Caregiver Health Research Articles

The Crucial Role of Psychosocial Research for Patients and Caregivers: A Narrative Review of Pediatric Psycho-Oncology Research in India

AbstractThe focus of pediatric cancer research in India has largely been medical and clinical, with little focus on psycho-oncological aspects. Receiving a cancer diagnosis can be life altering for both the patients as well as their families and points to a need for psycho-oncological research. The present narrative review examined original articles on pediatric psycho-oncology research conducted in India particularly in the past two decades. There is promising research in various domains such as survivorship and quality of life, patient needs and psychosocial concerns, communication between health care providers, patients, and caregivers, parent and caregiver needs including psychosocial support and information, as well as some intervention-based studies. With much of the research being conducted within clinical setups through surveys and retrospective data, psychosocial issues faced by patients and their families are discussed along with physical, logistical, and financial concerns, while forays into intervention-based research are still in primary phases but show potential in terms of outcomes and feasibility. There is need for more methodologically rigorous research rooted in strong theoretical foundations, culturally sound models, and with evidence-based examination of all stages and stakeholders involved in providing and receiving care in pediatric cancer.

Nursing Experience Caring for a Premature Infant With Bronchopulmonary Dysplasia

A nursing experience supporting parents experiencing anxiety related to their 26+2 weeks preterm infant on continued ventilator assistance at home due to bronchopulmonary dysplasia is described in this article. Data were collected from March 21st to June 1st, 2021 via observation, interviews, clinical care, medical record reviews, and discharge preparation services. A holistic nursing assessment identified the main health issues as: gas exchange disorder, inefficient infant feeding patterns, and caregiver role stress. The parents were encouraged to participate in care activities, create individualized discharge plans, and view health education videos and caregiving skill demonstrations. Kangaroo care, comfortable positioning and soothing techniques were used to stabilize the emotions of the infant and to strengthen the parent-child bond. Psychological support was provided to alleviate parental anxiety and to enhance parenting ability and confidence. This experience supports the importance of tailoring clinical care to individual needs, adopting a family-centered approach, assessing family interactions, and making early preparations to obtain appropriate continuous care after discharge to ensure proper continuum of care.

Disparity in oncology therapy access and differences in clinical pathological features and outcomes in indigenous population lung cancer (LC): A retrospective study from Martinique.

1599 Background: The epidemiology of cancers in terms of incidence and mortality are different in the French overseas compared to mainland France (FRANCIM 2019 data). Indigenous population are under-represented in clinical trials. Little is known about clinic-pathological features and outcomes from Caribbean islands. We report clinico-pathological features and survival in populations of patients with lung cancer (LC) and delays in access to therapy in Martinique. Methods: We conducted an academic retrospective study on patients with lung cancer (LC), treated at the University Hospital in Martinique between 2020-2022. The hospital in Martinique centralized all cancer patients in the territory for treatment. Demographic, risk factors, disease features, and treatment outcomes were collected from medical records. The molecular profile was determined using next-generation sequencing with the Archer FUSION Plex Lung v2 panel, evaluating at least EGFR, ALK, KRAS, ERBB2, MET, ROS1, BRAF, RET, NUTM1, PIK3CA, FGFR1, FGFR2, FGFR3, NRG1, NTRK1, NTRK2, NTRK3. We assessed time from symptoms to diagnosis and treatment, and overall survival (OS). Results: Overall, 268 patients (pts) were included. Pts were male in 51% cases (N=136), had a smoking history in 57% (N=139/243), with a median pack-years of 40 [IQR 22-50]. Median age was 67 years-old [IQR 58-78]. Histology was adenocarcinoma in 78% (N = 208), squamous cell in 13% (N=34), neuroendocrine tumors in 8% (N=21), and others in 2% (N=5). No small cell carcinoma diagnosed. Tumors had high PD-L1 expression (≥50%) in 18% (N=41/227) of cases. An oncogenic addiction was reported in 58% (N =105/181) of non-small cell and non-squamous lung carcinoma: EGFR36% (N=65), ALK3.3% (N=6), BRAF1.1% (N=2), KRAS13.3% (N=24). Pts had an ECOG performance status of 0-1 at diagnosis in 66% (N =162/244). LC was metastatic from diagnosis in 65% cases (N=175), with 18% having brain metastases (N=48). Median time between symptom occurrence and diagnosis was 66 days [IQR 21-171] and time between biopsy and treatment start was 56 days [IQR 31-77]. In pts with stage IV disease, 33% (N=59/175) never received a systemic treatment. In patients with at least 6 months of follow-up in the absence of death, median OS was 12.4 months (95% CI 8.6 – 17.1) overall and 8.6 months (95% CI 5.3 – 13.3) in patients with initial metastases. Conclusions: The lower overall survival rate than expected in this cancer context address the question of disparity population. One-third of LC metastatic patients did not receive systemic therapy. The local inadequacy of care pathways, leading to disparities in access to imaging, may explain the delays and poorer prognosis. A new initiative from a collaborative group with health authorities, caregivers, politicians and patient’s advocacy is actively working to improve cancer patient’s outcomes.

