Existential behavioural therapy for informal caregivers of palliative patients: a randomised controlled trial.

BACKGROUND: Existential behavioural therapy (EBT) was developed to support informal caregivers of palliative patients in the last stage of life and during bereavement as a manualised group psychotherapy comprising six sessions. We tested the effectiveness of EBT on mental stress and quality of life (QOL). METHODS: Informal caregivers were randomly assigned (1:1) to EBT or a treatment-as-usual control group using computer-generated numbers in blocks of 10. Primary outcomes were assessed with the Brief Symptom Inventory (subscales somatisation, anxiety and depression), the Satisfaction with Life Scale (SWLS), the WHOQOL-BREF and a numeric rating scale for QOL (QOL-NRS, range 0-10). Data were collected at baseline, pre-treatment, post-treatment and follow-ups after 3 and 12âeuro0/00months. Treatment effects were assessed with a multivariate analysis of covariance. RESULTS: Out of 160 relatives, 81 were assigned to EBT and 79 to the control group. Participants were 54.5âeuro0/00±âeuro0/0013.2âeuro0/00years old; 69.9% were female. The multivariate model was significant for the pre-/post-comparison (pâeuro0/00=âeuro0/000.005) and the pre-/12-month comparison (pâeuro0/00=âeuro0/000.05) but not for the pre-/3-month comparison. Medium to large effects on anxiety and QOL (SWLS, WHOQOL-BREF, QOL-NRS) were found at post-treatment; medium effects on depression and QOL (QOL-NRS) emerged in the 12-month follow-up. No adverse effects of the intervention were observed. CONCLUSION: Existential behavioural therapy appears to exert beneficial effects on distress and QOL of informal caregivers of palliative patients. Further longitudinal evidence is needed to confirm these findings. Copyright © 2013 John Wiley & Sons, Ltd.

Relações de gênero em África: as rabidantes e o comércio informal em Cabo Verde

Este trabalho visa analisar a relação entre dinâmicas de gênero, processos de reconstrução de identidades e comércio informal transatlântico, tendo como ponto de partida as experiências de mulheres negociantes, no Mercado de Sucupira, localizado na ilha de Santiago, em Cabo Verde. As rabidantes, como são conhecidas comercializam produtos adquiridos em outros países africanos, em alguns países europeus e, também, do continente americano, como EUA e Brasil. No caso brasileiro, as mercadorias se originam, principalmente, de Fortaleza, no estado do Ceará. Para tanto, utilizar-se-á da metodologia da historia oral, buscando captar memórias de mulheres, dando especial atenção às suas histórias de vida no que concerne a inserção na profissão, as relações conjugais e de parentesco, processos de reconstrução de identidades e formas de resistência e, empoderamento, por elas desenvolvido. Acredita-se que este será o meio mais eficaz para captar a realidade do contexto vivido pelas rabidantes em todas suas dimensões. Assim, pretende-se fazer uma abordagem interdisciplinar, dialogando com algumas disciplinas das ciências humanas, em especial, a antropologia, a sociologia e a história.

Modes of acquisition of health literacy skills in informal learning contexts

In this article we try to analyze the learning processes of health literacy skills in informal contexts. We intend to broaden the understanding of the learning process beyond the formal contexts, thus contributing to the elucidation of health professionals on how individuals acquire and manage their knowledge in health matters. Given our goal, we use an analytic corpus constituted by one hundred autobiographical narratives written between 2006 and 2011, in educational contexts but with recognized potential for use in different scientific fields, including health. The results reveal the existence of three different types of modes of learning health literacy skills in informal context: : i) learning that takes place in action, in achieving daily tasks; ii) learning processes that result from problem solving; iii) learning that occurs in an unplanned manner, resulting from accidental circumstances and, in some cases, devoid of intentionality.

The street and children’s informal economy in Cape Verde

Since the 1990s Cape Verde has undergone dramatic economic and political transformations that have brought about growing social class distinction. The two main towns (Praia and Mindelo) have grown rapidly in the last decades and their urban structure today reflects the increasing polarisation of the population. Middle and upper class families occupy the older parts of town and the recently built planned areas, while spontaneous neighbourhoods spread without planning on the less valuable land. It is in these latter areas that most social issues associated with childhood and youth have become highly visible in the last decade. In this article I will focus on children’s reasons for going to live on the streets of Mindelo, arguing that it is in terms of autonomous mobility within a non-heterogeneous and profoundly divided urban and social space that we can better understand what is commonly defined as the phenomenon of street children.

Development of the short version of the informal caregiver burden assessment questionnaire

OBJETIVE to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION Confirmatory factor analysis revealed a good fit with the advocated theoretical model.

