Validation of the multidimensional scale of perceived social support (MSPSS) for family caregivers of people with dementia.

BACKGROUND AND OBJECTIVES: The Multidimensional Scale of Perceived Social Support (MSPSS) is a measure of perceived adequacy of social support. Whilst this is an important area of research for family caregivers of people with dementia, it is not clear whether the MSPSS retains its psychometric properties when used with this population. The aim was to conduct an in-depth psychometric analysis of the MSPSS to ensure that it remains a psychometrically robust measure for this population. RESEARCH DESIGN AND METHODS: Participants completed measures online using a self-complete procedure. A subsample completed the MSPSS twice, within a 4-week period. Properties assessed were internal consistency, floor and ceiling effects, test-retest reliability, convergent validity and factor structure. RESULTS: 270 participants completed the study and 58 comprised the test-retest sample. Internal consistency was excellent for the total score (α = 0.92) and three subscales (α = 0.92-0.94). Significant correlations were observed in the expected directions with depression (r = -.48, p < .001) and mental (r = 0.32, p<.001) and physical (r = 0.17, p=.003) health-related quality of life. Test re-test reliability was excellent for the total score (ICC = 0.90 95%CI = 0.84, 0.94) and subscale scores (ICC = 0.84-0.89). Confirmatory factor analysis indicated acceptable fit indices for the three-factor solution. DISCUSSION AND IMPLICATIONS: The MSPSS has robust psychometric properties when used with caregivers of people with dementia and may be recommended for use with this population. Further research is required to establish responsiveness and determine cross-cultural validity.

A psychometric appraisal of positive psychology outcome measures in use with carers of people living with dementia: a systematic review.

OBJECTIVES: This review aimed (i) to identify all positive psychology measures in use with family carers and (ii) to determine their psychometric properties. DESIGN: Literature searches were made in Ovid MEDLINE, PsychINFO, and Web of Science. The identified measures were then subjected to analysis via an established quality appraisal tool. RESULTS: Twenty-five instruments representing the positive psychology constructs of resilience, self-efficacy, and positive aspects to caregiving were found. Two reviewers independently evaluated the measures using the quality appraisal tool. The Gain in Alzheimer Care Instrument, the Resilience Scale, and the Caregiver Efficacy Scale were found to be the highest scoring measures within their respective constructs. CONCLUSIONS: Although some robust instruments were identified, there were numerous examples of important psychometric properties not being evidenced in development papers. Future researchers and clinicians should administer evidence-based outcome measures with adequate psychometric properties representing positive and negative constructs to obtain a comprehensive picture of a person's well-being.

Sudden gains in the outpatient treatment of anorexia nervosa: A process-outcome study.

OBJECTIVE: Sudden gains (SGs), broadly defined as sudden symptom reductions occurring between two consecutive treatment sessions, have been associated with improved treatment outcomes in anxiety and depression. The present study is the first to formally define SGs in anorexia nervosa and explore the characteristics, demographic and baseline clinical predictors, and clinical impact of SGs in anorexia nervosa. METHOD: This is a secondary analysis of data from 89 outpatients with broadly defined anorexia nervosa who received one of two psychotherapeutic interventions as part of the MOSAIC trial (Schmidt et al., 2015). SGs were defined using session-by-session body mass index (BMI) measures. This study investigated whether SGs were associated with changes in BMI, eating disorder symptomology, general psychopathology, and psychosocial impairment between baseline and 6, 12, and 24 months follow-up. RESULTS: SGs, experienced by 61.8% of patients, mostly occurred during the early and middle phases of treatment. A larger proportion of SGs predicted larger increases in BMI between baseline and 6, 12, and 24 months follow-up. Amongst those experiencing at least one SG, fewer days between baseline and a patient's first SG predicted a larger increase in BMI between baseline and both 6 and 12 months follow-up. The proportion and timing of SGs did not predict changes in other outcome measures. DISCUSSION: SGs in BMI during the outpatient treatment of anorexia nervosa are clinically useful predictors of longer-term weight outcomes.

Measuring hope and resilience in carers of people living with dementia: The positive psychology outcome measure for carers (PPOM-C).

