Maternity Mates at Sister Circle

In a perinatal cohort of women in urban and rural Turkey, we investigated associations between antenatal depressive symptoms and subsequent changes in perceived quality of key family relationships. Of 730 women recruited in their third trimester (94.6% participation), 578 (79.2%) were reassessed at a mean of 4.1 (s.d. = 3.3) months after childbirth, 488 (66.8%) were reassessed at 13.7 (s.d. = 2.9) months, and 448 (61.4%) at 20.8 (s.d. = 2.7) months. At all four examinations, self-reported quality of relationship with the husband, mother and mother-in-law was ascertained using the Close Persons Questionnaire with respect to emotional support, practical support and negative aspects of the relationship. Antenatal depressive symptoms were defined using the Edinburgh Postnatal Depression Scale. A range of covariates in mixed models was considered including age, education, number of children, family structure, physical health, past emotional problems and stressful life events. Key findings were as follows: (i) reported emotional and practical support from all three relationships declined over time in the cohort overall; (ii) reported emotional support from the husband, and emotional and practical support from the mother-in-law, declined more strongly in women with antenatal depressive symptoms; (iii) associations between depressive symptoms and worsening spouse relationship were more pronounced in traditional compared with nuclear families. Antenatal depressive symptoms predicted marked decline in the quality of key relationships over the postnatal period. This may account for some of the contemporaneous associations between depression and worse social support, and may compound the risk of perinatal depression in subsequent pregnancies.

Practical support predicts medication adherence and attendance at cardiac rehabilitation following acute coronary syndrome

Family quality of life (FQOL) is a recent concept in intellectual/developmental disability research. Outcomes for the family are important to the provision of services because families, rather than institutions, are increasingly considered the primary support unit. This article presents Australian findings using the international Family Quality of Life Survey: Main Caregivers of People with Intellectual or Developmental Disabilities (FQOLS-2006). Forty-two South Australian main caregivers of people with an intellectual/developmental disability were interviewed using the FQOLS-2006. The FQOL domains assessed were Health of the Family, Financial Well-being, Family Relationships, Support from Other People, Support from Disability-Related Services, Influence of Values, Careers, Leisure and Recreation, and Community Interaction. Domains were measured in terms of Importance, Opportunities, Attainment, Initiative, Stability and Satisfaction. The FQOLS-2006 asked about the family's practical and emotional Support from Other People together, whereas the current study separated the constructs of practical and emotional support. Questions pertaining to FQOL in the past were also added, in order to gain a broader picture of present FQOL. Results indicated that families considered all the FQOL domains to be important. However, Health, Family Relationships and Financial Well-being were regarded as slightly more important than Practical and Emotional Support from Others. The attainment of Family Relationships, Health, Values, and Leisure and Recreation were rated as quite a bit, but Practical Support from Other People was only rated as a little. Families were generally satisfied with all FQOL domains, but they were satisfied with their Family Relationships and they were neither satisfied or dissatisfied with their Financial Well-being. Results also indicated that there was a need to distinguish between the provision of practical and emotional support from others, because the attainment of emotional support was rated at a slightly higher level than practical support. The FQOLS-2006 provided a comprehensive measure of FQOL, which, with some additional modifications, could be used to better inform service provisions and ultimately enhance the quality of life of people with intellectual/developmental disabilities and their families.

Family caregivers of people with dementia in nursing homes may need support from healthcare providers, especially when death is approaching. To increase our understanding of family caregivers' experiences in their relative's last week of life before and during the pandemic, their needs for emotional, practical, and spiritual support, and the extent to which those needs are accommodated by healthcare providers. Survey among bereaved family caregivers of people with dementia recruited from six nursing homes in the Netherlands in 2018-2019 and 2020-2022. The questionnaire was completed by 165 family caregivers (response rate: 55%). Most respondents (79%) rated the overall care they received as "excellent," "very good," or "good." More respondents reported a need for emotional (74%) and practical (64%) support than for spiritual support (37%). Emotional and practical support were more commonly "always" or "most of the time" provided (63% and 51%, respectively) than spiritual support (22%). Differences existed in the presence of practical, emotional, and spiritual support needs (p < 0.001) and the frequency in which those support types were provided when there was a need (p < 0.001). The overall care that was received was more likely to be rated as "excellent" or "very good" when a higher frequency of emotional (p < 0.001), spiritual (p < 0.002), or practical (p < 0.001) support was reported. Before and during the pandemic, family caregivers' responses were mostly similar. Family caregivers had support needs that were not always met, which was especially the case for spiritual support needs. Healthcare providers should be trained to accommodate support needs and refer to appropriate support services when necessary.