Stakeholders' perspectives on adverse effects of ECT: A qualitative thematic analysis.

In the Indian context, published systematic research on the opinions of mental health professionals and other stakeholders (patients and caregivers) regarding the different adverse effects of electroconvulsive therapy (ECT) is not available. This type of study allows for an in-depth exploration of complex phenomena, such as the perspectives of mental health professionals, which can provide a rich understanding of their experiences regarding ECT and also helps to understand the views of mental health professionals regarding the adverse effects of ECT during the post-ECT recovery period and its management. Conversely, the perception of patients and caregivers regarding the adverse effects of ECT can provide a more comprehensive understanding of the treatment and its impact on the patients who receive it. To explore the understanding of participants about the various adverse effects following ECT and their perception of managing different adverse effects of ECT during the post-ECT recovery period. A qualitative approach using focus group discussion (FGD) was used. A convenience sampling technique was followed for selecting the participants. FGDs were conducted with stakeholders including mental health professionals, patients, and caregivers. Five FGDs were conducted with psychiatry residents, nursing officers from the ECT suite, and different psychiatry wards at NIMHANS. Four FGDs were held separately for patients receiving ECT and their caregivers, admitted to various psychiatry wards at NIMHANS. A total of 28 mental health professionals, 20 patients, and 20 caregivers participated. The number of participants for FGDs was decided based on data saturation. The FGDs, lasting 30-40 minutes each, occurred between October 2022 and December 2022. The FGDs were audio-recorded with prior permission from the participants. All the participants were informed about the study. Written informed consent was obtained. All FGDs were transcribed. Thematic analysis was done using Atlas. ti software. The broad categories identified were adverse events associated with ECT during the ECT procedure, adverse events associated with ECT after the ECT procedure, prevalence of different adverse effects according to mental health professionals, effects of adverse effects on the continuity of ECT, and difficulties encountered by mental health professionals throughout the management. Other broad categories were found after conducting FGDs with caregivers and patients, which were patients' experience as per the caregivers over the course of ECT, caregivers' and patients' willingness to continue ECT, unfavorable impacts of ECT experienced by the patients immediately after ECT sessions, and, later till the end of that day, suggestions of the caregivers and patients to improvise the management of ECT-related adverse effects and management of adverse effects by the treating team. The findings will develop a standard operating procedure that may help nursing officers monitor and identify the adverse effects immediately after ECT and minimize the complications during the post-ECT recovery period.

Narrating the Sociocultural Experience and Management of Stigma Related to Military Caregiving

ABSTRACT Despite accelerating the recovery and rehabilitation of wounded veterans and saving the U.S. substantial sums in avoided long-term care costs, military caregivers (MCs) are an underserved community lacking resources and support. On top of managing a variety of emotional, physical, relational, and occupational challenges, MCs experience stigma. Indeed, caregiving can be a stigmatized task, especially for military-affiliated individuals who may be expected to adhere to cultural norms of personal sacrifice and resilience in the face of adversity. The current study uses narrative inquiry to better understand the unique experiences and characteristics of MCs providing care for veterans experiencing posttraumatic stress. Specifically, this study examined MCs’ narratives to uncover the sociocultural experience and management of stigma related to military caregiving. Interviews with 15 military caregivers of veterans experiencing PTS demonstrated that military caregivers experienced stigma for 1) staying in the relationship, 2) enabling the veteran, 3) mismanaging the condition, and 4) flaking on plans and relationships. In response to stigma, MCs often challenged stigma through strategies of denial or evasion of responsibility. This study contributes to communication scholarship by introducing co-stigma management and further interrogating processes related to stigma management communication. In addition, the results can inform Veteran Affairs (VA) healthcare, caregiver assistance programs, health practices, and support-seeking behaviors.

