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PubMedDate not supplied

Early postsurgery experience of prostate cancer patients and spouses.

PURPOSE: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery. DESCRIPTION OF STUDY: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery. RESULTS: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption. CLINICAL IMPLICATIONS: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.

Activities of Daily Living↗
PubMed2002

[Financial burden on caregivers of schizophrenic patients: a comparison between parents and spouses].

OBJECTIVE: Part II of this study will explore more accurately, how caregivers of schizophrenic patients perceive the financial burdens of the disease. METHOD: 42 In-depth-interviews with parents and spouses of schizophrenic patients were analysed using a qualitative-interpretative technique. RESULTS: When talking about their living situation, caregivers tended to keep away from the topic of financial charges; often they played down objective financial disadvantages or didn't assess them as burdensome. Considerable financial burdens were reported by parents of young patients still living in the parents' household and by spouses in families with very low income. DISCUSSION: Financial burdens are usually superimposed by other problems of the caregivers, such as dealing with acute episodes and sorrow about the future. Thus, not only the material, but also the immaterial costs of caregivers should be taken into consideration when taking health policy decisions.

Adaptation, Psychological↗
PubMedDate not supplied

Theories of spouse abuse: relevance to African Americans.

This article reviews several sociocultural theories of spouse abuse. However, their relevance to ethnic people of color, and African Americans in particular, is questionable because of different cultural and historical experiences. It is suggested that the use of unidimensional sociocultural theories may not adequately explain spousal abuse cross culturally. Recommendations are made for the development and testing of multidimensional theoretical frameworks that consider the unique cross-cultural variations related to abusive relationships among ethnic people of color. Additionally, studies that are conducted by culturally competent researchers may better explain cultural similarities and differences regarding spouse abuse and thus ultimately lead to more culturally competent nursing care.

Black or African American↗
PubMedDate not supplied

Negative associations of chronic stress and cognitive performance in older adult spouse caregivers.

Despite research on psychosocial and physical correlates of caregiving, associations of caregiving with cognitive functioning have rarely been studied. We compared the cognitive functioning of 44 spouse caregivers of persons with Alzheimer's disease to 66 demographically-similar non-caregiver spouses; and, whether such differences are explained by demographic variables and distress. We observed that variance in Digit Symbol scores was explained by age [F(1,108)=26.80, p<.001, R(2)=.20] and education [DeltaF(1,107)=5.33, p=.023, DeltaR(2)=.04], and caregiver status [DeltaF(1,106)=4.57, p<.035, DeltaR(2)=.03]. However, when Distress (a composite of Uplifts, Burden, and Sleep Problems) was added to the equation, the lower level of cognitive functioning in caregivers was no longer significant (beta declined from.18 to.06), but distress was significant (beta=-.30). These results may have implications for caregiver adherence and may have relevance to the complex tasks caregivers must perform for care-recipients and the information they report to health care workers/researchers about their care-recipients.

Aged↗
PubMed1995

A preliminary study of the impact of terminal illness on spouses: social support and coping strategies.

This study examined whether social support and particular coping strategies were associated with self-reported depression, anxiety, anger, and physical symptoms in spouses of terminally ill patients recently admitted to a hospice program. Forty-four spouses were assessed within two weeks of the patients' admission. Results showed that specific types of social support (namely, socialization, guidance, and cognitive information) and the coping strategy of wishful thinking were associated with self-reported level of anxiety. In addition, cognitive information and the coping strategies of wishful thinking and express emotions were associated with self-reported level of anger. Directionality and possible explanations for these findings are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Death of a spouse: illusory basic assumptions and continuation of bonds.

Recently psychologists have questioned the traditional model of grief, arguing that the continuation of bonds with the deceased spouse is generally adaptive. Continuing bonds can be seen as attempts to cope with the loss of a spouse but also with the shattering of the normal illusory basic assumptions about the self, the world, and the future. At this time, however, scholarship has provided few concepts to understand how continuing bonds and illusions express adaptive or maladaptive forms of grief. Therefore, the purpose of this article is to identify, in the context of the illusory basic assumptions, the circumstances by which the bond with the deceased is adaptive or maladaptive. So Epstein (1980) distinguished between higher order postulates and lower order postulates. Higher order postulates are an abstract form of schemas, or generalized theories about the self, the world, and the future, that are resistant to changes. On the other hand, lower order postulates are a concrete form of schemas normally flexible and responsive to the changes in the reality of the new situation. On the basis of this distinction, the author argues that higher order bonds or symbolic bonds are adaptive, whereas lower order bonds or concrete bonds are maladaptive.

