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BMC Geriatrics Oct 2023It is estimated that more than 57 million people have dementia worldwide, and it is one of the leading causes of care dependency in old age. Relatives and other...
BACKGROUND
It is estimated that more than 57 million people have dementia worldwide, and it is one of the leading causes of care dependency in old age. Relatives and other informal caregivers are the most important support for individuals with dementia, but caring for a loved one with dementia may burden the caregiver. Caregiver burden may have adverse outcomes for both the informal caregiver and the care recipient, including decreased quality of life. Caregiver burden is associated with several factors concerning the informal caregiver, the care recipient, and relational and other contextual factors. The aim of this study was to explore which factors are associated with informal caregivers' subjective burden when caring for individuals living at home with dementia.
METHODS
This study was a cross-sectional survey among informal caregivers of home-dwelling individuals with dementia in all five geographical regions of Norway. There were 540 informal caregivers who participated, 415 of whom were included in the regression analyses. Caregivers' subjective burden was assessed with the Relatives' Stress Scale. Covariates included were classified into four levels: individual (twofold: informal caregiver and person with dementia), relational, community, and time. Linear multivariable regression analyses were used to identify associations between subjective burden and included factors.
RESULTS
Several covariates were statistically significantly associated with subjective burden at the four levels. These covariates included self-rated health, mental distress, age, coping through resignation and denial, emotional and instrumental support, substance use, and humor at the informal caregiver level; behavioral and psychological symptoms of dementia, dementia severity, and degree of disability at the care recipient level; the extent of care, being the primary caregiver, and previous relationship satisfaction at the relational context level; and informal caregivers spending time with friends, leisure activities, social restriction, and knowledge of available health services at the community context level.
CONCLUSIONS
Informal caregivers' mental distress and care recipients' neuropsychiatric symptoms were the factors with the strongest association with subjective burden.
Topics: Humans; Caregivers; Quality of Life; Cross-Sectional Studies; Dementia; Adaptation, Psychological
PubMed: 37817101
DOI: 10.1186/s12877-023-04358-3 -
Journal of General Internal Medicine Jun 2024Congressional hearings and public reports have drawn attention to problems afflicting Medicare Advantage (MA), the privatized version of Medicare. Private plans became a...
Congressional hearings and public reports have drawn attention to problems afflicting Medicare Advantage (MA), the privatized version of Medicare. Private plans became a staple of Medicare through the passage of the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Congress passed this law during a furor of privatization, when think tanks and powerful financial interests emphasized the power of corporations' profit incentive to improve the efficiency and quality of social enterprise. Yet the surging criticism of MA suggests a misalignment between the financial interest of some MA plans and the well-being of their patient populations. The criticisms range from deceptive marketing, ghost networks, and patient cherry-picking to unethical prior authorization denials and defrauding the government. In total, MA plans cost the federal government 22% more per patient than if these patients in question were enrolled in traditional Medicare. Moreover, it is not clear that this additional funding is producing proportional benefits. These developments raise questions about the presence of a profit incentive in Medicare, and perhaps health care more broadly.
PubMed: 38926321
DOI: 10.1007/s11606-024-08876-7 -
Linguistics and Philosophy 2024This paper discusses a set of observations, many of which are novel, concerning differences between the adjectival modals and and their adverbial counterparts and ....
This paper discusses a set of observations, many of which are novel, concerning differences between the adjectival modals and and their adverbial counterparts and . It argues that the observations can be derived from a standard interpretation of / as universal and / as existential quantifiers over possible worlds, in conjunction with the hypothesis that the adjectives quantify over knowledge and the adverbs quantify over belief. The claims on which the argument relies include the following: (i) knowledge implies belief, (ii) agents have epistemic access to their belief, (iii) relevance is closed under speakers' belief, and (iv) commitment is pragmatically inconsistent with explicit denial of belief.
PubMed: 38344658
DOI: 10.1007/s10988-023-09391-4 -
Journal of Anaesthesiology, Clinical... 2023Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was...
BACKGROUND AND AIMS
Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was planned to describe the stressors, stress levels, emotional responses, and coping strategies adopted by HCWs amidst this pandemic.
MATERIAL AND METHODS
This cross-sectional, web-based survey was conducted after ethics approval, using a structured performa incorporating standardized stress (PSS-10 C), emotional responses (PANAS-10), and coping strategy (Brief COPE) scales. The snowball sampling technique was used to conduct the study and collect data. Data were analyzed using SPSS 26 version (SPSS Inc., Chicago, IL, USA) statistical software. A value of <0.05 was considered significant.