Research conducted to examine nurses' breastfeeding support to first-time mothers is sparse in Turkey. To identify informational, practical and emotional support that mothers had received from nurses in the early postpartum period. A descriptive and cross-sectional study of 192 mothers who took part in the research prior to discharge from a maternity hospital in Ankara, Turkey. Mean, standard deviation and percentages were used to analyze the maternal characteristics. Chi-square test was used to analyze informational, practical and emotional support received by the mothers in relation to socio-demographic characteristics. Multiple logistic regression analyses were performed to evaluate risk factors for in-hospital formula supplementation and experiencing breastfeeding problem. The mothers stated that the information provided should be adequate (41%), given individually (36.3%) and taught through practice (41%). Supplementary feeding was the only statistically significant predictor of in-hospital breastfeeding problems [P<0.01, odds ratio (OR) 0.109, 95% confidence interval (CI) 0.33-0.361]. Experiencing a breastfeeding problem, not receiving practical support, and the unavailability of nurses were statistically significant predictors of supplementation respectively (P<0.01, OR 0.084, 95% CI 0.023-0.309; P<0.05, OR 0.239, 95% CI 0.071-0.809; P<0.05, OR 3.442, 95% CI 1.059-11.183, respectively). Informational, practical and emotional support offered by nurses has the potential to make a difference in reducing breastfeeding problems and in-hospital supplementation. Practical support could be enhanced through effective implementation of early maternal/infant skin-to-skin contact in a busy hospital environment.

The role of emotional and practical support is critical to the healing process for a mother and her family when suffering from a postpartum mental illness. It is imperative for the healthcare provider and mental healthcare provider to have an evidenced-based understanding of the roles of family, friends, and community support networks. This chapter will explore the types of support that mothers and families can benefit from on the road to recovery from postpartum mood and anxiety disorders. Understanding the roles of partner and families can facilitate communication leading to better support. By reviewing the current research on the links between social support and how this interfaces with maternal well-being and treatment, this chapter will provide a comprehensive overview of both formal and informal social networks with the components of each. Reviewing the institutional supports and operational guidelines that define and provide social support for mothers gives a roadmap for families searching for support during this critical postnatal time. Also included in this chapter are special considerations regarding diverse populations with multicultural needs and cultural beliefs that can affect prompt treatment and support for perinatal mood and anxiety disorders. This chapter provides the reader a comprehensive review of the emotional and practical social support needed in the holistic treatment of the mother and her support system during the postnatal period.

