Elizabeth W. Gonzalez

Resourcefulness, appraisals, and coping efforts of family caregivers.

Despite the large body of literature on caregiver stress, there has been a relative dearth of investigation of the experience of caregiving among African Americans. African Americans are currently the largest minority group in the United States and a rapidly growing segment of the American elderly population. Increasing evidence demonstrates the stressfulness of, as well as the variability in adaptation to, caregiving in this population. There are differences in individuals psychological resources and coping with the caregiving experience, which to date are not well understood. This descriptive study examined similarities and differences in appraisals of behavior problems, resourcefulness, and coping efforts between 25 African American and 25 Anglo-American caregivers of relatives diagnosed with probable Alzheimers disease. African American caregivers were found to have higher scores in resourcefulness than Anglo-American caregivers, and they reported benign appraisal of disruptive behavior in the impaired elders. No differences were found in caregivers coping efforts.

REVIEW OF INTERVENTION STUDIES ON DEPRESSION IN PERSONS WITH MULTIPLE SCLEROSIS

Depression is prevalent among persons with multiple sclerosis (MS), an acquired neurologic disability that affects predominantly women. The purpose of this article is to review intervention studies on depression in persons with MS. An integrative review of eight intervention studies published from 2000 to 2005 has revealed that various interventions could potentially alleviate depression. Although no definite conclusions can be made from this review, there is reasonable evidence that cognitive behavioral approaches are beneficial in the treatment of depression and in helping people adjust to, and cope with, having MS.

Enhancing Resourcefulness to Improve Outcomes in Family Caregivers and Persons with Alzheimer’s Disease: A Pilot Randomized Trial

This pilot randomized trial tested an intervention aimed at enhancing resourcefulness in family caregivers of persons with dementia, postulating that caregivers emotional outcomes (anxiety and depression) and role outcomes (reward, strain, mutuality, and preparedness) would be improved, and problem behaviors in the care recipients (persons with dementia) would be reduced as a result of the intervention. Subjects were stratified by race (white or African American) and by baseline resourcefulness (high or low). Family caregivers were randomly assigned to an intervention group in which subjects attended six resourcefulness training sessions, meeting for 2 hours weekly over 6 weeks, or to a control group that received no treatment. Small to medium effects were shown for the intervention program on resourcefulness, anxiety, and preparedness of the caregivers and on frequency of behavior problems in the care recipients. Caregivers in the intervention group reported significantly more resourcefulness skills, with a medium effect at week 6 and a small effect 12 weeks later, compared with the control group. Persons with dementia had fewer behavior problems in the intervention group compared with control, although the difference was not significant. Caregivers anxiety was reduced in the intervention group at 12 weeks.

Family Caregivers At Risk: Who Are They?

This study examined the characteristics, activities, challenges, and perceived burden of high-risk family caregivers of persons diagnosed with Alzheimers disease. A descriptive design was used. A convenience sample of 121 family caregivers participated in the interview. High-risk family caregivers with poor health and one medical condition were compared with low-risk family caregivers. Caregivers with low income, depressive symptoms, and high care demands are more likely to be in the high-risk group. Health care providers need to screen family caregivers for depression and monitor those with high care demands.

Self-concept in older adults: an integrative review of empirical literature.

The aging process leads to normative age-related bodily and functional declines and numerous social changes and life events that potentially threaten the self-concept. Despite these changes, the majority of older adults are able to maintain a positive sense of self and remain resilient. This article presents an integrative review of the empirical literature addressing self-concept in older adults.

Relationships of nurses' critical thinking ability and perceived patient self-disclosure to accuracy in assessment of depression.

This descriptive study examined the relationships of nurses critical thinking ability and perceived patient self-disclosure to accuracy in nursing assessment of depression in older medical patients. The sample consisted of 120 female nurse-patient dyads. Critical thinking ability was measured by the Watson-Glaser Critical Thinking Appraisal. Accuracy in nursing assessment was measured by deviations between the patients SDS observed score and the patients SDS predicted score. The patients predicted score was based on the relationship between the Depression Status Inventory and Self-Rating Depression Scale. Perceived patient self-disclosure was measured by a 3-point system on patients disclosure of information on symptoms of depression. A Pearson product-moment correlation and multiple regression analysis were used to analyze the data. The result showed that nurses education was not significantly related to accuracy in assessment but related to critical thinking ability (r = .26; p = .004). Nurses critical thinking ability was significantly related to accuracy in nursing assessment depression (r = -.24; p = .008). Perceived patients self-disclosure was not significantly related to accuracy in nursing assessment of depression.

