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PubMed1996

Exploring the Caregiver Burden Inventory (CBI): further evidence for a multidimensional view of burden.

The purpose of this study was to examine the multidimensional nature of caregiver burden by specifically analyzing the patterns of association between five dimensions of burden as measured by the Caregiver Burden Inventory [1] and selected demographic, health, functioning, and well-being indicators. Subscales measuring each dimension were internally consistent and relatively independent in a sample of 160 caregivers. Time dependence burden was most influenced by patient impairment and caregiving involvement, whereas emotional burden was largely a function of caregiving satisfaction. Most of the variance in developmental burden was explained by depression and caregiving satisfaction. Contrary to expectations, physical health measures explained little variance in physical burden, of which most was explained by depression. Less than 10 percent of the variance in social burden was explained by depression and caregiver days sick. The findings lend support to a multidimensional view of burden and with minor modifications, the CBI appears to be a promising instrument with which to measure the construct.

Absenteeism↗
PubMed1994

Subchronic and chronic inhalation toxicity of antimony trioxide in the rat.

Fischer 344 rats were exposed by inhalation to Sb2O3 (antimony trioxide) dust at exposure levels of 0, 0.25, 1.08, 4.92, and 23.46 mg/m3 for 6 hr/day, 5 days/week for 13 weeks followed by a 27-week observation period. Subsequently, an inhalation oncogenicity study was conducted at exposure levels of 0, 0.06, 0.51, and 4.50 mg/m3 for 12 months followed by a 12-month observation period. The Sb2O3 in the subchronic study had a mass median aerodynamic diameter (MMAD) of 3.05 +/- 0.21 microns (mean +/- SD) with a geometric standard deviation (GSD) of 1.57 +/- 0.06. In the chronic study, the MMAD was 3.76 +/- 0.84 and the GSD was 1.79 +/- 0.32. Except for the eyes, no adverse clinical observations were attributed to Sb2O3 in either study. In the subchronic study, corneal irregularities were seen after about 2 weeks of exposure and did not abate during the observation period. In the chronic study, ophthalmoscopic evaluation at 24 months revealed a dose-related increase in cataracts of 11, 24, 28, and 32% (both sexes combined) for each group, respectively. Body weights were significantly lower (6%) than the control group's weights in the 23.46 mg/m3 males in the subchronic study. These rats did not recover this weight during the 27-week observation period. Body weights of the females in both studies and males in the chronic study were unaffected. There were no Sb2O3 effects on clinical chemistry or hematology in either study. Mean absolute and relative lung weights were significantly increased in the 4.92 and 23.46 mg/m3 groups in the subchronic study. The 23.46 mg/m3 group's lung weights did not recover to control levels during the 27-week observation period. Lung weights for rats in the chronic study were unaffected. Microscopic changes in the lungs in the subchronic and chronic study were limited to subacute-chronic interstitial inflammation, increased numbers of alveolar-intraalveolar macrophages, foreign material in the alveolar-intraalveolar macrophages in the peribronchial and perivascular (chronic study only) lymphoid aggregates and in the peribronchial lymph nodes, granulomatous inflammation/granulomas, and fibrosis. In the chronic study, any observed neoplasms occurred with comparable incidence among all groups and were within the historical range for controls. Clearance of Sb2O3 from the lung was burden dependent and was reduced by 80% in the 4.50 mg/m3 group in the chronic study. The previously reported studies, which found Sb2O3 to be a carcinogen, were run at higher lung burdens. Under the exposure conditions of the current study, Sb2O3 was not a carcinogen.

Administration, Inhalation↗
PubMed1999

Parental burden, coping, and family functioning in primary caregivers of children with Joubert syndrome.