Adaptation, Psychological↗
PubMed2003

Genetic evolution of human immunodeficiency virus type 1 in two spouses responding successfully to highly active antiretroviral therapy.

The current case study provided an unusual setting to track the evolution of HIV-1 envelope gene over a maximum period of 6 years in two asymptomatic spouses undergoing suppressive highly active antiretroviral therapy. For this purpose, proviral DNA samples taken from uncultured peripheral blood mononuclear cells and spanning the C2-V5 regions of env were analyzed at three sampling points per subject. Two distinct topological patterns were observed in the phylogenetic reconstructions of the genetically linked sequences of the couple: an intermingled pattern and a sequentially shifting pattern in the virus populations of the male index case and his spouse, respectively. Application of three evolutionary models for the amino acid-encoded sites, using the maximum likelihood approach, indicated the operation of positive selection in the region only at the second time point in the woman, before receiving therapy. These findings reinforce the evidence of a crucial role for host-selective constraints on HIV-1 env evolution in vivo.

Antiretroviral Therapy, Highly Active↗
PubMed1997

The influence of spouse cognitive impairment on respondents' depressive symptoms: the moderating role of marital closeness.

An earlier report documented that, in a community-dwelling sample of 317 older married couples, cognitive impairment in a wife was associated with depressive symptoms in her husband (Moritz, Kasl, and Berkman, 1989). No similar effects were found for wives. Here we examine the extent to which marital closeness moderates the impact of a spouse's cognitive impairment, the stability of influences over 3 years, and gender differences in the associations. Analyses of covariance, controlling for respondent risk factors and potential confounders in the spouse, showed that marital closeness moderated the impact of a wife's cognitive impairment, with husbands in close marriages affected more strongly than husbands in less close marriages. These effects held over 3 years. In addition, husbands became less depressed following the death of a severely impaired wife, whereas widowers whose wife had been unimpaired at baseline were more depressed. None of these effects were found for wives.

Aged↗
PubMed1998

Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups.

The purpose of this study were to examine the influence of personality on mental and physical health of spouse caregivers and to determine whether there were differences in such influences depending on disease context. The disease contexts compared were Alzheimer's disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both chronic, degenerative diseases of later life. It was predicted that personality would be related to mental and physical health, directly and indirectly, and that AD caregivers would have higher levels of perceived stress and worse mental and physical health outcomes. Participants in the study were 175 caregivers (88 AD; 87 PD) living at home with their ill spouses. The data provided an excellent fit to the hypothesized model of the relationships between personality, disease group, social support, perceived stress, and mental and physical health. Seventy-eight percent of the variance in mental health was accounted for and 35% of the variance in physical health was explained. Personality had significant direct and indirect effects on mental health and significant indirect effects on physical health. As predicted, AD caregivers had significantly worse mental health than PD caregivers; however, AD caregivers had better physical health than PD caregivers, controlling for other variables in the model. These results are discussed in relation to the existing caregiving and behavioral medicine literature. Future research should include different domains of personality--states and longer term self-regulatory processes in addition to traits--to advance models of caregiving processes further.

Adult↗
PubMed2004

Neuroticism and longitudinal change in caregiver depression: impact of a spouse-caregiver intervention program.

PURPOSE: We examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention. DESIGN AND METHODS: We analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. We used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention. RESULTS: Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression. IMPLICATIONS: Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention like ours, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment.

Aged↗
PubMed1996

Spouse correlations in cardiovascular risk factors and the effect of marriage duration.

