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The concept of altruism is evidenced in various disciplines but remains understudied in end-of-life (EOL) contexts. Patients at the EOL are often seen as passive recipients of care, whereas the altruism of professionals and families receives more research and clinical attention. Our aim was to summarize the state of the scientific literature concerning the concept of patient altruism in EOL contexts.
Methods
In May 2023, we searched 11 databases for scientific literature on patient altruism in EOL contexts in consultation with a health information specialist. The scoping review is reported using the PRISMA checklist for scoping reviews. We used a data charting form to deductively extract data from the selected articles and then mapped data into 4 themes related to our research questions: how authors describe and employ the concept of patient altruism; expressions of patient altruism; consequences of patients’ altruistic acts; and possible interventions fostering patient altruism.
Results
Excluding duplicates, 2893 articles were retrieved; 33 were included in the final review. Altruism was generally considered as an act or intention oriented toward the benefit of a specific (known) or non-specific (generic) recipient. Patients expressed altruism through care and support, decisions to withhold treatment or actively hasten death, and engagement in advance care planning. Consequences of altruism were categorized in patient-centered (contribution to meaning in life and quality of life), non-patient-centered (leaving a positive impact and saving money), and negative consequences (generating feelings of guilt, exposing individuals with low self-esteem). Interventions to encourage altruism comprised specific interventions, providing opportunities to plan for future care, and recognizing and respecting the patients’ altruistic motivations.
Significance of results
We identified heterogeneous and limited research conceptualization of patient altruism and its operationalization in palliative care settings. A deeper conceptual, empirical, and theoretical exploration of patient altruism in EOL is necessary.
Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.
OBJECTIVES/GOALS: Use an easily accessible medium to educate life science researchers and academic innovators interested in the commercialization of academic research at the University of Michigan (UM). METHODS/STUDY POPULATION: Life science research investigators and academic innovators interested in research commercialization and technology development from across the state of Michigan were invited to attend the Idea to Impact: The Translation & Commercialization of Academic Research webinar series, presented by Fast Forward Medical Innovation at the University of Michigan. The webinar series outlined the significance and critical milestones of developing novel therapeutics, medical devices, diagnostics, and digital health innovations, as well as essential collaborations with industry partners to translate a research-based idea into a product of impact. RESULTS/ANTICIPATED RESULTS: 113 investigators and innovators from 28 different institutions, organizations, and companies, registered for the webinar series. Results (N=24) of an evaluation immediately following each webinar revealed that 100% of respondents strongly agreed or agreed that the series was effective in helping them to identify and describe commercialization resources, including funding, education, and mentorship, available at the University of Michigan and within the state. Participants stated that they “loved the practical information” “shared” and that the series was a “great overview that inspired a lot more questions.” The Fast Forward Medical Innovation team was then able to consult with participants to connect them with additional resources. DISCUSSION/SIGNIFICANCE: The data suggests that easily accessible and digestible commercialization education can make navigating the academic entrepreneurial ecosystem easier for investigators and innovators. The recorded webinar series, Idea to Impact: The Translation & Commercialization of Academic Research, serves this purpose.
When vaccination depends on injection, it is plausible that the blood-injection-injury cluster of fears may contribute to hesitancy. Our primary aim was to estimate in the UK adult population the proportion of COVID-19 vaccine hesitancy explained by blood-injection-injury fears.
Methods
In total, 15 014 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, took part (19 January–5 February 2021) in a non-probability online survey. The Oxford COVID-19 Vaccine Hesitancy Scale assessed intent to be vaccinated. Two scales (Specific Phobia Scale-blood-injection-injury phobia and Medical Fear Survey–injections and blood subscale) assessed blood-injection-injury fears. Four items from these scales were used to create a factor score specifically for injection fears.
Results
In total, 3927 (26.2%) screened positive for blood-injection-injury phobia. Individuals screening positive (22.0%) were more likely to report COVID-19 vaccine hesitancy compared to individuals screening negative (11.5%), odds ratio = 2.18, 95% confidence interval (CI) 1.97–2.40, p < 0.001. The population attributable fraction (PAF) indicated that if blood-injection-injury phobia were absent then this may prevent 11.5% of all instances of vaccine hesitancy, AF = 0.11; 95% CI 0.09–0.14, p < 0.001. COVID-19 vaccine hesitancy was associated with higher scores on the Specific Phobia Scale, r = 0.22, p < 0.001, Medical Fear Survey, r = 0.23, p = <0.001 and injection fears, r = 0.25, p < 0.001. Injection fears were higher in youth and in Black and Asian ethnic groups, and explained a small degree of why vaccine hesitancy is higher in these groups.
Conclusions
Across the adult population, blood-injection-injury fears may explain approximately 10% of cases of COVID-19 vaccine hesitancy. Addressing such fears will likely improve the effectiveness of vaccination programmes.
Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents.
Aims:
The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS).
Method:
We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment.
Results:
Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings.
Conclusions:
The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.
Our aim was to estimate provisional willingness to receive a coronavirus 2019 (COVID-19) vaccine, identify predictive socio-demographic factors, and, principally, determine potential causes in order to guide information provision.
Methods
A non-probability online survey was conducted (24th September−17th October 2020) with 5,114 UK adults, quota sampled to match the population for age, gender, ethnicity, income, and region. The Oxford COVID-19 vaccine hesitancy scale assessed intent to take an approved vaccine. Structural equation modelling estimated explanatory factor relationships.
Results
71.7% (n=3,667) were willing to be vaccinated, 16.6% (n=849) were very unsure, and 11.7% (n=598) were strongly hesitant. An excellent model fit (RMSEA=0.05/CFI=0.97/TLI=0.97), explaining 86% of variance in hesitancy, was provided by beliefs about the collective importance, efficacy, side-effects, and speed of development of a COVID-19 vaccine. A second model, with reasonable fit (RMSEA=0.03/CFI=0.93/TLI=0.92), explaining 32% of variance, highlighted two higher-order explanatory factors: ‘excessive mistrust’ (r=0.51), including conspiracy beliefs, negative views of doctors, and need for chaos, and ‘positive healthcare experiences’ (r=−0.48), including supportive doctor interactions and good NHS care. Hesitancy was associated with younger age, female gender, lower income, and ethnicity, but socio-demographic information explained little variance (9.8%). Hesitancy was associated with lower adherence to social distancing guidelines.
Conclusions
COVID-19 vaccine hesitancy is relatively evenly spread across the population. Willingness to take a vaccine is closely bound to recognition of the collective importance. Vaccine public information that highlights prosocial benefits may be especially effective. Factors such as conspiracy beliefs that foster mistrust and erode social cohesion will lower vaccine up-take.
In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.
Aims
To conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.
Method
A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.
Results
Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.
Conclusions
A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.
Declaration of interest
K.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
Background: Trauma-focused CBT (TFCBT) is an evidence-based treatment for post-traumatic stress disorder (PTSD), but little is known about whether it is an acceptable and effective treatment for asylum-seekers presenting with PTSD. Aims: This study considers the acceptability of TFCBT for asylum-seekers with PTSD by exploring their experiences of this treatment. Method: Seven asylum-seekers who had received CBT involving a TFCBT component were interviewed using a semi-structured schedule. The transcribed interviews were analysed using interpretative phenomenological analysis (IPA). Interpretative themes were developed iteratively to closely reflect participants’ common and distinct experiences. Results: Six super-ordinate interlinking themes are discussed: Staying where you are versus engaging in therapy; Experiences encouraging engagement in therapy; Experiences impeding engagement in therapy; Importance of the therapeutic relationship; “Losing oneself” and “Regaining life”. Conclusions: Participants described their ambivalence about engaging in TFCBT. Such treatment was experienced as very challenging, but most participants also reported finding it helpful. Various experiences that appeared to encourage or impede engagement are outlined. These preliminary findings suggest that fear of repatriation can impede engagement in TFCBT, but that some asylum-seekers with PTSD still report finding TFCBT beneficial. The clinical implications are discussed, including the special importance of the therapeutic relationship.
This article problematises international heritage interventions in divided cities through exploring UNESCO's role in Jerusalem's Old City. It examines the tension between universal heritage values and protocols and nationalist agendas which often involve politicised archaeological responses. Drawing on comparative case studies of UNESCO-affiliated projects in Fez and Aleppo, and in the violently divided cities and regions of Mostar and Kosovo, it assesses future challenges and possibilities facing UNESCO in Jerusalem. While the article confirms an increased need for an international arbitrator and protector for the city's sacred sites and divided cultural heritage, it also underscores the limitations of UNESCO's legal remit and the political sensitivities which hinder its praxis.
We reintroduced 33 peregrine falcons (Falco peregrinus) at two release areas with contrasting habitat configurations to assess landscape influences on dispersal. One site (Daniel Boone National Forest) had non-forested corridors within a forest matrix, whereas the other site (Tom Dorman State Nature Preserve) had forested corridors within an agricultural matrix. We used aerial telemetry and ground observation to assess differences in dispersal between sites and we used multivariate statistical analyses to detect combinations of response variables depicting landscape influences. Non-forested corridors at Daniel Boone affected post-fledging movements and initiation of dispersal, whereas no discernable pattern in dispersal initiation was observed at Dorman Preserve. Results included significant (p<0.05) differences between peregrines at Daniel Boone and Dorman Preserve in $\bar{x}{\pm}$ SD post-fledging area (PFA) size (2643.5±2599.0 and 931.7±732.1 ha, respectively), maximum movement distances (12.9±13.9 and 6.1±4.6 km, respectively), orientation of movements (second-order $\bar{x}$ angle±95% confidence interval (CI)=280.8±58.6 (non-random orientation) and 358.8±98.8 (random orientation), respectively), time spent on the PFA (16.0±12.2 and 31.0±3.3 days, respectively) and selection of agricultural habitats (Euclidean distance vectors ρ=0.66 and ρ=2.50, respectively). Selection of agriculture by peregrines released on Daniel Boone reflected selection of corridors as part of pre-dispersal movement. These results, coupled with generally unorientated movement behaviour by Dorman Preserve peregrines, provided evidence for an influence of functional landscape connectivity on dispersal in peregrines.
