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Family burden and participation in care: differences between relatives of patients admitted to psychiatric care for the first time and relatives of re-admitted patients.

Studies on emotional and physical strain imposed on family members in connection with their responsibility of caring for a person with a severe mental illness have focused on the chronic patients. The situation of family members with patients who are at an early stage of illness and admitted for the first time may illuminate different patterns. In this Swedish multi-centre study, 162 relatives of patients in acute psychiatric wards, both those admitted for the first time and those re-admitted, were interviewed concerning their experience of family burden and their participation in care. There were relatively few differences found in burden measures and participation in care between the two subgroups of relatives. However, relatives who were in a career of being a relative to a person with severe mental illness earlier, more often viewed the psychiatric services to be of good quality, although they had had less contact with the staff of the psychiatric services during the last year. The relatives of re-admitted patients experience more often psychological aspects of burden, equivalent to associated stigma. The future task of maintaining the relatives' good opinion of psychiatric services, as well as the issue of giving informationare discussed.

Acute Disease↗

Well-being of 12-year-old children related to interpersonal relations, health habits and mental distress.

AIM: The main purpose was to examine if interpersonal relations, mental distress, somatic symptoms and health behaviours could be protective or risk factors for the subjective well-being of 12-year-old school children. METHODS: After ethical and parental permission a questionnaire was completed by 807 pupils in the sixth grade of 18 randomised schools in seven rural and urban districts in the north-west area of Stockholm. The questionnaire was a modified version of the WHO Health Behaviour in School-Ages Children Study and the Youth Self-Report Questionnaire. Well-being was measured by the question, 'How are you these days'? Measures of protective or risk factors were relations to parents, teacher/schoolwork and peers, eating and safety habits, somatic symptoms, anxious/depressed and aggressiveness. RESULTS: Logistic regressions were performed with well-being as dependent variable before and after adjustment for gender, which was the only significant background factor. Finally, a multiple logistic regression analysis was conducted with gender and the six significantly related predictors as independent variables. In the multiple model, relations to teacher/school and peers, eating habits, anxious/depressed and somatic symptoms were associated with well-being and yielded significant odds ratios. CONCLUSIONS: Relations to teacher/school, relations to peers and good eating habits could be protective factors for subjective well-being, while somatic and anxious/depressed symptoms may be risk factors for ill-being. This indicates an increased need for interpersonal relations and mental health-oriented, promotive interventions in schools.

Attitude to Health↗

Family burden and relatives' participation in psychiatric care: are the patient's diagnosis and the relation to the patient of importance?

BACKGROUND: Studies that differentiate among diagnoses have detected divergent results in the experience of family burden. AIM: This study aimed to investigate differences in family burden and participation in care between relatives from subgroups of psychoses, affective disorders and 'other diagnoses', and between different subgroups of relatives. METHOD: In a Swedish longitudinal study performed in 1986, 1991 and 1997, 455 close relatives of both committed and voluntarily admitted patients were interviewed concerning different aspects of their burden, need for support and participation in the actual care situation. RESULTS: Relatives showed burdens in several of the aspects measured. In only one aspect of the investigated burden items was a difference found between different diagnostic subgroups. The relatives of patients with affective disorder more often had to give up leisure time. However, spouses showed more burdens and more often experienced sufficient participation in the patient's treatment than other subgroups while siblings more seldom experienced burdens and more seldom felt that their own needs for support had been met by the psychiatric services. Within each diagnostic subgroup there were differences between subgroups of relatives. CONCLUSION: Being a close relative, and living together with a severely mentally ill person in an acute situation, is one factor of importance for experiencing burden and participation in care, contradicting the conventional wisdom which differentiates between diagnoses.

Adult↗

Getting to know you: the relational self-construal, relational cognition, and well-being.

Individuals with a highly relational self-construal define the self in terms of their close relationships with others. Consequently, they seek to nurture and develop new relationships. These studies examine individual differences in the self-construal in the context of a new roommate relationship, with a focus on cognitive aspects of relationship development. Study 1 revealed that persons with a highly relational self-construal were better able than others to predict a new roommate's values and beliefs. Study 2 showed that highly relational individuals tended to think optimistically about a new roommate's feelings about the relationship. The relational self-construal was more strongly related to these measures of relationship cognition in distant relationships than in very close relationships. Participants' self-construals and their perceptions of the closeness of the roommate relationship interacted in predicting well-being, revealing an unexpected negative relation between closeness and well-being for participants with a low relational self-construal.