Real-Life Achievements of MiniMed 780G Advanced Closed-Loop System in Youth with Type 1 Diabetes: AWeSoMe Study Group Multicenter Prospective Trial.

Background: We assessed real-life glycemic outcomes and predictors of composite measures of optimal glycemic control in children and adolescents with type 1 diabetes (T1D) during their initial 12 months of the MiniMed™ 780G use. Methods: This prospective observational multicenter study collected demographic, clinical, and 2-week 780G system data at five time points. Optimal glycemic control was defined as a composite glycemic control (CGC) score requiring the attainment of four recommended continuous glucose monitoring (CGM) targets, as well as the glycemia risk index (GRI) of hypoglycemia and hyperglycemia and composite CGM index (COGI). Outcome measures included longitudinal changes in multiple glycemic parameters and CGC, GRI, and COGI scores, as well as predictors of these optimal measures. Results: The cohort included 93 children, 43% girls, with a median age of 15.1 years (interquartile range [IQR] 12.9,17.0). A longitudinal analysis adjusted for age and socioeconomic index yielded a significant improvement in glycemic control for the entire cohort (ptime < 0.001) after the transition to 780G. The mean hemoglobin A1c (HbA1c) (SE) was 8.65% (0.12) at baseline and dropped by >1% after 1 year to 7.54% (0.14) (ptime < 0.001). Optimal glycemic control measures improved at 12 months post 780G; CGC improved by 5.6-fold (P < 0.001) and was attained by 24% of the participants, the GRI score improved by 10-fold (P = 0.009) and was achieved by 10% of them, and the COGI improved by 7.6-fold (P < 0.001) and was attained by 20% of them. Lower baseline HbA1c levels and increased adherence to Advanced Hybrid Closed-Loop (AHCL) usage were predictors of achieving optimal glycemic control. Conclusions: The AHCL 780G system enhances glycemic control in children and adolescents with T1D, demonstrating improvements in HbA1c and CGM metrics, albeit most participants did not achieve optimal glycemic control. This highlights yet ongoing challenges in diabetes management, emphasizing the need for continued proactive efforts on the part of health care professionals, youth, and caregivers.

Engagement personas in patients living with atrial fibrillation and multimorbidity, and their caregivers: results from the AFFIRMO international online survey

Abstract Introduction Patients with atrial fibrillation (AF) often experience concomitant long-term health conditions. Their level of engagement, defined as their active role in the management of their condition, is crucial in identifying strategies to improve their care and self-management; similarly, the engagement level of their caregivers is also important. Purpose The AFFIRMO study aims to examine ways of optimising care and self-management for AF patients with multimorbidity by identifying characteristics of engagement personas for patients and their caregivers. Methods An online survey, distributed between June 2022 and January 2023, open to AF patients and their caregivers in five countries (UK, Italy, Denmark, Romania and Spain) collected data related to patients and caregivers’ engagement in the healthcare process using the Patient Health Engagement Scale® (PHE-s), the Altarum Consumer Engagement (ACE), and the Caregiver Health Engagement Scale® (CHE-s). Patients and caregivers were grouped into ‘high’ and ‘low’ engagement groups, based on scale-specific cut-off values, and compared by age group, sex, level of education and country of recruitment, using Chi-square tests (p&amp;lt;0.05). Results 659 patients (311 (47.2%) male, 70.9 (10.2) years), and 201 caregivers (54 (26.9%) male, 58.3 (15.2) years) participated. Based on the PHE-s®, 428 (64.9%) were classified as ‘high’ engagement level. Patients in the high engagement group were significantly more likely to be male, aged &amp;lt;75 years, have secondary level education or above, and have &amp;lt;3 co-morbidities; no differences in engagement level based on country of recruitment. Based on the ACE scale, 369 (56.0%) were categorised as ‘high’ engagement level. Those with ‘high’ engagement were significantly more likely to be &amp;lt;65 years old, living in Northern Europe, educated to degree level or above, and had &amp;lt;3 co-morbidities, with no sex differences in engagement level. One hundred thirty-eight (68.7%) caregivers reported ‘high’ engagement. However, there were no significant differences between sex, age group, region of recruitment, or level of education between high and low engagement in caregivers. Conclusions Identification of engagement personas of patients and their caregivers could help to develop better management pathways for AF patients with multimorbidity.Table 1.Level of engagement

Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review.

