Subjective Burden Research Articles

Care-related Case Management and the experienced burden of informal caregivers: empirical study

Care-related Case Management and the experienced burden of informal caregivers: empirical study Abstract. Background: Informal caregivers are responsible for the majority of home care in Germany. Their experience of stress is becoming more and more relevant given the tense staffing situation in outpatient professional care in rural areas. Case management as an innovative approach to caring in peripheral areas also focuses on the burden experienced by informal caregivers. Aim: The question arises as to whether care-related case management can have a positive influence on the burden experienced by informal caregivers. Methods: In a mixed-method approach, the influence of case management on the experience of stress is analyzed quantitatively (N = 251) and qualitatively (N = 40) using a pre-post design with a control group. Group difference tests based on the HPS-scale and content analysis of the interviews are conducted. Results: The analyses suggest that case management can have a positive influence on the experience of burden. From a quantitative perspective, there was a stabilizing influence on the experience of burden in the intervention group, while burden increased in the control group. Qualitatively, there was an influence on subjective burden. In particular, the role of the case manager as a central contact person in matters regarding the care situation is relevant. Conclusions: By providing new resources and coping strategies, case management can effectively alleviate the burden experienced by informal caregivers.

Experiences of parents of children with mental illnesses: A systematic review and meta-ethnographic synthesis.

In this paper, we present a qualitative meta-ethnographic synthesis of 26 articles reporting experiences of subjective burden in 389 parents of children with mental illnesses. The studies were identified through a systematic literature search of PubMed, CINAHL Ultimate, APA PsycInfo, and MedLine Ultimate. We conducted a quality appraisal and followed the seven stages of meta-ethnographic synthesis. We developed a line of argument synthesis in the form of a model that depicts the subjective, temporal, and psychological experiences of parents. The model proposes a cyclical process characterized by five stages, each depicting a transitional point in which parents re-evaluate their experiences: caring for an intimate stranger; turning point; unavoidable role; uncertain future; transcendence. This model highlights the complex psychological processes that parents endure when caring for a child with a mental illness. The review highlights several methodological issues in this field of research, including issues related to sampling, poor reporting of data analysis, limited critical appraisal, and a lack of reflexivity. Future research should address the gaps in the literature while also attending to the issues that have been highlighted by this review.

Chronic illness and financial burden in Switzerland (FINK): a protocol for a mixed methods research project

IntroductionPeople with cancer and other chronic illnesses, their families and caregivers report financial burden as a problem that affects multiple aspects of daily life. While cancer research has coined the...

Presence and Impact of Adverse Childhood Experiences and Reflective Functioning on Aggression in Adults With Antisocial Behaviour.

This cross-sectional study investigated the relationship between the presence and impact of ACEs with both reactive and proactive aggression, and the possible moderating role of mentalization (operationalized as reflective functioning) in these expected relationships. Sixty-five inpatient and outpatient adults with any kind of antisocial behaviour completed the Dutch version of the Traumatic Experiences Checklist, the Reactive-Proactive Aggression Questionnaire, and the Adult Attachment Interview with the use of the Reflective Functioning Scale. Preliminary analysis showed a remarkably high level of ACEs, and a relatively high reported impact of these experiences. We found a positive relationship between the total presence of ACEs (including childhood maltreatment and adverse household factors), and both reactive and proactive aggression. We also found positive relationships between the experienced impact of these ACEs and both reactive and proactive aggression. Regarding childhood maltreatment in family of origin, we did not find a correlation between the presence of these experiences and respectively reactive and proactive aggression. However, we found a correlation between the impact of childhood maltreatment and reactive aggression. These results suggest that in addition to the cumulative experience of ACEs, the subjective burden of these experiences on individuals must not be underestimated in case of aggression. Additional moderation analysis showed no differences in these relationships in case of less developed versus medium-high developed reflective functioning. The findings substantiate the importance of early prevention and treatment programs with focus on ACEs to possibly reduce aggression.

