Lynn McCleary

The Contribution of Group Cohesion and Group Alliance to the Outcome of Group Psychotherapy

The contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.

Pathways to diagnosis: exploring the experiences of problem recognition and obtaining a dementia diagnosis among Anglo-Canadians.

Increasing evidence suggests that early diagnosis and management of dementia-related symptoms may improve the quality of life for patients and their families. However, individuals may wait from 1-3 years from the onset of symptoms before receiving a diagnosis. The objective of this qualitative study was to explore the perceptions and experiences of problem recognition, and the process of obtaining a diagnosis among individuals with early-stage dementia and their primary carers. From 2006-2009, six Anglo-Canadians with dementia and seven of their carers were recruited from the Alzheimers Society of Calgary to participate in semi-structured interviews. Using an inductive, thematic approach to the analysis, five major themes were identified: becoming aware of memory problems, attributing meanings to symptoms, initiating help-seeking, acknowledging the severity of cognitive changes and finally obtaining a definitive diagnosis. Individuals with dementia reported noticing memory difficulties earlier than their carers. However, initial symptoms were perceived as ambiguous, and were normalised and attributed to concurrent health problems. The diagnostic process was typically characterised by multiple visits and interactions with health professionals, and a diagnosis was obtained as more severe cognitive deficits emerged. Throughout the diagnostic pathway, carers played dynamic roles. Carers initially served as a source of encouragement to seek help, but they eventually became actively involved over concerns about alternative diagnoses and illness management. A better understanding of the pre-diagnosis period, and the complex interactions between peoples beliefs and attributions about symptoms, may elucidate some of the barriers as well as strategies to promote a timelier dementia diagnosis.

Quality of life in young adults who underwent resective surgery for epilepsy in childhood.

Purpose:  This study investigated quality of life (QOL) in young adults who had undergone epilepsy surgery before the age of 16 years. The contribution to QOL of seizure status in the prior year, sex, number of antiepileptic drugs, and mood were evaluated.

Evaluation of an Assessment Battery for Estimating Dementia Caregiver Needs for Health and Social Care Services

Objectives: The aim of this study was to examine a battery of questionnaires for assessing the personal resources and vulnerabilities of family caregivers of persons with dementia (Alzheimer or other). Methods: A cross-sectional survey design was used to obtain dementia caregiver responses to questionnaires that targeted caregiver stress response, physical/mental health status, self-efficacy, personality, and social support. Results: A personality factor (neuroticism) explained over 20% of the variance in caregiver mental health status and depression. With caregiver distress as the dependent variable, personality and self-efficacy accounted for 15% to 17% of the explained variance. Conclusions: The results suggest that measures of personality factors, self-efficacy, mental health status, and distress response could be used for assessing caregiver vulnerabilities and health service needs. This individualized approach could ensure allocation of multicomponent intervention programs that have been shown to be more effective in sustaining caregiver role functions.

Pathways to dementia diagnosis among South Asian Canadians

Urban centers are increasingly ethnically diverse. However, some visible minorities are less likely than their majority counterparts to seek and receive services and treatment for dementia. This study explored experiences of South Asian Canadians, Canada’s largest visible minority group, prior to dementia diagnosis. Six persons with dementia and eight of their family carers described their early perceptions of dementia-related changes, actions taken, including help seeking and diagnosis, and affective responses. Early signs were attributed to aging or personality. Even after cognitive enhancers were prescribed, some respondents continued to believe that the dementia symptoms were ‘normal’. Family carers’ affective responses may be related to their attributions. Before seeking medical attention, family carers modified physical or social environments because of symptoms. Help seeking was delayed up to four years, even with significant dementia symptoms. Recognition of a health problem was influenced by safety concerns, emergence of new symptoms following trauma, and treatment for other health problems. For some, relatives living outside the home or outside Canada were instrumental in recognizing a problem and convincing family carers and persons with dementia to seek medical attention. The pathway to diagnosis might be easier with outreach to help South Asian immigrants differentiate between normal aging and dementia. Symptom recognition by physicians treating other acute conditions was a portal to dementia services for others. Screening and referral in acute care could result in earlier diagnosis and treatment.

Patient‐reported outcome of pediatric epilepsy surgery: Social inclusion or exclusion as young adults?

Purpose:  The purpose of this study was to examine the social relationships and participation in educational, vocational, and community life in young adults who had undergone epilepsy surgery during childhood or adolescence.

Negotiating access to a diagnosis of dementia: Implications for policies in health and social care.

The ‘Pathways to Diagnosis’ study captured the experience of the prediagnosis period of Alzheimer’s disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the ‘Candidacy’ framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups.

The Objective Behavioral Index: a measure for assessing treatment response of patients with severe personality disorders.

A measure that captures the frequency and intensity of experienced dysfunctional behaviors as well as the use of mental health services was developed and tested as part of a treatment controlled trial of patients with borderline personality disorder. The Objective Behavioral Index (OBI) was completed by 136 subjects with the diagnosis of borderline personality disorder before random assignment to treatment and by 35 subjects at each follow-up point. With one exception, the OBI subindexes (Dysfunctional Behaviors and Service Utilization) were not intercorrelated nor were they associated with any of the other patient status measures. Both of the OBI subindexes were sensitive to change after a course of psychotherapy. The OBI measurement system is easy to use and provides important information about behavioral dysfunction and service utilization. Also, contrary to expectations, service utilization is not associated with patient symptomatic and behavioral status.

Effects of the implementation of a breastfeeding best practice guideline in a Canadian public health agency

Several strategies were used to implement a breastfeeding best practice guideline (BPG) in a Canadian public health agency. Nurses surveyed before and 1 year after implementation reported increased BPG-related knowledge and stronger beliefs regarding breastfeeding duration beyond 1 year. Telephone surveys also were conducted with mothers; 90 before BPG implementation and another cohort of 141 mothers following implementation. Post-implementation mothers were more knowledgeable about sources of breastfeeding help, obtained more help from public health nurses, and reported more breastfeeding-related discussion with healthcare providers. Compared to the pre-implementation cohort, mothers in the post-implementation cohort who were still breastfeeding at 6 months intended to continue breastfeeding longer. Implementing a breastfeeding BPG can affect breastfeeding-related experiences at a population level.

Integrating gerontological competencies in Canadian health and social service education: An overview of trends, enablers, and challenges

ABSTRACT As the number of older adults increases, it is imperative that gerontological competencies are imbedded in health and social service education reviews of Canadian published and grey literature presents trends, barriers, and enablers of sustained movement toward graduating professionals with gerontology competencies. Overall, gerontological education remains insufficient. Main barriers include resources for faculty and teaching. This review also identified discipline-specific competency frameworks that could inform curriculum enhancement and education accreditations; however, most educators were unaware of these. Further limiting workforce development is the lack of gerontology competency statements within regulatory documents. This review concludes with recommendations for federal and provincial policies to establish educational accreditation programs in geriatrics, develop core competencies, and integrate these into regulatory frameworks. Failure to do so will continue the trend of insufficient preparation of health and social service professionals to care for older adults.