Children with Joubert syndrome have physical and intellectual disabilities. The purpose of this study was to assess the impact of Joubert syndrome on parental burden, coping, and family functioning. Forty-nine primary caregivers were surveyed. Forty-three primary caregivers were mothers and six were fathers; their mean age was 34 years. The following measures were used: Beck Depression Inventory, Child Development Inventory, Caregiver Strain Index, Family Assessment Device, and Ways of Coping Checklist-Revised. The data show that caregiver burden is not related to the severity of the child's illness, but that caregivers report significant burden. Higher burden was associated with the use of palliative coping methods, and family functioning was problematic. The results of this study suggest that for parents of children with Joubert syndrome, degree of parental burden depends more on the parents' coping skills and the level of family functioning rather than on the degree of the child's impairment. These findings highlight the importance of assessing caregiver burden, as well as decreased family functioning or coping abilities, since these problems often can be managed with psychologic intervention.

Activities of Daily Living↗
PubMed1986

Evidence of differential hematopoietic compensation to lead intoxication in blood, liver and kidney.

The dependence of fluorescent porphyrin levels on the concentration of lead in blood, liver and kidney has been examined as functions of both the level and duration of dosing. Individually housed male Wistar COBS rats of 200 g were randomly selected for 3, 7, 21 and 35 day dosing periods in groups of: control, 50, 100 and 1000 ppm dosing in drinking water. The plot of all data points for porphyrin concentration against measured lead burden covers the same range of levels and closely resembles the scatter of data observed in humans. However, subsets of this plot defined by individual dose levels and durations yield well-defined linear relationships. At all dose levels at 7 days the correlation of porphyrin concentration to lead tissue burden is negative in all tissues, showing a direct inhibition of hemopoiesis with lead burden. Depending on the tissue the slope becomes less negative, or, as in blood, positive at 21 and 35 days at all doses. This compensation is most rapid in blood, then liver and is least evident in kidney. The time at which compensation is observed is the same for all doses in each tissue and seems therefore, to depend on the rate of protein turnover in different tissue types. These results suggest that a direct correlation of porphyrin concentration to lead burden is not valid without knowledge of the dosing history. As well, evidence of compensation in one tissue does not imply successful compensation in other affected tissues where regeneration rates are slower.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2005

The Caregiver Burden Inventory in evaluating the burden of caregivers of elderly demented patients: results from a multicenter study.

BACKGROUND AND AIMS: The burden perceived by caregivers of patients with dementia is a fundamental prognostic aspect in the history of the disease. The aim of this study was to demonstrate the internal consistency of the Caregiver Burden Inventory (CBI), a scale used to quantify burdens in different aspects of a caregiver's life, and the influence of patients' and caregivers' characteristics on its different dimensions. METHODS: In this cross-sectional study, 419 demented patients and their caregivers were evaluated in 16 geriatric centers in Italy. Cognitive status and behavioral disturbances were assessed by the Mini Mental State Examination (MMSE) and Neuropsychiatric Inventory (NPI), respectively. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were also evaluated. Comorbidity was assessed by the Cumulative Illness Rating Scale (CIRS). The severity of dementia was evaluated by the Clinical Dementia Rating (CDR) score. Caregiver distress due to the behavioral problems of the patient was assessed by the Neuropsychiatric Inventory-Distress, a subscale of the NPI which evaluates stress caused by each behavioral disturbance of the patient, and by the Brief Symptom Inventory which evaluates anxiety and depression. Burden was evaluated by the CBI. RESULTS: The CBI showed very high internal consistency (Cronbach's alpha value > 0.80). Factor analysis showed that the items clustered into four dimensions, and not five as originally proposed. Multiple regression analysis revealed that patients' behavioral disturbances and disability were the major predictors of the time-dependent burden; the psychophysical burden was explained mainly by caregiver anxiety and depression. CONCLUSIONS: The CBI proved to be an effective multidimensional tool for evaluating the impact of burden on many aspects of caregivers' lives.

Activities of Daily Living↗
PubMed1997

Migration between home country and diaspora: an economic analysis.

