Need For Support Services Research Articles

Abstract PO-039: The African American Cancer Survivor Network study: Utilizing social support and social networks to address unmet needs and challenges of African American cancer survivors

Abstract Introduction: More research is needed to understand the role of social support and social networking in addressing the unmet needs experienced by African American cancer survivors, as well as the effects of such programs. A study of low income African American cancer survivors documented their need for support services, especially emotional support, in their own neighborhoods. Our study continues this work to explore the unmet needs and challenges of this population. Methods: We conducted five 90-minute focus groups with cancer survivors, and 1 focus group and 5 interviews with service providers and key informant leaders. Focus groups were audio-recorded and transcripts were checked for accuracy and maintained in MAXQDA. Transcripts were independently coded while the team collectively discussed interpretations, created corresponding codes, and categorized codes into larger representative groups. Results: Twenty-six participants have completed a focus group or interview to date (n =16 survivors, n=10 key informants). Survivor participants’ ages range from 44 to 78 years. Survivor participants’ cancer types are primarily breast, but also includes colon and lung, among others. Key informant interviews included oncologists, nurses, navigators, and peer leaders. Key topics that emerged were health literacy, treatment costs, limited support groups, and community resources. As one key informant describes, “A lot of the African- American cancer survivors that I've worked with, they don't have -They're not given enough resources. They don't know about the Nurse Navigators, they don't know about a lot of things that they -They don't know about American Cancer Society (sic) or, you know, the things that are offered to them.” Yet other survivors have leveraged the expertise of their peers through cancer support groups to meet their needs. As one survivor describes, “the most helpful thing that I've found once I was diagnosed was [to] meet another woman who was also diagnosed. That was the most helpful thing I found.” Conclusions: African American cancer survivors face many challenges and unmet needs around survivorship care. Our next step is to develop an intervention that raise awareness of minority-led support groups; improve the knowledge and availability of community resources; and connect individuals to local resources. Citation Format: Jamila L. Kwarteng, Staci Young, Bria Grant, Melinda R. Stolley. The African American Cancer Survivor Network study: Utilizing social support and social networks to address unmet needs and challenges of African American cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-039.

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services.

PurposeDisparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen.MethodsIn-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data.ResultsFour themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence.ConclusionsPrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.

Mediation Role of Perceived Benefit in the Relationship between Perceived Government Support, Religiosity, Awareness and the Acceptance of Islamic Microfinancing in Nigeria

Social Exchange Theory highlights the possible mediating role perceived benefit in social and economic relationships, however, extent literature falls short is validating such theoretical insights in the context of Islamic microfinance. Following this theoretical insights the mediating role of perceived benefit on the relationship between perceived government support, religiosity, awareness and intention to accept Islamic micro-financing was examined. Quantitative research design through data collected from smallholder farmers in Jigawa state was employed; the data was analyzed using PLS-SEM. The finding revealed that perceived benefit mediates the relationship between perceived government support, religiosity, awareness and intention to accept Islamic micro-financing. It implied that perceiving the benefit is one of the mechanisms through which government support, religiosity and awareness influence intention to accept Islamic micro-financing. The study expands the understanding of TPB through the support of SET to explain the mediating effects of perceived benefits in the context of Islamic micro-financing. Thus, it will benefit policymakers in understanding that perceived benefit of Islamic micro-financing is a key to its acceptance, hence, the need for awareness campaigns, support services and religious preaching to that end. Implementing the finding will not only solve problem of access to finance among the smallholder farmers but also ease life through employment generation and poverty eradication. To the researchers’ knowledge, this work could be first to examine the mediating role of perceived benefit in the context of Islamic microfinance among the smallholder farmers with inferences from Social Exchange Theory

Prevalence of perceived depression and anxiety among hypertensives attending imo specialist hospital owerri, Nigeria