Nasal immunization of mice with AFCo1 or AFPL1 plus capsular polysaccharide Vi from Salmonella typhi induces cellular response and memory B and T cell responses

The response to infection against Salmonella involves both B and T cell mediated immunity. An effective immunization can activate an adequate immune response capable to control the primary infection and protect against a secondary infection. Mucosal vaccination, by inducing local pathogen-specific immune responses, has the potential to counter mucosally transmitted pathogens at the portal of entry, thereby increasing the efficacy of vaccines. The aim of this work was to explore the efficacy of AFCo1 or AFPL1, as mucosal adjuvants to stimulate cell immunity and memory responses against Vi polysaccharide antigen of Salmonella typhi (PsVi). Mice immunized with 3 intranasal doses exhibited high levels of PsVi-specific IgG (p<0.05), IgG2a and IgG2c subclasses. Also, an amplified recall response after a booster immunization with a plain polysaccharide vaccine was induced. Avidities index were higher in mice immunized with adjuvanted formulations at different chaotropic concentrations. Furthermore, IL-12 and IFN-γ levels in nasally vaccinated mice with both adjuvants were induced. Moreover, priming with 3 doses followed by booster immunization with VaxTyVi(®) resulted in high levels of anti-Vi specific IgG, IgG subclasses and antibody avidity. Long lived plasma cells in bone marrow, memory B cells and long-term memory T cells after booster dose were induced. The combined formulation of Vi polysaccharide with mucosal adjuvants provides an improved immunogenicity, in particular with regard to cellular responses and long lasting cells responses.

Chronobioengineering indoor lighting to enhance facilities for ageing and Alzheimer's disorder

Evolutionary processes generate a variety of paradoxes which must be faced in order to design the most effective structures to fulfil various human requirements and preferences. One of these paradoxes comes from the evolution of circadian rhythm systems, which are normally synchronized to the geophysical cycle of night and day and coordinate internal temporal order, but are now in conflict with modern technology and the 24/7 paradigm for urban living. Modern lighting systems have traditionally focused on providing sufficient illumination for people to navigate and manipulate their environments without regard to the side effects that lighting might have on temporal aspects of behaviour and physiology. However, studies involving shift work and other applications of artificial lighting have indicated that these side effects can be quite significant. Furthermore, when an ageing circadian system is coupled with a deteriorating physiology, the side effects of a 24/7 artificially illuminated indoor environment can be especially debilitating, especially for older adults with dementia. Chronobiology is the field of biology that examines periodic (cyclic) phenomena in living organisms, whereas photobiology is the scientific study of the interaction of light on living organisms. Chronobioengineering is an emerging field of scientific study that translates research results and concepts from these fields into practical applications. The following discussion focuses on the use of light cycles to synchronize circadian rhythms and ways human health and wellbeing can be enhanced through light-emitting diode (LED) lighting in the ageing population, specifically those with dementia of Alzheimers type. The hypothesis is that the implementation of a lighting system specifically designed to synchronize circadian rhythms in this population will alleviate symptoms of dementia and thus enhance the quality of life for both residents and caregivers. The research team is working with a lighting industry partner to manufacture a 2′u2009×u20092′ retrofit LED luminaire for installation at St. Francis Country House, a skilled-nursing facility near Philadelphia. Research includes working with the nursing home caregivers and administrators to establish criteria and protocols for evidence-based design research that will evaluate the efficacy of the daylight-matching luminaire.

Self-disclosure of sexually transmitted diseases: an integrative review.

In the United States, there are currently more than 65 million individuals living with a sexually transmitted disease (STD), and approximately 19 million new infections will continue to occur each year. To decrease the transmission of potentially dangerous and life-altering STDs, self-disclosure of sexual and drug history and sexual orientation is paramount. This integrative review examines the concept of self-disclosure of STDs, suggests areas of additional research, and proposes a comprehensive public health campaign, with a specific focus on the recent human papillomavirus epidemic to improve the physical and psychological health of all individuals.

Needs Assessments of Memory Disorder Patients

Background: Previous research shows that informal caregivers of individuals with a memory disorder experience financial strain, declining physical health, and psychological distress. Various resources and services have been developed to address and/or prevent these potential outcomes, yet caregivers continue to be negatively affected by the demands of caregiving. We hypothesize that better identification and clarification of concrete patient and caregiver needs will aid in the modification and improvement of the available resources. The purpose of this study is to determine the psychosocial needs of the cognitively impaired population and their caregivers. Methods: A one-page Needs Assessment was created to address areas of potential concern for the individual with a memory disorder and the caregiver. This assessment was administered during visits to an outpatient clinic in Philadelphia. Results: A total of 204 Needs Assessments were collected. The significant needs found in our study cohort include sleep, exercise, clinical trials, education, and assistance with ADLs and IADLs. Conclusions: This study satisfied the initial identification of caregiver and patient needs; now each must be explored further to determine how to successfully meet such needs. If the primary needs of the patient can be met by a focused service, the caregiver will no longer be the sole provider of meeting the specific need. This will decrease the involved role of the caregiver, maximize patient homecare, minimize caregiver stress, and increase the quality of life for both the patient and caregiver.