People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination.

Field testing of user-friendly perennial malaria chemoprevention packaging in Benin, Côte d’Ivoire and Mozambique

BackgroundPerennial malaria chemoprevention (PMC) aims to protect children at risk from severe malaria by the administration of anti-malarial drugs to children of defined ages throughout the year. Sulfadoxine-pyrimethamine (SP) has been widely used for chemoprevention in Africa and a child-friendly dispersible tablet formulation has recently become available.MethodsThis qualitative non-interventional observational study was conducted in Benin, Côte d’Ivoire, and Mozambique between February and June 2022. Prototype blister packs, dispensing boxes and job aids designed to support dispersible SP deployment for PMC were evaluated using focus group discussions (FGD) and semi-structured in-depth individual interviews (IDI) with health authorities, health personnel, community health workers (CHWs) and caregivers. The aim was to evaluate knowledge and perceptions of malaria and chemoprevention, test understanding of the tools and identify gaps in understanding, satisfaction, user-friendliness and acceptability, and assess the potential role of CHWs in PMC implementation. Interviews were transcribed and imported to ATLAS.ti for encoding and categorization. Thematic content analysis used deductive and inductive coding with cross-referencing of findings between countries and participants to enrich data interpretation. Continuous comparison across the IDI and FGD permitted iterative, collaborative development of materials.ResultsOverall, 106 participants completed IDIs and 70 contributed to FGDs. Malaria was widely recognised as the most common disease affecting children, and PMC was viewed as a positive intervention to support child health. The role of CHWs was perceived differently by the target groups, with caregivers appreciating their trusted status in the community, whereas health authorities preferred clinic-based deployment of PMC by health professionals. Empirical testing of the prototype blister packs, dispensing boxes and job aids highlighted the context-specific expectations of respondents, such as familiar situations and equipment, and identified areas of confusion or low acceptance. A key finding was the need for a clear product identity reflecting malaria.ConclusionSimple modifications profoundly affected the perception of PMC and influenced acceptability. Iterative quantitative investigation resulted in PMC-specific materials suited to the local context and socio-cultural norms of the target population with the aim of increasing access to chemoprevention in children most at risk of severe malaria.

A Visualization Tool to Study Dyadic Caregiving Health Profiles.

Guided by a life course perspective and fundamental cause theory, this study aims to visualize co-trajectories of health between partners and examine how changes in one spouse's cognitive status can cohesively impact the health of the other spouse along three dimensions (functional, mental, and cognitive). Drawing longitudinal data from the Health and Retirement Study 2000-2016 (N = 3582), we measure women's health profiles by functional limitation (physical health), depression (mental health), and cognitive function (cognitive health). We use multivariate linear mixed models to summarize these paths in the same visual representation. The approach provides a visualization tool that depicts data and model in the same spatial representation allowing assessment of model fit and comparison. This study advances the traditional life course studies by representing underlying processes as a multidimensional time vector of health outcomes. The described approach provides a blueprint for studying complex health profiles or trajectories.

Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App.

Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials. This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs. Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases. Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens. The co-design process appears to be beneficial in having participants voice both barriers and preferences.

Evaluation of activities of daily living using an electronic version of the Longshi Scale in patients with stroke: reliability, consistency, and preference