Adaptation, Psychological↗

Mycotoxin production in wheat grains by different Aspergilli in relation to different relative humidities and storage periods.

Four different Aspergilli (Aspergillus oryzae, A. parasiticus, A. terreus and A. versicolor) were grown on wheat grains underdifferent degrees of relative humidity 14, 50, 74, 80 and 90%. Samples of wheat grains were taken monthly for a period of six months and examined for mycotoxin production. A. oryzae was found to produce aflatoxins B1, B2, zearalenone, DON and T-2 toxins under elevated degrees of humidity and prolonged periods of storage. A. parasiticus produced aflatoxins B1, G1, NIV, DON and T-2 toxins in high concentrations during a period of not more than three months storage at 14% relative humidity; at an increased level of relative humidity of 74% ochratoxin A, zearalenone and sterigmatocystin were also produced at high levels. The isolate was drastic in toxin production. A. terrus produced toxins at 14% relative humidity (aflatoxin G2 and DON) at levels much higher than any other prevalent degrees of humidity. A. versicolor is highly sensitive to relative humidity and grain moisture content It produced aflatoxins B1, G1, NIV and DON at a relative humidity of 50% and another toxins (aflatoxin G2, ochratoxins A, B and zearalenone) at 74%. The microorganism can be considered a trichothecene producer under suitable relative humidity.

Aflatoxins↗

Increased prothrombin fragment 1 + 2 and D-dimer in first-degree relatives of type 2 diabetic patients. Prethrombotic state in relatives of type 2 diabetic patients.

To evaluate whether or not activated coagulation is present in the preclinical phases of type 2 diabetes mellitus, we studied 46 non-diabetic first-degree relatives of type 2 diabetic patients and 21 matched controls with no family history of diabetes. We determined the plasma levels of prothrombin fragment 1 + 2, D-dimer, fibrinogen, plasminogen activator inhibitor type 1, tissue plasminogen activator, von Willebrand factor and coagulation factors VII and VIII. Glucose tolerance, beta-cell function and insulin sensitivity were assessed in all subjects by a continuous glucose infusion of 5 mg.kg ideal body weight-1.min-1 for 60 min with model assessment of glucose, insulin and C-peptide values. Plasma levels of prothrombin fragment 1 + 2 (median 1.24 vs 0.68 nmol.l-1; P = 0.0001) and D-dimer (331 vs 254 micrograms.l-1 UEF; P = 0.018) were higher in relatives, without significant differences in the other haemostatic variables. Relatives showed higher fasting (5.5 vs 4.9 mmol.l-1, P = 0.004) and post-infusion (9.3 vs 8.3 mmol.l-1, P = 0.02) serum glucose, no differences in insulin or C-peptide levels, lower beta-cell function (122% vs 147%; P = 0.02) and no significant differences in insulin sensitivity. Fifteen relatives were glucose-intolerant and had lower beta-cell function and insulin sensitivity than glucose-tolerant relatives. Both subsets of relatives exhibited higher levels of prothrombin fragment 1 + 2 and D-dimer than control subjects. Thus, first-degree relatives of type 2 diabetic patients present an activated coagulation, even in the absence of minor degrees of glucose intolerance. These abnormalities can play a role in the pathogenesis of cardiovascular diseases frequently seen at diagnosis of type 2 diabetes.

Adult↗

Soluble vascular cell adhesion molecule-1 and E-selectin levels in relation to vascular risk factors and to E-selectin genotype in the first degree relatives of NIDDM patients and in NIDDM patients.