"This paper investigates the distribution of a population group between a home country and diaspora, given sequential decision-making regarding migration at the individual level. The home country is attractive to the members of the group, yet their presence there requires a fixed amount of public spending (e.g., on defense). The per-capita tax burden depends then on the size of the domestic population, reflecting a case of ¿fiscal externality'. This results in an inefficient distribution of the group between the home country and the diaspora. Encouraging immigration to the home country is an interest not only of those individuals who are currently in the home country but also of those residing in the diaspora. However, only when the burden of public spending in the home country is large enough do the latter volunteer to bear part of it. Even then, in general, this part is smaller than socially optimal."

Behavior↗
PubMed2000

Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting.

STUDY DESIGN: A cross-sectional retrospective study was carried out with structured questionnaires and semi-structured interviews on 66 persons with spinal cord injury (SCI) and 40 spouses. OBJECTIVES: The study aimed to explore the psychosocial adjustment of Hong Kong Chinese couples at the post SCI stage. An important study interest was the impact of care-giving in spouses of persons with SCI. SETTING: Three major regional rehabilitation centres and one community resource centre in Hong Kong. METHODS: A set of psychometric measures tapping different aspects of psychological functioning was included. These were locus of control (Levenson's Internality, Powerful Others, and Chance Scale), perceived social support (Provision of Social Relationship), coping strategies (Ways of Coping Checklist), marital adjustment (Dyadic Adjustment Scale), caregiving burden (Caregiver Burden Inventory), depression (Beck Depression Inventory), life satisfaction (Satisfaction with Life Situation), and social role adjustment (Katz Adjustment Scale - Relative Form). RESULTS: Persons with SCI with pre-injury marriage were more depressed (P<0.05) as compared with those with post-injury marriage. However, the two groups did not differ in terms of satisfaction with life situation and social role dissatisfaction. The spouses in the preinjury marriage reported a significantly higher score in time-dependent burden than those in the post-injury marriage (P<0.05). Care-giving burden was associated with locus of control, social support, and modes of coping (P<0.05). CONCLUSION: The impact of SCI is a long-lasting effect not limited to the patients but also extending to their spouses. Findings from the adjustment outcomes and coping styles of persons with SCI and their spouses indicate that they are not passive victims. A similar injury may produce different outcomes in different individuals. Rehabilitation professionals should thus be alert to both the couple's differing needs and idiosyncrasies in their helping process.

Adaptation, Psychological↗
PubMed2006

Validation of the Burden Index of Caregivers (BIC), a multidimensional short care burden scale from Japan.

BACKGROUND: We constructed a concise multidimensional care burden scale that reflects circumstances unique to Japan, with a focus on intractable neurological diseases. We surveyed 646 family caregivers of patients with intractable neurological diseases or stroke using 28 preliminary care burden scale items obtained from qualitative research. The results were used to finalize the feeling of care burden scale (BIC: burden index of caregivers), and verify its reliability and validity. METHODS: The survey was conducted among caregivers providing home health care to patients with intractable neurological diseases (PD [Parkinson's disease], SCD [spinocerebellar degeneration], MSA [multiple system atrophy], and ALS [amyotrophic lateral sclerosis]) or CVA (cerebrovascular accident) using a mailed, self-administered questionnaire between November, 2003 and May, 2004. RESULTS: Response rates for neurological and CVA caregivers were 50% and 67%, respectively, or 646 in total (PD, 279; SCD, 78; MSA, 39; ALS, 30; and CVA, 220). Item and exploratory factor analyses led to a reduction to 11 items, comprising 10 items from the 5 domains of time-dependent burden, emotional burden, existential burden, physical burden, and service-related burden; and 1 item on total burden. Examination of validity showed a moderate correlation between each domain of the BIC and the SF-8 (Health related quality of life scale, Short Form-8), while the correlation coefficient of the overall BIC and CES-D was 0.62. Correlation between the BIC and ZBI, a preexisting care burden scale, was high (r = 0.84), while that with the time spent on providing care was 0.47. The ICC (Intraclass correlation coefficient) by test-retest reliability was 0.83, and 0.68 to 0.80 by individual domain. CONCLUSION: These results show that the BIC, a new care burden scale comprising 11 items, is highly reliable and valid.

