Caregiving demands and caregivers’ psychological outcomes: The mediating role of perceived injustice.

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Caregiving demands and caregivers’ psychological outcomes: The mediating role of perceived injustice.

Clin Rehabil. 2016 Apr 28;

Authors: Mohammadi S, de Boer MJ, Sanderman R, Hagedoorn M

Abstract

OBJECTIVES: This study hypothesized that higher caregiving demands are related to higher perceived injustice. Furthermore, this study investigated the mediating role of perceived injustice in the link between caregiving demands and caregivers’ psychological well-being.

DESIGN: A cross-sectional design.

SETTING: The Pain Centre of the university medical centre.

SUBJECTS: Participants were 184 family caregivers of patients with chronic musculoskeletal pain.

MAIN MEASURES: Participants completed questionnaires that assessed caregiving demands (i.e. The Dutch Objective Burden Inventory), perceived injustice (i.e. The Injustice Experience Questionnaire), how much they considered different sources responsible for the injustice they experienced (i.e. A newly developed inventory), perceived burden (i.e. The Zarit Burden Interview), distress (i.e. The Depression, Anxiety, and Stress Scale), and anger (i.e. The Hostility subscale of the Symptom Checklist-90-Revised).

RESULTS: The findings showed that caregiving demands are significantly related to perceived injustice in family caregivers (r = .44; P < .001). Only a small group of family caregivers considered the patient or themselves responsible, but more than half of the caregivers considered healthcare providers at least somewhat responsible for the unjust situation. Finally, perceived injustice mediated the association between caregiving demands and burden (b = .11, CI: .04-.23) and distress (b = .05, CI: .006-.12), but not anger (b = .008, CI: -.01-.06).

CONCLUSION: The findings suggest that perceived injustice plays an important role in the well-being of family caregivers and caregivers’ well-being may be improved by changing their perceptions about their caregiving tasks and their condition.

PMID: 27127200 [PubMed - as supplied by publisher]

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A Reconsideration of the Self-Compassion Scale’s Total Score: Self-Compassion versus Self-Criticism.

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A Reconsideration of the Self-Compassion Scale’s Total Score: Self-Compassion versus Self-Criticism.

PLoS One. 2015;10(7):e0132940

Authors: López A, Sanderman R, Smink A, Zhang Y, van Sonderen E, Ranchor A, Schroevers MJ

Abstract

The Self-Compassion Scale (SCS) is currently the only self-report instrument to measure self-compassion. The SCS is widely used despite the limited evidence for the scale’s psychometric properties, with validation studies commonly performed in college students. The current study examined the factor structure, reliability, and construct validity of the SCS in a large representative sample from the community. The study was conducted in 1,736 persons, of whom 1,643 were included in the analyses. Besides the SCS, data was collected on positive and negative indicators of psychological functioning, as well as on rumination and neuroticism. Analyses included confirmatory factor analyses (CFA), exploratory factor analyses (EFA), and correlations. CFA showed that the SCS’s proposed six-factor structure could not be replicated. EFA suggested a two-factor solution, formed by the positively and negatively formulated items respectively. Internal consistency was good for the two identified factors. The negative factor (i.e., sum score of the negatively formulated items) correlated moderately to strongly to negative affect, depressive symptoms, perceived stress, as well as to rumination and neuroticism. Compared to this negative factor, the positive factor (i.e., sum score of the positively formulated items) correlated weaker to these indicators, and relatively more strongly to positive affect. Results from this study do not justify the common use of the SCS total score as an overall indicator of self-compassion, and provide support for the idea, as also assumed by others, that it is important to make a distinction between self-compassion and self-criticism.

PMID: 26193654 [PubMed - indexed for MEDLINE]

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Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study.

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Depressive symptom trajectories in women affected by breast cancer and their male partners: a nationwide prospective cohort study.

J Cancer Surviv. 2016 Apr 15;

Authors: Rottmann N, Hansen DG, Hagedoorn M, Larsen PV, Nicolaisen A, Bidstrup PE, Würtzen H, Flyger H, Kroman N, Johansen C

Abstract

PURPOSE: The purpose of this study was to identify subgroups of breast cancer patients and their partners based on distinct trajectories of depressive symptoms, to examine how relationship quality and medical and sociodemographic factors were associated with these trajectories, and to explore whether patients and partners had similar trajectories.

METHODS: A nationwide, population-based cohort of couples dealing with breast cancer was established in Denmark. Participants completed the Center for Epidemiologic Studies-Depression Scale at baseline and 5 and 12 months later. Sociodemographic and medical characteristics were retrieved from registers. A trajectory finite mixture model was used to identify trajectories.