Background: Depression is a burdensome disease of global importance, and although prevalent, it is mostly undiagnosed in patients with hypertension. Anxiety is another significant factor associated with increased Blood Pressure and is an independent predictor of future hypertension. The aim of this study was to determine the prevalence of depression and anxiety among hypertensive’s attending Imo Specialist Hospital Owerri, Nigeria. Methods: A hospital based cross sectional study was undertaken, utilizing systematic random sampling method in the recruitment of 334 respondents. Depression and anxiety was determined using a standard tool known as depression, anxiety, and stress scale-21 (DASS-21). The questionnaire was administered to the respondents by the researcher after an informed consent was obtained. Data were analyzed using SPSS version 21. Results: A total of 334 respondents were recruited for the study comprising 190 (56.9%) females and 144 (43.1%) males. The Overall prevalence of depression and anxiety among the hypertensive patients was 77.8%. The result indicated that among the hypertensive’s, 242 (72.5%) had both conditions of depressed and anxious, 74 (22.2%) were neither depressed nor anxious, 14 (4.1%) were anxious but not depressed while 4 (1.2%) were depressed but not anxious. Conclusion: A combination of hypertensive medications with psychotherapy and antidepressants can definitely help prevent severe attacks of High Blood Pressure. Hence, the study recommends the need for psychiatric evaluation, counseling, and support services for hypertensive patients as an important component for the management of hypertension especially at advanced stage.

Quantifying the size of the informal care sector for Australian adults with mental illness: caring hours and replacement cost

To quantify and value the total informal support provided by family and friends to Australian adults with mental illness in 2018. The number of mental health carers was drawn from the 2015 Survey of Disability, Ageing and Carers (SDAC), adjusted to the 2018 population. Annual caring hours by type of assistance were estimated using the SDAC, 2007 National Survey of Mental Health and Wellbeing and an online carer survey. Caring hours for each task were assigned an hourly replacement cost from the National Disability Insurance Scheme. Informal caring was valued as the sum of these costs minus expenditure on carer income support payments, estimating how much it would hypothetically cost governments to replace this care with formal support services. An estimated 354,000 (95% uncertainty interval (UI): 327,000-383,000) Australian mental health carers provided 186 million (95% UI: 159-215) hours of support in 2018. The estimated replacement cost was AU$8.4 billion (95% UI: 7.0-10.0), excluding AU$1.3 billion in income support. Univariate sensitivity analyses demonstrated that results were robust to variation in model inputs, with total caring hours the most influential parameter. Using an alternative estimate of mean caring hours, the replacement cost could be as high as AU$13.2 billion (95% UI: 11.2-15.4). Informal carers provide substantial support to people with mental illness, highlighting their important contribution to the mental health system and reinforcing the need for carer support services. Future valuation studies would benefit from refinement of available data collections, particularly on hours and types of care provided.

Trends in health and disability in Botswana. An analysis of the global burden of disease study

Purpose Globally, years of life lost are declining, while years lived with disability are increasing. In high socio-demographic index countries, this trend has been attributed to an overall ageing population and rehabilitation services have begun to adjust to this change. In low- and middle-income countries, this trend is less well understood. Hence, the WHO’s ‘Rehabilitation 2030 Call for Action’ and ‘Rehabilitation in Health Systems Guide’ call for better assessment of the situation. In order to understand trends and causes in middle income countries such as Botswana, we examine the change over time in causes and number of years lived with disability and years of life lost. Methods We conducted a secondary analysis of the Global Burden of Disease 2017 data, exploring the change over time in Disability Adjusted Life Years per 100 000 people over the period 1990–2016. The descriptive analysis focuses on the contribution of years lived with disability towards the burden of disease within Botswana compared with the world, sub-Saharan Africa, and high-income countries. Results Our results show that Botswana’s top causes of years of life lost are HIV and other sexually transmitted infections, cardiovascular diseases, maternal and neonatal disorders, respiratory infections and tuberculosis, and neoplasms. Years lived with disability have increased over time, which is driven by mental disorders, HIV and other sexually transmitted infections, musculoskeletal disorders, neurological disorders, and skin and subcutaneous diseases. Conclusions Botswana needs better data to prepare its emerging health systems to accommodate the increased need for disability support and rehabilitation services caused by communicable and non-communicable diseases. Implications for Rehabilitation Botswana has an increase in disability prevalence over time that requires the development of disability and rehabilitation services. The greatest contributors towards disability adjusted life years in Botswana are currently mental disorders (13.7%), HIV and other sexual transmitted diseases, (13.0%), musculoskeletal disorders (9.9%), neurological disorders (8.0%), and sense organ diseases (6.2%). This requires strengthen of services such as mental health interventions, physiotherapy, optometry and audiology as well as linkages from major disease clusters such as HIV to rehabilitation services.