Aged↗
PubMed2005

[Intensive medicine criteria for operability].

BACKGROUND: Operability is mainly determined by the interaction between the magnitude of an operation and the patient's tolerance for the procedure. A further factor is the benefit gained by performing the procedure versus the sequelae caused by its omission. RESULTS: Major operations within the first 3 days after trauma appear to have an increased risk, particularly if they are performed during impaired respiratory function (pO(2)/F(i)O(2) ratio <280 mmHg) or increased inflammatory status. Such interventions are recommended to be postponed until a later time. Surgical interventions after day 3 require an individual decision with respect to the timing of the operation. Criteria that are of value in this decision comprise a pO(2)/F(i)O(2) ratio above 280 mmHg, a stable circulation, a platelet count above 100.000 to 150.000/microl, normal global coagulation tests, only moderate systemic inflammation as indicated by C-reactive protein or interleukin-6 levels, a normal fluid balance and in case of traumatic brain injury there should be no signs of increased intracranial pressure. Whether liver function, level of PEEP, catecholamine therapy and other factors will influence operability remains to be elucidated. CONCLUSION: The pathophysiological consequences of accidental trauma show a phasic course with respect to the immunomodulatory response. An operative trauma inflicted by a secondary surgical intervention contributes an additional burden. Depending on the inflammatory phase during which this secondary hit is inflicted there may be a disturbance of homoeostasis that may even lead to multiple organ failure. Whether this happens can depend on type and magnitude of the surgical intervention. Minor operations result in smaller systemic effects and will be less critical with respect to operability.

Clinical Trials as Topic↗
PubMed2006

[The importance of biographical approaches in nursing science].

Critical life events (e. g. disease, loss of be loved one) biographically represent important turning points, which concerned people have to cope and deal with. While biographical research, which is established in the human and social sciences, has been dealing for a long time with typical features, such as on the type of a disease-dependent burden and coping processes, biographical oriented research approaches in nursing science are in their early stages. The article at hand has its goal in discussing the connectivity, particularly the social-interpretative biographical research in nursing science and their relevance for the development of supporting concepts regarding nursing; with the intention to rehabilitate the sufferer as the author of his own life story.

Activities of Daily Living↗
PubMed2006

Psychological correlates of quality of life in atrial fibrillation.

OBJECTIVE: Atrial fibrillation (AF) is associated with significant health-related quality of life (QoL) impairments. Markers of heart disease severity have explained little variance in QoL and it is unclear what other factors will better account for the observed differences in adjustment. We examined whether specific personality traits and illness management styles would help explain the severity of QoL impairments reported in this population. METHODS: Patients with AF (N = 93) completed validated questionnaires measuring disease burden (dependent variables: physical and mental QoL, symptom severity, psychological distress), personality (independent variables: anxiety sensitivity, optimism), and illness management style (mediating variable: symptom preoccupation). Hypothesized relationships were evaluated using mediation models. RESULTS: Anxiety sensitivity was associated with poorer physical and mental QoL, greater symptom severity, and higher distress. Optimism was correlated with better mental QoL and lower distress, but unrelated to physical QoL and symptom severity. Symptom preoccupation significantly mediated the relationships between anxiety sensitivity and each of the QoL measures, as well as the relationships between optimism and mental well-being. CONCLUSIONS: Personality traits and illness management styles are important to consider when assessing the impact of AF on QoL. The data support a cognitive-behavioral model that explains the direct and indirect relationships between psychological predictors and multiple indices of QoL.

Aged↗
PubMed1984

Analysis of anthelmintic trial protocols using sheep experimentally or naturally infected with Fasciola hepatica.

Analytical models of the common anthelmintic trial protocols for ovine fascioliasis are used to investigate the way in which the conventional measure of anthelmintic efficiency (percentage reduction in mean fluke burden) depends on factors other than the additional fluke death rate due to chemotherapy. In prophylactic protocols where infection and dosing are coincident, the natural death rate of the parasites (both flukes and metacercariae) is an important factor. Numerical simulations indicate that the between-trial variations in anthelmintic efficiency due to fluctuations in natural parasite mortality may be substantial, especially for anthelmintic trials in the field.

