Mid- to late-Holocene climate variability and anthropogenic impacts: multi-proxy evidence from Lake Bliden, Denmark

We conducted multi-proxy geochemical analyses (including measurements of organic carbon, nitrogen and sulphur stable isotope composition, and carbonate carbon and oxygen isotope composition) on a 13.5 m sediment core from Lake Bliden, Denmark, which provide a record of shifting hydrological conditions for the past 6,700 years. The early part of the stratigraphic record (6,700-5,740 cal year BP) was wet, based on delta O-18(carb) and lithology, and corresponds to the Holocene Thermal Maximum. Shifts in primarily delta O-18(carb) indicate dry conditions prevailed from 5,740 to 2,800 cal year BP, although this was interrupted by very wet conditions from 5,300 to 5,150, 4,300 to 4,050 and 3,700 to 3,450 cal year BP. The timing of the latter two moist intervals is consistent with other Scandinavian paleoclimatic records. Dry conditions at Lake Bliden between 3,450 and 2,800 cal year BP is consistent with other paleolimnological records from southern Sweden but contrasts with records in central Sweden, possibly suggesting a more northerly trajectory of prevailing westerlies carrying moisture from the North Atlantic at this time. Overall, fluctuating moisture conditions at Lake Bliden appear to be strongly linked to changing sea surface temperatures in the Greenland, Iceland and Norwegian seas. After 2,800 cal year BP, sedimentology, magnetic susceptibility, delta C-13(ORG), delta C-13(carb) and delta O-18(carb) indicate a major reduction on water level, which caused the depositional setting at the coring site to shift from the profundal to littoral zone. The Roman Warm Period (2,200-1,500 cal year BP) appears dry based on enriched delta O-18(carb) values. Possible effects of human disturbance in the watershed after 820 cal year BP complicate attempts to interpret the stratigraphic record although tentative interpretation of the delta O-18(carb), magnetic susceptibility, delta C-13(ORG), delta C-13(carb) and delta O-18(carb) records suggest that the Medieval Warm Period was dry and the Little Ice Age was wet.

Psychological and social profile of family caregivers upon commencement of palliative care provision

Context
Palliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized.

Objectives
We sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services.

Methods
A self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire.

Results
Three hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief.

Conclusion
This study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers.