Poor Support Systems Research Articles

Depression among people living with HIV at a district hospital in KwaZulu-Natal, South Africa.

Depression is a debilitating condition worldwide and a major contributor to the overall global burden of disease. The prevalence of depression is estimated to be higher in people living with HIV and AIDS (PLWHA) compared to the general population, with disease related complications increasing when mental health problems remain untreated. The aim of the study was to determine the prevalence of depression among PLWHA who attend a district hospital ART clinic in KwaZulu-Natal (KZN), South Africa (SA). Using strict systematic sampling, a descriptive cross-sectional study was employed with 121 adult outpatients attending an antiretroviral clinic at a district hospital in KZN, SA. Their biographical and clinical characteristics were obtained through a questionnaire and medical records, while depression was evaluated using the PHQ-9 scale. The data were analysed using descriptive and inferential statistics. A total of 121 participants were recruited for this study. The prevalence of depression was 19.8% and significantly associated with a poor support system (adjusted odds ratio [aOR] = 3.60,p= 0.010). Female patients were more likely to have depressive symptoms than males (aOR = 0.73; confidence interval: 0.28-1.90) although this was not statistically significant. Age, marital status and viral load were not contributors to depression. Routine screening for depression among PLWHA at primary health care (PHC) level may improve detection rates, earlier treatment and overall health outcomes.Contribution:The results emphasise the need for patient-centeredness and holistic care that involves addressing mental health for PLWHA, given that HIV is a lifelong condition.

Experiences of teachers in vocational programmes in special needs schools, City of Cape Town.

Vocational programmes run by teachers in the special needs school context can play a significant role in the vocational development of learners with severe intellectual disability (SID). This study aimed to answer the question 'what are the challenges faced by teachers in the implementation of vocational programmes in selected public special needs schools for learners with SID in the Metropolitan (Metro) District within the City of Cape Town?' The objectives were to describe the challenges as perceived by participants, to highlight common and contrasting challenges in the different schools and to share recommendations on support needed. A qualitative descriptive study was conducted. A combination of purposive and snowball sampling strategies was used to select six teachers from six special needs schools. One-on-one semi-structured interviews with teachers were performed. An interview schedule was used as a tool and all interviews were transcribed and translated into English verbatim. Thematic analysis was applied. The findings showed that teachers encounter inadequate resources, a lack of training, and poor support systems. This study highlights the issues of existing policy and the lack of a mandatory policy on vocational programmes in South Africa. The participants' experiences added to the existing literature by providing valuable insights into the obstacles teachers encounter in this relatively new curriculum. A multifaceted policy framework that is well funded and implemented is much needed to address the challenges identified. The findings may contribute to the development and strengthening of policies on vocational programmes within the South African context.

Gender, sexuality, and food access: An exploration of food security with LGBTQIA2S+ university students

Although research has been limited to date, food insecurity in the United States has been shown to be more pervasive among the lesbian, gay, bisexual, transgender, queer, questioning, intersex, agender, asexual, and Two-Spirit (LGBTQIA2S+) commu­nity, affecting millions annually. College and uni­versity students also experience statistically signifi­cantly higher rates of food insecurity than nonstudents. This research examines food insecu­rity at the intersection of the LGBTQIA2S+ com­munity and the university and college student pop­ulation, as told by the community itself. A qualitative, participatory approach and methods of Photovoice and semi-structured interviews with eight self-identified LGBTQIA2S+ university stu­dents studying at the University of North Carolina at Greensboro (UNCG) were used to explore the factors influencing participants’ food access. Data were analyzed using thematic decomposition analy­sis guided by intersectionality and queer theories. LGBTQIA2S+ identities were found to signifi­cantly impact food access, which was further influ­enced by physical, socio-cultural, and political envi­ronments. Barriers to food access include experiences with discrimination on and off cam­pus, poor support systems, a lack of full-selection grocery stores on or near campus, religious influ­ences, the stigma associated with needing food assistance, mental and physical health conditions, financial constraints, time limitations, and lacking transportation options. Understanding the intersec­tionality of LGBTQIA2S+ students’ experiences and providing relevant and effective support is needed to improve equitable access to nutritious and affordable foods. The findings of this research provide novel insights into food insecurity, an issue that is increasingly influencing the health and well-being of LGBTQIA2S+ university students.