OBJECTIVES: Positive psychology outcome measures aim to quantitatively document the character strengths that people use to maintain their wellbeing. Positive aspects of caregiving including the use of character strengths is gaining credence in dementia carer literature but there remain few psychometrically robust tools by which to capture this. The current study evaluated the psychometric properties of a newly developed measure of hope and resilience for family carers of people living with dementia. METHODS: An online study where family carers (n = 267) completed the newly adapted Positive Psychology Outcome Measure - Carer version (PPOM-C), the Hospital Anxiety and Depression Scale - Depression subscale (HADS-D), The Short Form Health Survey (SF-12), and The Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: Psychometric analysis indicated strong properties for the PPOM-C in family carers, with two items dropped to improve the internal consistency. Convergent validity was established, with strong correlations between the hope, resilience, depression symptomology, quality of life and social support. A Confirmatory Factor Analysis indicated acceptable model fit. DISCUSSION: The PPOM-C is a psychometrically robust tool that can be recommended for use in large scale psychosocial research. The use of this measure in research and practice will provide a more nuanced understanding of the caregiving role and how to support wellbeing in this population.

Domestic/Family Homicide: A Systematic Review of Empirical Evidence.

BACKGROUND: Domestic/family homicide (D/FH) is a global social, economic and public health problem. To date, the research studies into risk factors associated with D/FH has largely focused on intimate partner homicide (IPH). A more contemporary approach recognizes that D/FH extends beyond the intimate partner relationship. This systematic review sought to identify and quantify the individual, relationship, community and societal factors in the empirical evidence literature on D/FH. METHODS: Eight electronic databases were searched from January 1999 to December 2020. Published journal articles on studies of D/FH were included if the study included victims and/or perpetrator of D/FH, reported risk and/or protective factors associated with D/FH, reported primary data and was published in English. Factors were descriptively synthesized by the categories of the social ecological model and D/FH sub-type. RESULTS: Three hundred and forty published articles met the inclusion criteria. From 1999 to 2020 the number of articles on D/FH increased globally from 10 to 40 respectively, declining to 23 in 2020. Almost half of the articles examined populations located in the Americas (160, 47.1%), predominately the United States and the majority of articles used quantitative designs (277, 81.5%). The forms of homicide more commonly studied were intimate partner (171, 50.3%), and filicide (98, 28.8%). Approximately 90% of articles reported individual victim and perpetrator factors, 64.7% examined relationship factors, 17.9% examined community factors and 15.6% examined societal factors. CONCLUSION: To inform universal and targeted D/FH elimination and prevention strategies, more research across different regions and a greater emphasis on community and societal-level factors is needed.

Common pathway coagulopathy and hemorrhagic edema of infancy.

When screening tests of haemostasis are abnormal, it is important to identify at which point in the coagulation cascade dysfunction may be occurring. This may assist to identify a specific deficiency/dysfunction, the type of bleeding to be anticipated, and replacement therapy if required. Unmasking of an inherited coagulopathy or the development of an acquired coagulopathy may occur in the setting of a second (febrile) illness. Differentiating between inherited and acquired coagulopathies will rely on clinicians taking a thorough personal and family bleeding history, and correlating these findings with the haemostasis screening results.

Exertional heat fatalities in Australian sport and recreation.

OBJECTIVES: To describe the number and case characteristics of sport and recreation-related exertional heat deaths in Australia and summarise recommendations derived from case narratives. DESIGN: Descriptive, population-based, retrospective cohort study. METHODS: Cases were identified using the National Coronial Information System (NCIS) through multiple search strategies comprising queries, keywords and cause of death codes. Cases were included where there was evidence that the deceased was actively engaged in sport or recreation and exertional heat illness was causal or contributory to the death. Data extraction were performed independently, in duplicate, to ensure accuracy. Descriptive statistics are used to report deceased's socio-demographic characteristics, incident characteristics, type of sport/recreational activity and time sequence of events. Content analysis is used to summarise recommendations. RESULTS: Thirty-eight deaths (males n = 29, 74%; median age = 40 years, range 8-77) were identified during the study period (2001 to 2018), with 22 recommendations for five cases. Two cases occurred during organised sport and 36 during active recreation, of which 27 were in hiking. Eleven (29%) individuals were international visitors. There were 22 recommendations across 5 cases presented, with a focus on education and training. CONCLUSIONS: Exertional heat deaths in outdoor recreation in Australia were far more prevalent than cases in organised sport. The largest proportion of deaths occurred in hiking with two populations featuring: males aged 15-45 years and international visitors. Considering the incident characteristics and time sequence of events, measures such as early recognition of symptoms, provision of first aid and timely access to emergency medical care are important to prevent fatalities.