RESULTS
Out of 402 participants (65% doctors and 35% nurses), 87% perceived moderate stress levels, and nearly half of the participants were interns, residents, and medical officers. Infection to self or family members (77.1%), survival of sick patients (75.6%), aggression by patients and relatives (70.3%), and long duty hours (67%) were some of the major stressors as reported by HCWs. The most common positive emotion felt was being alert (19.17 ± 5.57) and negative emotion perceived was being upset (15.6 ± 6.06). Many participants adopted emotion and problem-focused coping strategies such as planning and strategization (68%) and positive reframing (67.6%), whereas dysfunctional coping strategies such as venting and denial were adopted less commonly.
CONCLUSION
Moderate stress levels perceived by HCWs are a cause for concern. Emotional responses of HCWs to stress vary; however, appropriate coping strategies including emotional and problem-focused coping strategies are the need of the hour to tackle pandemic-related stress.
PubMed: 38269173
DOI: 10.4103/joacp.joacp_196_22 -
The Oncologist Feb 2024Few studies examine how patients with advanced cancer cope with stress. The objective of our study was to evaluate coping strategies adopted by patients with cancer and...
BACKGROUND
Few studies examine how patients with advanced cancer cope with stress. The objective of our study was to evaluate coping strategies adopted by patients with cancer and their relationship with symptom burden.
METHODS
A secondary data analysis of a prospective cross-sectional survey of patients with cancer and tobacco use was conducted, which examined demographics, symptom burden (Edmonton Symptom Assessment System), and coping strategies (the Brief COPE Questionnaire). Demographic characteristics were summarized by standard summary statistics; we also examined associations between patient characteristics and coping strategies using t-test, rank-sum test, chi-squared test, or Fisher's exact test depending on the distribution of data.
RESULTS
Among 399 patients, the majority were female (60%), Caucasian (70%), the mean age was 56.5 (±12.0) years, and the most common malignancies were gastrointestinal (21%) and breast (19%). Patients with cancer adopted multiple adaptive coping strategies, most frequently acceptance (86.7%) and emotional support (79.9%), with humor (18.5%) being the least. Common maladaptive strategies included venting (14.5%) and self-distraction (36.6%), while substance use (1.0%) was infrequently reported. Of the adaptive strategies, female gender was significantly associated with higher engagement with emotional and instrumental support, positive reframing, religious coping, and acceptance (P < .05 for all). College educated patients reported significantly higher implementation of humor, planning, and acceptance. Maladaptive coping strategies such as denial were associated with increased pain and depression, while patients adopting emotional-focused strategies rated decreased emotional distress.
CONCLUSIONS
The majority of patients with advanced cancer reported adopting multiple, adaptive coping strategies, and a minority utilized maladaptive or avoidant strategies, rarely substance use, and may need additional psychological support.
Topics: Humans; Male; Female; Middle Aged; Adaptation, Psychological; Coping Skills; Symptom Burden; Cross-Sectional Studies; Prospective Studies; Substance-Related Disorders; Neoplasms; Surveys and Questionnaires; Psychological Tests; Self Report
PubMed: 37669020
DOI: 10.1093/oncolo/oyad253 -
International Journal of Environmental... Jul 2023Our study aimed to investigate the correlation between medicine, health perception, and music as well as the role of music in the healthcare setting. To gain insights...
Our study aimed to investigate the correlation between medicine, health perception, and music as well as the role of music in the healthcare setting. To gain insights into the dynamics between these two fields, we gathered opinions from attendees and presenters at an international conference on music medicine, musicians' health, and music therapy. A team of six interviewers conducted a total of 26 semi-structured interviews. The interview guide focused on four predetermined themes: (1) "music in medicine", (2) "performing arts medicine", (3) "music for the individual", and (4) "music for society". The responses were analyzed using grounded theory methods as well as thematic and content analysis. To enhance the analytical strength, investigator triangulation was employed. Within the predefined themes, we identified several subthemes. Theme 1 encompassed topics such as "listening and performing music for treating diseases and establishing non-verbal relationships", "the value of music in specific disorders, end-of-life care, and pain management", and "the design of sound spaces". Theme 2 explored aspects including the "denial and taboo surrounding physical and mental health issues among musicians", "the importance of prevention", and an antithesis: "pain and suffering driving creativity". Theme 3 addressed the "mental role of music in ordinary and extraordinary life" as well as "music's ability to enable self-conditioning". Lastly, Theme 4 examined the role of music in "cultural self-identification" and "development and education for children". Throughout the interviews, participants expressed a lack of knowledge and awareness regarding interdisciplinary research and the fields of music and medicine. Our findings affirm the significance of music therapy and performing arts medicine as well as the broader relationship between music and medicine. They highlight the potential benefits of perception and experiential pathways for individuals and, consequently, for human society.