Cross-cultural adaptation of the Caregiver Reaction Assessment for use in Brazil with informal caregivers of the elderly

This study aimed to carry out the cross-cultural adaptation of the Caregiver Reaction Assessment CRA for use in Brazil with informal caregivers of dependent elderly METHOD A methodological study, of five steps: initial translation, synthesis of translations, retro-translation, evaluation by a judge committee and a pre-test, with 30 informal caregivers of older persons in Fortaleza, Brazil. Content validity was assessed by five experts in gerontology and geriatrics. The cross-cultural adaptation was rigorously conducted, allowing for inferring credibility. RESULTS The Brazilian version of the CRA had a simple and fast application (ten minutes), easily understood by the target audience. It is semantically, idiomatically, experimentally and conceptually equivalent to the original version, with valid content to assess the burden of informal caregivers for the elderly (Content Validity Index = 0.883). CONCLUSION It is necessary that other psychometric properties of validity and reliability are tested before using in care practice and research.

Do Spanish informal caregivers come to the rescue of dependent people with formal care unmet needs?

This paper analyses the effect of unmet formal care needs on informal caregiving hours in Spain using the two wavesof the Informal Support Survey (1994, 2004). Testing for double sample selection from formal care receipt and theemergence of unmet needs provides evidence that the omission of either variable would causes underestimation of thenumber of informal caregiving hours. After controlling for these two factors the number of hours of care increaseswith both the degree of dependency and unmet needs. More importantly, in the presence of unmet needs, the numberof informal caregiving hours increases when some formal care is received. This result refutes the substitution modeland supports complementarity or task specificity between both types of care. For a given combination of formal careand unmet needs, informal caregiving hours increased between 1994 and 2004. Finally, in the model for 2004, theselection term associated with the unmet needs equation is larger than that of the formal care equation, suggestingthat using the number of formal care recipients as a quality indicator may be confounding, if we do not complete thisinformation with other quality indicators.

Efeitos da Interação Conjunta da Volatilidade das Taxas de Juro e da Dívida nas Decisões de Investimento: Evidências nas Empresas Portuguesas do Setor Industrial

Focalizando, essencialmente, sobre os efeitos da interação. conjunta da volatildade das taxas de juro e da dívida nas decisões de investimento das empresas portuguesas, listadas na Euronext Lisbon, e considerando a composição de dados em séries temporais empilhadas, extraímos 291 observações completas, durante o período de 1999 a 2009. Os resultados encontrados mostram que uma maior exposição ao risco da dívida das empresas portuguesas depende do nível de endividamento. As empresas moderadamente endividadas e amantes do risco não diminuem os seus investimentos, quando se verifica uma maior volatilidade do risco da dívida. Por outro lado, as empresas sobreendividadas e inimigas do risco respondem perante a uma maior volatilidade do risco da dívida, diminuindo os seus investimentos. Além disso, descobrimos que as empresas portuguesas reduzem os seus investimentos face a uma maior volatilidade das taxas de juro. Entretanto, fomos surpreendidos que as empresas portuguesas não reduzem os seus investimentos, face a um efeito marginal das taxas de juro. Este resultado sugere que, o benefício fiscal resultante do efeito de reavaliação da dívida (Lensink et al., 2001), é mais relevante para as empresas sobreendividadas, uma vez que podem atenuar o efeito dos encargos financeiros (Bo e Sterken, 2002).

Estratégia para o Desenvolvimento do Setor Portuário de Cabo Verde, com Base nas Tendências Internacionais

O setor portuário Cabo-verdiano apresenta-se como um dos mais importantes quando analisado o sistema de transportes nacionais. Tendo em vista este facto, o presente trabalho tem por objetivo analisar o setor portuário Cabo-verdiano, identificando possíveis falhas do modelo de gestão atual, assim como propor mudanças no modelo de administração portuária Cabo-verdiana, através do levantamento das melhores práticas internacionais. A observação de algumas experiências internacionais permitiu concluir que houve aumento da participação privada no setor portuário, principalmente no que se refere à prestação de serviços. Tendo em vista o cenário atual no qual se insere o setor portuário Cabo-verdiano, assim como as experiências internacionais analisadas, algumas mudanças são propostas, tais como a delimitação das responsabilidades na organização institucional do Governo em relação ao sistema portuário; a intensificação do processo de descentralização, permitindo maior autonomia administrativa e financeira das Autoridades Portuárias; e também o incentivo à concessão da administração portuária à iniciativa privada.