Spouse correlations in cardiovascular risk factors were investigated using data on 2,836 spouse pairs collected in the Busselton Population Health Surveys over the period 1966-1981. The risk factors considered were systolic blood pressure, diastolic blood pressure, body mass index, triceps fatfold, cholesterol, and forced expiratory volume (1 second). Statistically significant positive correlations (p < 0.01) were found for all (age-adjusted) variables. There was a statistically significant decreasing trend in the correlations for systolic blood pressure with marriage duration (trend p < 0.01). Although no other variables showed statistically significant trends, the correlations for diastolic blood pressure (p = 0.29), body mass index (p = 0.14), and forced expiratory volume (p = 0.16) also decreased with marriage duration, and correlations for cholesterol (p = 0.61) and triceps fatfold (p = 0.99) increased with marriage duration. These results suggest that there is spousal concordance in cardiovascular risk factors. The lack of consistent increasing trends in the correlations with marriage duration suggests that assortative mating may be a more likely explanation than the sharing of a common environment.

Adult↗
PubMedDate not supplied

Burns in men secondary to spouse abuse.

A retrospective study of adult patients admitted to the burn center identified 61 male patients who claimed their injury to be secondary to spouse abuse. This may not be a true prevalence, because there may be many more unidentified cases. Few data are available concerning male spouse abuse in literature. Increased awareness is necessary to identify these patients for adequate psychosocial rehabilitation and to prevent a second injury.

Adult↗
PubMed2000

HIV incidence and HIV-associated mortality in a cohort of factory workers and their spouses in Tanzania, 1991 through 1996.

OBJECTIVE: To describe HIV incidence and HIV-associated mortality in a cohort of factory workers and their spouses with access to adequate sexually transmitted diseases (STD) treatment services and moderate exposure to sexual health interventions. METHODS: Follow-up visits at 4-month intervals and home follow-up of those who failed to keep appointments were used to estimate HIV incidence and mortality in a cohort of factory workers and their spouses in Mwanza, Tanzania, during 1991 to 1996. RESULTS: HIV prevalence at intake was 10.5% and 15.3% among 1,594 men and 880 women, respectively. HIV incidence was just over 1/100 person-years (PY) in 1,427 men and 1.9/100 PY in 745 women. The main risk factors were related to sexual behavior and clinical evidence of an STD, although only one seventh of those with HIV seroconversions had had an STD during the period following the second-from-last follow-up visit. HIV incidence among discordant couples was 5.0 and 8.3/100 PY for 41 men and 37 women, respectively. Mortality rates were 9.0 and 7.8/1,000 PY for men and women, respectively, and 65% of male and 60% of female deaths were attributable to HIV infection. CONCLUSIONS: In this factory population with good access to and use of STD treatment and with a moderate level of exposure to HIV prevention education, HIV incidence among men and women is still over 1/100 PY, which suggests a relatively high level of program effort is needed to lower incidence. More than half of all adult deaths were attributable to HIV, but greater increases in HIV-associated mortality are likely.

Adult↗
PubMed1994

Living kidney transplantation between spouses: results in 100 cases.

The use of unrelated living donors in kidney transplantation is still controversial but many transplant centres have accepted this procedure. The main argument against this approach is usually an ethical one. Because of this, at our institution we accept biologically unrelated donors only if they have an emotional closeness to the recipient. From January 1983 to October 1993, out of 654 kidney transplantations we performed at our institution, 364 kidney allografts were from living donors. Of these living donors, 245 were first-degree relatives of the recipient (LRD) while 119 were unrelated (LURD); 100 cases were spouses--wife to husband in 76 cases and husband to wife in 24 cases. Statistical analysis of the results (chi-square) revealed actuarial patient and graft survival rates of 89.8% and 86.8% at 1 year, 82.9% and 72.3% at 5 years and 72.3% and 60.3% at 9 years, respectively. In our series, the result of living donor kidney transplantation in this group were similar to those obtained in the LRD group, while they were significantly better than those from cadaver donors (P = 0.003). In conclusion, cadaver organs given the shortage of kidney transplantation between spouses may be a good alternative and can be performed successfully, providing a "gift of life" for both the patient and the family.