Heart failure is a complex pathological syndrome resulting from a number of cardiac disease processes and leading to the development of a number of clinical symptoms that defy simple definition.14 Symptoms of heart failure include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, decreased appetite, and peripheral oedema, among others.4,10 The clinical course of heart failure is characterized by recurrent readmission with congestion and an increased burden on health care services.6,11,13 Pharmacological therapy, such as with ACE inhibitors, spironolactone, and beta-blockers, has proven to benefit survival.21 Non-pharmacological therapies, such as multidisciplinary team management programs that include nursing interventions, have been demonstrated to reduce readmission rates, especially in high-risk groups of patients such as the elderly2,5,12,18,19 (Figure 1). In addition to reducing readmission rates, nursing intervention has been shown in studies to improve medication prescription, medication compliance, improve understanding of the condition, and improve quality of life in the high-risk heart failure patient. Pharmacological therapy, including drug titration within protocols Patient education and self-care Psychosocial support Coordination of services It is essential that nurses possess appropriate knowledge and practical experience in medication prescription for heart failure patients. Within this role, nurses schedule patients for titration of their medication and follow-up of their care. The importance of this role is shown by the evidence that prescribing to the maximum-tolerated dose improves patient outcomes (ESC guidelines: Swedberg et al. 2005). Treatment of heart failure with diuretics improves symptoms such as dyspnea and ankle edema and improves exercise tolerance.21 The ESC guidelines recommend that increases or decreases in diuretic dose should be monitored for clinical response within one week. Metolazone, a potent thiazide diuretic, has a complementary effect in combination with loop diuretics and is recommended only as a drug of “last resort”. Following initiation of diuretic therapy, patients should be very carefully monitored for potential side effects of hyponatremia and worsening of renal function.21 ACE inhibitors and angiotensin receptor blockers may be titrated at 2-weekly intervals. In these patients, renal profile and blood pressure measurements are repeated within 2 weeks, with monitoring for worsening renal function or hypotension <90 mmHg. Potential side effects should be discussed with the patient and, particularly if symptoms of dizziness develop, patients should be advised to notify the heart failure service. Patients should also be offered advice on the use of non-steroidal anti-inflammatory and COX-2 inhibitors, as many such medications are available over-the-counter.21 Beta-blockers are recommended in all cases of mild, moderate, and severe heart failure, either ischemic or non-ischaemic, and in patients with reduced left ventricular ejection fraction.21 Titration is recommended at 1–2 weekly intervals. Patients may potentially develop transient worsening heart failure symptoms, hypotension, and bradycardia.21 Aldosterone antagonists are indicated for NYHA III or IV heart failure. Management requires intensive follow-up after medication initiation. The renal profile is checked at 5–7 days after initiation of therapy to measure serum potassium and creatinine and is repeated thereafter until levels are stable; the renal profile is then checked every 3–6 months.21 In the presence of potassium levels >5.5 mmol/L or creatinine >221 µmol/L, the dose or frequency of the aldosterone antagonist should be reduced. If there is evidence of potassium >6.0 mmol/L or creatinine >310 µmol/L, the medication should be stopped. Patients may require a reduction in diuretic dose when aldosterone antagonist therapy is introduced.21 Liaising with the general practitioner (GP) and pharmacist is an important role for the heart failure nurse when medications are being titrated. Changes in medication can be confusing for patients and treatment should be tailored to the needs of each individual. Many patients, for example, are elderly, and blister packs prepared by the pharmacy can simplify the medication. Supervision or assistance by a family member is an alternative. It is important to explain the purpose of each medication to the patient, giving both its trade and generic name and potential side effects as outlined previously. Patient education may be initiated either prior to discharge or following discharge.2,5,12,18,19 Which of these approaches is most advantageous to patients and their carers remains unclear. Topics for patient education should follow the ESC guidelines21 (Table Table 1). Education of the patient at our institution begins during the inpatient period. Patients receive a minimum of three 30–60 minute sessions of education, and every effort is made to include their carers in this program.11,12 A booklet for later reference is also provided.9 It should be stressed that education continues up to and beyond discharge. Symptoms that are covered during patient education include dyspnea, fatigue, ankle swelling, loss of appetite, dizziness, and palpitations. Patients are particularly encouraged to report any change in their symptoms. Episodes of paroxysmal nocturnal dyspnea should be reported by telephone the next day, as should weight gain unresponsive to adjustment in diuretics. During the inpatient period, patients are monitored daily. At discharge, patients can be monitored via telephone for any signs of symptom deterioration.12 Scheduled clinic visits ensure assessment compliance with medications, titration of medications, and monitoring for potential side effects, as well as any signs of deterioration. Patients should have the facility to report a deterioration in their condition and are encouraged to telephone the heart failure nurse if this occurs.12 In cases of weight gain, nurses are permitted to change the diuretic dose over the telephone, guided by accepted hospital protocols. Other reported symptoms are triaged by the nurse and a follow-up is scheduled based on the assessment. Education is based on principles of self-care that are supported by the heart failure nursing literature.1,4,8,17 According to 15, self-care may be defined as: “The practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being”.15 A self-care agent is: “An individual who possesses the ability to engage in activities that promote and maintain healthy behavior” which are activated when there is an identified need.15 This is the basis of the education that patients receive from their nurse. A definition of self-care that may be more pertinent to heart failure was provided by 1717: “The naturalist decision-making process involving the choices of behaviors that maintain physiologic stability (self-care maintenance) and the response to symptoms when they occur (self-care management).” Breaking this definition down, self-care maintenance is where patients monitor their symptoms on a daily basis and adhere to recommended treatments. Self-care management is where there is recognition of symptom deterioration, evaluation of that deterioration, treatment implementation, and evaluation of treatment effectiveness.17 For self-care in heart failure, it is important that patients understand their condition and use decision-making skills to choose the appropriate action, which may be directed by the nurse or doctor by telephone. Before patients can initiate self-care, they must “gain knowledge of their condition, reflect on its meaning, determine the course of action open to them and assess the effectiveness and desirable outcomes of the measure they employ”.15 The role of the heart failure nurse is exemplified by Orem in these terms: “the knowledge required must be imparted to them from individuals with knowledge and expertise”.15 A named nurse system is advantageous so that each patient has an identified contact following discharge, should they require reassurance or assistance if symptoms of heart failure worsen. A diagnosis of heart failure is very distressing for patients and their carers, and they require emotional and practical support. Providing appropriate emotional and practical support helps to reduce readmissions.7 Emotional support can be provided not just by health care personnel but by partners, family friends, and the extended community.1,8 Patients living with a partner show better compliance with medications. Practical support may be provided by assistance with activities of daily living and can take the form of help in transportation and the preparation of meals, especially for the elderly after their initial diagnosis. Depression, anxiety, and fear are common, both in patients and carers.1,8 It is important to identify the cause, looking into role changes, changes in financial circumstances, and the social isolation that may accompany a diagnosis of heart failure. Use of the Hospital Anxiety and Depression scale can identify those at risk, who can be then referred to other members of the multidisciplinary team.16 It is important during this process to allow patients time to express their concerns and fears, and to include carers in this discussion. The heart failure nurse has a diverse role that has extended and expanded beyond the traditional role of nurses. The skills required by heart failure nurse include communication and organizational abilities. Nurses must act in a supportive role in bringing about lifestyle changes to assist heart failure patients maintain an improved quality of life. This is best achieved when an open and therapeutic relationship has developed between the patient and nurse. It is important for the nurse to act as the patient's advocate and to remember that patients are individuals. The nurse must also liaise with other health care professionals so that a holistic approach is provided for patients.

