[The benefits of mobile caregiver support team consultations]. / Les bénéfices des consultations d'équipe mobile d'accompagnement des aidants.

While it's obvious these days to turn to a healthcare professional in the event of suffering, it's less so when the caregiver (or family) accompanying a sick person is experiencing difficulties. Indeed, those close to the patient often don't think about seeking help, or don't know where to turn for support. This article looks at the situation of Mr. N., his journey and the questions raised by the new role he has taken on, and describes the work of the mobile caregiver support team. Through its consultations, this team aims to promote caregiver health through prevention.

Suicidal Ideation in Canadian Family Caregivers for a Person with Dementia: A Portrait of the Situation.

This study aimed to explore the prevalence of suicidal thoughts and potential associations (i.e., strength and direction) with caregiver characteristics or factors. A targeted survey was distributed to dementia caregivers aged 55+ years. Questions concerning psychological distress, suicidal thoughts while caregiving and antecedents of suicidal behaviours were administered. A sample of 71 French-speaking Canadian caregivers completed the survey between May and October 2019. Among them, 52.1 per cent (n = 37) reported suicidal ideation while providing care to a relative or a friend living with dementia. Caregivers who presented suicidal ideation reported more abusive behaviour toward the care recipient. Caregivers who reported suicidal thoughts were significantly more distressed than caregivers without them on measures of burden, depression, and anxiety. Suicidal thoughts in caregivers are important evaluation targets, primarily for the prevention of suicide, but also because caregivers who report suicidal thoughts also present a heightened risk for abusing the care recipient.

Multimorbidity Treatment Burden Questionnaire (MTBQ): Translation, Cultural Adaptation, and Validation in French-Canadian.

Reliable treatment burden measures are needed given the aging population and the associated increase in multimorbidity and polypharmacy. Treatment burden is defined as the effort to care for one's health and the resulting impact on one's daily life. This study aimed to translate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for French-Canadians and assess its reliability and validity. The MTBQ was translated and tested with cognitive debriefing interviews, and the French version (MTBQ-F) was then administered 2 times among 105 participants. Reliability and validity were examined using the intra-class correlation coefficient (ICC), Cronbach's alpha, and Spearman's correlations. The median global MTBQ-F scores were 32.69 (interquartile range [IQR]: 21.15-48.08) and 30.77 (IQR: 21.15-46.15) for the first and second administrations, respectively. Test-retest (ICC: 0.73; 95% CI: 0.63-0.81) and internal consistency reliability (Cronbach's alpha: 0.80) were good. There was a moderate positive correlation between the MTBQ-F score and the number of self-reported conditions (rho: 0.28). This valid instrument could identify patients experiencing a high treatment burden and assess the impact of interventions among them.

High-Intensity Hospital Utilization Among Adults With Diabetic Foot Ulcers: A Population-based Study.

BACKGROUND: Diabetic foot ulcers (DFUs) are common and disabling, necessitating lengthy hospitalizations. In this study we sought to identify potentially modifiable determinants of high-intensity hospital care use among adults with DFUs. METHODS: Three related case-control studies were conducted using Canada-wide cohorts of adults hospitalized with a DFU from 2011 to 2015. In study 1, cases comprised the top 10% with the highest cumulative 1-year acute care hospital costs; controls were randomly selected from those below the top 10%. Study 2 comprised cases/controls within/below the top 10% for cumulative acute care hospital length of stay (LOS). Study 3 included cases/controls within/below the top 10% for cumulative number of acute care hospitalizations. Using generalized linear models, predictor variables were tested between cases and controls, while adjusting for age and sex. RESULTS: In study 1, mean acute care costs among 8,971 cases and 3,174 controls were $71,757 and $13,687, respectively. Sepsis conferred the greatest excess cost (mean, $38,790; 95% confidence interval [CI], $34,597 to $43,508), followed by chronic kidney disease (mean, $30,607; 95% CI, $28,389 to $32,825) and major lower limb amputation (mean, $30,884; 95% CI, $28,613 to $33,155). In study 2, mean LOS was higher among 8,477 cases (69 days) than 3,467 controls (12 days). Lower limb amputation conferred the greatest adjusted excess in mean LOS (mean, 28 days; 95% CI, 27 to 28 days). In study 3, there was a mean of 3 hospitalizations among 10,341 cases and 1 among 5,509 controls. Peripheral artery disease conferred the greatest excess number of hospitalizations (1.3 more hospitalizations; 1.2 to 1.4). CONCLUSIONS: Early aggressive treatment of chronic kidney disease and peripheral artery disease, alongside guideline-based amputation prevention strategies, may reduce high-intensity hospital care use among adults with DFUs.

