High Financial Strain Research Articles

Impact of Burnout on Anaesthesiologists.

Professional burnout syndrome (PBS) is an issue affecting individuals and organizations alike, characterized by emotional exhaustion and reduced effectiveness resulting from overwhelming work demands. Root causes include excessive workload, unrealistic expectations, and blurred work-life boundaries, which are often intensified by organizational culture and inadequate support systems. The consequences range from decreased productivity and creativity to high turnover rates and financial strain on organizations. Mitigating PBS requires a comprehensive approach that addresses both individual and organizational levels. Individually, stress management techniques and self-care practices are crucial for building resilience and coping with work-related stressors. Organizations play a vital role in promoting employee well-being by fostering a supportive work environment, promoting work-life balance and providing access to support systems such as counseling and mentorship programs. Leadership is key in creating a culture that values employee health and prioritizes open communication and empathy. Policy interventions can further support efforts to combat PBS by enforcing labor laws that protect employee rights, such as setting limits on working hours and ensuring access to mental health services. Additionally, incentivise organizations to prioritize employee well-being through tax incentives or certification programs can encourage proactive measures against burnout. The aim of this review is to provide a comprehensive exploration of PBS, examining its causes, consequences, and potential mitigation strategies in individuals and organizations, with a focus on anaesthesiology.

Psychosocial stressors associated with frailty in community-dwelling older adults in the United States.

Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway. This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway. Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant. CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty.

Black Women as Superwomen? The Mental Health Effects of Superwoman Schema, Socioeconomic Status, and Financial Strain

Abstract Informed by Black feminist thought and intersectionality, Superwoman Schema (SWS) is a construct that captures a collective response of Black women to racial and gender marginalization by highlighting expectations that they exude strength, suppress emotions, resist vulnerability, succeed despite limitations, and help others to their own self-neglect. Using a sample of Black women (N = 390) in early-midlife (between 30 and 46 years old; M = 37.54 years; SD = 4.29), this study integrates the intersectionality framework and the stress process model to examine the independent and interactive effects of SWS endorsement as well as socioeconomic status (SES) and financial strain on Black women’s mental health. Study results reveal that SWS dimensions “emotion suppression” and “obligation to help others” are associated with elevated depressive symptoms. In addition, net worth and financial strain, but not traditional measures of socioeconomic status such as education and income, moderate the association between SWS endorsement and depressive symptoms. Specifically, the association between SWS and depressive symptoms is strongest among Black women reporting negative net worth or high financial strain (e.g., not being able to make ends meet). Broader implications and future research directions are discussed.

SOCIAL ENGAGEMENT IN OLDER PEOPLE LIVING WITH HIV

Abstract More than 50% of people with HIV (PWH) are at least 50 years old. PWH experience a high prevalence of multiple chronic conditions and fragile social structures. Although social engagement may be protective against detrimental physical, cognitive, and mental health outcomes, there is limited evidence on older PWH’s social engagement and associated factors in engaging with family, friends, and community. This study sought to examine social engagement in a population of older PWH, using the 13-item Frequency of Leisure Activities Scale from the Research on Older Adults with HIV (ROAH 2.0) study at the Weill Cornell Campus in New York City. We conducted factor and regression analyses to characterize social engagement activities and examine their relationships with AIDS diagnosis, social vulnerability index (SVI), financial strain, loneliness, HIV-related stigma, and depressive symptoms, controlling for demographic factors. PWH (n=349, age range=50-84) were less engaged in social (Mean=1.31; SD=0.71) and cultural-physical (e.g. attending cultural events) (Mean=1.55; SD=0.78) than media-based activities (Mean=3.09; SD=0.72), with Omega reliability estimated at 0.716, 0.651, and 0.620 respectively. Having AIDS, experiencing increased HIV-related stigma, loneliness, and depressive symptoms were associated with low social activity engagement (F(6, 316) = 9.87, p &amp;lt; .001). High SVI score and financial strain were negatively associated with engagement in cultural-physical activities (F(5, 317) = 2.61, p &amp;lt; .001). Increased depressive symptoms were negatively associated with engagement in media-based activities (F(4, 318) = 5.88, p &amp;lt; .001). The findings provide foundations for future research to improve our understanding of social engagement in older PWH.

Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit.

The engagement of family caregivers in oncology is not universal or systematic. We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed. We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3%), financial (n=6, 31.6%), and physical (n=6, 31.6%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6%, 13/15 who completed the user experience interview) and caregivers (94%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7% agreed "quite a bit" (n=1, 16.7%) or "very much" (n=3, 50%) that the system allowed them to provide better care. Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses.

Interactive effects of financial strain and distress tolerance on prequit tobacco withdrawal symptoms in smokers preparing to initiate a quit attempt.

Smokers experiencing greater financial strain are less likely to successfully quit smoking, possibly due to greater severity of tobacco withdrawal. However, limited research has explored whether individual-level psychological factors (i.e., distress tolerance) may buffer the deleterious effects of financial strain on withdrawal. This study examined the main and interactive effects of financial strain and distress tolerance on tobacco withdrawal experienced prior to quitting smoking among smokers preparing to initiate a quit attempt. Fifty-nine adult smokers completed a baseline session including a financial strain measure and subjective and behavioral assessments of distress tolerance. Participants were then instructed to initiate a quit attempt, without any behavioral or pharmacological assistance, 14 days following baseline. Prequit tobacco withdrawal symptoms were assessed once per day for 3 days prior to quit date. Linear regression models tested main and interactive effects between financial strain and distress tolerance on experiences and perceptions of prequit withdrawal. Findings demonstrated significant interactions between financial strain, distress tolerance, and perceptions of tolerating withdrawal. Negative associations found between higher distress tolerance and lower perceptions of tobacco withdrawal and negative mood as being "intolerable" prior to quitting were stronger for those experiencing greater levels of financial strain. Financial strain may negatively impact one's perceived ability to tolerate mood- and tobacco-related withdrawal prior to quitting. Yet, higher distress tolerance may buffer the effects of financial strain on smoking cessation processes. Psychosocial interventions designed to promote tolerance of distress from both internal and external stressors may benefit cessation efforts among smokers experiencing high financial strain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal patterns of polysubstance use throughout adolescence: association with adult substance use and psychosocial outcomes controlling for preadolescent risk factors in a male cohort.

Inconsistent reports raise the question of the extent to which poor adult outcomes are associated with adolescent polysubstance use (PSU: alcohol, marijuana, other illicit drugs) above and beyond earlier risk factors. Early adulthood substance-related and psychosocial outcomes were examined in association with age 13 to 17 developmental patterns of PSU in boys from urban, low SES neighborhoods (N = 926). Three classes obtained by latent growth modeling described low/non-users (N = 565, 61.0%), lower risk PSU (later onset, occasional use, 2 ≤ substances; N = 223, 24.1%), and higher risk PSU (earlier onset, frequent use, 3 ≥ substances; N = 138, 14.9%). Preadolescent individual, familial and social predictors of adolescent PSU patterns were used as covariates. Adolescent PSU contributed to both age-24 substance-related outcomes (frequency of alcohol, drug use, and getting drunk, risky behaviors under influence, and use-related problems) and psychosocial outcomes (no high school diploma, professional or financial strain, ASP symptoms, criminal record) over and above preadolescent risk factors. Controlling for preadolescent risk factors, adolescent PSU made a more important contribution to adult substance use outcomes (increasing the risk by about 110%) than to psychosocial outcomes (16.8% risk increase). PSU classes showed poorer adjustment for all age-24 substance use, and for various psychosocial outcomes than low/non-users. Higher risk polysubstance users also reported poorer outcomes than their lower risk peers for most substance use outcomes, and for professional or financial strain and criminal record. Findings highlight the contribution of adolescent PSU in a dose-response fashion, over and above preadolescent risk factors, on both homotypic and heterotypic outcomes in early adulthood.