Many studies have found that people with cancer value family support. Feminist work suggests that women carry most responsibility for practical and emotional support in families, but few qualitative cancer studies explicitly incorporate a gender perspective. We undertook secondary analysis of in-depth interviews with 33 married or cohabiting respondents with colorectal cancer in the UK to compare men and women's accounts of ‘spousal’ support. Both men and women described the vital role that their partners played in providing emotional and practical support. Mutual support and reciprocity were also key features of narratives; both men and women reported controlling their emotions to protect spouses and preserve ‘normal’ household routines. Traditional gender roles had some influence; some women organised ‘cover’ for domestic work and childcare when they were ill, while some men focused on making sure that their families were financially secure and partners were ‘protected’ from the effects of their stomas. Our findings illustrate the complexity of gendered constructions and performances of ‘care’ and contribute to debates about gender and emotional labour.

Individual development and relationships are embedded in a sociohistorical context. In the present study, we examined how relationship functioning of heterosexual couples differs across historical time in 3 population-based samples. We used data from the Swiss Social Stratification, Cohesion and Conflict in Contemporary Families Study (COUPLES: waves 1998 vs. 2011), the Swiss Household Panel (SHP: waves 2000 vs. 2016), and the British Household Panel Survey (BHPS: 1996-1997 vs. 2008-2009), each including a different measure of relationship functioning (COUPLES: conflict, SHP: practical and emotional support, and, BHPS: relationship satisfaction). We also examined the role of age and other correlates. Using propensity score matching methods, we selected couples in both waves matched by age, relationship duration, and region within each study (COUPLES: 174 couples per wave, mean age = 30 in men and 27 in women; SHP: 1,071 couples per wave, mean age = 47 in men and 44 in women; and, BHPS: 316 couples per wave, mean age = 36 in men and 33 in women). Our results revealed that while women and men in the later wave reported more frequent conflict, women in the later wave reported more emotional and practical support from their partner, resulting in a smaller gender gap over historical time, and men in the later wave reported higher relationship satisfaction. Taken together, this pattern of historical differences is largely consistent with what would be expected based on increased egalitarianism. We discuss the role of societal change in shaping romantic relationships. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Potential sources of cessation support for high smoking prevalence groups: a qualitative study

Informal carers lack adequate practical and emotional support. This PhD investigates how a software agent could be used to help maintain a carer's personal social network by mediating communication and facilitating the provision of emotional and practical support. The agent should use features of the carer and their social network to provide a personalized support interface.