Type 2 Diabetes Burden and Diabetes Distress: The Buffering Effect of Patient-centred Communication.

OBJECTIVES: Our aim in this study was to assess the moderating role of patient-centred communication as a source of social support in the relationship between burden of diabetes and diabetes distress. METHODS: Individuals with type 2 diabetes (N=1,267) completed validated tools of diabetes distress and multiple aspects of patient-centred communication. A path approach was used to evaluate the moderating role of patient-centred communication in the relationship between diabetes burden, as indicated by prescription of insulin and presence of complications, and distress. RESULTS: Lower Hurried Communication, higher Elicited Concerns/Responded, higher Explained Results/Medications, greater Patient-centred Decision-making and Compassionate/Respectful were significantly associated with lower distress after controlling for burden. Hurried Communication, Explained Results/Medications and Patient-centred Decision-making moderated the relation between insulin and diabetes distress. CONCLUSIONS: Our findings support the stress-buffering hypothesis of patient-centred communication and imply that aspects of patient-centred communication may protect against diabetes-related distress.

Is Living with Persons with Dementia and Depression Correlated to Impacts on Caregivers? A Scoping Review.

Caregivers of persons with dementia and depression experience adverse effects associated with their role. The aim of this scoping review was to identify the challenges faced by caregivers of people with dementia and depression, along with interventions to support them. The MEDLINE®, Embase and PsycINFO databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Grey literature was assessed using the Canadian Agency for Drugs and Technologies in Health's Gray Matter tool.The population consisted of caregivers of people with dementia and depression; the concept was to identify the negative impacts that caregivers experience and whether there are interventions to reduce them; the context was any study design targeting family or friends who were caregivers. A total of 12,835 citations were identified; 139 studies were included. Dementia and depression have variable impacts on outcomes experienced by caregivers, including burden/strain (n = 52), depression (n = 27), distress (n = 53), quality of life (n = 5) and health/well-being (n = 9). Pharmacological and non-pharmacological interventions have mixed effects. This study is important considering that depression in people with dementia is associated with caregiver distress. The use of a variety of non-pharmacological interventions could be beneficial to the latter.

COVID-19 and the Experiences and Needs of Staff and Management Working at the Front Lines of Long-Term Care in Central Canada.

Across the globe, long-term care has been under increased pressure throughout the COVID-19 pandemic. This is the first study to examine the experiences and needs of long-term care staff and management during COVID-19, in the Canadian context. Our group conducted online survey research with 70 staff and management working at public long-term care facilities in central Canada, using validated quantitative measures to examine perceived stress and caregiver burden; and open-ended items to explore stressors, ways of coping, and barriers to accessing mental health supports. Findings indicate moderate levels of stress and caregiver burden, and highlight the significant stressors associated with working in long-term care during the COVID-19 pandemic (i.e., rapid changes in pandemic guidelines, increased workload, "meeting the needs of residents and families", fear of contracting COVID-19 and COVID-19 coming into long-term care facilities, and concern over a negative public view of long-term care staff and facilities). A small subset (13.2%) of our sample identified accessing mental health supports to cope with work-related stress, with most participants identifying barriers to seeking help. Novel findings of this research highlight the significant and unmet needs of this high-risk segment of the population.

Fardeau de la dermatite atopique chez l'enfant et l'adolescent: Burden of atopic dermatitis in children and adolescents.

Atopic dermatitis has a very significant impact on children and adolescents. Having visible lesions, but above all almost permanent pruritus or sometimes skin pain inevitably has consequences on all aspects of daily life, including sleep, education and relationships with others, family and emotional life. It also has an impact on the whole family. Stigmatization may occur. Treatment and especially local care can be very demanding. Adherence to treatment is therefore often difficult. Quality of life can be severely impaired and atopic dermatitis can be a heavy burden. The psychological consequences can be major. Family problems related to the disease often arise. The best way out of it is probably to have very effective and well-tolerated treatments. © 2020 Elsevier Masson SAS. All rights reserved.

Caregiver in Alzheimer's disease, pharmacist, and pharmacy technician attitudes and knowledge about caregiver burden screening in community pharmacies.