Predicting the need for supportive services after discharged from hospital: a systematic review

BackgroundSome patients admitted to acute care hospital require supportive services after discharge. The objective of our review was to identify models and variables that predict the need for supportive services after discharge from acute care hospital.MethodsWe performed a systematic review searching the MEDLINE, CINAHL, EMBASE, and COCHRANE databases from inception to May 1st 2017.We selected studies that derived and validated a prediction model for the need for supportive services after hospital discharge for patients admitted non-electively to a medical ward. We extracted cohort characteristics, model characteristics and variables screened and included in final predictive models. Risk of bias was assessed using the Quality in Prognostic Studies tool.ResultsOur search identified 3362 unique references. Full text review identified 6 models. Models had good discrimination in derivation (c-statistics > 0.75) and validation (c-statistics > 0.70) cohorts. There was high quality evidence that age, impaired physical function, disabilities in performing activities of daily living, absence of an informal care giver and frailty predict the need for supportive services after discharge. Stroke was the only unique diagnosis with at least moderate evidence of an independent effect on the outcome. No models were externally validated, and all were at moderate or higher risk of bias.ConclusionsDeficits in physical function and activities of daily living, age, absence of an informal care giver and frailty have the strongest evidence as determinants of the need for support services after hospital discharge.Trial registrationThis review was registered with PROSPERO #CRD42016037144.

Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients.

Patients with inflammatory bowel disease (IBD) are diagnosed with anxiety/depression at higher rates than the general population. We aimed to determine the frequency of anxiety/depression among IBD patients and the temporal association with abdominal surgery and stoma formation. We conducted a retrospective cohort study in adult patients with IBD using difference-in-difference methodology and a large commercial claims database (2003-2016). Outcomes were anxiety/depression diagnoses before and after major abdominal surgery or stoma formation. We identified 10481 IBD patients who underwent major abdominal surgery, 18.8% of whom underwent stoma formation, and 41924 nonsurgical age- and sex-matched IBD controls who were assigned random index dates. Rates of anxiety and depression increased among all cohorts (P<0.001). Surgical patients had higher odds of anxiety [one surgery, adjusted OR 6.90 (95% CI 6.11-7.79), P<0.001; two or more surgeries, 7.53 (5.99-9.46), P<0.001] and depression [one surgery, 6.15 (5.57-6.80), P<0.001; two or more surgeries, 6.88 (5.66-8.36), P<0.001] than nonsurgical controls. Undergoing multiple surgeries was associated with a significant increase in depression from 'pre' to 'post' time periods [1.43 (1.18-1.73), P<0.001]. Amongst surgical patients, stoma formation was independently associated with anxiety [1.40 (1.17-1.68), P<0.001] and depression [1.23 (1.05-1.45), P=0.01]. New ostomates experienced a greater increase in postoperative anxiety [1.24 (1.05-1.47), P=0.01] and depression [1.19 (1.03-1.45), P=0.01] than other surgical patients. IBD patients who undergo surgery have higher rates of anxiety and depression than nonsurgical patients. Rates of anxiety and depression increase following surgery. Stoma formation represents an additional risk factor. These findings suggest the need for perioperative psychosocial support services.

Long-term effects of rent supplements and mental health support services on housing and health outcomes of homeless adults with mental illness: extension study of the At Home/Chez Soi randomised controlled trial