Improvement of Mental Health Symptoms in Response to Ketamine Therapy in Medicaid-Eligible Patients

Since 2020 there has been an expansion in the number of studies highlighting the positive effect that Ketamine for Non-Anesthetic Indications (KNAI) can have on patients suffering with mental health disorders. Medicaid programs cover a large community of patients that face significant health disparities and suffer more frequently from mental health conditions. Many of these conditions are exacerbated due to socioeconomic stressors, lack of access to care, and poor support systems. Our case study focuses on 289 Medicaid-eligible patients and the effect ketamine treatment had on their mental health symptoms. These participants had an established diagnosis of Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD) and/or Post Traumatic Stress Disorder (PTSD) prior to beginning treatment. The GAD-7, PHQ-9, and PCL-5 surveys were utilized for assessment of symptomatology in this cohort of patients. These instruments were all deployed prior to beginning treatment and at the end of the six-session Induction Series of ketamine treatments. The comparison of scores on these screening instruments pre-and post-treatment demonstrated a clinically significant reduction in symptomatology in the three diagnosis cohorts of patients listed above.

Returning to Normalcy: an Evidence-Based Overview of Strategies for Creating a Psychologically Safer Workplace in Ghanaian Health Industry

The study focused on returning to normalcy: an evidence-based overview of strategies for creating a psychologically safer workplace in Ghanaian health industry. The study used a Qualitative Research Approach, specifically, a phenomenological research approach, and an exploratory research design to explore and comprehend individuals' lived experiences, views, and strategies for creating a safe psychological workplace. The study used the non-probability sampling method, which involved purposive sampling method to select participants for the study. The study found that most health professionals communicate politely with patients. There were mixed reactions regarding the overall sense of safety and well-being within the Ghanaian health industry. On one hand, most of the Ghanaian health institutions has put in place excellent support systems, and there is a culture of camaraderie among colleagues that generates a reassuring work atmosphere. On the other hand, there is a lack of financial resources in the health industry, which has adverse effect on staff well-being, producing an environment of frustration and tension. Due to budget restrictions, the health industry frequently translates to insufficient worker levels, outmoded equipment, and poor support systems. According to the results of the poll, most policies regarding staff allowances favour senior leaders and senior staff over junior employees. As a result, an organization's policy on allowances allocation favour senior leaders and management over junior employees. The study acknowledged that creating a psychologically safe workplace is a complex and ongoing process that involves various stages. These stages are interconnected and require ongoing commitment and effort from leadership and employees. The study found eight (8) key stages to consider when creating a psychologically safe workplace. These stages covered Assessment and Diagnosis, Leadership Commitment and Training, Communication and Transparency, Inclusive Decision-Making, Feedback and Recognition, Training and Skill Development, Continuous Monitoring and Adaptation, and Support for Mental Health and Well-being.

Mindful parenting-A thematic exploration of narratives from Indian mothers.

With the global crisis of COVID-19 continuing, Indian mothers have not received adequate attention with respect to their challenges and mothering experiences. The current study explored mindful parenting practices in a cohort of Indian mothers of children aged 10 years and below that emerged in response to the challenges posed by COVID-19. In-depth virtual interviews were conducted with 31 urban Indian mothers to explore their lived experiences of mothering during the global crisis and their engagements with mindful parenting practices. The data were thematically analyzed. The study identified two overarching themes and nine subthemes. The first theme, pandemic-induced stress, included the sub-themes of increased workload, poor support system, lack of time for self, and emotional and physical distress. The second theme of mindful parenting included the sub-themes of awareness as a mother and around the child, acceptance toward self and the child, empathic understanding of self and the child, active engagement with the child, and emotional regulation. Increased workload on all fronts coupled with poor support and a lack of time for self-contributed to exacerbated emotional and physical stress in mothers. They addressed these concerns posed by their lived experiences by engaging in mindful parenting processes in their mothering practices. Mindfulness-based cognitive therapy, mindfulness-based stress reduction, and mindfulness-based parenting techniques could be explored as possible interventions for mothers to alleviate their distress while drawing attention to larger structural changes and policy-level interventions addressing social issues such as gender inequality and childcare concerns.

A Comparative Study On Stressor In Children And Adolescent Patients With Dissociative Disorder And Their Age And Gender Matched Controls In Western Rajasthan

Introduction:-The dissociative disorders (DDs) are a disturbance in the organization of identity, memory, perception, or consciousness involving both restricted access of information to consciousness and disruptions of consciousness.Methodology:- This study is a hospital based cross-sectional case-control study. The subjects were selected by consecutive sampling with proper inclusion and exclusion criteria fulfilled. Socio-demographic profile of cases and controls was compared using the Chi-square test. For normally distributed quantitative continuous variables were compared using an independent T-test.Result:-In this study, mean age of onset of dissociative disorder was late adolesesent, female were more affected then male. The cases were more of lower socio-economic status with nuclear family. In cases71% had identifiable stressor while in control only 15% ,major stressor was mainly study related.Conclusion:- Adolescent (late age),Female sex, Nuclear family (poor support system), lower socio-economic status had high prevalence while Children (young age), Male sex, Joint Family (good support system), and Upper socio-economic status had less prevalence of dissociative disorder. Major stressors were study and familial issues.

ODP260 New Type of Autoimmune Diabetes

Abstract Immune checkpoint inhibitors (ICIs) are an emerging therapy that has revolutionized the management of certain cancers. Data on long-term side effects of these drugs are now showing a risk for development of new endocrinopathies. In this case report, a patient with new Type I diabetes (DMI) is discussed. The patient is a 67 year old male with past medical history of metastatic renal cell carcinoma with multiple recurrences of disease. A brief review of the patient's oncologic history revealed multiple surgeries, including complete nephrectomy, multiple drugs, including ICIs, and radiation therapy. Over the course of his treatment, he received Nivolumab (anti-PD1 agent) for 5 cycles with HbA1c increased from 5.4% to 6.9% from pre-treatment to post-treatment, but the HbA1c improved to 5.8% one year after drug cessation. Later he was started on Pembrolizumab (anti-PD1) and has had 10 cycles of therapy to date. Random blood glucose frequently exceeded 200 after start of pembrolizumab therapy. Ipilimumab (anti CTLA-4) was started in combination with pembrolizumab six months later, but it was held after the second cycle due to development of diabetes with HbA1c of 11.1%. He was also found to have persistent, severe hyperglycemia noted during routine bloodwork. Autoimmune DM was confirmed with a positive glutamic acid decarboxylase antibody (GAD65) of 8 nmol/L. Consequently, the patient had multiple hospital admissions for glucose exceeding 400. His condition was exacerbated by the fact that he had difficulty coming to terms with his diagnosis, and he was noncompliant with medication. At that time, the patient stated that he had not done anything wrong and did not understand why this had happened to him. He was resistant to starting therapy and had difficulty understanding insulin dosing, blood glucose monitoring, and the consequences of hyperglycemia/hypoglycemia. After extensive education during a 2 week hospitalization, the patient was eventually place on an appropriate dose of basal-bolus insulin therapy and is currently doing well. It is important to note some emerging challenges to treating this new population of patients with DM1 due to ICI therapy. Firstly, many patients in this scenario live alone and have poor support systems. They have difficulty learning new technology (glucometer, insulin pen, etc.) and self adjusting medication (sliding scale). Older patients can also be more resistance to change in diet and lifestyle. They may have pre-existing insulin resistance that makes initial insulin dosage difficult. Finally, noncompliance is dangerous due to risk of hypoglycemia, diabetic ketoacidosis, and exacerbation of other comorbidities. Clinicians should also consider the patient's psychosocial ability to understand and manage this condition. Presentation: No date and time listed

S3656 Primary Diagnosis of Metastatic Breast Cancer via Esophagogastroduodenoscopy With Gastric Biopsies