To investigate the metabolic and genetic associations of levels of soluble adhesion molecules, plasma levels of soluble E-selectin and vascular cell adhesion molecule-1 were measured in 60 non-insulin-dependent diabetes mellitus (NIDDM) patients, 60 first-degree relatives of NIDDM patients and 60 control subjects, none of whom displayed clinical features of vascular disease. In addition, E-selectin A561C genotype, coding for a serine to arginine change, was determined. E-selectin levels were elevated in the patient group; 57 [52-63] (mean [95% confidence intervals]) ng/ml, compared with both relatives; 44 [39-50] ng/ml p = 0.001 and controls 39.5 [36-43] ng/ml p = 0.0001. E-selectin levels correlated with triglycerides, tissue-plasminogen activator and plasminogen activator inhibitor-1 activity in all groups. Levels of E-selectin were related to E-selectin genotype, being higher in subjects possessing the arginine allele (51.4 vs 44.5 ng/ml p < 0.05). E-selectin levels were higher in males than females in controls (female 35 [32-39] vs male 45 [40-51] ng/ml p = 0.004), and NIDDM relatives (female 38 [33-44] vs male 52 [45-61] ng/ml p = 0.004) but not in NIDDM patients where levels were similar (female 58 [49-69] vs male 56 [50-62] ng/ml, ns). There was no difference in soluble vascular cell adhesion molecule-1 levels between the three groups (control 640 [598-686] ng/ml, NIDDM relatives 634 [593-678] ng/ml and NIDDM patients 664 [608-725] ng/ml). In controls and patients vascular cell adhesion molecule-1 levels correlated with von Willebrand factor (vWF). The results indicate that levels of E-selectin relate to vascular risk factors in control subjects, NIDDM relatives and NIDDM patients.

Adult↗

The relative risks of hyperglycaemia, obesity and dyslipidaemia in the relatives of patients with Type II diabetes mellitus.

Type II (non-insulin-dependent) diabetes mellitus has a substantial genetic component; however, its molecular basis remains largely unknown. The mode of inheritance is likely to be polygenic, with penetrance influenced by environmental factors. Although the familial aggregation of Type II diabetes is acknowledged, there is little data concerning the prevalence of diabetes in the relatives of subjects with diabetes in comparison with the general population, and our objective was to address this question in the defined geographic region of Oxfordshire, England. We studied 139 first degree relatives of 90 probands with Type II diabetes who attended routine diabetes clinics in Oxfordshire and documented the fasting plasma glucose, triglyceride and HDL-cholesterol concentrations and BMI of these subjects. The probands were selected without regard to family history of diabetes. The control population data were derived from two large-scale Oxford community studies which documented the prevalences of known and newly diagnosed diabetes. The prevalences of newly diagnosed and known diabetes were calculated for each group. The mean BMI, and concentrations of fasting glucose, triglyceride and HDL-cholesterol were compared and prevalence ratios for obesity (defined as BMI > 30 kg/m2), hyperglycaemia (defined as fasting plasma glucose > or = 6.1 mmol/l), and dyslipidaemia (defined as triglyceride > 2.0 mmol/l, HDL < 1.0 mmol/l) were calculated. There was a fourfold higher prevalence of hyperglycaemia in the first degree relatives of subjects with Type II diabetes compared with the control population: the prevalence ratio after adjustment for age, sex and BMI was 4.32 (95 % confidence interval 2.29-8.17). The relatives had a considerably higher fasting plasma glucose concentration than the control population (5.18+/-0.67 mmol/l (mean +/- 1 SD) vs 4.76+/-1.59 mmol/l, p = 0.0001), and this difference remained statistically significant after adjustment for age, sex and obesity. The relatives were significantly more obese, had higher fasting plasma insulin concentrations and had lower HDL-cholesterol concentrations. In conclusion, there is a strong familial aggregation of hyperglycaemia and obesity in the relatives of subjects with Type II diabetes and these subjects have higher fasting plasma insulin concentrations and lower HDL-cholesterol than the general population. These data indicate the particular relevance of screening the first degree relatives of subjects with Type II diabetes, as intervention strategies which aim to improve the metabolic profile are indicated for a large proportion of these subjects.

Adult↗

Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care.

OBJECTIVE: To evaluate the effectiveness of the provision of information in the form of a rehabilitation program following critical illness in reducing psychological distress in the patients' close family. DESIGN: Randomised controlled trial, blind at follow-up with final assessment at 6 months. SETTING: Two district general hospitals and one teaching hospital. PATIENTS AND PARTICIPANTS: The closest family member of 104 recovering intensive care unit (ICU) patients. INTERVENTIONS: Ward visits, ICU clinic appointments at 2 and 6 months. Relatives and patients received the rehabilitation program at 1 week after ICU discharge. The program comprised a 6-week self-help manual containing information about recovery from ICU, psychological information and practical advice. MEASUREMENTS AND RESULTS: Psychological recovery of relatives was assessed by examining the rate of depression, anxiety, and post-traumatic stress disorder (PTSD)-related symptoms by 6 months after ICU. The proportion of relatives scoring in the range >19 on the Impact of Events Scale (cause for concern) was high in both groups at 49% at 6 months. No difference was shown in the rate of depression, anxiety, or PTSD-related symptoms between the study groups. CONCLUSION: A high incidence of psychological distress was evident in relatives. Written information concerning recovery from ICU provided to the patient and their close family did not reduce this. High levels of psychological distress in patients were found to be correlated with high levels in relatives.