Housing First is increasingly implemented for homeless adults with mental illness in large urban centres, but little is known about its long-term effectiveness. The At Home/Chez Soi randomised controlled trial done in five cities in Canada showed that Housing First improved housing stability and other select health outcomes. We extended the At Home/Chez Soi trial at the Toronto site to evaluate the long-term effects of the Housing First intervention on housing and health outcomes of homeless adults with mental illness over 6 years. The At Home/Chez Soi Toronto study was a randomised, controlled trial done in Toronto (ON, Canada). Here, we present the results of an extension study done at the same site. Participants were homeless adults (aged ≥18 years) with a serious mental disorder with or without co-occurring substance use disorder. In phase 1, participants were stratified by level of need for mental health support services (high vs moderate), and randomly assigned (1:1) using adaptive randomisation procedures to Housing First with assertive community treatment (HF-ACT), Housing First with intensive case management (HF-ICM), or to treatment as usual (TAU). Participants with moderate support needs were further stratified by ethnoracial status. Considering the nature of the Housing First intervention, study participants and study personnel were not masked to group assignment. Phase 1 participants could choose to enrol in the extension study (phase 2). The primary outcome was the rate of days stably housed per year analysed in the modified intention-to-treat population, which included all randomly assigned participants who had at least one assessment for the primary outcome. Participants contributed data to the study up to the point of their last interview. Multilevel multiple imputation was used to handle missing data. The trial was registered with ISRCTN, ISRCTN42520374. Between Oct 1, 2009, and March 31, 2013, 575 individuals participated in phase 1 of the Toronto Site At Home/Chez Soi study (197 [34%] participants with high support needs and 378 [66%] with moderate support needs). Of the 378 participants with moderate support needs, 204 were randomly assigned to receive the HF intervention with ICM or with ethnoracial-specific ICM services (HF-ER-ICM; HF-ICM or HF-ER-ICM groups) and 174 were randomly assigned to TAU. Of the 197 participants with high support needs, 97 were randomly assigned to receive the HF intervention with ACT (HF-ACT treatment group) and 100 were randomly assigned to TAU group. Between Jan 1, 2014, and March 31, 2017, 414 (81%) of 575 phase 1 participants participated in the extended phase 2 study. The median duration of follow-up was 5·4 years (IQR 2·1-5·9). Among phase 2 participants, 141 had high support needs (79 participants in the HF-ACT group; 62 participants in the TAU group), and 273 had moderate support needs (160 participants in the HF-ICM or HF-ER-ICM group; 113 participants in the TAU group). 187 high support needs participants (93 participants in the HF-ACT group, 94 participants in the TAU group), and 361 moderate support needs participants (201 participants in the HF-ICM or HF-ER-ICM group, 160 participants in the TAU group) were included in the modified intention-to-treat analysis for the primary outcome. The number of days spent stably housed was significantly higher among participants in the HF-ACT and HR-ICM or HF-ER-ICM groups than participants in the TAU groups at all timepoints. For participants with moderate support needs, the rate ratio (RR) of days stably housed in the Housing First group, compared with TAU, was 2·40 (95% CI 2·03-2·83) in year 1, which decreased to 1·13 (1·01-1·26) in year 6. The RR of days stably housed for participants with high support needs, compared with TAU, was 3·02 (2·43-3·75) in year 1 and 1·42 (1·19-1·69) in year 6. In year 6, high support needs participants in the Housing First group spent 85·51% of days stably housed compared with 60·33% for the TAU group, and moderate needs participants in the Housing First group spent 88·16% of days stably housed compared with 78·22% for the TAU group. Rent supplements and mental health support services had an enduring positive effect on housing stability for homeless adults with mental illness in a large, resource-rich urban centre, with a larger impact on individuals with high support needs than moderate support needs. Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care, and the Canadian Institute of Health Research.

Racial/ethnic differences in caregivers' perceptions of the need for and utilization of adolescent psychological counseling and support services.

Black caregivers may be more likely to have negative experiences with mental health services/providers and lack knowledge of psychopathology and mental health services relative to White caregivers. These perceptual and informational barriers could influence the likelihood that Black caregivers utilize psychological counseling and support services for their adolescents compared to White caregivers. The current study examined differences between Black and White caregivers in the associations between their adolescents' internalizing and externalizing problems and their perceptions of need for and utilization of psychological counseling and support services. Data for the present study were collected from 741 diverse caregivers (63% Black, 37% non-Hispanic White) about their adolescents. Caregivers reported their adolescent's psychopathology and their perceptions of their adolescent's need for and utilization of psychological counseling, parenting classes, and youth mentoring programs. Caregivers who reported that their adolescents had clinically elevated psychopathology were more likely to report a need for psychological counseling or support services in general. However, they were only more likely to report that their adolescents received psychological counseling services. Black caregivers were significantly less likely than White caregivers to report that their adolescent needed psychological counseling and were more likely than White caregivers to report that their adolescents needed a youth mentoring program if they had clinically elevated externalizing problems. Black caregivers may perceive mentoring programs as a less stigmatizing and more culturally congruent support service for addressing externalizing problems. Integration and dissemination of evidence-based intervention strategies to underserved populations using culturally acceptable intervention modalities is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Needs of Individuals Recovering from a First-Episode of Mental Illness: A Qualitative Descriptive Analysis of Focus Group Discussions

