Coping with a diagnosis of Alzheimer's disease: A client and caregiver perspective

The purpose of this study was to examine how individuals and their caregivers cope with a diagnosis of Alzheimer's disease. The sample size consisted of six patients with Alzheimer's disease and seven caregivers. The caregivers included spouses and adult children. The study was conducted at an academic medical center in the South Florida area. Using a phenomenological approach, data were collected by audiotaped interviews. Data were analyzed following the seven steps of Colaizzi (1978).^ The results of the study indicated that clients experienced fear, social withdrawal, decreased self-esteem and a need for love and support. Caregivers experienced psychological strain, burden, lifestyle adjustments and sacrifice. Both clients and caregivers identified numerous strategies for coping with Alzheimer's disease. The findings reflect the need for a holistic approach to promoting the quality of life for patients and caregivers. ^

Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

Teacher efficacy of special education teachers of English language learners with disabilities

This research examined the perceived teacher efficacy of special education teachers of English Language Learners (ELLs) with educational disabilities by surveying 202 elementary special education teachers using the EXCEL Teacher Inventory. EXCEL consists of 20 teacher efficacy items, three open-ended questions, and participant demographic items. ^ Overall participant teacher efficacy scores were high. Of the variables assessed, a statistically significant difference in perceived efficacy was found with self-reported proficiency in the language of the target students. No statistically significant differences in teacher efficacy scores were found for (a) levels of teacher preparation; (b) number of years of teaching experience; or (c) socioeconomic status of the students. A multiple regression analysis indicated that, of the variables listed above, proficiency in the language of the target students accounted for significant variance in predicting the level of teachers' perceived efficacy. ^ Responses to the open-ended questions about what was most helpful when working with ELLs with disabilities yielded two major themes: organizational issues and teacher issues. Participants wrote numerous comments about the value of support from educational professionals and parents. Many participants recommended individuals in preservice programs take ESOL content specific courses. ^ The results demonstrate the positive correlation between proficiency in the language of the target students and teacher efficacy. This suggests that teachers of ELLs with disabilities have proficiency in the ELLs' native language (or have support from others who are language proficient) that allows them to distinguish between language difference and language disability and provide instruction in the native language when needed. Further, results from open-ended questions suggest that special education teacher preparation programs should include courses related specifically to strategies for teaching ELLs with disabilities, not just ELLs. ^

Intuition and its component parts in the heuristic processing of deception detection: Hunch, *evidence, and reliance on intuitive efficacy

Rated trust in intuitive efficacy (measured as trust, belief, use, accuracy and weighting of intuition) was investigated as a predictor of self-designated use of intuitive (hunch and hunch plus evidential belief) vs. deliberative (evidential belief and evidential belief plus hunch) deception detection judgments and actual accuracy. Twenty-nine student participants were filmed as they made true and deceptive statements about their everyday activities on a given evening (last Friday night), and college students (N=238) judged 20 (10=true, 10=deceptive) of these filmed statements as truthful or deceptive. Participants provided ratings of reliance on hunches vs. evidential belief, confidence in film judgments, intuitive efficacy, accuracy in deception detection, reliance on cues to deception, and experiences with intuition. Generalized estimated equation modeling using binary logistics demonstrated accuracy in identifying true vs. deceptive statements was predicted by film number, hunch-evidence ratings, weighting of intuition, and total cues cited. Weighting of intuition was predictive of accuracy across participants, with higher weighting predictive of higher accuracy in general. Participants who cited evidential belief plus hunch and moderate to high weighting incorrectly reversed their true vs. deceptive judgments. Accuracy for true statements was higher for hunches and hunch plus evidential belief, whereas accuracy for deceptive statements was higher for evidential belief Accuracy for participants who relied on evidential belief plus hunch was at chance. Subjective experiences underlying judgments differed by participant and type of film viewed (true vs. deceptive) and were predicted by hunch-evidence ratings, trust, use, intuitive accuracy, and total cues cited. Trust predicted increases in judging films to be true, whereas use and accuracy predicted increases in judging films as deceptive; none were predictive of accuracy. Increased number of cues cited predicted judgments of deception, whereas decreased number of cues cited predicted truth. The study concluded that participants have the capacity to self-define their judgments as subjectively vs. deliberately based, provide subjective assessments of the influence of intuitive vs. objective information on their judgments, and can apply this self-knowledge, through effective weighting of intuition vs. other types of information, in making accurate judgments of true and deceptive everyday statements.

Molecular epidemiology of sexually transmitted human papillomavirus in a self referred group of women in Ireland

Background: Human papillomavirus (HPV) causes cervical cancer and external genital warts. The purpose of this study is to document the genotype distribution of HPV in females aged between 18 and 34 who self-referred to an STI clinic with visible external genital warts (EGW). Scrapings were taken from visible external genital warts (EGW). These scrapings were analysed by PCR for the presence of HPV DNA. Positive samples were then genotyped by means of a commercially available assay (LiPA). A comparison of genotyping results determined by the LiPA assay and direct amplicon DNA sequencing was also performed. Results: Ninety-two patients out of 105 samples (88%) had detectable levels of HPV DNA. The majority of individuals with EGW (66%) showed the presence of two or more genotypes. The most common HPV genotypes present in the study population were HPV-6, HPV-11, HPV-16, HPV-18, HPV-33 and HPV-53. Potential effects of vaccination on HPV molecular epidemiology indicate that 40% of the patients could have been protected from the high risk genotypes HPV-16 and HPV-18.Conclusion: This is the first report of the molecular epidemiology of external genital warts in women aged between 18 and 34 from Ireland based on results from a LiPA assay. The study shows that most individuals are infected with multiple genotypes including those with high oncogenic potential and that the newly available HPV vaccines could have a significant impact on prevalence of the most common HPV genotypes in this study population.

Group problem-solving skills training for self-harm: randomised controlled trial

Background: Rates of self-harm are high and have recently increased. This trend and the repetitive nature of self-harm pose a significant challenge to mental health services. Aims: To determine the efficacy of a structured group problem-solving skills training (PST) programme as an intervention approach for self-harm in addition to treatment as usual (TAU) as offered by mental health services. Method: A total of 433 participants (aged 18-64 years) were randomly assigned to TAU plus PST or TAU alone. Assessments were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up. Results: The treatment groups did not differ in rates of repeated self-harm at 6-week, 6-month and 12-month follow-up. Both treatment groups showed significant improvements in psychological and social functioning at follow-up. Only one measure (needing and receiving practical help from those closest to them) showed a positive treatment effect at 6-week (P = 0.004) and 6-month (P = 0.01) follow-up. Repetition was not associated with waiting time in the PST group. Conclusions: This brief intervention for self-harm is no more effective than treatment as usual. Further work is required to establish whether a modified, more intensive programme delivered sooner after the index episode would be effective.