Analysis of Intervention Effects of Prototyping Utilizing UI Stencils in Elementary School Students

This study examines the impact of using stencils in paper prototyping on work time, subjective burden, and idea generation among Japanese sixth-grade students, focusing on the role of personality traits, specifically openness. Two groups were involved: Group 1 used stencils after a lecture, and Group 2 worked freehand without prior instruction. Results showed no significant difference in work time; however, a reduction in subjective burden was noted in the stencil group. While no significant correlation was found between openness and the number of stencil icons used, children with higher openness scores engaged more intensively, suggesting that stencils influence the quality and depth of engagement. The findings highlight the importance of tailored educational approaches to enhance learning outcomes.

Identifying the Burden of Inappropriate Prescribing Using Consensus in a Day Hospital Setting

Abstract Background Inappropriate prescribing (IP) is highly prevalent in older adults and is associated with increased risk of adverse drug reactions, increased morbidity, mortality and healthcare utilisation. Risk factors associated with IP include older age, polypharmacy and having multiple healthcare providers. The aim of our study was to identify the prevalence of polypharmacy and potential IP in the day hospital setting. Methods Patients attending our day hospital over two months were included. Consensus was reached between two Geriatric medicine SpRs and the day hospital pharmacist regarding various categories of potentially IP, and a proforma was agreed. We gathered demographic data, number of medications and subjective medication burden. We recorded data in Excel, and we quantified potentially inappropriate medicines and categorised all identified IP. Results 179 participants were included, mean age 83 (range 68-98). 80% of patients were taking ≥5 medications, overall, 40% perceived they were taking too many. 79% of participants had at least one example of IP, 25% had ≥3. The commonest example of IP involved PPIs, involving 26% participants, followed by antihypertensives involving 21% of participants. Overall, 48% of potentially inappropriate medications were identified due to ‘inappropriate indication’, and 37% related to side-effects. People aged 65-69 and 90-94 were the most likely to report they were taking too many medicines, 75% and 46% respectively. This correlated with the same age brackets having the highest number of average IP, 2.75 and 2.2 respectively. Conclusion Despite the well-known associated risk of harm, our study confirms ongoing high prevalence of polypharmacy and IP amongst older adults. Prescriber vigilance is key in reducing harm. Regular presence of a pharmacist, liaising strongly with medical staff, is invaluable in the day hospital setting.

A qualitative exploration of changes and mechanisms of changes in a psychoeducational intervention for family dementia caregivers

Background‘Learning to feel better… and help better’ is a psychoeducational intervention that aims to empower family caregivers of people with dementia by helping them cope better with the daily stress of dementia caregiving. The intervention has been adapted to a Swiss context and evaluated with a mixed-method design, yielding promising results in caregivers, such as a reduced subjective burden and improved self-efficacy. Qualitative findings have provided insight into potentially relevant intermediate changes that must be further explored to better understand how the intervention precipitates the achieved changes. We aim to qualitatively explore such changes, related mechanisms and key intervention components in the context of this intervention.MethodsA constructivist grounded theory approach was used to achieve this aim. Changes, related mechanisms and key intervention components were identified by exploring the following: 1) longitudinal qualitative data, collected from 13 family caregivers via interviews performed before, during and after the intervention (39 interviews total) and 2) cross-sectional post-intervention interview data collected from 22 family caregivers (22 interviews).ResultsExperiencing calmness was the most important change for caregivers in the context of this intervention. The calmness model, developed based on the qualitative analysis, illustrates the intermediate changes that contributed to calmness, such as being able to cope with daily life and experiencing positive interactions with the family member with dementia. Related key intervention components were the coping strategy ‘reframing’, employed in diverse ways by the caregivers to reduce daily stress, and the didactic method ‘active skills’ training’, which involved active participation by the caregivers and the guidance of a professional group leader. One important factor hampering changes in caregivers was having difficulties accepting the caregiver role or accepting the losses due to dementia.ConclusionThe calmness model offers valuable insight into how this intervention can benefit family caregivers and aid in developing interventions targeting similar mechanisms and changes.Trial registrationISRCTN13512408 (registration date 17.05.2021, retrospectively registered).

Caregivers' burden of care during emergency department care transitions among older adults: a mixed methods cohort study.

Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it. This mixed-methods observational study nested within LEARNING WISDOM included caregivers of older patients who experienced an ED care transition. Burden was collected with the brief Zarit Burden Interview (ZBI-12), and caregivers also commented on the care transition. A qualitative coding scheme of patient care transitions was created to reflect themes important to caregivers. Comments were randomly analyzed until saturation and themes were extracted from the data. We followed both the SRQR and STROBE checklists. Comments from 581 caregivers (mean age (SD) 64.5 (12.3), 68% women) caring for patients (mean age (SD) 77.2 (7.54), 48% women) were analyzed. Caregivers overwhelmingly reported dissatisfaction and unmet service expectations, particularly with home care and domestic help. Communication and follow-up from the ED emerged as an area for improvement. Caregivers who reported an increased level of burden following a patient's care transition had significantly higher ZBI scores than caregivers who self-reported stable burden levels. Caregivers with increasing, stable, and improved levels of subjective burden all reported areas for improvement in the care transition process. Themes centering on the capacity to live at home and inadequate communication were most frequently mentioned and may represent serious challenges to caregivers. Addressing these challenges could improve both caregiver burden and ED care transitions.

Insights into psychological characteristics of persons (not) agreeing to use an e-coach-application to reduce elevated Internet Use Disorder tendencies

The present work aims to shed light on the question of whether certain psychological characteristics go along with choosing an e-coach offer to support healthy Internet use when reporting elevated Internet Use Disorder (IUD) tendencies. Data were from a large-scale stepped care approach study to treat persons with varying degrees of IUD tendencies. Recruitment for advertising the download of a smartphone app included social media, videos by influencers, paid ads, TV, radio, newspapers, workshops, and vocational schools. We contrasted a final sample of 184 declining, 907 agreeing, and 216 agreeing but not providing follow-up details needed to use such an e-coach, as well as 995 who did not explicitly decline or agree to participate (but refrained from using the e-coach). Participants were compared on several study variables, including sociodemographics, mental health, fear of missing out, personality, perceived stress, and IUD tendencies. Interestingly, we observed only two significant findings when contrasting the aforementioned groups using ANOVA. First, the group not agreeing to use the e-coach was associated with the lowest IUD tendencies and highest conscientiousness scores. Second, agreeing to use the e-coach was associated with older age. Further significant differences could be observed, but in general the accompanying effect sizes were very mild. In sum, the present study findings support the idea that greater subjective burden of IUD might result in more willingness to seek e-help, but also the personality trait of conscientiousness and a person’s age might play a role here.

Psychosocial burden in mothers with epilepsy and their caregiver: Feasibility and preliminary results of a digital screening procedure

ObjectiveThe present study aims to evaluate the feasibility of utilizing a digital procedure to screen for anxiety and depression as well as impairments in psychosocial aspects, such as social support, social activity and quality of life (QoL) in women with epilepsy (WWE) after childbirth. Furthermore, the study intends to digitally screen for burden of the respective caregivers in WWE compared to a healthy control group. Materials and methodsThis comparative cross-sectional study was conducted in the post-partum period on 30 WWE and 33 healthy controls who gave birth between 01/2018 and 05/2021. Additionally, 24 caregivers of WWE and 26 caregivers of healthy mothers took part in this study. Information on psychosocial health and psychosocial burden was collected digitally using the short version of the Social Support Questionnaire, the Social Activity Self-Report Scale and the Hospital Anxiety and Depression Scale. The caregiver burden was digitally assessed with the Zarit Burden Scale in its German adaptation (i.e., Zarit Burden Interview and the Family Burden Questionnaire). Furthermore, QoL was assessed with the QOLIE-31 (Quality of Life in Epilepsy Inventory) in WWE and with the Life Satisfaction Questionnaire in healthy controls. ResultsWhen comparing WWE and healthy controls, the groups were comparable on psychosocial aspects, such as self-reported social support, anxiety, depression and social activity, when assessed with self-report measures in a digital screening procedure.Although not significantly different between groups, anxiety, depression, self-reported social support and social activity were correlated with overall QoL in both, WWE and healthy controls.Caregivers of WWE and healthy controls were neither significantly different in their objective burden nor in their subjective burden as reported in digitally applied self-report measures. ConclusionAlthough not significantly different between groups, given the correlation between psychosocial aspects and QoL, it is worthwhile to include these aspects in standard clinical screening extending beyond the screening of anxiety and depression in WWE.Overall, the preliminary psychosocial data presented in this study suggest that a digital assessment of psychosocial burden seems reasonable in WWE and warrants integration into further research and clinical practice.Nevertheless, since no significant differences concerning psychosocial aspects were found in the present study, one may argue that highly specialized clinical care, as provided in the present study, may counteract potential psychosocial impairment experienced by WWE who do not receive such specialized care.Hence, further investigations outside of specialized outpatient clinics as well as prospective investigations of subjective factors that may dynamically change during pregnancy ought to be addressed in clinical practice and research for improving care during and after pregnancy in WWE.