Adult↗
PubMed1995

Headache disability inventory (HDI): short-term test-retest reliability and spouse perceptions.

We have reported previously that the 25-item Headache Disability Inventory has good internal consistency reliability, robust long-term (2 month) test-retest stability, and good construct validity. We conducted further investigations to evaluate the short-term (1 week) test-retest reliability and spouse perceptions of patients' self-perceived headache disability. The short-term test-retest reliability of the Headache Disability Inventory was excellent. Additionally, the spouse and patients' perceptions of the patient's headache disability generally were congruent, although we observed instances where the differences were marked.

Adult↗
PubMed2004

A pilot study of an intervention for breast cancer survivors and their spouses.

Recent studies have shown that interventions that increase breast cancer patients' communication with family members lead to reduced patient distress. In this article, we report on a treatment development and pilot study of an intervention for couples coping with breast cancer. In phase 1 of this study, 10 couples participated in two focus groups that generated ideas and themes for the intervention. In phase 2, we developed and pilot tested our intervention with 48 couples: 12 in a 2-session format, 21 in a 1-session format, and 15 in a non-experimental control group. Our response rate shows that breast cancer patients and spouses were willing to participate and that treatment providers were willing to refer patients and their spouses. The 2-session format showed the most promise for producing positive change in mental health functioning and cancer-related stress.

Breast Neoplasms↗
PubMed2006

Five years after the launch of Viagra in Korea: changes in perceptions of erectile dysfunction treatment by physicians, patients, and the patients' spouses.

INTRODUCTION: When Viagra was first launched in Korea in 1999, there were high expectations for its efficacy, and strong concerns regarding its safety and potential for misuse. PURPOSE: To research changes in perceptions of erectile dysfunction (ED) treatment 5 years after Viagra was launched. MATERIALS AND METHODS: Participants in the study were drawn from six provinces in Korea. They were 120 physicians, 80 patients with ED who had been treated with Viagra, and 40 women who knew that their husbands were being treated with Viagra. The study was conducted using a random face-to-face interview and a questionnaire. RESULTS: Most physicians responded that since the launch of Viagra, discussions on the topic of sex are more acceptable (92%), and the number of patients seeking medical treatment for ED has increased (92%). They now have a better understanding of ED (98%). They are more confident of treatment (96%), more interested in identifying ED patients (72%), and more comfortable at initiating discussions on ED with patients (80%). Prior to the launch of Viagra, 65% of internal medicine/family medicine doctors did not prescribe any special treatment for ED. However, after Viagra became available, 92% of these doctors prescribed oral medication for ED, thus confirming their position as primary physicians for ED treatment. One of the most distinct changes in perceptions related to Viagra is the higher level of confidence shown by physicians, patients, and patients' spouses in the safety of the drug. CONCLUSION: Five years after the launch of Viagra, the social environment has changed, making discussions of sex more acceptable. A larger number of patients now seek medical treatment for ED, and there is an increased acknowledgment for ED treatment by physicians, patients, and patients' spouses. Moreover, these parties are now more confident about the safety of Viagra.

Adult↗
PubMed2006

Assessing effects of disease genes and gene-environment interactions: the case-spouse design and the counterfactual-control analysis.

BACKGROUND: Assessing joint genetic and environmental contributions to disease risk is the central issue in many genetic epidemiological studies. To characterise the effects of a gene, the case-control study may suffer from the problem of population stratification bias. For a late onset disease, recruiting control subjects into case-parents and case-sibling studies may be difficult. METHODS: Two novel approaches to analysing case-spouse data are introduced: the 1:1 case-counterfactual-control analysis (genotype swapping between the case and their spouse) and the 1:5 case-counterfactual-controls analysis (allele swapping). RESULTS: Both can be implemented using statistical packages that allow matched analysis (the conditional logistic regression) to yield valid estimates of the genotype relative risk, the gene-environment interaction parameter, the gene-sex interaction parameter, and the gene-environment-sex three factor interaction parameter (if desired), if certain assumptions are fulfilled. CONCLUSION: Because of the ease in recruiting subjects, and in collecting and analysing data, this approach makes a convenient tool for gene characterisation.

Bias↗