OBJECTIVES: To explore caregiver, pharmacist and pharmacy technician attitudes toward burden screening in community pharmacies and assess caregiver burden in community pharmacies. METHODS: Descriptive cross-sectional study conducted in 10 community pharmacies in France. Pharmacists, pharmacy technicians and caregivers of patients with Alzheimer's disease were included in this study. Two self-reported questionnaires were used to explore attitudes of participants toward the burden screening in community pharmacy and to assess the caregiver burden in community pharmacy. The short version of the Zarit Burden Interview (range 0-7) was used for the burden screening. RESULTS: Fifty-two pharmacists and pharmacy technicians, and 20 caregivers (61.8±13.7years) participated in this study. Seventy percent of caregivers and 96% of pharmacists/pharmacy technicians stated that caregiver burden screening should be conducted in community pharmacies. 65% of caregivers reported their caregiver status to their community pharmacist. Eighty-two percent of pharmacist/pharmacy technicians thought they had to inform the caregiver's general practitioners (GP) about the detected burden level. Of the 20 included caregivers, 18 had a perception of burden. The mean caregiver burden score detected in this exploratory study was 4.0±1.7, corresponding to a moderate to severe burden. CONCLUSIONS: According to caregivers' opinion, community pharmacists and pharmacy technicians represent accessible health care professionals in primary care to quantify caregiver burden. The burden screening can be easily incorporated into clinical service offerings in community pharmacy practice. It provides a valuable opportunity to identify high-risk caregivers with the aim of referring them to their GP to prevent the caregiver's frailty.

Burden on Caregivers of Adults with Multiple Chronic Conditions: Intersectionality of Age, Gender, Education level, Employment Status, and Impact on Social Life.

Intersectionality analysis is the study of overlapping or intersecting social identities. Intersecting social identities may have an impact on the perception of burden by family caregivers of older persons with multiple chronic conditions (MCC). The purpose of this study was to explore the interaction of social factors on the burden of caring for older adults with MCC. A total of 194 caregivers of older adults with MCC were recruited from Alberta and Ontario. Survey data were collected at two time points, six months apart. Additive and multiplicative models were analysed using a generalised linear model to determine the level of caregiver burden. Medium-high social interference (impact on social life) was associated with higher burden when adjusted for age, gender, education, and employment status. The overall results of the five-way interaction suggest that males in general had lower burden scores than females. Irrespective of their education and employment status, females had generally higher burden scores. These results add to the current body of literature, suggesting areas for further research to fill knowledge gaps, and promoting ideas for evidence-guided public health interventions that focus on caregivers.

[Do caregivers of non-dependent elderly have specific characteristics? Study among 876 elderly-caregiver dyads]. / Les aidants de personnes âgées non dépendantes ont-ils des spécificités ? Étude auprès de 876 dyades personnes âgées-aidants.

BACKGROUND: The increase in life expectancy and the aging of the population have a significant impact on the informal care provided by caregivers. Protecting caregivers against excessive burden has become a public health priority. The majority of studies target only those providing care for dependent elderly people. The aim of this study was to describe the characteristics of informal caregivers of non-dependent elderly persons, their difficulties and their level of burden. METHODS: A cross-sectional study was conducted among 876 dyads: elderly people (over 70 years of age, non-dependent, living at home and having requested assistance from CARSAT South-East) and their caregivers. Two questionnaires were administered: one for the elderly (including the Frailty Group Iso-Resource Evaluation) and one for caregivers (including the Mini-Zarit Scale). A multi-component analysis and a logistic regression were performed. RESULTS: The elderly were mainly women (77.6%) with a mean age of 82.2±5.8 years and most were frail (94.7%). Most of the caregivers were women (64.5%) with a mean age of 62.7±13.7 years. The multi-component analysis showed three categories of caregivers: spouses, children and others. Among them, spouses performed the most tasks (4.8±2.6) and had the greatest burden. Caregivers in the "others" category were the least burdened and were the least impacted in their daily life. The children category caregivers were divided into two subgroups: those with characteristics similar to "others" caregivers and those with characteristics similar to "spouse" caregivers. Heavy burden was related to greater impact on daily life, poor relationships with the elderly and caregivers' difficulties in performing their role. CONCLUSION: This study confirms the heterogeneous nature of informal caregiver profiles. It also shows that the characteristic features and the burden of these caregivers are similar whether the elderly person is dependent or non-dependent but frail.

[Therapeutic adherence in chronic obstructive pulmonary disease: A literature review]. / Revue générale sur l'adhésion aux traitements inhalés de la BPCO.