A broad array of needs often arise for individuals when significant physical or mental illness occurs. The aim of this study was to investigate the needs experienced by individuals recovering from a first-episode of mental illness, to explore how these needs have been assessed and to gauge the acceptability of participating in formal, systematic needs assessments in the future. Fifteen individuals who had presented to a tertiary mental health service within the previous 3 years, and who were considered to be recovering from a first-episode of mental illness discussed their current and previous needs in small focus groups. A qualitative descriptive methodology was adopted to analyse data. Three themes incorporating the broad range of inter-related and often complex needs were identified as being: the need for safety, stability and security; the need to be understood and to understand and; the need for support networks and services. Participants reported a lack of involvement in discussions with mental health clinicians regarding their needs, and were in favour of participating in formal, systematic needs assessments in the future.

Voluntary work: an appropriate approach to improve the practical response and care of older victims of domestic violence?

Up until now, in the Federal Republic of Germany, little attention has been paid to domestic violence experienced in the partnerships of senior citizens, both in the public eye, in terms of state action, as well as in specialised psychosocial services. The elderly women and men in question form a heterogeneous group, who have until now, found it difficult to access existing intervention and support systems, or are barely accommodated by them. Current research findings and action programmes pinpoint the need for low-threshold support services. The research project has been examining the question of whether volunteer guides in the senior/health/integration area can reach this target group more effectively, and make it easier for those affected to access the help system in a low-threshold aid setting. Based on insights gleaned from 17 qualitative expert interviews and three focus group discussions with volunteer guides and in cooperation with three local partners, training has been developed that should provide the guides with knowledge of domestic violence and information about the support system. While the guides are showing great interest in tackling the problem, the assessments of the professionals range from approval, scepticism and reservations to rejection.

Academic and psychosocial characteristics of incoming college freshmen with autism spectrum disorder: The role of comorbidity and gender.

There is a pressing need to better characterize the college-bound population of individuals with autism spectrum disorder (ASD), as prior studies have included small samples, consisting of individuals who are either recruited due to diagnosis or are treatment seeking. As postsecondary institutions look to respond to the growing need for support services for individuals with ASD, insights derived from large, population-based samples is a necessity. The current study included a sample of over 2000 incoming postsecondary students who self-identified with ASD as a part of surveys distributed by institutions nationally. The impact of heterogeneity (gender, comorbid attention-deficit/hyperactivity disorder [ADHD], and/or learning disability) on demographic characteristics, and psychosocial (psychological health, interpersonal self-confidence) and academic (self-regulated learning, intellectual self-confidence) domains critical for success in postsecondary education were compared to a matched sample of students with ADHD or no diagnoses. College-bound students with ASD broadly endorsed similar rates of ADHD, LD, and psychological disorder comorbidity to clinic-referred samples, and were more similar than different from their typically developing peers. A comorbid diagnosis of ADHD was associated with greater academic disengagement. Females with ASD and those with any comorbid disorder were more likely to self-report poorer psychological health. Findings revealed that self-reported levels of functioning in critical domains differed by self-reported comorbid disorders and gender. Findings have implications for targeted support service recommendations based on unique sources of heterogeneity (e.g., gender, presenting comorbid disorders) and are detailed in the current study. Autism Res 2019, 12: 931-940. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: College-bound students with ASD feel academically competent; however feel less confident with their peers. Students with ASD and another diagnosis (e.g., ADHD, learning disability) and girls with ASD may be particularly at risk of experiencing poorer psychological health while enrolled in postsecondary education. Using this information, postsecondary institutions can provide more targeted support services to students with ASD enrolled in postsecondary education.