BackgroundThe Longshi Scale is a pictorial assessment tool for evaluating activities of daily living (ADL) in patients with stroke. The paper-based version presents challenges; thus, the WeChat version was created to enhance accessibility. Herein, we aimed to validate the inter-rater and test–retest reliabilities of the WeChat version of the Longshi Scale and explore its potential clinical applications.MethodsWe recruited 115 patients with stroke in the study. The ADL results of each patient were assessed using both the WeChat and paper-based version of the Longshi Scale; each evaluation was conducted by 28 health professionals and 115 caregivers separately. To explore the test–retest reliability of the WeChat version, 22 patients were randomly selected and re-evaluated by health professionals using the WeChat version. All evaluation criteria were recorded, and all evaluators were surveyed to indicate their preference between the two versions.ResultsConsistency between WeChat and the paper-based Longshi Scale was high for ADL scores by health professionals (ICC2,1 = 0.803–0.988) and caregivers (ICC2,1 = 0.845–0.983), as well as for degrees of disability (κw = 0.870 by professionals; κw = 0.800 by caregivers). Bland–Altman analysis showed no significant discrepancies. The WeChat version exhibited good test–retest reliability (κw = 0.880). The WeChat version showed similar inter-rater reliability in terms of the ADL score evaluated using the paper-based version (ICC2,1 = 0.781–0.941). The time to complete assessments did not differ significantly, although the WeChat version had a shorter information entry time (P < 0.001, 95% confidence interval: –43.463 to –15.488). Health professionals favored the WeChat version (53.6%), whereas caregivers had no significant preference.ConclusionsThe WeChat version of the Longshi Scale is reliable and serves as a suitable alternative for health professionals and caregivers to assess ADL levels in patients with stroke. The WeChat version of the Longshi Scale is considered user-friendly by health professionals, although it is not preferred by caregivers.Trial registrationThis study was approved by the Ethics Committee of the Second People’s Hospital of Shenzhen (approval number: 20210812003-FS01) and registered on the Clinical Trial Register Center website: clinicaltrials.gov on January 31, 2022 (registration no.: NCT05214638).

Growth and impact of Project ECHO for workforce development in age-friendly care.

Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration-funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age-friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban-underserved reach across the United States, and their hub teams include many health professions. Age-friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community-level outcome of Age-Friendly Health System designation. The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age-friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas.

Sleep quality differences among caregivers for persons living with and without dementia

Objectives This study examined the relationship between caring for a person with/without dementia and caregiver sleep quality, and analyzed the extent to which perceived benefits of caregiving and assessments of caregiver-recipient relationship quality explain the relationship between care recipient dementia status and caregiver sleep quality. Method Data were analyzed from caregivers for persons with no or probable dementia who participated in the 2017 National Study of Caregiving (NSOC) and National Health and Aging Trends Study. Caregiver sleep quality was measured using NSOC time diary interview. Perceptions of caregiving and relationship quality were assessed using 4-item surveys. We used multivariable logistic regressions to examine the association between care recipient dementia status and caregiver sleep quality controlling for covariates. Results The sample consisted of 1,374 caregivers (mean age = 62.3, SD = 14, 68.3% women, 69.4% non-Hispanic White). In multivariable models adjusting for caregiver and care recipient characteristics, being a caregiver for someone with dementia was associated with 23% lower odds of reporting “excellent/very good” sleep quality (OR: 0.77, 95%CI: 0.61-0.98, p = 0.032). Greater perception of caregiving benefits was associated with 8% greater odds of “excellent/very good” sleep quality (AOR: 1.08, 95%CI: 1.02-1.15, p = 0.013), but did not explain the relationship between dementia and caregiver sleep quality. Positive ratings of relationship quality explained the relationship between care recipient dementia status and caregiver sleep quality (AOR: 0.82, 95%CI: 0.65-1.05, p = 0.12). Conclusion Improving assessments of relationship quality and amplifying perceptions of caregiving benefits may reduce disparities in sleep quality between caregivers of persons living with or without dementia.

Low back pain, work overload, and associated factors among hospital caregivers.

Caregivers assist patients in treatment based on their care needs and living activities. Very few studies have been conducted specifically on the occupational health and safety of hospital caregivers. This study aimed to investigate the prevalence of excessive workload and low back pain among hospital caregivers and to identify potential associated factors. This cross-sectional study included caregivers working at Gazi University Hospital. Socio-demographic and working-life characteristics were assessed. The Role Overload Scale was used to determine excessive workload and the Roland-Morris Disability Questionnaire was used to evaluate low back pain. The study included 528 participants. A total of 18.7% had work accidents in their department. 49.0% had sharp injuries. 68.9% of the participants performed tasks such as positioning, turning, lifting, or helping patients to walk. 72.2% stood for a long time during the workday. 52.8% thought that they worked under stress. 57.6% had low back pain in the last year and 38.6% in the last month, Significant differences exist in low back pain according to gender, body-mass index, standing for a long time and working under stress. Those who worked at night, had a work accident, positioned patients, stood for a long time, and worked under stress had higher mean scores on the Role Overload Scale. Tools should be used to lift and transport patients. In addition to occupational health and safety training, awareness of musculoskeletal risks should be increased. Employee well-being can be improved through exercise and stress reduction techniques.