INTRODUCTION: In France, only a small number of studies have focused on therapeutic adherence in patients with chronic obstructive pulmonary disease COPD) despite its impact in terms of multimorbidity. The objective of this literature review was a better understanding of adherence as a whole, and the identification of the effects of non-adherence, in order to optimise patient management. METHODS: A search algorithm was developed to identify all publications on therapeutic adherence in COPD published between 2010 and 2017, in English and in French. The databases used were MEDLINE, ScienceDirect, BDSP, Cochrane and CAIRN. RESULTS: Of the 1551 articles initially identified, 94 were included in the review (65 observational studies, 11 interventional studies and 18 reviews or general overviews). Observational studies considered the predictive factors for adherence/non-adherence, and their consequences. Interventional studies evaluated the efficacy of interventions designed to improve adherence. CONCLUSIONS: Despite major therapeutic progress, the essential problems of COPD management remain. While the treatment armamentarium has expanded in recent years, there is still a great deal of work to be done in simplifying treatment regimens, improving the administration of these treatments and motivating patients to be compliant with them. This review also highlights the need for better physician-patient communication.

[Psychological distress and caregiving burden among spouses of women with breast cancer]. / Niveau de détresse psychologique et de fardeau perçu chez les conjoints de femmes atteintes d'un cancer du sein.

Breast cancer is a chronic disease that affects both patients and their caregivers. Spouses, in particular, will generally assume the role of primary caregiver and experience significant physical, social, economic and emotional stress. In the face of cancer, being the spouse of a patient is synonymous with unmet psychosocial needs and a new role assignment, that of a primary caregiver. In addition, cancer confronts spouses with fear of partner loss. This leads to a set of adverse consequences such as depression, anxiety, uncertainty, stress, etc. Several studies have shown that breast cancer reduces the quality of life of patients' spouses and increases their emotional distress, their psychosocial needs, and their responsibilities within the family. Spouses may live a complex powerful emotional experience, which is equal to or greater than that experienced by patients during the diagnosis and treatment process. These multiple solicitations contribute to the heavy symptom burden. Therefore, in the context of breast cancer, identifying vulnerable spouses and providing them with appropriate support would help ensure better adherence to the care of their wives at different stages of the disease.

[Occupational burnout in geriatrics, an Echo complex]. / L'épuisement professionnel en gériatrie, un complexe d'Écho.

Caregivers in nursing homes are exposed to numerous risk factors of occupational burnout. Lack of time, work overload, caring for frail people, an imbalance between hierarchical demands and the amount of decision-making power accorded to them, as well as insufficient resources: it is difficult to provide individualised care to patients in these conditions. There are, however, ways to improve this situation.

Reconstruction of a Caregiver Burden Scale: Identifying Culturally Sensitive Items in Saudi Arabia.

ABSTRACTFor this study, we adapted the Montgomery Borgatta Caregiver Burden Scale, used widely in the United States, to the Saudi Arabian context. To produce an Arabic, culturally sensitive version of the scale, we conducted semi-structured interviews with 20 Saudi family caregivers. The Arabic version of the scale was tested, and participants were asked to comment on the appropriateness of items for the construct of "caregiver burden" using the repertory grid technique and laddering procedure - two constructivist methods derived from personal construct theory. From interview findings, we examined the content of the items and the caregiver burden construct itself. Our findings suggest that the use of constructivist methods to refine constructs and quantitative instruments is highly informative. This strategy is feasible even when little is known about the investigated constructs in the target culture and further elucidates our understanding of cross-cultural variations or invariance of different versions of the scale.

THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH.

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth -3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.

UNPACKING THE BURDEN OF CARE FOR INFANTS IN THE NICU.

Infants who begin early life in the medicalized environment of the neonatal intensive care unit (NICU) experience disruption to numerous fundamental expectancies. In the NICU, infants are exposed to chronic, extreme stressors that include painful medical procedures and parental separation. Due to their preverbal stage of development, infants are unable to fully express these experiences, and linking these experiences to long-term outcomes has been difficult. This clinical article proposes the terminology Infant Medical Trauma in the NICU (IMTN) to describe the infant experience. Following a discussion of the NICU as an adverse childhood event, the article has three sections: (a) the unique and critical factors that define the newborn period, (b) a review of the IMTN conceptual model, and (c) recommendations for supportive neuroprotective strategies to moderate the intensity of adverse NICU infant experiences.

[Burden of atopic dermatitis in adults]. / Retentissement de la dermatite atopique chez l'adulte.

