Dagmar Radin

Informal care giving to more disabled people with multiple sclerosis.

Purpose. About 30% of the people with multiple sclerosis (MS) require some form of home care assistance and 80% of that assistance is provided by informal or unpaid care givers. This study focusses on the care givers for 530 more disabled people with MS, with the objective of learning more about informal care giving to people with greater dependency and need for assistance. Method. The data presented in this study were collected in a national survey of 530 people who provided informal care to more disabled people with MS. Results. Almost half of these care givers reported that they provided more than 20 h of care per week to the person with MS, with more than 9 in 10 shopping for groceries, doing indoor housework, preparing meals or providing transportation for the person with MS. More than 4 in 10 employed care givers reduced the amount of time worked in the previous 12 months because of their care giving responsibilities. Although more than half of the MS care givers in our study reported that care giving was demanding, time consuming or challenging, about 90% of these MS care givers were happy that they could help. About two in three of these MS care givers found that care giving was rewarding, with more than 8 in 10 proud of the care they provided. Conclusions. More than a quarter of the informal care givers to people with MS thought they would benefit from treatment or counselling provided by mental health professionals. Not only it is necessary to provide access to mental health services for people with MS, but it is also important to assure that their informal care givers also have access to appropriate mental health care, given the scope of their care giving responsibilities.

WHEN AND HOW THE FIGHTING STOPS: EXPLAINING THE DURATION AND OUTCOME OF CIVIL WARS

Previous research has shown that the duration of a civil war is in part a function of how it ends: in government victory, rebel victory, or negotiated settlement. We present a model of how protagonists in a civil war choose to stop fighting. Hypotheses derived from this theory relate the duration of a civil war to its outcome as well as characteristics of the civil war and the civil war nation. Findings from a competing risk model reveal that the effects of predictors on duration vary according to whether the conflict ended in government victory, rebel victory, or negotiated settlement.

Burden among male caregivers assisting people with multiple sclerosis.

BACKGROUND Caregiver burden is a multidimensional response to many factors associated with providing assistance to people with multiple sclerosis (MS), including physical, psychological, emotional, and social stressors. OBJECTIVE The aim of this analysis was to identify the characteristics of male informal caregivers, the assistance provided, and the people receiving assistance who were associated with the burden of care. METHODS Data were collected from a national survey (which included the Mental Component Summary of the SF-8 Health Survey) of informal caregivers and analyzed using an ordered logistic regression model to identify characteristics associated with burden among male informal caregivers. RESULTS Greater burden among male caregivers was associated with significantly greater hours per week providing assistance (P = 0.009) and significantly greater restriction on the caregivers ability to perform daily activities (P < 0.001) due to assisting the person with MS. We found a strong association between the perception of burden and the mental health status of the male caregiver (P < 0.001). CONCLUSIONS Our findings highlight the strong association of caregiver burden and the Mental Component Summary of the SF-8. Reducing burden may improve the mental health of informal caregivers. Health professionals treating either male caregivers or people with MS should be sensitive to the impact that providing assistance has on the mental health of informal caregivers.

Perceptions of informal care givers: health and support services provided to people with multiple sclerosis.

Purpose. About 30% of people with multiple sclerosis (MS) need some form of home care assistance, with 80% of that assistance provided by informal or unpaid care givers. This study focuses on the care givers to 530 more disabled people with MS, with the objective to learn more about informal care giving to people with greater dependency and need for assistance. Method. The data presented in this study were collected in a national survey of 530 informal care givers to people with MS who have greater levels of physical dependency. Results. About 70% of informal care givers responded that assisting the person with MS perform daily activities or personal care took up the largest amount of their care giving time. Care givers also reported a range of home and community-based services that would make care giving easier or improve the care provided. However, informal care givers generally reported low satisfaction with health insurance coverage of these services, especially coverage by health maintenance organizations and other managed care plans. Conclusions. Lack of health insurance coverage of needed home and community-based services can reduce the quality of informal care provided, as well as increase the burden of informal care giving.

Caregiver burden among informal caregivers assisting people with multiple sclerosis.

Multiple sclerosis (MS) burdens not only patients but also their informal or family caregivers. This study was conducted to identify characteristics of caregivers, caregiving, and MS patients receiving informal care that are associated with caregiving burden. Data were collected through a national survey of informal MS caregivers and analyzed using an ordered logistic regression model to identify factors associated with burden. Burden was found to be significantly greater among male caregivers than among female caregivers. Moreover, greater burden was associated with more frequent patient bladder dysfunction, more hours per week spent providing assistance, and greater restriction on the caregivers ability to perform daily activities because of caregiving responsibilities. A strong association was found between the mental health status of the caregiver and burden. Health professionals should be sensitive to the impact of caregiving on the mental health of MS caregivers. The results of this study suggest that treating patient bladder dysfunction and facilitating respite care may reduce burden and improve the mental health of informal caregivers of people with MS. Future research should identify programs and services designed specifically to reduce burden experienced by male caregivers.