Animals↗
PubMed1997

Effects of positive inotropic stimulation on postischemic myocardium with graded dysfunction.

OBJECTIVE: To investigate the effects of moderate prolonged and of maximum short-term positive inotropic stimulation of postischemic myocardium as a function of the severity of stunning. METHODS: Stunned isolated rat hearts (n = 116) after 30 min and 45 min of ischemia were stimulated with dopamine to raise systolic function (double product) back to control levels. In the isovolumetrically beating hearts, left ventricular developed pressure, double product, dp/dtmax, coronary flow, and myocardial oxygen consumption were determined during steady-state conditions. After maximum stimulation the contractile reserve was examined. Measurements of adenine nucleotides (n = 47) and electron microscopy (n = 9) were made. RESULTS: 30 min ischemia resulted in moderate postischemic dysfunction (LVP 81 +/- 3%; P < 0.05). After 45 min ischemia, function was more severely reduced (LVP 66 +/- 5%; P < 0.01). Coronary flow tended to be lower after ischemia. Myocardial oxygen consumption was not reduced in parallel with the dysfunction. Adenine nucleotides were gradually reduced after ischemia (ATP: 2.5 +/- 0.2 and 1.2 +/- 0.1 vs. 4.2 +/- 0.2 mumol/gww; P < 0.01). Contractile reserve also decreased in relation to the previous ischemic injury (after 45 min ischemia max. LVP 105 +/- 10% vs. max. LVP 152 +/- 8% in controls, P < 0.01). Prolonged stimulation did not result in further reduction in adenine nucleotides and function. CONCLUSIONS: Contractile reserve is decreased in postischemic myocardium in parallel with the previous ischemic burden. Depending on the degree of contractile dysfunction a disturbed function-flow-oxygen consumption relation is present. Prolonged stimulation of stunned myocardium with dopamine back to the control level of function has no harmful short-term effects, indicating sufficient mitochondrial energy generation.

Adenosine Triphosphate↗
PubMed1996

Strategies for the prevention of senile (type II) osteoporosis: an update.

Hip fractures in the elderly represent a global issue, associated with significant morbidity and mortality. Considering the magnitude of the problem, any substantial reduction in the hip fracture burden depends on prevention. In view of the complex pathogenesis of senile (type II) osteoporosis, preventive strategies should focus on the frequency of falling in the elderly as well as on the prevalence of compromised femoral integrity as a consequence of bone loss. Although many risk factors for senile osteoporosis are potentially preventible or reversible with targeted interventions, the beneficial effects of most strategies have not yet been adequately documented, indicating the need for additional long-term controlled studies.

Accidental Falls↗
PubMed2001

Online monitoring of air quality at the postanesthetic care unit by proton-transfer-reaction mass spectrometry.

The subthreshold exposure to trace anesthetic gases is not associated with considerable risk of adverse health effects. Online control of ambient air exchange at the postoperative workplace may help in supervising air quality and lead to cost reduction. A proton-transfer-reaction mass spectrometer system was used for online monitoring of volatile organic compounds, especially anesthetic gases. The mean exposure to sevoflurane and isoflurane at the urological postanesthesia care unit (PACU) was 15.9 and 9.5 parts per billion, respectively. Sevoflurane and isoflurane concentrations at the urological PACU showed a patient turnover-dependent burden during our investigation period. Because modern PACUs have a high ventilation capacity, the 24-h occupational burden by anesthetic gases at the PACU is relatively low. Monitoring and controlling of ambient air by automatic built-in alarm systems would be useful for quality control of the postoperative workplace. Moreover, energy costs of ventilation systems could be reduced by coupling ventilation capacity to the effective exposure.

Air Pollutants, Occupational↗
PubMed1984

Metabolism of 51Cr, 54Mn, 59Fe and 60Co in lactating dairy cows.