ABSTRACTHow can the ‘social capital’ inherent in social networks provide contacts through which older people access practical and emotional support? What is the relative importance of kin and non-kin, and of participation in organisations and informal ties such as contacts with neighbours? Following a brief contextualisation that draws on previous literature, this paper addresses these questions through analysis ofBritish Household Panel Survey(BHPS) data. It examines the extent to which people feel they can count on emotional and practical support from friends and relatives. A dependent variable was created that measures the outcome of the ‘social capital’ residing in a respondent's social network. Relatively poor support was found amongst elders who were childless or had been continuously without a partner; relatively rich support was found amongst those who had frequent contact with other people, who interacted frequently with neighbours, and who regarded their neighbourhood as a positive social environment. Being active in organisations had less effect on social support than informal social contacts. Amongst many different forms of organisational activity, the only ones that had a positive association with social support were being in contact with others through religious activities, and engaging in sports clubs. The social support of working-class elders, even those ‘well networked’ in formal or informal ways, was strengthened less by their social capital than was that of the professional and managerial occupational groups.

Dementia caregiving is often associated with high levels of burden which can lead to negative outcomes. Caregiver burden consists of disease-specific and perceived stressors - or objective and subjective indicators of burden. Amyloid-β positron emission tomography (PET) scans can be used to enhance the accuracy of dementia diagnoses. However, the relationship between amyloid scan results and caregiver burden is less well understood. We conducted a parallel mixed-methods study. We used quantitative survey data from 1,338 care partners to persons with MCI and dementia who received an amyloid scan as part of the CARE-IDEAS study in the US. Logistic regression models were used to test the association between the scan result and objective measures of caregiver burden. Semi-structured interviews were conducted with a subsample of 62 care partners. Thematic analysis was used to investigate subjective indicators by exploring care partners’ perceptions of their role following an amyloid scan. Quantitative analysis showed that an elevated amyloid scan result was associated with spending more hours caregiving for MCI care partners. However, our thematic analysis showed that the scan result influenced participants’ perceptions and expectations of their caregiving role and helped some care partners to develop coping strategies. All care partners described needing practical and emotional support. Amyloid scan results can influence objective and subjective indicators of burden and may present an opportunity for diagnosing clinicians to identify and address care partners’ emotional and practical support needs.

The Academy of Breastfeeding Medicine27^th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

To date, little attention has been paid to supportive relationships as factors contributing to weight loss from bariatric surgery. This prospective study examined whether total percentage weight loss (%TWL) at 3, 12 and 24months post-surgery varies by distinct aspects of pre-surgery social support (received emotional and practical support and contact with friends and family) in a sample of bariatric surgery candidates (n = 182). These associations were tested with linear regression models adjusted for gender, age, ethnicity, employment status, self-esteem, mastery and time elapsed since the day of surgery. One hundred fifty-four participants underwent a bariatric procedure, and all but seven provided weight loss data at least at one occasion. Emotional support and contact with friends were positively associated with %TWL at 3, 12 and 24months, and the magnitude of these associations was large. For instance, in the fully adjusted models, %TWL at 24months increased by 2.36% (SE 1.17, p = 0.048) with each increase of one standard deviation in emotional support and was higher by 9.23% (SE 4.31, p = 0.035) for participants who reported seeing 1-5 friends per month compared with those who saw none. There was some evidence for a positive association between practical support and %TWL at 3 and 12months post-surgery. Supportive relationships are important contributors to weight loss from bariatric surgery. If replicated in future studies, these findings could inform clinical care and interventions aimed at improving support systems of bariatric surgery candidates.