Rural–Urban Analyses of Health-Related Quality of Life Among People With Multiple Sclerosis

CONTEXT Health-related quality of life (HRQOL) is a multi-dimensional construct including aspects of life quality or function that are affected by physical health and symptoms, psychosocial factors, and psychiatric conditions. HRQOL gives a broader measure of the burden of disease than physical impairment or disability levels. PURPOSE To identify factors associated with HRQOL among people with multiple sclerosis (MS) utilizing the SF-8 Health Survey. METHODS Data presented in this study were collected in a survey of 1,518 people with MS living in all 50 states. The survey sample was randomly selected from the database of the National Multiple Sclerosis Society, using ZIP codes to recruit the survey sample. A multiple linear regression model was employed to analyze the survey data, with the Physical Component Summary and the Mental Component Summary of the SF-8 the dependent variables. Independent variables were demographic characteristics, MS-disease characteristics, and health services utilized. FINDINGS People with MS in rural areas tended to report lower physically related HRQOL. Worsening MS symptoms were associated with reduced physical and mental dimensions of HRQOL. In addition, people with MS who received a diagnosis of depression tended to have reduced physical and mental dimensions of HRQOL. Receiving MS care at an MS clinic was associated with better physically related HRQOL, while having a neurologist as principal care physician was associated with better mental-related HRQOL. CONCLUSION The challenge is to increase the access that people living with MS in rural areas have to MS-focused specialty care.

Caregiver perceptions associated with risk of nursing home admission for people with multiple sclerosis

BACKGROUND About one quarter of people with multiple sclerosis (MS) will need long term care during their disease, with about 5% to 10% requiring extended nursing home care. The study objective was to identify perceptions of informal caregivers associated with the possibility of future nursing home admission for people with MS. METHODS Data were collected in a national survey of informal caregivers (78% were spouses) to people with MS. An ordered logistic regression model analyzed contributions that characteristics of the person with MS and caregiver made to the perceived probability of future nursing home admission. RESULTS Aging, bowel dysfunction, poorer health, and functional decline in the person with MS, as well as caregiver burden, were associated with increased probability of future admission. Higher family income and greater satisfaction with access to MS-focused care were associated with lower risk of nursing home admission. CONCLUSIONS The rehabilitative, therapeutic, supportive, and maintenance services that contribute to MS-focused care could assist the person with MS and the caregiver adapt to the symptoms that interfere with the ability of the person with MS to function independently in daily life. Informal caregivers provided insights into factors associated with the perceived probability of future nursing home admission, gaining a better understanding of people with MS at risk for institutional care.

Too Ill to Find the Cure?: Corruption, Institutions, and Health Care Sector Performance in the New Democracies of Central and Eastern Europe and Former Soviet Union

This article tackles the questions of why some Central and East European countries have been more successful at creating a better-performing health care sector while others left it in decay. To answer this question, the effects of corruption, institutional effectiveness, and level of democratic consolidation are considered regarding the ability of the health care sector to prevent cancer deaths. The tests of the hypotheses through an auto-regressive distributed lags model yield a mixed bag of results. First, corruption has a significant increasing short-term effect on cancer mortality in some models and a decreasing effect in models where the alternative measure of corruption is used. These same effects persist over the long term. Institutional effectiveness also has mixed results. However, effective institutions lower cancer mortality in the long term.

Does corruption undermine trust in health care? Results from public opinion polls in Croatia.

Health and health care provision are one of the most important topics in public policy, and often a highly debated topic in the political arena. The importance of considering trust in the health care sector is highlighted by studies showing that trust is associated, among others, with poor self-related health, and poorer health outcomes. Similarly, corruption has shown to create economic costs and inefficiencies in the health care sector. This is particularly important for a newly democratized country such as Croatia, where a policy responsive government indicates a high level of quality of democracy (Roberts, 2009) and where a legacy of corruption in the health care sector has been carried over from the previous regime. In this study, I assess the relationship between health care corruption and trust in public health care and hypothesize that experience with health care corruption as well as perception of corruption has a negative effect on trust in public care facilities. Data were collected in two surveys, administered in 2007 and 2009 in Croatia. Experience with corruption and salience with corruption has a negative effect on trust in public health care in the 2007 survey, but not in the 2009 survey. While the results are mixed, they point to the importance of further studying this relationship.

World Bank Funding and Health Care Sector Performance in Central and Eastern Europe

This article looks at the impact of World Bank funding on health care sector performance in Central and Eastern European countries. The World Bank has been one of few organizations involved in health care sector assistance in these nations during the transition period, mainly through funds disbursement. This article tests hypotheses that those countries that perform better economically, that are more favorably evaluated by the World Bank, and that have more effective institutions are also more likely to benefit from World Bank assistance, through improvements in the performance of their health care sectors.