Psychological distress in family caregivers of people with Alzheimer’s disease: Positive and negative aspects of caregiving

Research focusing on family caregivers of people with Alzheimer’s disease (PWAD) has predominantly highlighted the negative aspects of caregiving, reporting variables associated with poor mental health such as depression, anxiety, and burden. In recent decades, efforts have also been made to study positive variables associated with care, such as gain (positive results from the caregiving activity), satisfaction, and quality of life. The present study includes both positive and negative aspects of caregivers of PWAD, aiming to clarify their relationships and how they affect psychological distress. The study employed a cross-sectional descriptive design, enrolling a sample consisting of 140 family caregivers of PWAD. The variables assessed as negative aspects included hours of care per day, perceived burden, and psychological distress, while happiness, gain in caregiving, and quality of life were assessed as positive aspects. The results confirmed that family caregivers of PWAD experience both negative and positive aspects associated with caregiving. The relationship between these aspects is inversed: as the perceived burden increases, the mental health of the caregiver declines, and the positive aspects associated with caregiving decrease. Specifically, the perception of happiness begins to decrease with more than 15 h of care/day, while the perception of gain increases after 10 h of care/day. Respite care or financial aid that helps PWAD family caregivers reduce the number of hours dedicated to caring, along with psychological and support interventions to reduce subjective burden, would result in improved mental health of caregivers of PWAD.

Is more care recipient time at home also a family caregiver-centered quality of life measure?

Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home-days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)-to understand how care recipient days not at home correspond to family caregiver QoL. Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted "days not at home" variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden). In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%-3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (-0.1%). An IP day had a slight protective effect (-0.2 to -0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (-0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL. Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.

Differential associations between SARS-CoV-2 infection, perceived burden of the pandemic and mental health in the German population-based cohort for digital health research

Understanding the potential adverse effects of the COVID-19-pandemic on mental health remains a challenge for public health. Differentiation between potential consequences of actual infection with SARS-CoV-2 and the subjective burden of the pandemic due to measures and restrictions to daily life still remains elusive. Therefore, we investigated the differential association between infection with SARS-Cov-2 and subjective burden of the pandemic in a study cohort of 7601 participants from the German population-based cohort for digital health research (DigiHero), who were recruited between March 4th and April 25th 2022. Data was collected using the online survey tool LimeSurvey® between March and October 2022 in consecutive surveys, which included questionnaires on infection status and symptoms following COVID-19 as well as retrospective assessment of the subjective burden of the pandemic. We observed an association of a past SARS-CoV-2 infection on deteriorated mental health related symptoms, whereas no association or interaction with burden of the pandemic occurred. The association was driven by participants with persistent symptoms 12 weeks after infection. On a symptom specific level, neuropsychiatric symptoms such as exhaustion and fatigue, concentration deficits and problems with memory function were the primary drivers of the association with small effect sizes between 0.048 and 0.062 ηp2.

Delirium care burden of intensive care nurses caring for patients undergoing open-heart surgery: A mixed-method research.