Influence of financial strain on intimate partner violence and the moderating role of employment status among wives in Nigerian military homes

ABSTRACT This study examines the influence of financial strain on intimate partner violence (physical and psychological) experienced by wives of military personnel in Nigeria. The moderating role of employment status was also sought. Data was collected using a structured questionnaire made up of standardized scales with appropriate psychometric properties. Participants of the cross-sectional survey were purposively sampled and comprised 284 female spouses of military personnel in South-Western Nigerian. Results indicated a significant difference in the level of physical [t(282) = 6.775; p < .05] and psychological violence [t(282) = 8.388; p < .05] reported by participants with high and low financial strain. Employment status did not moderate the influence of financial strain on both dimensions of intimate partner violence (β1 = 0.027; p > .05; β2 = 0.052; p > .05) and accounted for an insignificant R2 increase of 0.01% and 0.08%, respectively. The practical implications of findings for intervention and future studies were discussed.

The Role of Financial Strain and Educational Attainment on Smoking Abstinence of African Americans and Whites Who Smoke.

To examine if reduced financial strain and higher educational attainment would confer less advantage for successful cessation among African Americans than for White individuals. A secondary data analysis of the Quit2Live study, a smoking cessation intervention for individuals who smoke. Recruited participants from a metropolitan city in the Midwest. The sample included 224 African American and 225 White individuals who smoke. Our outcome variable was cotinine-verified smoking abstinence at the end-of-treatment (week 12). Our explanatory variables were a combination of financial strain (high, low) and educational attainment (high, low). We implemented a logistic regression analysis and a two-way interaction of the combined financial strain and educational attainment variable and race on smoking abstinence. About 25% of the study participants were low financial strain and high education, 41% high financial strain and high education, 23% high financial strain and low education, and 11% low financial strain and low education. A greater proportion of African Americans vs Whites were in the high financial strain/low educational attainment category (28% vs 18%, P = .01). Participants with high financial strain and low educational attainment had substantially lower odds of abstinence (OR = .29 [95% CI: .12, .68]) compared to participants with low financial strain and high educational attainment. Contrary to our hypothesis, race did not moderate this association. Findings highlight the constraining role of high financial strain and low educational attainment, irrespective of race, on smoking abstinence among smokers actively engaged in a quit attempt.

Post-migration Stressors and Subjective Well-Being in Adult Syrian Refugees Resettled in Sweden: A Gender Perspective.

A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (Nsample = 4,000, nrespondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0–100), dichotomized into high (≥50) and low (<50) SWB. Main analyses were stratified by gender, and regressed SWB on four domains of post-migration stress (financial strain, social strain, competency strain and discrimination) using logistic regression, adjusting for sociodemographic variables and traumatic experiences. Social support was tested as an effect modifier. In fully adjusted models, main risk factors for low SWB were high financial strain, especially in males (ORhigh vs. low strain, males = 10.30 [4.91–21.6], p < 0.001 vs. ORhigh vs. low strain, females= 3.84 [1.68–8.79], p = 0.002), and high social strain, only in males (ORhigh vs. low strain, males = 9.21 [3.96–21.4], p < 0.001 vs. ORhigh vs. low strain, females = 1.03 [0.40–2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.

Differential Impact of Home Nurse Contact After Discharge by Financial Strain, Primary Care Access, and Medical Complexity.

