary outcome will be the neuropsychiatric symptoms in the dementia group. Secondary outcomes in the dementia group will be activities of daily living and instrumental activities of daily living, use of health facilities, quality of life, agitation, dementia severity, and use of psychotropic medication. Secondary outcomes in the caregiver group will be the subjective and objective burdens, health and health care facility use, psychotropic medication use, depression, anxiety, and perseverance time. DISCUSSION: We anticipate that the outcomes will allow us to confirm the effectiveness of the intervention, and in turn, potentially inform the introduction of this program into care plans. It is also expected that the experiences and recommendations of participants will help us to develop the training program further. TRIAL REGISTRATION: Registered in the Netherlands Trial Register on March 9, 2016, number 5775 .