RESULTS: The trajectories of depressive symptoms over time were analyzed in 546 patients and 508 partners. Among patients, 13 % had a high stable trajectory, 38 % an intermediate decreasing trajectory, and 49 % a low trajectory. Similar trajectories were found for partners (11, 22, and 67 %, respectively). Compared to the low trajectory, trajectories with higher depressive symptoms were associated with poorer relationship quality and previous use of antidepressants for patients and partners and with younger age, comorbidity, basic education, and chemotherapy for patients. The trajectories of patients and their partners were weakly correlated.

CONCLUSIONS: A considerable minority of patients and partners had a persistently high level of depressive symptoms. Poorer relationship quality and previous antidepressant use most consistently characterized patients and partners with higher depressive symptom trajectories.

IMPLICATIONS FOR CANCER SURVIVORS: In clinical practice, attention to differences in depressive symptom trajectories is important to identify and target patients and partners who might need support.

PMID: 27084710 [PubMed - as supplied by publisher]

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Assessment and Treatment of Pain during Treatment of Buruli Ulcer.

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Assessment and Treatment of Pain during Treatment of Buruli Ulcer.

PLoS Negl Trop Dis. 2015;9(9):e0004076

Authors: de Zeeuw J, Alferink M, Barogui YT, Sopoh G, Phillips RO, van der Werf TS, Loth S, Molenbuur B, Plantinga M, Ranchor AV, Stienstra Y

Abstract

BACKGROUND: Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.

METHODOLOGY: A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed.

PRINCIPAL FINDINGS: In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.

CONCLUSIONS: Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.

PMID: 26402069 [PubMed - indexed for MEDLINE]

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Identifying the determinants of use of the G&G interventions for older adults in health and social care: protocol of a multilevel approach.

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Identifying the determinants of use of the G&G interventions for older adults in health and social care: protocol of a multilevel approach.

BMC Res Notes. 2015;8:296

Authors: Kuiper D, Goedendorp MM, Sanderman R, Reijneveld SA, Steverink N

Abstract

BACKGROUND: Despite aging-related losses, many older adults are able to maintain high levels of subjective well-being. However, not all older adults are able to self-manage and adapt. The GRIP&GLEAM [Dutch: GRIP&GLANS] (G&G) interventions have shown to significantly improve self-management ability, well-being and loneliness in older adults. Actual use of the evidence-based G&G interventions, however, remains limited as long as the interplay between implementation factors at different hierarchical stakeholder levels is poorly understood. The aim of the study is to identify the determinants of successful implementation of the G&G interventions.

METHODS/DESIGN: The study is performed in health and social care organizations in the northern part of the Netherlands. The degree of implementation success is operationalized by four parameters: use (yes/no), pace (time to initial use), performance (extent of use) and prolongation (intention to continue use). Based on the Fleuren model, factors at four hierarchical stakeholder levels (i.e. target group, professionals, organizations and financial-political context) are assessed at three measurement points in 2 years. The nested data are analyzed applying multilevel modeling techniques.

DISCUSSION: In this study, health and social care organizations are considered to be part of multilevel functional systems, in which factors at different hierarchical stakeholder levels impede or facilitate use of the G&G interventions. Strengths of the study are the multifaceted measurement of use, and the multilevel approach in identifying the determinants. The study will contribute to the development of ecologically valid implementation strategies of the G&G interventions and comparable evidence-based practices.

PMID: 26148775 [PubMed - indexed for MEDLINE]

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Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four european countries (Ospi-Europe).

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Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimised multi-level suicide prevention intervention in four european countries (Ospi-Europe).

BMC Public Health. 2016;16(1):268

Authors: Harris FM, Maxwell M, O’Connor R, Coyne JC, Arensman E, Coffey C, Koburger N, Gusmão R, Costa S, Székely A, Cserhati Z, McDaid D, van Audenhove C, Hegerl U

Abstract

BACKGROUND: The Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these.

METHODS: A realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection.

RESULTS: All four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention.

CONCLUSIONS: The QuaSIC approach enabled us to develop and refine our definition of synergistic interactions and add the innovative concept of catalytic effects. This represents a novel approach to the evaluation of complex interventions. By exploring synergies and catalytic interactions related to a complex intervention or programme, we reveal the added value to planned activities and how they might be maximised.

PMID: 26979461 [PubMed - in process]

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The Therapeutic Alliance Predicts Outcomes of Cognitive Behavior Therapy but Not of Mindfulness-Based Cognitive Therapy for Depressive Symptoms.

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The Therapeutic Alliance Predicts Outcomes of Cognitive Behavior Therapy but Not of Mindfulness-Based Cognitive Therapy for Depressive Symptoms.

Psychother Psychosom. 2015;84(5):314-5

Authors: Snippe E, Fleer J, Tovote KA, Sanderman R, Emmelkamp PM, Schroevers MJ

PMID: 26278928 [PubMed - indexed for MEDLINE]

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Pain Associated with Wound Care Treatment among Buruli Ulcer Patients from Ghana and Benin.