The Hospital to Home Outcomes (H2O) trials examined the effectiveness of postdischarge nurse support on reuse after pediatric discharge. Unexpectedly, children randomly assigned to a nurse visit had higher rates of reuse than those in the control group. Participants in randomized control trials are heterogeneous. Thus, it is possible that the effect of the intervention differed across subgroups (ie, heterogeneity of treatment effect [HTE]). We sought to determine if different subgroups responded differently to the interventions. The H2O trial is a randomized controlled trial comparing standard hospital discharge processes with a nurse home visit within 96 hours of discharge. The second trial, H2O II, was similar, except the tested intervention was a postdischarge nurse phone call. For the purposes of the HTE analyses, we examined our primary trial outcome measure: a composite of unplanned 30-day acute health care reuse (unplanned readmission or emergency department or urgent care visit). We identified subgroups of interest before the trials related to (1) financial strain, (2) primary care access, (3) insurance, and (4) medical complexity. We used logistic regression modeling with an interaction term between subgroup and treatment group (intervention or control). For the phone call trial (H2O II), financial strain significantly modified the effect of the intervention such that the subgroup of children with high financial strain who received the intervention experienced more reuse than their control counterparts. In HTE analyses of 2 randomized controlled trials, only financial strain significantly modified the nurse phone call. A family's financial resources may affect the utility of postdischarge support.

Stressful social environment and financial strain drive depressive symptoms, and reveal the effects of a FKBP5 variant and male sex, in African Americans living in Tallahassee.

The World Health Organization estimates that almost 300 million people suffer from depression worldwide. African Americans are understudied for depression-related phenotypes despite widespread racial disparities. In our study of African Americans, we integrated information on psychosocial stressors with genetic variation in order to better understand how these factors associated with depressive symptoms. Our research strategy combined information on financial strain and social networks with genetic data to investigate variation in symptoms of depression (CES-D scores). We collected self-report data on depressive symptoms, financial strain (difficulty paying bills) and personal social networks (a model of an individual's social environment), and we genotyped genetic variants in five genes previously implicated in depressive disorders (HTR1a, BDNF, GNB3, SLC6A4, and FKBP5) in 128 African Americans residing in Tallahassee, Florida. We tested for direct and gene-environment interactive effects of the psychosocial stressors and genetic variants on depressive symptoms. Significant associations were identified between high CES-D scores and a stressful social environment (i.e., a high percentage of people in participants' social network who were a source of stress) and high financial strain. Only one genetic variant (rs1360780 in FKBP5) was significantly associated with CES-D scores and only when psychosocial stressors were included in the model; the T allele had an additive effect on depressive symptoms. Sex was also significantly associated with CES-D score in the model with psychosocial stressors and genetic variants; males had higher CES-D scores. No significant interactive effects were detected. A stressful social environment and material disadvantage increase depressive symptoms in the study population. Additional associations with FKBP5 and male sex were revealed in models that included both psychosocial and genetic data. Our results suggest that incorporating psychosocial stressors may empower future genetic association studies and help clarify the biological consequences of social and financial stress.

Managed care opportunities and approaches to select treatment for sight preservation.

Neovascular (or wet) age-related macular degeneration (AMD) affects more than 10% of people older than 65 years in North America, Europe, Australia, and Asia. It is estimated that about 11 million Americans have some form of AMD, with that number expected to double by 2050. Approximately 20% of patients will advance from a nonneovascular form of the disease to neovascular AMD, which is associated with central visual acuity loss that can result in severe visual impairment and blindness. Improvements in vision preservation and quality of life require regular clinical visits for intravitreal therapy, which, while effective, come at high cost and potential financial strain, often complicated by the fact that most patients with the disease will be covered by Medicare and subject to the regulations and restrictions within their insurance plans. The requirement for frequent treatment also threatens adherence to therapy, and many patients do not follow up clinically as advised. The confluence of high-cost drug therapy and growing demand for treatment of a sight-threatening disease creates a mandate that managed care professionals and payers focus on current and emerging management options in neovascular AMD and on how to administer therapies in both a clinically responsible and cost-effective manner to diminish risk of vision loss and improve overall patient outcomes.

Social Risk Factors for Medication Nonadherence: Findings from the CARDIA Study.

Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.

Financial Strain and Contraceptive Use Among Women in the United States: Differential Effects by Age.