Introduction: Gastric metastases are a rare manifestation of breast cancer and previous case reports suggest they typically occur in patients with a long standing history of breast cancer. We present a case of a patient whose primary diagnosis of breast cancer was made via gastric biopsies taken during esophagogastroduodenoscopy (EGD) after the patient presented to the hospital with symptoms of persistent nausea and vomiting. Case Description/Methods: The patient is a 58-year-old female with a reported history of alcohol use disorder who presented to the emergency department with intractable nausea and vomiting. On arrival, the patient’s vitals were stable and labs were only significant for a mildly elevated creatinine of 1.40, which normalized with IV fluids. Computed tomography (CT) of the abdomen and pelvis showed diffuse gastric wall thickening. Following the results of the CT, an EGD was performed which revealed diffuse gastritis with friable mucosa and concern for malignancy or ischemia. Gastric biopsies were suggestive of adenocarcinoma with likely primary being breast cancer. Immunohistochemical staining was positive for CDK7, GATA3, mammaglobin, and 80-90% estrogen receptor. Following consideration of both the pathologic appearance and immunohistochemical staining, the diagnosis was made of metastatic lobular carcinoma. Due to the patient's poor support system and functional status, the patient elected to pursue hospice, and therefore further workup was not performed (Figure 1). Discussion: Breast cancer is the second most common malignancy in women in the United States, with metastasis of breast cancer classically spreading to lungs, liver, bone, soft tissue, and adrenal glands. Metastasis to the gastrointestinal (GI) tract is rare, with lobular breast cancer having higher predilection over ductal carcinoma. The average time for breast cancer to metastasize to GI tract has been previously reported as many years after primary diagnosis. Here we present a case of breast cancer where the primary diagnosis was made after EGD assisted gastric biopsies. After extensive literature review, there is sparse information on early gastric metastasis of breast cancer. While our patient's previous history of breast cancer screening is unknown, she had no prior knowledge of her breast cancer diagnosis. This case signifies the importance of endoscopic evaluation and gastric biopsies in patients with nonspecific symptoms, especially with abnormal imaging findings suggestive of gastritis.Figure 1.: Endoscopic appearance of the gastric mucosa.

Existing barriers to utilization of health services for maternal and newborn care in rural Western Kenya

BackgroundUnderstanding the existing barriers to utilization of maternal and newborn health care services can inform improvement of care services in the rural settings in sub-Saharan Africa. However, how unintended pregnancy relates to the uptake of antenatal care (ANC) services and also how gaps in the role of the community health workers and health facilities affect maternal and newborn care and referral services are poorly understood.MethodsThis was a formative ethnographic study design to determine barriers to the utilization of health care services for maternal and newborns in rural Western Kenya. We interviewed 45 respondents through in-depth interviews in rural Bondo Sub- County, Western Kenya: Mothers and Fathers with children under 5 years), 2 Focus Group Discussions (FGDs) with Traditional Birth Attendants (TBA), and 2 FGDs with Skilled Birth Attendants (SBAs). The data were analyzed using Atlas-ti.ResultsWe found that unintended pregnancy results into poor uptake of antenatal care (ANC) services due to limited knowledge and poor support system. The respondents appreciated the role of community health workers but poor government infrastructure exists. Also, perceived harshness of the health care providers, poor management of high-risk pregnancies, and unavailability of supplies and equipment at the health facilities are of concern.ConclusionsThe findings of this study highlight barriers to the utilization of maternal and newborn services that if addressed can improve the quality of care within and outside health facilities.

Qualitative study of knowledge, perception, behavior and barriers associated with cardiovascular disease risk among overweight and obese Hispanic taxi drivers of South Bronx, NYC

BackgroundTaxi drivers are prone to developing cardiovascular disease (CVD) risk factors by adopting poor health behaviors due to their work environment. The population of Hispanic taxi drivers in inner city South Bronx, NYC, have not been studied. The goal of our qualitative study is to understand the perception, knowledge, behavior and barriers that influence CVD risk in overweight and obese inner-city Hispanic drivers.MethodsA cross-sectional qualitative study was conducted among community-based taxi drivers in South Bronx, NYC. Hispanic taxi drivers with body mass index of greater than 25 kg/m2 were screened and recruited for the study. Focus groups were organized to evaluate CVD and obesity risk factors through open-ended questions. The discussions were recorded, transcribed and analyzed using standard qualitative techniques. The Health Belief Model framework was applied to understand and evaluate likelihood of promoting health behaviors in this population based on the findings from the focus groups.ResultsWe conducted 3 focus groups (N = 25) and themes that emerged were evaluated. Through the Health Belief Model framework, Hispanic taxi driver participants reported demanding and stressful work shifts, barriers to better nutrition and good health, poor support systems, and low self-efficacy in overcoming barriers to improve their risk for CVD, due to lower perceived benefits and greater perceived barriers.ConclusionsInner-city Hispanic NYC taxi drivers have several contributing factors and barriers leading to a poor CVD risk and high body weight profile. Understanding their knowledge, perception and barriers the drivers face in improving their CVD risk, underscores the importance of community outreach programs to develop a framework in empowering and improving the health of this population.