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Pain Associated with Wound Care Treatment among Buruli Ulcer Patients from Ghana and Benin.

PLoS One. 2015;10(6):e0119926

Authors: Alferink M, de Zeeuw J, Sopoh G, Agossadou C, Abass KM, Phillips RO, Loth S, Jutten E, Barogui YT, Stewart RE, van der Werf TS, Stienstra Y, Ranchor AV

Abstract

Buruli ulcer (BU) is a necrotizing skin disease caused by Mycobacterium ulcerans. People living in remote areas in tropical Sub Saharan Africa are mostly affected. Wound care is an important component of BU management; this often needs to be extended for months after the initial antibiotic treatment. BU is reported in the literature as being painless, however clinical observations revealed that some patients experienced pain during wound care. This was the first study on pain intensity during and after wound care in BU patients and factors associated with pain. In Ghana and Benin, 52 BU patients above 5 years of age and their relatives were included between December 2012 and May 2014. Information on pain intensity during and after wound care was obtained during two consecutive weeks using the Wong-Baker Pain Scale. Median pain intensity during wound care was in the lower range (Mdn = 2, CV = 1), but severe pain (score > 6) was reported in nearly 30% of the patients. Nevertheless, only one patient received pain medication. Pain declined over time to low scores 2 hours after treatment. Factors associated with higher self-reported pain scores were; male gender, fear prior to treatment, pain during the night prior to treatment, and pain caused by cleaning the wound. The general idea that BU is painless is incorrect for the wound care procedure. This procedural pain deserves attention and appropriate intervention.

PMID: 26030764 [PubMed - indexed for MEDLINE]

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Antibiotic information application offers nurses quick support.

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Antibiotic information application offers nurses quick support.

Am J Infect Control. 2016 Feb 19;

Authors: Wentzel J, van Drie-Pierik R, Nijdam L, Geesing J, Sanderman R, van Gemert-Pijnen JE

Abstract

BACKGROUND: Nurses can be crucial contributors to antibiotic stewardship programs (ASPs), interventions aimed at improving antibiotic use, but nurse empowerment in ASPs adds to their job complexity. Nurses work in complex settings with high cognitive loads, which ask for easily accessible information. An information application (app) was developed to support nurses in ASPs. The efficiency, effectiveness, and user satisfaction regarding this antibiotic app were tested in a pilot study.

METHODS: The app was introduced into 2 lung wards of a local teaching hospital. During the 8-month pilot study, the 62 nurses of the wards had access to the app. Changes in user satisfaction regarding information support, safety attitudes, and ASP behavior were assessed with a questionnaire. At baseline, 28 nurses completed the (e-mail) questionnaire; after the study, 18 nurses participated. Scenario-based tests were done to assess app efficiency and effectiveness at baseline (n = 16) and in a randomized control (without the app, n = 17) and intervention condition (with the app, n = 17).

RESULTS: Significant improvements were found regarding task support (P = .041), reliability (P = .004), unobtrusiveness (P = .000), relevance (P = .002), user friendliness (P = .000), speed, and hyperlinks (P = .001). An improvement in communication was observed regarding nurse-physician understanding (P = .034). With the app, nurses solved the scenarios faster than without it.

CONCLUSIONS: The human-centered design approach and persuasive strategy of task support were effective in reducing time needed to find information. Stewardship-related behaviors need active education strategies.

PMID: 26905792 [PubMed - as supplied by publisher]

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The buffering effect of family functioning on the psychological consequences of headache.

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The buffering effect of family functioning on the psychological consequences of headache.

Psychol Health Med. 2016 Feb 17;:1-7

Authors: Mohammadi S, Zandieh S, Dehghani M, Assarzadegan F, Sanderman R, Hagedoorn M

Abstract

The current study aimed to examine whether high family functioning mitigates the association between headache intensity and distress. The sample consisted of 124 patients with chronic or recurrent headache. Patients completed validated questionnaires about headache intensity, family functioning, and distress. Hierarchical regression analyses were performed to examine the interaction between headache intensity and family functioning on distress. Headache intensity was positively associated with distress (r = .28, p = .002). As hypothesized, family functioning moderated this association (B = -.01, p = .023). More specifically, the positive association between headache intensity and distress was significant only among patients with lower family functioning (B = .01, p < .001) and not among patients with higher levels of family functioning (B = .006, p = .075). Functional families appear to buffer the distress level in patients; they showed relatively low levels of distress regardless of the severity of their headache. In contrast, patients with dysfunctional families who experienced more pain reported more distress, presumably because they did not receive adequate help and support from these families. This study underlines the importance of a broader perspective on family dynamics in coping with pain.

PMID: 26885696 [PubMed - as supplied by publisher]

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