Delirium is an acute confusional state characterized by inattention, cognitive dysfunction and an altered level of consciousness. Delirium causes negative outcomes in patients, and patients with delirium increase the workload of nurses. Therefore, it is important to recognize the challenges and burdens experienced by nurses caring for patients with delirium. To determine the subjective burden experienced by intensive care nurses caring for patients who have undergone open-heart surgery. A mixed-method sequential explanatory design. A non-probability purposive sampling method was used for the quantitative stage. Using OpenEpi, we employed the method of sample calculation with an unknown universe. The sample size of the quantitive study comprised 130 nurses. Quantitative data were collected with Google survey. For gathering qualitative data, online video interviews were conducted with 10 nurses, an interpretive phenomenological approach was used and content analysis was performed. In the quantitative phase, we found that the subjective burden was high. In the qualitative phase, five main themes emerged: difficulty in recognizing delirium, physical burden, emotional burden, burden in care management of patients with delirium and the effect of patients with delirium on other patients. The nurses experienced physical and emotional burden in delirium management and felt lonely while caring for patients with delirium. Because nurses play a key role in the care of patients with delirium, reducing the burden nurses experience when caring for patients with delirium should be considered important in ensuring that this patient population receives adequate care. Delirium patients create a care burden for intensive care nurses. To reduce this burden of care, in-service training in patient management and bedside teaching support should be provided to nurses. Furthermore, the use of a valid scale to diagnose delirium should be integrated into health policies. Nurses should not be left alone in the management of delirium. Managing delirium patients with a team including physicians, nurses and professionals from other health disciplines will ensure that patients receive high-quality care, thereby reducing the care burden of nurses.

Relationship quality perceived by family caregivers of people with dementia in the context of a psychoeducational intervention: A qualitative exploration.

Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better . . . and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention. A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups. A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes. Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia.

Machine Learning-Based Prediction of 1-Year Survival Using Subjective and Objective Parameters in Patients With Cancer.

Palliative care is recommended for patients with cancer with a life expectancy of <12 months. Machine learning (ML) techniques can help in predicting survival outcomes among patients with cancer and may help distinguish who benefits the most from palliative care support. We aim to explore the importance of several objective and subjective self-reported variables. Subjective variables were collected through electronic psycho-oncologic and palliative care self-assessment screenings. We used these variables to predict 1-year mortality. Between April 1, 2020, and March 31, 2021, a total of 265 patients with advanced cancer completed a patient-reported outcome tool. We documented objective and subjective variables collected from electronic health records, self-reported subjective variables, and all clinical variables combined. We used logistic regression (LR), 20-fold cross-validation, decision trees, and random forests to predict 1-year mortality. We analyzed the receiver operating characteristic (ROC) curve-AUC, the precision-recall curve-AUC (PR-AUC)-and the feature importance of the ML models. The performance of clinical nonpatient variables in predictions (LR reaches 0.81 [ROC-AUC] and 0.72 [F1 score]) are much more predictive than that of subjective patient-reported variables (LR reaches 0.55 [ROC-AUC] and 0.52 [F1 score]). The results show that objective variables used in this study are much more predictive than subjective patient-reported variables, which measure subjective burden. These findings indicate that subjective burden cannot be reliably used to predict survival. Further research is needed to clarify the role of self-reported patient burden and mortality prediction using ML.

How do care-related beliefs contribute to depression and anxiety in family caregivers of people with dementia? Testing a cognitive vulnerability-stress model

Objectives Care-related beliefs are considered risk factors for decreased mental health in family caregivers of people with dementia. However, their exact role in the caregiver stress process remains unclear. Hence, we tested a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. Method A cross-sectional study was conducted using baseline data from a caregiver intervention trial (N = 322). Within Bayesian moderated mediation analysis, we examined mediation of effects of objective demands (severity of dementia, challenging behavior, caregiving intensity, caregiving duration) on depression and anxiety via subjective caregiver burden and moderation by care-related beliefs in four domains (dysfunctional caregiving standards, dysfunctional attitudes towards dementia, functional self-care-related beliefs, functional acceptance-related beliefs). Results The relation between objective demands and subjective burden was amplified by dysfunctional caregiving standards and dysfunctional attitudes towards dementia and mitigated by functional self-care-related beliefs. Further, functional acceptance-related beliefs attenuated the effect of subjective caregiver burden on depression. Conclusion The study provides preliminary evidence for a cognitive vulnerability-stress model of depression and anxiety in family caregivers of people with dementia. The results indicate that the four-domain model of care-related beliefs is a valuable framework for future research and may serve as a heuristic model for cognitive-behavioral therapy in this population.