Low-income and young women experience disproportionately high rates of unintended pregnancy. Traditional measures of socioeconomic status may not be appropriate indicators of financial status, particularly during emerging adulthood. This study investigates the relationship between financial strain and contraceptive use, focusing on the differential effects by age group. Multinomial logistic regression analyses assessed the relationship between financial strain and contraceptive use in a national sample of U.S. women ages 18-39years (N=932). Models were adjusted for income, employment status, and other sociodemographic characteristics and tested the interaction of financial strain and age group. Women with high financial strain were less likely to use short-acting methods (compared with using no method) in the adjusted model; when the age and financial strain interaction was included, associations held only for women ages 18-24 and 25-29years of age. Relative to contraceptive nonuse, women ages 18-24years with high financial strain were less likely to use long-acting reversible (relative risk ratio [RRR], 0.10; 95% confidence interval [CI], 0.01-0.99) and short-acting hormonal (RRR, 0.03; 95% CI, 0.00-0.18) methods. Women ages 25-29 with high financial strain were less likely to use short-acting hormonal (RRR, 0.20; 95% CI, 0.05-0.87) and coital-specific (RRR, 0.11; 95% CI, 0.02-0.51) methods. Young women may be vulnerable to the effect of high financial strain on contraceptive nonuse. Providers working with this group should consider incorporating financial strain into screening tools to identify patients who may need extra attention in contraceptive decision-making conversations. Antipoverty programs could also have a positive effect on effective contraceptive use.

Socioeconomic Predictors of Incident Depression in Systemic Lupus Erythematosus.

To assess different measures of socioeconomic status (SES) as predictors of incident depression among women with systemic lupus erythematosus (SLE). Data were derived from the 2010-2015 waves of the Lupus Outcomes Study, where individuals with confirmed SLE were interviewed annually by telephone. Depression was assessed using the Center for Epidemiologic Studies Depression Scale, using a validated lupus-specific cutoff (≥23) for major depressive disorder. Women interviewed in ≥2 consecutive waves, with scores <23 in the first wave (T1), were included. The level of financial strain was classified as high, moderate, or none based on responses to 3 questions. Generalized estimating equations were used to assess the impact of poverty status, income, education, and financial strain at T1 on the risk of incident depression the next year (T2), with adjustment for sociodemographic and disease status measures. Individuals could contribute more than one 2-year dyad to the analysis. In total, 682 women contributed 2,097 observations, with 19% having high financial strain, 47% moderate strain, and 34% no strain. There were 166 women who had 184 episodes of incident depression (rate = 8.8/100 person-years). In bivariate analysis, poverty, lower income and education, disease activity, and high financial strain were associated with depression onset; race/ethnicity was not. Poverty, income, and education were not significant in multivariate analyses, but disease activity and high financial strain were (odds ratio 1.85 [95% confidence interval 1.06-3.23]). High financial strain was a significant predictor of new-onset depression in women with SLE, controlling for disease factors and other SES measures. Determining specific, modifiable sources of financial strain may help prevent the development of depression.

The Association of Socioeconomic Conditions and Readiness to Learn New Ways of Performing Daily Activities in Older Adults With Functional Difficulties.

Behavioral interventions for older adults can reduce difficulties in performing daily activities, hospitalizations, and mortality risk. The success of behavior change interventions, however, can be affected by a participant's readiness to adopt changes. This study evaluates whether socioeconomic conditions, particularly financial strain affording food, are associated with readiness to change. We conducted a cross-sectional, descriptive study of baseline data from disabled older adults ( N = 147) participating in an intervention to reduce physical disability. Readiness to change score was rated at the start of the intervention by interventionists as either pre-action (precontemplation = 1, contemplation = 2, preparation = 3) or action (=4). Participants reporting high financial strain affording food were more likely to have high readiness at the start of intervention; the association of this specific socioeconomic condition with readiness may be an important consideration in implementing interventions to reduce disability.