Atopic dermatitis may have a very important impact on adults. Visible lesions, but especially near-permanent pruritus or sometimes pain for decades, necessarily have consequences on all aspects of everyday life, including sleep, and professional, social, family and emotional life. Financial consequences are also possible. Poorly known, stigmatisation can be real. Treatments can be very demanding. Thus, the quality of life can be greatly altered and atopic dermatitis could be a heavy burden. The psychological consequences can be major. Co-morbidity appears more and more as a major problem. Patients can therefore be caught in an infernal circle, consequences of the disease aggravating the disease. The best way out is probably to have very effective and well-tolerated treatments.

[Advocacy for the establishment of a comprehensive strategy to reduce the "burden" of schizophrenic disorders]. / Plaidoyer pour la mise en place d'une stratégie globale pour atténuer le « fardeau ¼ des troubles schizophréniques.

This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention. In the scope of screening and early treatment, genetic risk, as well as the predictive ability of the clinical criteria for individuals at "ultra-high risk" of developing schizophrenia justify an increased vigilance for the detection of symptoms in order for treatment to begin earlier and to be more effective. These risk factors should not be neglected as the benefits of early management impact the course of illness and functional outcome. At this stage of the emergence of the disorder, it is difficult to systematize a therapeutic protocol. Two options are open to the clinician: "wait and watch" given the lack of a conclusive diagnosis and a more pro-active intervention, focused on the therapeutic alliance and enhancing insight and awareness. The second approach seems more productive but requires transparency with the patient and family regarding the uncertainty of the clinical situation, and an attitude that favors sharing information, along the lines of early psych education. Once a pathological stage is reached, early and accurate clinical care is fundamental. They depend heavily on access to care, proximity and availability to clinics or out-reach teams, capable of a thorough diagnostic work-up. Yet conversely, the availability for early and accurate clinical care faces obstacles which are closely related to the pejorative view of psychiatry held by the general public, health care professionals, and public officials. This poor image of psychiatry is partly due to cases of clinical decompensation, dangerous in some instances, underscoring why it is be important to understand and anticipate the contributory factors to these outcomes in the first place so as to avoid them. In this sense, defending a complacent and conciliatory approach can be counter-productive. Following developments of recent decades in other chronic diseases (diabetes, cancer, AIDS, severe heart disease…), the implementation of systematic clinical programs, treatment protocols, psycho-education to reinforce adherence to therapeutic measures, their simplification, the support and appreciation of the role of caregivers, destigmatizing due to proximity of contact, and therefore an increase in the use of care. Similarly, the systematic search for side-effects of medication and pro-actively managing to minimize their occurrence strengthen compliance, a recognized factor of relapse prevention. Preventable comorbidities, addictions, and common physical illnesses are not systematically screened (neoplastic diseases, diabetes, hypertension, dental health, gynecology…) in this population and thus also represent significant potential for a better life expectancy. The tools of psychosocial rehabilitation, unfortunately, are too infrequently used in France. Their goal is to improve the functional outcome of patients, a determinant of social integration and to lessen the burden shouldered by family and other carers, and ultimately to reduce exacerbations of the illness due to situations of interpersonal stress. Work has also proven its worth as a protective factor, as well as strengthening a sense of self-efficiency, of self-esteem, of empowerment, of quality of life, helping attain recovery. It is clear that not all social and health care systems are primarily geared towards these objectives, although they have at their disposal, by the means described above, strong preventive measures for relapses. Beyond the issue of the implementation of clinical programs, the existing culture would benefit from being infused with a prioritization of resource deployment, with debates of these issues regarding parity for mental health services, advocated by users, and forging a place, for example, for the intervention of "peer supports", sociologists, social workers, interested beyond the disease, in community environment, employment opportunities, and housing. Overall, this work argues for updating our conceptions of clinical care, supporting the systematic implementation of modern models of care, and expanding the scope of our concerns regarding patients' lives.

[Neuropsychological benefit of cataract surgery among sight impaired Alzheimer's patient]. / Modifications des troubles du comportement après l'opération de la cataracte chez les patients Alzheimer.

PURPOSE: Evaluation of neuropsychological benefits of cataract surgery for 46 Alzheimer patients on the basis of neuropsychiatric index (NPI), as the principal criterion of analysis of the VIVA study. METHODS: Prospective, monocentric neuropsychiatric study, performed from 2005 to 2011. All Alzheimer's patients with 10