Adolescent↗

Human movement coordination implicates relative direction as the information for relative phase.

The current studies explore the informational basis of the coupling in human rhythmic movement coordination tasks. Movement stability in these tasks is an asymmetric U-shaped function of mean relative phase; 0 degrees is maximally stable, 90 degrees is maximally unstable and 180 degrees is intermediate. Bingham (2001, 2004a, 2004b) hypothesized that the information used to perform coordinated rhythmic movement is the relative direction of movement, the resolution of which is determined by relative speed. We used an experimental paradigm that entails using a circular movement to produce a linear motion of a dot on a screen, which must then be coordinated with a linearly moving computer controlled dot. This adds a component to the movement that is orthogonal to the display. Relative direction is not uniquely defined between orthogonal components of motion, but relative speed is; it was therefore predicted that the addition of the component would only introduce a symmetric noise component and not otherwise contribute to the U-shape structure of movement stability. Results for experiment 1 supported the hypothesis; movement that involved the additional component was overall less stable than movement that involved only the parallel component along which relative direction can be defined. Two additional studies ruled out alternative explanations for the pattern of data in experiment 1. Overall, the results strongly implicate relative direction as the information underlying performance in rhythmic movement coordination tasks.

Adult↗

Health- and vision-related quality of life among patients with choroidal neovascularization secondary to age-related macular degeneration at enrollment in randomized trials of submacular surgery: SST report no. 4.

PURPOSE: To describe the effect of subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) on health-related quality of life (HRQOL) of patients at enrollment in two randomized clinical trials; to examine the relation of visual acuity to HRQOL; to compare HRQOL scores between participants with unilateral and bilateral CNV independent of other characteristics. DESIGN: Randomized clinical trials. METHODS: Two Submacular Surgery Trials (SST) recruited patients with AMD and either new subfoveal CNV (Group N Trial) or predominantly hemorrhagic CNV (Group B Trial). Health-related quality of life interviews included the National Eye Institute Visual Function Questionnaire [NEI-VFQ], the SF-36 Health Survey, and the Hospital Anxiety and Depression Scale [HADS]. Linear correlation and regression analyses were used to relate baseline HRQOL scores to visual acuity and bilateral disease. RESULTS: Interview data were analyzed for 789 AMD patients: 454 patients in the Group N Trial and 335 patients in the Group B Trial. Participants reported poor vision-related functioning in many domains measured by the NEI-VFQ (mean overall scores of 65 for Group N and 63 for Group B). Visual acuity of the better eye was strongly associated with NEI-VFQ scores but not with SF-36 or HADS scores. After adjusting for visual acuity of the better eye and other factors, bilateral cases had NEI-VFQ overall scores six points lower than unilateral cases in Group N Trial and 10 points lower than unilateral cases in the Group B Trial. CONCLUSIONS: Subfoveal CNV profoundly affects vision-related quality of life. The effect is more pronounced with bilateral disease, even after controlling for visual acuity.

Aged↗

On the relation of movement-related potentials to the go/no-go effect on P3.