United and Divided by Stress: How Stressors Differentially Influence Social Support in African American Couples Over Time

The factors that allow people to be good support providers in relationships are not fully understood. We examined how support providers' stressful experiences (financial strain and racial discrimination) differentially influence their supportiveness, using longitudinal data from two samples of African American couples. Among couples that provided observational data ( N = 163 couples), providers who experienced high chronic financial strain behaved less supportively toward their partners, while those who experienced frequent racial discrimination behaved more supportively over a 2-year period. In a second sample of 213 couples over a 3-year period, support providers who experienced financial strain were perceived by their partners as slightly less supportive, while providers who experienced frequent racial discrimination were perceived by their partners as more supportive. Findings suggest that supportiveness in relationships may be differentially shaped by the specific stresses and strains that partners face.

Effectiveness of Supporting Informal Caregivers of People with Dementia: A Systematic Review of Randomized and Non-Randomized Controlled Trials.

Dementia is known as a major public health problem affecting both patients and caregivers, and placing a high financial strain upon society. In community-dwelling patients, it is important to support informal caregivers in order to help them sustain their demanding role. Previous reviews about effectiveness of such supporting strategies often included a small number of studies, focused only on particular supportive types, particular outcomes, or solely on caregivers. A general systematic review was conducted investigating effectiveness of different supportive strategies on at least the well-being of the caregiver or the care-recipient. A systematic literature search was conducted in Web of Science and PubMed. An adapted version of the Downs and Black (1998) checklist was used to assess methodological quality. A new classification was developed to group different types of caregiver support. Fifty-three papers met the inclusion criteria. Although 87% of the interventions were to some extent effective, methods and findings were rather inconsistent. Psychoeducational interventions generally lead to positive outcomes for caregivers, and delay permanent institutionalization of care-recipients. Cognitive behavioral therapy decreases dysfunctional thoughts among caregivers. Occupational therapy decreases behavioral problems among patients and improves self-efficacy of caregivers. In general, those interventions tailored on individual level generate better outcomes. Comparative research on respite care was very rare. Despite methodological inconsistency, supporting caregivers appears to be an effective strategy often improving well-being of caregiver or care-recipient and resulting in additional benefits for society. However, there is a need for more research on the (cost)-effectiveness of respite care.

Rápida cicatrización de la úlcera venosa con técnica TAPIRS (ecoesclerosis del eje axial, perforantes y terminal insuficientes) más vendaje multicapa. Ensayo clínico

IntroductionChronic venous ulcers (CVU) are the most common ulcers occurring in the lower limbs, having a high morbidity and place a high financial strain on the health system. The traditional surgical techniques are being replaced by minimally invasive procedures, such as foam sclerotherapy. ObjectiveThe aim of this study was to determine CVU healing times and rates using the terminal, axial and perforator interruption of the reflux source (TAPIRS) protocol, which included an endoluminal venous occlusion with ultrasound-guided foam and a multilayer bandage system until achieving ulcer healing. Material and methodsA prospective uncontrolled trial was conducted on patients with chronic venous leg ulcers (CEAP [clinical, etiological, anatomical and pathological elements] C6) during 2013 and 2014. A total of 17 patients aged 18 years and over, presenting with venous insufficiency, CVU, and an ankle-brachial index greater than 0.8, were included, and total of 17 limbs were analysed. All of the patients were subjected to endoluminal occlusion with ultrasound-guided foam in the axial superficial venous system and perforator and terminal veins near to the ulcer, using Tessari method with 3% polidocanol. Follow-up was carried out at every week and a doppler test was conducted after 4 and 12 weeks. ResultsThe mean age of the patients was 56.4 years. The active ulcer duration prior to treatment was 2.96 years. The study showed that all CVU were healing before 7 weeks, the healing rate was 3.92 cm2/week, and the time until the ulcer was healed was 3.53 weeks (24 days). ConclusionsThe minimally invasive ablation of terminal, axial and perforator reflux with compression in patients is a technique that leads to faster healing times of CVU.