Streptomyces isolate SOM013, a potential agent against microbial resistance and gastric ulcers

The menace of microbial resistance and re-emerging disease is still a problem for healthcare givers globally, and the need for newer sources of potent antibiotics has become paramount. This study investigated the antimicrobial and antiulcer activities of Streptomyces isolate SOM013. Streptomyces isolates were cultivated and purified following standard microbiological protocols. Secondary metabolites were recovered and characterized from Streptomyces isolate SOM013 via broth fermentation and extraction. Varying concentrations (0.5 mg/mL, 0.025 mg/mL and 0.0125 mg/mL) of the SOM013 extract were used for antimicrobial screening against resistant bacteria and medically important fungi (methicillin-resistant Escherichia coli, Oxacillin resistant Helicobacter pylori, Shigella spp, extended broad-spectrum resistant Pseudomonas aeruginosa, Streptococcus spp, Campylobacter spp, Candida albicans, Aspergillus niger, and Aspergillus flavus). The antiulcer activity of the SOM013 was also examined in a methanol-induced gastric ulcer animal model. A total of 23 Streptomyces spp were recovered from the study. Methanolic extract of the SOM013 isolates was more potent across the clinical test microorganisms compared to water extract. The antimicrobial activity was dose dependent, with methanolic extract at 0.05 g/mL displaying the highest zone of inhibition (18.8 ± 0.3 mm) when tested against extended broad-spectrum resistant Pseudomonas aeruginosa. Further, the extract's ulcer index and protection efficacy were significant as the concentration increased (P < 0.01). SOM013 isolate has a moderate antimicrobial and high antiulcer activity worthy of pharmacological exploration.

"I am adhering to HIV treatment so that I can live to support her": A qualitative study of upward intergenerational support in South Africa.

Intergenerational family care, which was upended by the HIV epidemic in sub-Saharan Africa (SSA), may return to a pre-HIV era arrangement as access to antiretroviral therapy (ART) expands and treated adults can once again provide support for older household members. Empirical research has demonstrated positive 'spillover effects' of ART uptake from treated adults to younger generations, yet much less is known about the nature and breadth of such effects to older generations. This study explores the role and lived experiences among adults who take up ART and those of an older generation with whom they live. We conducted a qualitative study consisting of semi-structured interviews (n = 46) embedded in the Agincourt Health and Demographic Surveillance System (HDSS) in rural South Africa, between July and September 2022. We purposefully sampled two respondent categories: (i) young or middle-aged adults on ART (aged 18-59 years old); and (ii) older adults (aged ≥60 years old) who were affiliated with a young or middle-aged adult on ART. We used thematic content analysis to extract, code, and categorise relevant text by types of upward spillover effects from ART in younger adults to older adults. Quantitative data was extracted from the existing Agincourt HDSS database and matched to qualitative interview data based on Clinic link unique identifiers of study participants. Mean age was 41 years among young or middle-aged adults (n = 29) and 72 years among older adults (n = 17). Among younger adults, time on ART ranged from five months to more than 21 years. Both young or middle-aged adults on ART and older adults reported positive spillover effects for older adults across five main tiers: caregiving, financial support, physical and mental health, living arrangements and household relationships, and stigma and reputation. Spillover challenges included financial costs and caregiving responsibilities following ART initiation of young or middle-aged adults, although these additional caregiving responsibilities were generally not perceived as particularly burdensome. ART is likely to benefit older adults in South Africa whose families are affected by HIV. This study identified a wide range of perceived spillover effects from ART in younger adults to older adults, including improvements to upward intergenerational support. These qualitative findings offer a guide to researchers, policymakers, and donors to capitalise on the broader societal effects of a large-scale health intervention to further support family structures and meet the needs of a growing older population.