Injury prevention among young people in nursing homes: Recommendations following expert consultation forums.

BACKGROUND: Approximately 6,000 people under the age of 65 years reside in nursing homes each year in Australia. These young people in nursing homes are at risk of premature death and preventable morbidity from injuries. Choking and falls are the leading causes of premature deaths in this cohort with reported rates of 44% and 33%, respectively. OBJECTIVES: To develop injury prevention recommendations for young people in Australian nursing homes. METHODS: This mixed-methods study comprised two expert consultation panels and a follow-up survey. Two expert and stakeholder consultation panels used a modified nominal group technique to formulate recommendations. A short survey was subsequently given to participants to validate responses from the panels and to provide an opportunity to evaluate and rank recommendations. RESULTS: Ten recommendations were formulated for consideration that focused on system-wide reforms. Four were ranked as most important for implementation: education and training for nursing home staff; implementation of National Disability Insurance Scheme; support for coordinated care; and increasing residential housing stock that is appropriately designed. CONCLUSION: Extensive changes are needed to prevent injury for young people in nursing homes. Implementation should reduce the risk of injury and lead to an improved quality of life for this cohort. IMPLICATIONS FOR PRACTICE: This study provides an evidence base for aged care practitioners to improve practice within nursing homes to reduce fatal and non-fatal injuries for young people in nursing homes.

The experiences of those affected by parental young onset dementia: A qualitative systematic literature review.

AIM: To develop understanding of the lived experiences of children of people living with young onset dementia, defined as individuals both under and over the age of 18 years whose parent was diagnosed with dementia before the age of 65 years. METHOD: A critical appraisal and thematic synthesis of the available qualitative literature regarding the lived experience of individuals whose parent has a diagnosis of young onset dementia. A three-stage approach for conducing thematic synthesis was followed. RESULTS: 15 articles were included in the review. Four analytical themes and 11 subthemes were found. The analytical themes were 'making sense of dementia', 'impact of dementia', 'coping' and 'support'. CONCLUSIONS: The experiences of those affected by parental young onset dementia vary widely. There is a lack of knowledge and understanding of young onset dementia by professionals and the public, and a scarcity of appropriate support. This has clinical implications for professionals working with families affected by young onset dementia, in particular with regards to service design and delivery.

Deaths of young people living in residential aged care: a national population-based descriptive epidemiological analysis of cases notified to Australian coroners.

AIM: This study provides a descriptive epidemiological analysis stratified by age of deaths reported to Australian Coroners of residential aged care facility residents aged under 65 years. METHOD: A national population-based retrospective analysis was conducted of deaths of Australian residential aged care facility residents reported to Australian Coroners between 2000 and 2013. Descriptive statistics compared adult residents categorised using age by factors relating to the individual, incident and death investigation. RESULTS: Of the 21,736 deaths of residential aged care facilities residents aged over 20 years reported to Australian Coroners, 782 (3.6%) were of residents aged 20-64 years. Natural cause deaths occurred at similar rates irrespective of age. Intentional external cause deaths were higher in residents aged 20-64 years (5.3% vs. 16.0%; OR 3.43, 95% CI 2.0-5.9; p < 0.001), with suicide rates three times that of the over 65 years group (13.2% vs. 4.1%; OR 0.28, 95% CI 0.16-0.51; p < 0.001). External cause deaths from choking and falls were most common in the younger and older groups respectively. CONCLUSIONS: More is required to prevent external cause deaths in young residential care facility residents.IMPLICATIONS FOR REHABILITATIONOne in seven (14.1%) deaths of people aged 20-64 years in residential aged care facilities are premature and potentially avoidable. The more common external causes of death include suicide, choking and falls.The prevalence and causes of preventable deaths in this study provide a basis for prompting and developing more specific prevention policies and practices to reduce harm for young people in residential aged care. Specifically, addressing loneliness would improve social inclusion, mental health and suicide risk. Better management of progressive neurological conditions with multidisciplinary team and re-ablement programs would reduce risk of choking and falls.Improving outcomes for young people in residential aged care requires a co-ordinated, multisector approach comprising relevant government departments, aged care providers, researchers and clinicians.Effective planning requires more information about the cause and nature of deaths, and due to the small event counts, this would ideally involve an international collaboration.