According to Simson et al. [Simson, R., Vaughan, H.G., Jr., Ritter, W., 1977. The scalp topography of potentials in auditory and visual go/nogo tasks. Electroencephalography and Clinical Neurophysiology 43, 864-875], the difference between no-go P3 and go-P3 (the go/no-go effect) is due to overlap of P3 onto the return of the preceding contingent negative variation (CNV) in no-go trials and onto the continuing CNV in go trials. Similarly, according to Kok [Kok, A., 1986. Effects of degradation of visual stimuli on components of the event-related potential (ERP) in go/nogo reaction tasks. Biological Psychology 23, 21-38], the go/no-go effect is due to movement-related negative potentials, in particular contralateral negativity, adding with P3 in go trials. To investigate these notions, we studied how CNV, go-P3 and no-go P3 are lateralized at fronto-central sites when the side of the response varies across trials, comparing these effects between hand movements and eye movements and delineating them more precisely for hand movements with multichannel recordings. The go/no-go effect was larger and contralaterally lateralized with hand movements than with eye movements. Dipole analysis dissected its components into a large contribution of the medial cingulate gyrus, into activity of motor areas contralateral to the cued hand and a left-frontal source. Motor-related portions of the effect seemed to build upon and extend motor-related components included in CNV. Results provide support for the notion that the go/no-go effect is related to movement-related potentials. We suggest that go-P3 and no-go P3 are characterized by addition and reduction of motor-related activation to the core P3.

Adult↗

An investigation of the cognitive organization of body comparison sites in relation to physical appearance related anxiety and drive for thinness.

Modeling cognitive processes that link variables associated with maladaptive behavior has led to successful interventions, particularly for alcohol use. In the present study, Individual Differences Scaling (INDSCAL) was used to model the cognitive structure of appearance-related comparisons in relation to physical appearance related anxiety and drive for thinness (DT) among 635 college students. Results were consistent with previous work in finding two primary comparison dimensions. A weight/nonweight dimension was primarily emphasized by females and a muscle/nonmuscle dimension was primarily emphasized by males. These gender differences continued to be evident when females and males were matched on levels of appearance-related anxiety and DT. Gender-specific analyses indicated that females with higher levels of appearance-related anxiety and DT primarily emphasized the weight dimension while females with lower levels of these characteristics tended to emphasize a physical attractiveness dimension. Males with higher levels of appearance-related anxiety and DT also primarily emphasized the weight dimension while males with lower levels of these characteristics tended to emphasize a muscle-related dimension. Findings are discussed in terms of risk factors for disturbance, and as a means of improving assessment, treatment, and prevention strategies.

Adolescent↗

Person-related and treatment-related barriers to alcohol treatment.

Treatment underutilization by persons with alcohol use disorder is well-documented. This study examined barriers to treatment at the latter stages of the treatment-seeking process, which was conceptualized as recognizing the problem, deciding that change is necessary, deciding that professional help is required, and seeking care. All participants identified themselves as having a drinking problem that was severe enough to warrant treatment. Differences between those who had (Treatment Seekers) and those who had not (Comparison Controls) sought treatment were evaluated, including the experience of person-related (e.g., shame) and treatment-related (e.g., cost) barriers. Person-related barriers were more commonly endorsed by both groups than treatment-related barriers. Comparison Controls were more likely to endorse both types of barriers, especially the preference for handling the problem without treatment. Treatment-related barriers were less relevant than person-related barriers at the latter stage of help seeking. The significance of barriers endured after accounting for other differences, such as drinking-related negative consequences. Treatment implications are discussed.

Adult↗

Perceived criticism in schizophrenia: a comparison of instruments for the assessment of the patient's perspective and its relation to relatives' expressed emotion.

The expression and perception of expressed emotion (EE) in schizophrenic patients and their relatives are likely to differ. The presented exploratory study compares the two views. EE in relatives of 25 chronic schizophrenic patients was assessed using an extended version of the Five-Minute Speech Sample (FMSS). Patients rated their relatives with the Perceived Criticism Scale (PCS), the Family Emotional Involvement and Criticism Scale (FEICS), and a German questionnaire on family atmosphere (FEF). Forty-eight percent of relatives were rated high in EE, due to criticism in all cases but one. Patients' assessments of the whole family on the FEICS and FEF criticism subscales were related to their relatives' EE status. Correlations between the self-rating instruments were moderate to good. As the patients' and the relatives' views corresponded with regard to the criticism domain, the application of a self-rating instrument may be a simple and useful tool for clinical and research purposes.

Adult↗

Clinical predictors of early infarct-related artery patency following thrombolytic therapy: importance of body weight, smoking history, infarct-related artery and choice of thrombolytic regimen: the GUSTO-I experience. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries.