Development and evaluation of a family-child reading picture book on reducing autism spectrum disorder caregivers' psychological stress: a mixed method study.

The rapid increasing prevalence of ASD has become a significant global health issue. Caregivers of children with ASD are experiencing higher level of psychological stress and mental disorders. However, interventions to improve the psychological health of caregivers of children with ASD have largely been neglected. Based on the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model, we initially did in-depth interviews with 8 caregivers, and conducted field observation in two rehabilitation centers to analyze the daily lives, the empowered components, the emotional moments of the children with autism and their caregivers. Then we designed the outline of the picture book, and developed it by a multi-disciplinary team by 4 rounds. After that, this picture book was sent out to 54 caregivers of children with ASD for family-child reading in one month. A quantitative questionnaire was administered before and after their reading to evaluate the efficacy of reducing their stress and affiliate stigma, and improving self-efficacy, resilience, empowerment capacity; and exit interviews were conducted after their initial reading to assess the acceptability, content appropriateness, perceived benefits and generalizability of this picture book. Quantitative data were analyzed by descriptive analysis and paired t-tests using IBM SPSS 26.0. Qualitative data were analyzed using template analysis. In total, 54 caregivers read the picture book with their child, with the total of 149 (an average of 2.76 per family) times reading in one month. Among them, 39 caregivers returned the following-up questionnaires. Although most of the outcome measures did not showed significant changes except the stress level decreased statistically significant (13.38 ± 3.864 to 11.79 ± 3.238, P=0.001), caregivers reported that the picture book echoed their daily lives and gave them a sense of warmth, inspiration, and hope, as well as some insight on family relationships and attitudes towards the disorder. They also expressed a willingness to disseminate the book to other families with children suffering ASD and the public. This specially designed picture book has been proven to be an acceptable, content-appropriate, and effective family-centered psychological intervention, which could be easily scaled up.

The impact of WeChat online education and care on the mental distress of caregivers and satisfaction of elderly postoperative colorectal cancer patients

ObjectiveWeChat-based nursing interventions alleviate mental distress. This study intended to investigate the effect of WeChat online education and care (WOEC) on the mental health of caregivers and the satisfaction of elderly postoperative colorectal cancer (CRC) patients. MethodsIn total, 92 elderly postoperative CRC patients and 92 caregivers were randomly separated into the WOEC group (46 patients and 46 caregivers) and the control care group (46 patients and 46 caregivers). Caregivers received corresponding intervention for 8 weeks. Beck depression inventory (BDI) and beck anxiety inventory (BAI) of caregivers, and self-report satisfaction (SRS) of patients were assessed. ResultsIn caregivers, BDI scores at 8 weeks after enrollment (W8) (P = 0.024) and BAI score at W8 (P = 0.009), depression severity at W8 (P = 0.036), as well as anxiety severity at 4 weeks after enrollment (W4) (P = 0.028) and W8 (P = 0.047) were declined in the WOEC group versus the control care group. Regarding patients, SRS scores at W4 (P = 0.044) and W8 (P = 0.025), the satisfaction degree at W4 (P = 0.033) and W8 (P = 0.034), as well as the satisfied and very satisfied rates at W4 (P = 0.031) and W8 (P = 0.029) were elevated in the WOEC group versus the control care group. By subgroup analyses, WOEC exhibited favorable effects on reducing mental stress in caregivers of patients with eastern cooperative oncology group performance status at enrollment <3, and in caregivers with an education level of high school & university and above. ConclusionWOEC effectively relieves mental stress in caregivers of elderly postoperative CRC patients, and also elevates satisfaction in these patients.

Comparing Caregiving Outcomes Among Male and Female Parents of Autistic Adults

This study compared aging male and female parents of autistic adults to determine if self-reported caregiver health, quality of life, caregiver burden, informal social support, and formal social support differ between the two groups. Fifty-seven female caregivers and 57 male caregivers were selected using data from a larger study. T-tests for independent samples compared dependent variables between female and male parents. Statistically significant differences were found on four dependent variables, self-reported health, quality of life, overall caregiver burden, and emotional burden. Male parents had better self-reported health, greater quality of life, and less emotional burden, while female parents experienced greater overall caregiver burden. Social workers and other professionals should be cognizant of differences experienced by aging caregivers when providing tailored support and services.