The Greater Chassahowitzka black bear population is the smallest documented in North America with fewerthan 20 individuals. Its future depends on landscape linkages with other bear populations that are separated bydenatured habitat. We used a Geographic Information System (GIS) to identify potential landscape linkagesbetween this isolated population and six others in Florida. Pathway lengths ranged from 60–194 km withvarying potentials for facilitating black bear dispersal. Each pathway incorporated 35Ð88% conservation landand encountered at least 11 dispersal bottlenecks. Even pathways that incorporated extensive conservationland encountered bottlenecks that make these linkages potentially unviable. All six pathways, however, passedthrough ≥95% core black bear habitat. Thus, the infrastructure for a conservation network is still largelyintact. The Suwannee pathway provides the best opportunity to restore connectivity between the GreaterChassahowitzka Ecosystem (GCE) and a southward colonising bear population in the Big Bend region.However, intensification of development poses an immediate threat to maintaining connectivity between theGCE and other bear populations in Florida. Through immediate strategic planning and active conservationand restoration measures, many of the generated pathways can provide long-term connectivity. Least-cost pathanalyses can aid in the conservation of wide-ranging animals by providing managers with a science-based,empirically derived blueprint of potential landscape linkages.
Risk factors of depression in later life, particularly for sub-cases and for psychotic and neurotic types of depression, are unclear.
Aims
To identify such risk factors.
Method
Over 5200 older people ($65 years), randomly selected from Liverpool, were interviewed using the Geriatric Mental State (GMS)and the Minimum Data Set (MDS). The computer-assisted diagnosis AGECAT identified 483 cases and 575 sub-cases of depression and 2451 with no mental problems. Logistic regression was employed to examine factors relevant to caseness.
Results
In multiple logistical regression, odds ratios (ORs) were significantly high for being female (2.04, 95% CI 1.56–2.69), widowed (2.00, 1.18–3.39), having alcohol problems (4.37, 1.40–2.94), physical disablement (2.03, 1.40–2.94), physical illness (1.98,.1.25–3.15), taking medications to calm down (10.04, 6.41 −15.71), and dissatisfaction with life (moderate 4.54, 3.50–5.90; more severe 29.00, 16.00–52.59). Good social networks reduced the ORs. If sub-cases were included as controls, the statistical significance was reduced.
Conclusions
Age was not associated with depression in later life whereas gender, physical disablement and dissatisfaction with life were. The sub-cases shared many risk factors with cases, suggesting that prevention may need to be attempted at an early stage.
This study investigated subgroup and task specificity of self-paced timing in children with developmental coordination disorder (DCD). Self-paced tempo (intertap interval) and timing stability (coefficient of variation) were measured in three repetitive tasks—hand tapping, foot tapping, and jumping in place—in 37 children aged 6 to 9 years classified into gross motor impaired (GM), fine and gross motor impaired (F&G), or coordinated control (CC) groups. Results showed that, although tempo did not vary between coordination groups, timing stability for the hand was significantly worse for the F&G motor impaired group (p < .05). Discriminant function analysis correctly classified 75% of CC, 67% of F&G, and 67% of GM children. Although timing inconsistency of hand tapping identified a coordination subgroup, these tasks provide only moderate prediction of group membership.
A random community sample of 1070 subjects aged 65 years and over was interviewed at home using the GMS-agecat package and followed up three years later. Neurotic symptoms were common, but symptoms sufficient to reach ‘case’ level were much less frequent. The overall prevalence of neurotic ‘cases' was 2.4% in year 0 and 1.4% in year 3. The incidence was estimated as a minimum of 4.4 per 1000 per year over the age of 65. Women were more likely to be ‘cases' than men but not ‘subcases', and there was a general decline in prevalence with increasing age, particularly for ‘subcases'. Anxiety was the commonest neurotic subtype. After three years, ‘cases' were shown not to persist, but this did not reflect wellness. There was a tendency still to have some symptoms, but the predominant symptom appeared to change, suggesting a possible chronic neurotic disorder with changing presentation over time. Depressive symptoms were closely associated with this presentation, suggesting that depression may be an important and integral part of a general, changing neurotic disorder.
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