Medical students' perception of their learning environment at a Nigerian University.

Background: The medical learning environment is an interactive network of factors that affect the medical student's academic progress and learning outcomes.This study was designed to assess the overall student's perception of their learning environment, identify the weak aspects of the environment, determine the effects of age, gender year of study on student's perception and recommend measures to further enhance students' learning experiences.Method: This is a cross-sectional study and cluster sampling technique was used to recruit respondents. The Dundee Ready Education Environment Measure (DREEM) questionnaire was applied to medical students of Ebonyi State University Abakaliki, to assess the following areas; student's perception of learning, student's perception of course organizers, student's academic selfperception, student's perception of atmosphere, and student's social self-perception. Completed questionnaires were analyzed with the SPSS software, version 17.Results: 180 questionnaires were analyzed. The mean global score was 120.4/200 (60.2%).It was noted to be significantly higher in the second year of study than in the fifth year of study. Further analysis of the subdomain revealed that students in their second year of study had significantly higher scores in all the subdomains except in the academic self-perception. Analysis of the individual items in the DREEM questionnaire showed that the students perceived the environment as not being relaxed during lectures, and that there was poor support system for students that get stressed in their course of study.Conclusion: Students' perception of their educational environment was positive but there was poor support system for students who get stressed. The school management needs to work on some aspects of social factors to improve on the perception and quality of teaching and learning.Key words: Medical, Students, Perception, Learning, Environment

Medical Students’ Perception about the Educational Environment in Western Maharashtra in Medical College using DREEM Scale

Educational Environment (EE) has significant impact on teaching-learning, satisfaction, performance and academic progress of students. Feedback obtained through structured questionnaire designed for them can serve as tool for identifying and solving these EE related problems. To assess the perceptions of medical students concerning their educational environment (EE) using Dundee Ready Education Environment Measure (DREEM) scale. Study involved all three years medical students; surveyed with DREEM questionnaire consisted of 50 items based on the Likert 's scale (scores from 0 to 200); and 5 domains namely students' perceptions of learning (SPL), perceptions of teachers (SPT), academic self-perceptions (SAP), perceptions of atmosphere (SPA) and social self-perceptions (SSP). The overall total score on Likert's scale was 136 (interpretation: predominantly positive). The scores obtained in the different domains were 35.5 in SPL (interpretation: a more positive perception); 30.9 in SPT (interpretation: moving in the right direction); 21 in SAP (interpretation: feeling more in the positive side); 29.8 in SPA (interpretation: a more positive atmosphere); and 16.1 in SSP (interpretation: satisfactory. The DREEM score assigned by female students was significantly greater (p<0.05) than male students. The second-year students were more positive in their perception of EE (p<0.05). Overall, student's perception about EE was satisfactory. However, the item with score <2 points i.e. authoritarian/strict teachers, factual, teacher-centred learning, inability to memorize all, poor support system for bored, tired or stressed students during their academic life were the problem areas identified need to be revisited and improvised to further improve learning experience.

Medical students’ perception of the educational environment in a medical college in India: a cross-sectional study using the Dundee Ready Education Environment questionnaire

Purpose:The objective of this study was to assess student perceptions of the environment in this medical college using the Dundee Ready Educational Environment Measure (DREEM).Methods:Cross-sectional study; 348 medical student volunteers (68.1%) of all semesters participated (511 enrolled). DREEM has 50 items, each rated from 0–4 (Likert scale: 0, strongly disagree to 4, strongly agree), that measure five domains: students’ perceptions of learning; perceptions of teachers; academic self-perception; perceptions of the atmosphere; and social self-perception. Mean item scores, domain scores, and global scores were computed.Results:The three highest rated items were knowledgeable teachers, having good friends, and confidence about passing; the three most problematic items were a poor support system for stressed students, inability to memorize everything, and over-emphasis on factual learning. The percentage score for perception of learning (47.26± 14.85) was significantly lower than that for teachers (52.28± 9.91; P< 0.001); academic self-perception (52.14 ± 15.21; P < 0.001); perception of the atmosphere (51.21 ± 13.60; P = 0.001); and social self-perception (50.63± 13.90; P= 0.010). The global scores were lowest for eighth-semester students (89.8± 21.24) when compared to second (101.33± 21.05; P= 0.003), fourth (107.69± 18.96; P< 0.001), and sixth (100.07± 20.61; P= 0.020).Conclusion:Improvement is required across all domains of the educational environment at this institution. Students, particularly of the eighth semester, perceived the teaching negatively. The lowest scores were given to the support system, burdensome course content, and factual learning; thus, a hybrid curriculum that includes problem-based learning might provide students with stimulating learning; structured clinical teaching with specific curricular objectives, as well as mentoring of senior students by faculty and near-peers, might improve the learning environment for senior students.