Different radionuclides which can be released by nuclear installations (Na2(51) CrO4 , 54MnCl2 , 59FeCl3 and 60CoCl2 ) were given to lactating dairy cows either orally or by intravenous (i.v.) injection. Excretion into feces and urine as well as secretion into milk were followed for several weeks. Distribution of activity in organs was determined at sacrifice 102 days after oral and 70 days after i.v. administration. After ingestion, excretion of chromate followed a three-term exponential function with half-lives of 0.88, 3.7 and 26 days. Intestinal absorption was on the order of 0.1-0.2%. About 63% of injected chromate was excreted into urine, about 18% into feces and about 3.6% into milk. Orally administered chromate was concentrated in liver, intestine and spleen. The transfer coefficient into milk was about 1 X 10(-5) days/1. Less than 1% of an ingested dose of manganese was absorbed. Excretion occurred mainly into feces and followed a three-term exponential function. Very little manganese was excreted into urine or secreted into milk. Manganese is concentrated in brain, pancreas, kidney and heart but the differences in concentration are small. The body burden is, therefore, mainly determined by manganese in muscle, skin and bone. The transfer coefficient of manganese into milk is about 3 X 10(-5). Excretion of iron into feces after oral administration follows a three-term exponential function with a small component having a half-life of 72 days. Intestinal absorption is on the order of 0.5-2% of the dose. After i.v. administration, 7% of the dose is excreted in the feces displaying two components of turnover. Very little iron is excreted into urine. Secretion into milk also follows a two-term exponential function. The transfer coefficient of iron into milk is about 3 X 10(-5). About 0.6% of an oral and about 94% of an i.v. dose were recovered from the cows at sacrifice. Most activity was present in blood, liver and spleen. Excretion of radiocobalt into feces after oral administration is described by a three-term exponential function, while excretion into milk and urine is described by two-term exponential functions. Long-lived components in urine and milk represent about 5-10% of the activity absorbed. Only 1-2% of an oral cobalt dose is absorbed and 0.05% of an oral and 5.85% of an i.v. dose is recovered from the cow at sacrifice where concentrations are highest in kidney and thyroid. The body burden depends mainly on cobalt in muscle, skin and bone. The transfer coefficient of cobalt into milk is about 7.5 X 10(-5).

Animals↗
PubMed1988

Intergenerational conflict: middle-aged women caring for demented older relatives.

This study examined the experiences of 181 middle-aged women who, while raising a family, were also primary care providers for an older demented relative. Results indicated that the caregiver burden depended on the context of the caregiving experience, particularly the relative's place of residence. Employment did not alter responsibilities but did affect coping strategies and perceived health of the caregiver.

Adaptation, Psychological↗
PubMed2003

Role of ET-1 in the regulation of coronary circulation.

Given that circulating ET levels in heart failure, in particular, may reach physiological threshold for coronary constrictor responses, the primary objective of the present review is to consider coronary vessels as an important target for circulating and locally produced endothelin(s). In healthy vessels, ET-1 causes biphasic coronary responses characterized by a transient dilation of large and small arteries followed by a sustained constriction. ETB receptors are pivotal in the early dilation of resistance vessels, whereas dilation of conductance vessels may be a secondary phenomenon triggered by flow increases. Exogenous ET-1 causes coronary constriction almost exclusively through ETA receptor activation. Human and canine large epicardial coronary vessels display significant baseline ET-1 dependent tone in vitro and in vivo, an ETA-dependent process. In contrast, ETB receptors located on smooth muscle cells are apparently less important for producing constrictor responses. NO production may serve as an important counter-regulatory mechanism to limit ET-dependent effects on coronary vessels. Conversely, in a dysfunctional endothelium, the loss of NO may augment ET-1 production and activity. By lifting the ET-dependent burden from coronary vessels, ET receptor blockade should help to ensure a closer match between cardiac metabolic demand and coronary perfusion.

Animals↗