OBJECTIVES: The purpose of this study was to determine patient characteristics that are a priori predictors of early infarct related artery patency following thrombolytic therapy, and to provide a paradigm which may identify patients who would be most likely to achieve restoration of normal (TIMI 3) coronary flow in response to thrombolytic therapy. BACKGROUND: Restoration of infarct-related artery perfusion in acute myocardial infarction is necessary for preservation of ventricular function and mortality reduction. Clinical variables that are a priori predictors of early patency with currently available thrombolytic regimens have not been fully characterized. METHODS: The probability of early infarct-related artery patency (TIMI 3 flow) was determined by multivariable logistic regression. We determined a reduced (parsimonious) model for predicting early (90 min) infarct-related artery patency (TIMI grade 3) based on data from 1,030 patients in the GUSTO-I Angiographic study. RESULTS: Predictors of 90 min TIMI 3 flow are use of an accelerated t-PA regimen (vs. streptokinase containing regimens) (chi2=39.1; p < or = 0.0001), infarct related artery (RCA/Lcx vs. LAD) (chi2=12.7; p=0.0004), body weight (chi2=10.3; p=0.001) and history of smoking (chi2=7.4; p=0.007). Time from symptom onset to treatment was not significant (p=0.71). CONCLUSIONS: The efficacy of currently available thrombolytic regimens is chiefly dependent on choice of thrombolytic regimen, body weight, infarct-related coronary artery and smoking history. Clinical variables alone correctly predict a priori TIMI 3 flow in the infarct-related artery 64% of the time. Patients with body weights greater than 85 kg are at a significant disadvantage with regard to achieving successful thrombolysis compared to those with lesser body weights.

Aged↗

Assessing relatives' needs for psychosocial interventions in schizophrenia: a relatives' version of the Cardinal Needs Schedule (RCNS).

BACKGROUND: The methodology for measuring the needs of patients with severe mental illness is now well established through the MRC Needs for Care Assessment Schedule and its modification in the form of the Cardinal Needs Assessment. This paper reports the rationale and construction of a relatives' version of the Cardinal Needs Schedule and looks at preliminary data reporting on reliability and validity. METHODS: Potential problem areas for relatives were identified from the literature. The criteria determining Cardinal Needs for each problem included objective threshold, carer concern, and carer cooperation. The reliability of the Schedule was assessed in a study whereby 27 relatives of patients with established schizophrenic illness completed two Schedules administered by two independent raters within a short time period. RESULTS: The Schedule was acceptably reliable for most areas of need although there were some difficulties associated with the cooperation criteria. Concurrent measures of relatives and patients including EE, relative distress and patient psychopathology indicated that the Relatives' Cardinal Needs Schedule shows acceptable validity when used with a sample of 45 relatives. CONCLUSIONS: The paper suggests that the Schedule may prove to be a useful tool for both clinicians and researchers interested in establishing and evaluating family interventions.

Activities of Daily Living↗

[Death, euthanasia and end-of-life decisions according to the relatives' perspective -- a survey after the death of a close relative].

UNLABELLED: Empirical research on euthanasia and medical decisions at the end of life usually focus on the doctors' perspective. The perspectives of patients, relatives respectively the bereaved families have been neglected so far. The project "Patients as partners. Tumour patients and their participation" aims to improve the participation of tumour patients in medical decision making at the end of life by means of several offerings for patients. In order to develop a theoretical model, interviews were conducted with patients, relatives, doctors and members of the bereaved families. Between March 2002 and July 2004 questionnaires were sent to the bereaved families about eight to ten weeks after their relatives had perished. Before dying, the patients had been looked after and offered consultation by a palliative care team either in hospital or at home. RESULTS: Of 151 sent out questionnaires, 59.6 % (n = 90) were filled in and sent back by members of the bereaved families. 52.3 % of the patients had died in hospital, 33.7 % in their private home. All of the patients who died at home, but only one in three patients who died in hospital also wanted to die there. The relatives were predominantly very satisfied or satisfied with the medical care (67.8 %). 11 % of the bereaved families said, their dying relatives had seriously asked for euthanasia. In 74.4 % of all cases, decisions for the renunciation of therapy were made, mostly due to a worsening of the general condition (54.4 %) or a progress of the disease (46.6 %). CONCLUSION: The questioning was successfully conducted. Members of bereaved families are able and also prepared to answer questions about the last days of their relatives lives. The question about the desired dying place has proved to be workable. In empirical research, the perspective of the relatives and bereaved families should be taken in to account seriously.

Adult↗