Postpartum Psychosis: What Happens When the Bough Breaks?

Childbearing Poster Presentation Background Postpartum psychosis is the most severe type of postpartum psychiatric illness. It can occur as early as 2 to 3 days after delivery but is more common in the first 2 to 4 weeks postpartum. The incidence of postpartum psychosis is 1 to 2 per 1,000 women. Risk factors identified are history of bipolar illness or depression, family history of mental illness, sleep deprivation, stress, poor support systems, and low self‐esteem. Early diagnosis and treatment are crucial for obtaining a positive outcome for both mother and infant. Case A42‐year‐old G7P3 was admitted at 41 weeks for a stat cesarean for fetal distress. A previous history of depression and two other psychotic episodes existed. The patient had a 9lb healthy infant daughter, who she was breast feeding. The husband stayed with his wife and daughter and other children visited. On day 3, the patient walked out of the bathroom with a blank stare, got into bed and started a rocking movement, clutched blankets to her chest and sang church hymns in a loud voice. The patient would not respond to name and would not eat or drink. At one point, the patient cried that the voices were telling her to kill her infant. A psychiatric consult was done immediately, and a stat head computed tomography scan, metabolic profile, thyroid stimulating hormone, rapid plasma regain, and 1:1 sitters were ordered. Antiagitation medications were ordered. Results of above tests were normal. A multidisciplinary team of social work, psychiatry, nursing, obstetricians, and pastoral care worked to address this patient's symptoms and needs. Six days post cesarean, the patient was transferred to a private inpatient psychiatric facility for 2 weeks. The patient then was treated as an outpatient with regular office visits. Conclusion Early identification and treatment of postpartum psychosis is imperative for the well‐being of the mother and to help establish her ability to care for her infant and resume her normal activities. Early and excellent nursing intervention and care were crucial in ensuing this patient's return to a productive role as a wife and mother.

Lessons from the 2004 Asian tsunami: Epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities

The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings. To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates. We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS. The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91). Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.

Traumatic Brain Injury: Caregivers’ Problems and Needs

Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers' problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, financial inadequacy, anxiety, distress, coping deficits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, financial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.

Burnout in the internist-intensivist

Caring for acutely ill patients imposes significant demands on physicians. The environment and stresses of the ICU may lead to the burnout syndrome. The purpose of this study was to evaluate the prevalence of burnout among internal medicine intensivists and the contributing factors present in ICU practice. Mailed survey utilizing the Maslach Burnout Inventory (MBI). Increasing burnout has been shown to be associated with low levels on personal achievement and high scores on depersonalization and emotional exhaustion. Random sample of members of the Internal Medicine Section of the Society of Critical Care Medicine. 248 people responded: 220 (88.7%) males and 28 females. Mean age of all respondents was 41.6 +/- 6.7 years. The majority (58.1%) worked in large hospitals (> 400 beds); 55.6% devoted more than 50% of their time to critical care. The emotional exhaustion subscale of the MBI averaged 22.2 +/- 9.5, with a third of respondents scoring in the high range. The depersonalization score averaged 7.1 +/- 5.1%, with 20.4% of respondents scoring in the high range. Similarly personal achievement subscores were poor, with a mean value of 30.9 +/- 6.4%, with 59% scoring in the low range. High levels of emotional exhaustion were associated with anticipating leaving critical care before retirement. Burnout as measured by the MBI appears to be common in internal medicine intensivists. High levels of emotional exhaustion and depersonalization are related not only to patient care issues but also to a poor support system.