Ocular Damage Index, Ocular Pain and Subjective Visual Rating in Patients with Behçet’s Uveitis: A Study of Impact on Health-Related Quality of Life

ABSTRACT Purpose The aim of our study is to assess subjective disease burden parameters (SVR and OP) as well as objective ones (BCVA and ODI) as predictors of HRQoL in Egyptian patients with BD uveitis. Methods Ninety-six patients with BD uveitis were recruited in this cross-sectional study from the Rheumatology Department, Cairo University Hospital. HRQoL was assessed using RAND-36 item health survey 1.0, subjective visual rating (SVR) was measured on a 6-point Likert scale. Ocular pain (OP) was rated on a numeric rating scale. The Ocular Damage Index (ODI) was calculated using the ocular domain of the BD damage index. Linear regression was performed to determine predictors of HRQoL metrics. Results SVR predicted Vitality (β = 0.15, p = 0.004), Emotional Well-being (EW) (β = 0.13, p = 0.005), General Health (β = 0.18, p = 0.012) and Mental Component Summary (β = 0.22, p = 0.002). OP predicted Social Function (β = -3.18 p < 0.001), General Health (β = −1.55, p = 0.004), Physical Component Summary (β = -2.00, p = 0.007) and Mental Component Summary (β = -1.53, p = 0.005). BCVA predicted Physical Function (β = 31.1, p = 0.02) and Emotional Well-being (β = 7.94, p = 0.01). ODI failed to predict any HRQoL metrics. ODI was independent predictor of legal blindness adjusted for uveitis duration and severity. Legally blind patients had worse HRQoL metrics than patients with better vision. Conclusion In BD uveitis patients, subjective disease burden parameters were more informative about HRQoL metrics than objective ones. Longitudinal studies are needed to elucidate the utility of ODI as an outcome measure in BD uveitis. Precis In Behcet’s uveitis patients, health-related quality of life was related to visual outcome, ocular pain, and subjective visual rating. Ocular damage was an independent predictor of legal blindness, adjusted for uveitis duration and severity.

In Search for a Pathogenesis of Major Depression and Suicide-A Joint Investigation of Dopamine and Fiber Tract Anatomy Focusing on the Human Ventral Mesencephalic Tegmentum: Description of a Workflow.

Major depressive disorder (MDD) is prevalent with a high subjective and socio-economic burden. Despite the effectiveness of classical treatment methods, 20-30% of patients stay treatment-resistant. Deep Brain Stimulation of the superolateral branch of the medial forebrain bundle is emerging as a clinical treatment. The stimulation region (ventral tegmental area, VTA), supported by experimental data, points to the role of dopaminergic (DA) transmission in disease pathology. This work sets out to develop a workflow that will allow the performance of analyses on midbrain DA-ergic neurons and projections in subjects who have committed suicide. Human midbrains were retrieved during autopsy, formalin-fixed, and scanned in a Bruker MRI scanner (7T). Sections were sliced, stained for tyrosine hydroxylase (TH), digitized, and integrated into the Montreal Neurological Institute (MNI) brain space together with a high-resolution fiber tract atlas. Subnuclei of the VTA region were identified. TH-positive neurons and fibers were semi-quantitatively evaluated. The study established a rigorous protocol allowing for parallel histological assessments and fiber tractographic analysis in a common space. Semi-quantitative readings are feasible and allow the detection of cell loss in VTA subnuclei. This work describes the intricate workflow and first results of an investigation of DA anatomy in VTA subnuclei in a growing naturalistic database.

The Relationship Between Objective Family Burden And Family Ability To Care For Schizophrenia

Background: Schizophrenia is one mental illness type. Family interactions are impacted by this disease because it leads individuals to behave erratically. Family caregivers will be less able to care for patients because of the strain this condition puts on them. The researchers at Dr. Amino Gondohutomo Hospital in Central Java Province set out to find out how family caregivers' capacity to care for their loved ones with schizophrenia correlated with their own subjective burdens. Methods: Using a cross-sectional method and a purposive sample technique, this study utilized a quantitative correlational type with a maximum of 38 respondents. A family burden questionnaire and the ability to care for one's family using the Spearman Rank test were the research instruments used. Results: The Spearman Rank test results reveal a significant value of 0.008 &lt;0.05 between the objective load of the family and the ability to care for the family, and a unidirectional correlation coefficient value of -0.427 between the two variables. Conclusion: The conclusion of this study is that there is a significant relationship, and the higher the perceived burden, the worse the family's ability to care. It is recommended to provide support and resources to families to alleviate their perceived burden, thereby enhancing their ability to provide effective care