Avoidant coping partially mediates the relationship between patient problem behaviors and depressive symptoms in spousal Alzheimer caregivers

OBJECTIVE: Caring for a loved one with Alzheimer disease is a highly stressful experience that is associated with significant depressive symptoms. Previous studies indicate a positive association between problem behaviors in patients with Alzheimer disease (e.g., repeating questions, restlessness, and agitation) and depressive symptoms in their caregivers. Moreover, the extant literature indicates a robust negative relationship between escape-avoidance coping (i.e., avoiding people, wishing the situation would go away) and psychiatric well-being. The purpose of this study was to test a mediational model of the associations between patient problem behaviors, escape-avoidance coping, and depressive symptoms in Alzheimer caregivers. METHODS: Ninety-five spousal caregivers (mean age: 72 years) completed measures assessing their loved ones' frequency of problem behaviors, escape-avoidance coping, and depressive symptoms. A mediational model was tested to determine if escape-avoidant coping partially mediated the relationship between patient problem behaviors and caregiver depressive symptoms. RESULTS: Patient problem behaviors were positively associated with escape-avoidance coping (beta = 0.38, p < 0.01) and depressive symptoms (beta = 0.26, p < 0.05). Escape-avoidance coping was positively associated with depressive symptoms (beta = 0.33, p < 0.01). In a final regression analysis, the impact of problem behaviors on depressive symptoms was less after controlling for escape-avoidance coping. Sobel's test confirmed that escape-avoidance coping significantly mediated the relationship between problem behaviors and depressive symptoms (z = 2.07, p < 0.05). CONCLUSION: Escape-avoidance coping partially mediates the association between patient problem behaviors and depressive symptoms among elderly caregivers of spouses with dementia. This finding provides a specific target for psychosocial interventions for caregivers.

Extended-spectrum cephalosporin-resistant Gram-negative organisms in livestock: an emerging problem for human health?

Escherichia coli, Salmonella spp. and Acinetobacter spp. are important human pathogens. Serious infections due to these organisms are usually treated with extended-spectrum cephalosporins (ESCs). However, in the past two decades we have faced a rapid increasing of infections and colonization caused by ESC-resistant (ESC-R) isolates due to production of extended-spectrum-β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs) and/or carbapenemase enzymes. This situation limits drastically our therapeutic armamentarium and puts under peril the human health. Animals are considered as potential reservoirs of multidrug-resistant (MDR) Gram-negative organisms. The massive and indiscriminate use of antibiotics in veterinary medicine has contributed to the selection of ESC-R E. coli, ESC-R Salmonella spp. and, to less extent, MDR Acinetobacter spp. among animals, food, and environment. This complex scenario is responsible for the expansion of these MDR organisms which may have life-threatening clinical significance. Nowadays, the prevalence of food-producing animals carrying ESC-R E. coli and ESC-R Salmonella (especially those producing CTX-M-type ESBLs and the CMY-2 pAmpC) has reached worryingly high values. More recently, the appearance of carbapenem-resistant isolates (i.e., VIM-1-producing Enterobacteriaceae and NDM-1 or OXA-23-producing Acinetobacter spp.) in livestock has even drawn greater concerns. In this review, we describe the aspects related to the spread of the above MDR organisms among pigs, cattle, and poultry, focusing on epidemiology, molecular mechanisms of resistance, impact of antibiotic use, and strategies to contain the overall problem. The link and the impact of ESC-R organisms of livestock origin for the human scenario are also discussed.

Bildung und Perspektivität. Zum Problem der Bildung in modernen demokratischen Gesellschaften

Das Problem der Orientierung ist ein Dauerproblem in modernen demokratischen Gesellschaften, vor dem Menschen nicht zuletzt auch in pädagogischen Zusammenhängen stehen. Antworten auf die Frage nach der Orientierung pädagogischen Denkens und Handelns, die der Situation in modernen demokratischen Gesellschaften angemessen sind, setzen eine Klärung dessen voraus, was für diese Art von Gesellschaften charakteristisch ist. Vor diesem Hintergrund wird in dem vorliegenden Beitrag die "Relation zwischen Bildung und Perspektivität" behandelt. [...] Das Prinzip der Transdisziplinarität kommt in diesem Beitrag zur Geltung, indem das Thema "Bildung" im Lichte des Problems der Perspektivität behandelt wird und zur Formulierung dieses Problems Erkenntnisse aus Disziplinen herangezogen werden, in denen die Situation der Perspektivität Gegenstand von Forschung ist. Dieser Logik folgend wird in einem ersten Schritt die Situation der Perspektivität bestimmt. Hierzu werden Parameter der Perspektivität skizziert und aufeinander bezogen (1.). Dies eröffnet die Möglichkeit, anschließend Bildung als eine pädagogische Antwort auf die Situation der Perspektivität zu rekonstruieren. Dabei wird gezeigt, dass der Begriff der Bildung die Perspektivität der modernen Gesellschaft in (mindestens) vierfacher Hinsicht systematisch berücksichtigt (2.).