School performance is age appropriate with support services in very preterm children at 11 years of age

AimThis Finnish regional birth‐cohort study compared the school performance of very preterm and full‐term children when they reached 11 years of age.MethodsTeachers rated the educational abilities of 123 preterm children and 133 full‐term controls at the age of 11 years as well as the support services they received. The children were all born in the Turku University Hospital between 2001 and 2005. In the preterm group, neurosensory impairments were confirmed at two years of corrected age, and full‐scale intelligence quotient (IQ) was assessed at 11 years of age using the Wechsler Intelligence Scale, Fourth Edition.ResultsEducational abilities, including academic skills and classroom functioning, did not differ between the two groups after excluding the children with a full‐scale IQ < 70. However, 40% of the preterm group and 26% of the controls had received at least one support service (p <0.02). The 13 preterm children with a full‐scale IQ <70 and the 10 with neurosensory impairment received more support services. Boys in both groups displayed more classroom‐functioning problems than girls.ConclusionA full‐scale IQ ≥ 70 and age‐appropriate educational abilities do not exclude a significant need for support services in very preterm children at the age of 11 years.

Who Needs What? Perceptions of Patients and Caregivers in Oncology Phase 1 Trials.

Background:The study design and nature of oncology phase 1 clinical trials create a uniquely vulnerable patient population yet little research has been conducted to identify the added burden these trials create for both cancer patients and their caregiver(s).Objective:Examining the perceptions and needs of patients and their caregivers participating in phase 1 oncology clinical trials, the investigators tested the hypothesis that the caregiver will exhibit a higher level of burden and/or distress than the patient.Method:A mixed-methods exploratory process utilizing patient and caregiver interviews and quality-of-life questionnaires was used to assess the psychosocial burdens associated with oncology clinical trial participation. A qualitative and quantitative analysis of the responses were 8 performed.Result:Both patients and caregivers reported similar themes identifying the burdens and benefits related to phase 1 clinical trial participation. However, the caregivers’ expressed burden exceeded that of the patients’ validating the study’s hypothesis.Conclusion:The need for ongoing additional support services for not only the patient but also the caregiver was identified.

Long-term issues and supportive care needs of adolescent and young adult childhood brain tumour survivors and their caregivers: A systematic review.

Long-term issues following diagnosis and treatment of a childhood brain tumour often become apparent as the survivor enters adolescence and young adulthood. Their caregivers may additionally face long-term impacts on their emotional and psychological functioning. This review synthesised evidence on the issues and supportive care needs of adolescent and young adult (AYA) survivors of a brain tumour diagnosed in childhood and their caregivers. Electronic databases were searched up until September 2017. All studies reporting on issues or needs of childhood brain tumour survivors (aged 14-39) and their caregivers were included. Narrative synthesis methods were used to summarise, integrate, and interpret findings. Fifty-six articles (49 studies) met the inclusion criteria. Social issues (ie, isolation and impaired daily functioning) were most commonly reported by survivors, followed by cognitive (ie, impaired memory and attention) and physical issues (ie, endocrine dysfunctions and fatigue). Survivors experienced poorer social functioning and sexual functioning and were less likely to be employed or have children, when compared with other AYA cancer survivors. Caregivers experienced reduced support as the survivor moved into young adulthood. Caregivers reported uncertainty, increased responsibilities, and problems maintaining their own self-well-being and family relationships. Few studies reported on supportive care needs. Survivors expressed a need for better educational support and age-specific psychosocial services. Surviving a childhood brain tumour can be particularly challenging for AYA survivors and their caregivers. Robust structured research is needed to identify specific support needs of both survivors and their caregivers and how these can be optimally addressed.

Perspectives of older person on health problem and health service utilization: A focus group study

Background: The state of well-being is generally involved happiness, autonomy, satisfying social relationships, and self-contentment. Joint pain was the most common morbidity followed by dental and chewing problem and decreased visual acuity. The community needs and perceptions about geriatric health are often ignored. Therefore, this study was conducted to assess the health of geriatric patient and awareness about medical service. Objectives: The objectives of the study were (a) to assess the health of the geriatric patient and (b) to obtain a perception of elderly participants about health service. Materials and Methods: Three Focus Group Discussions with seven participants in each group were conducted at rural area of Patan after taking permission from the Institutional Ethics Committee. The principal investigator was the moderator and observer noted down the verbatim. Seven to eight questions were prepared to direct the flow of discussion. The discussion lasted from 60 to 90 m. Results: Females were seen dominant in the discussions. Majority of participants (81.0%) had at least one disease. Most of them were suffering from aches followed by loss of vision, reducing hearing ability, and loss of teeth. Preserving good mental health, staying alert, and independent were important contributors to the health of elder person. Concept of Self Help Groups was suggested for increasing social participation. Poor economic status, self-rated poor health status, and having no faith in government medicine were obstacle in health-care services utilization. Conclusion: Dependency, low social participation and loneliness, negative attitude, no respect to elderly by a family member and ignored in decision-making may adversely affect the health of elderly. There is a need for caregiver support services to improve the health of the elderly.