Trade-off between formal and informal care in Spain

The remarkable growth of older population has moved long term care to the front ranks of the social policy agenda. Understanding the factors that determine the type and amount of formal care is important for predicting use in the future and developing long-term policy. In this context we jointly analyze the choice of care (formal, informal, both together or none) as well as the number of hours of care received. Given that the number of hours of care is not independent of the type of care received, we estimate, for the first time in this area of research, a sample selection model with the particularity that the first step is a multinomial logit model. With regard to the debate about complementarity or substitutability between formal and informal care, our results indicate that formal care acts as a reinforcement of the family care in certain cases: for very old care receivers, in those cases in which the individual has multiple disabilities, when many care hours are provided, and in case of mental illness and/or dementia. There exist substantial differences in long term care addressed to younger and older dependent people and dependent women are in risk of becoming more vulnerable to the shortage of informal caregivers in the future. Finally, we have documented that there are great disparities in the availability of public social care across regions.

Informal care and labour force participation among middle-aged women in Spain

Informal care is today the form of support most commonly used by those who need other peoplein order to carry out certain activities that are considered basic (eating, dressing, taking a shower,etc.), in Spain and in most other countries in the region. The possible labour opportunity costsincurred by these informal carers, the vast majority of whom are middle-aged women, have not asyet been properly quantified in Spain. It is, however, crucially important to know these quantities ata time when public authorities appear to be determined to extend the coverage offered up to nowas regards long-term care.In this context, we use the Spanish subsample of the European Community Household Panel (1994-2001) to estimate a dynamic ordered probit and so attempt to examine the effects of various typesof informal care on labour behaviour. The results obtained indicate the existence of labouropportunity costs for those women who live with the dependent person they care for, but not forthose who care for someone outside the household. Furthermore, whereas caregiving for morethan a year has negative effects on labour force participation, the same cannot be said of those who start caregiving and stop caregiving .

Análise da relação interpessoal do grupo informal “Malta sempri djunto” - Estudo de caso: Caixa Económica de Cabo Verde

O presente trabalho insere-se no âmbito do trabalho de fim de curso de Bacharelato em Psicologia na Universidade Jean Piaget de Cabo Verde. O seu objectivo é analisar o relacionamento interpessoal existente entre os membros do grupo informal “Malta sempri djunto” na Caixa Económica de Cabo Verde (CECV). É sabido que hoje os grupos, sobretudo os informais, assumem cada vez mais uma maior importância na vida das organizações. Neste contexto, constitui tarefa de qualquer responsável, conhecer os seus colaboradores, os processos de grupos, a cultura organizacional e o modo que estes processos e pessoas interagem entre si. Estes aspectos têm fortes impactos no sucesso de qualquer organização. A CECV é uma instituição financeira cabo-verdiana que conta com mais de duas centenas de colaboradores. O grupo informal “Malta sempri djunto” surgiu em 2003 e é constituído por cerca de 32 colaboradores da CECV, que por motivos vários se identificam uns com os outros quer na vivência dos mesmos problemas que os afectam, quer na vontade de realizar certas actividades fora do horário normal de trabalho, quer na procura de soluções de problemas provenientes de situações ligados ao trabalho.

Estudi sobre el perfil de persones grans amb dependència del servei d'ajuda a domicili del Consell Comarcal d'Osona i el tipus de suport formal i informal

The aim of this study is to determine the profile of dependent elderly people users of the home care services (SAD) of the regional council in Osona (Consell Comarcal d´Osona) , and the characteristics of formal and informal types of support they use. Methodology. An observational study of a transversal format has been carried out, with retrospective and descriptive purposes. The target population is 63 people (26 men and 37 women) included in the program of the regional SAD They have a recognized dependence grade approved by the law 39 /2006, December 14th , promoting the individual autonomy and care of elderly people in a dependent situation. The data were collected by social workers of basic social services, first with a home visit and followed by handed out questionnaires, specifically designed for this study, in order to obtain information on socio-demographic characteristics, and the type of support formal and informal. The obtained results on the SAD users are women in a 58.7% and a 41.3 % are men. The 84% of the total sampling are 80 years old and more, being the average age of 85.2 years old. 45% of them are married, 41% are widows and widowers and 14% are single. 54% are rated with severe dependence (grade II), 42.8% with high dependence (grade III). 86% live accompanied. 100% have an informal caregiver and a 95% of the times, the caregiver is a relative who in 73% of the cases the dedication time is permanent. The coverage of the SAD has an average of 4.27 hours per week and per user. The formal services most used are the technical (62%), also the assessment of an occupational therapist at home (57%) and the telecare service in a (56%). Conclusions. The SAD is used primarily for women in an advanced age and severe dependence. The informal assistance structures have an informal caregiver, being a member of the family mostly, living with the dependent, and mainly in a permanent dedication basis. The SAD has a varied intensity in each case. The formal support services complementary to the SAD, are largely used in all cases.

Understanding informal payments in health care: motivation of health workers in Tanzania

BACKGROUND: There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. METHODS: Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. RESULTS: The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. CONCLUSION: This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also tackles an environment in which corruption is endemic.