Topics: Child; Humans; Music; Music Therapy; Auditory Perception; Pain Management; Delivery of Health Care
PubMed: 37510618
DOI: 10.3390/ijerph20146386 -
Cureus Nov 2023Tuberculosis (TB) remains a major global public health concern, which has become worse in low- and middle-income nations due to the rise of drug-resistant strains of the... (Review)
Review
Tuberculosis (TB) remains a major global public health concern, which has become worse in low- and middle-income nations due to the rise of drug-resistant strains of the disease. Bedaquiline, a groundbreaking anti-TB drug, shows great promise for addressing multidrug-resistant TB (MDR-TB). However, the recent decision by India to reject the application for a patent extension on bedaquiline raises crucial questions regarding access to essential medicines and public health requirements. This article examines the significance of India's rejection of the patent extension for bedaquiline, outlining the global implications of this decision and its impact on intellectual property rights, access to medicines, and the future of drug development. India's stance serves as a model for other countries to prioritize public health in their patent-related decisions, underlining the need for a balanced approach to intellectual property rights, innovation, and affordability in the pharmaceutical sector. In the context of the ongoing battle against drug-resistant TB, India's decision on bedaquiline signifies the evolving landscape of pharmaceutical patent practices in the service of global public health.
PubMed: 38156185
DOI: 10.7759/cureus.49542 -
External and internal influences yield similar memory effects: the role of deception and suggestion.Frontiers in Psychology 2023In legal cases, testimonies can become contaminated because of an amalgam of external and internal influences on memory. It is well-established that external influences... (Review)
Review
In legal cases, testimonies can become contaminated because of an amalgam of external and internal influences on memory. It is well-established that external influences (e.g., suggestive interviews) can hurt memory. However, less focus has been placed on the impact of internal influences (e.g., lying) on memory. In the current review, we show that the available evidence suggests that both external and internal influences exert similar effects on memory. That is, we review studies showing that suggesting non-occurrences and suggesting non-experiences can lead to omission errors and false memories, respectively. Likewise, these memory effects are also observed when focusing on internal influences. That is, false denials, feigning amnesia and fabrication have been shown to affect memory in terms of forgetting (i.e., omissions) and false memories (i.e., commissions). Also, we show that both external and internal influences can lead to changes in the belief that an event occurred. We argue that in legal cases, triers of fact should concentrate on whether both types of influences might have affected testimonial accuracy in witnesses, victims, and suspects.
PubMed: 37701866
DOI: 10.3389/fpsyg.2023.1081528 -
Ethnicity & Health May 2024Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for... (Review)
Review
Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions.
OBJECTIVE
Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs.
METHOD
217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs.
RESULTS
: In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs.
CONCLUSIONS
: Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.
PubMed: 38698588
DOI: 10.1080/13557858.2024.2347569 -
Frontiers in Artificial Intelligence 2024The rapid proliferation of Internet of Things (IoT) devices across various industries has revolutionized the way we interact with technology. However, this widespread... (Review)
Review
The rapid proliferation of Internet of Things (IoT) devices across various industries has revolutionized the way we interact with technology. However, this widespread adoption has also brought about significant security challenges that must be addressed to ensure the integrity and confidentiality of data transmitted and processed by IoT systems. This survey paper delves into the diverse array of security threats faced by IoT devices and networks, ranging from data breaches and unauthorized access to physical tampering and denial-of-service attacks. By examining the vulnerabilities inherent in IoT ecosystems, we highlight the importance of implementing robust security measures to safeguard sensitive information and ensure the reliable operation of connected devices. Furthermore, we explore cutting-edge technologies such as blockchain, edge computing, and machine learning as potential solutions to enhance the security posture of IoT deployments. Through a comprehensive analysis of existing security frameworks and best practices, this paper aims to provide valuable insights for researchers, practitioners, and policymakers seeking to fortify the resilience of IoT systems in an increasingly interconnected world.
PubMed: 38845684
DOI: 10.3389/frai.2024.1397480