Determining the caregivers' burden in caregivers of patients with mental illness.

Objective:To examine the factors associated with caregivers’ burden in individuals providing care to family members suffering from serious mental illness.Methods:This Cross Sectional Study was carried out at Armed Forces Institute of Mental Health, Rawalpindi, from May 2015 to December 2015. A purposive sample of 120 family caregivers (60 males and 60 females, age range= 18-65) who were taking care of patients with serious mental illness (i.e. Major Depressive Disorder, Bipolar Disorder & Schizophrenia) for at least one year were recruited from the hospital and assessed through Zarit Burden Interview (ZBI) and Brief COPE inventory. The decline in functional status, and diminished physical capacity compromising the independent living of the care recipient was assessed through Katz Index of Independence in Activities of daily living (ADL) and Lawton Instrumental activities of daily living (IADL).Results:The results suggest that the longer the duration of illness (F=25.71, p < 0.01), with increased impairments of care-recipients, (decline in functional status, F=21.33, p < 0.001; diminished physical capacity F =32.41, p < 0.001) the more the burden experienced by the caregivers. Moreover, caregivers who were married (t=-2.98, p < .01), less educated (t =5.48, p < .01), lived in rural area (t = -7.99, p < .01), had lower monthly income (t = -4.95, p < .01) provide longer hours of caregiving (F=19.12, p < 0.001) and used avoidant coping behavior (F= 56.37, p < 0.001) reported significantly higher caregiver burden than caregivers who were unmarried, more educated, lived in urban area and had better income.Conclusion:The results of study demonstrate that caring for family members with serious mental illness impacts the caregivers’ wellbeing. It, therefore, highlights the need for support and counseling services for the caregivers to reduce the burden of caring.

How to Strengthen Innovation Support Services in Agriculture with Regard to Multi-Stakeholder Approaches

The new EU agricultural policy aims to strengthen actors’ capacities for innovation by taking into account the complexity of innovation processes. This paper characterizes the key innovation support services (ISS) that support actors in innovating. In the EU AgriSpin project, we analyzed 57 case studies describing innovation processes. We used a common grid to characterize ISS. Our results show that ISS depends on the phase of the innovation. During the initial phases, there is a need for innovative support services (e.g. network building, support for the innovator). In the latter phases, there is a need for more conventional services (e.g. training, credit) at farm, value chain and territory level. Brokering functions and new services are key to supporting actors to innovate by facilitating interactions for the co-production of knowledge, co-design of technologies, and identification of new institutional arrangements. JEL Codes: Q10, O31, O32, O33, O35, O52

Linguistic Support Services for Immigrant Domestic Violence Victims

Intimate partner violence is increasing among immigrant women in the U.S., but because of language barriers, abused immigrant women may be unable to access formal services. The purpose of this study was to examine the influence of geographical location (urban/rural) and percentage of non-native English speakers on the availability of linguistic support services in one highly diverse state-Florida. Using a sample of 258 service providers for domestic violence victims, the results show significant differences between rural and urban providers’ perceptions of the need for linguistic support services in law enforcement, legal, and mental health needs. Urban service providers perceived a greater need for these services than rural service providers. The study found that a higher percentage of non-native English speakers predicted greater bilingual linguistic service availability. Lastly, the study found the more frequently providers perceived a victim’s basic needs to be met, the more likely that providers indicated linguistic support services were frequently met in their service area. Findings indicate that immigrants experiencing abuse who reside in rural areas might endure added difficulties in accessing assistance. While it may not be cost-efficient for rural service providers to hire translators or multilingual staff, such services may be cost-shared with other agencies.