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This study examines the efforts and needs associated with family care for disabled and frail adults. A survey of 117 primary caregivers focused on: the health problems associated with caregiving; the existence of informal, family support systems; the use of formal social services, and the need for additional social service programs. Most caregivers report physical and emotional problems due to caregiving ranging from hypertension and back problems to depression and mental exhaustion. The characteristics of caregivers at high risk for health problems are identified. Less than half of the caregivers have family or friends to assist them with caregiving. At least one type of social service was being used by over 80% of caregivers, with utilization patterns in male and female caregivers. Based on the study findings, several policy implications are reviewed.
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PMID:The unmet needs of family caregivers for frail and disabled adults. 315 88

In the present study, 58 relatives of cancer patients (50 women and 8 men, mean age 53) who experienced the grief and tension induced by severe illness in the family were followed. The aim of the study was to examine possible associations between anxiety, depression, and mental exhaustion, on one hand, and glycosylated hemoglobin (HbAlC) level and changes in HbAlC level on the other hand. The relatives were studied approximately once a month during part of the patient's period of illness. On each occasion their psychiatric state was evaluated by means of a standardized observation and interview technique. A blood sample in the nonfasting state was taken for HbAlC assay. The main finding is that a high level of anxiety during the course of a close relative's cancer illness is associated with increasing HbAlC levels (p less than .01).
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PMID:Elevation of glycosylated hemoglobin in a severe crisis situation--cancer in a close relative. 316 40

As part of a larger study on recovery from myocardial infarction in a national sample of male cardiac patients, data was collected on slightly under 400 men and their wives over a 5-year period. This longitudinal data set was used to investigate the role of patient health cognitions and marital factors on long-term psychological response to the illness. Negative appraisals of threat and loss due to cardiac impairment/disability were found to be the best predictor of anxiety and depression at 3-4 years after hospitalisation. Patient cognitions appeared to be a chief mediator of medically-defined illness. Supportive marital environments were defined by scales measuring intimate attachment and spouse conflict. The latter was found associated with negative health cognitions and elevated anxiety. High intimacy marriages appeared to provide adequate social support, and the level of intimacy between the spouses was inversely related to the level of depressed mood. These findings were suggestive of a buffering effect of the patient's social support system. Other predictors, including the type A pattern, 'vital exhaustion', and social class were investigated as components of a multifactorial model for clinical screening purposes.
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PMID:Marriage and the psychological consequences of a heart attack: a longitudinal study of adaptation to chronic illness after 3 years. 317 1

In order to assess the incidence of silent myocardial ischaemia, 190 consecutive patients with cerebral ischaemia and without symptoms or electrocardiographic signs of ischaemic heart disease, underwent a maximal exercise treadmill test. Patients with a positive exercise test were submitted to exercise thallium myocardial scintigraphy. Results were compared with those obtained in a control group of 113 healthy subjects submitted to the same study protocol. An adequate exercise test was obtained in 140 patients with cerebral ischaemia. The exercise test was positive in 36 cases (26%). The end points were exhaustion in 24 patients, ST segment depression greater than or equal to 3 mm in seven and systolic blood pressure greater than or equal to 240 mmHg in five. The exercise thallium myocardial scintigraphy was normal in three and abnormal in 33: reversible perfusion defects were detected in 26 cases and fixed defects in seven. In the control group, matched for age and sex, the exercise test was positive in only seven cases (6%; P less than 0.01); the exercise myocardial scintigraphy was normal in five and abnormal in two subjects. In conclusion, in a remarkable proportion of middle-aged patients with cerebral ischaemia, silent myocardial ischaemia can be detected by means of noninvasive cardiologic investigations.
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PMID:Incidence of silent myocardial ischaemia in patients with cerebral ischaemia. 326 46

Twelve trained males, in a fed state, were studied to examine the effect of pre-exercise fructose ingestion on endurance capacity during prolonged cycling exercise. Sixty minutes prior to exercise, subjects ingested either 60 or 85 g fructose or a sweet placebo. Mean exercise intensity initially required 62% of the maximal aerobic power and thereafter increased to elicit 72 and 81% of maximal aerobic power at 90 and 120 min of exercise, respectively. Exercise time (mean +/- SE) to exhaustion was significantly increased after fructose ingestion, as compared to placebo ingestion (145 +/- 4 vs 132 +/- 3 min, P less than 0.01). During the exercise, no differences were observed between both trials for oxygen uptake, heart rate, or perceived exertion. Serum glucose and insulin levels between both trials were not significantly different throughout the experiment. There were also no significant differences in serum-free fatty acids and glycerol levels as well as respiratory exchange ratio between fructose and placebo trials during the exercise. The results suggest that fructose ingestion is of benefit before prolonged exercise, because it provides a carbohydrate source to contracting muscles without transient hypoglycemia and a depression of fat utilization, and thereby delays the fatigue.
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PMID:Effect of pre-exercise fructose ingestion on endurance performance in fed men. 328 17

Central fatigue was induced by running rats on a treadmill. Amino acid and ammonia metabolism in the brain and blood were followed with time to correlate its changes with physical exhaustion. The blood ammonia level did not change during running, but was prominently increased at exhaustion. The brain level of ammonia was also prominently high at the end of exercise with a time course of change similar to that of the blood level. Plasma concentrations of branched chain amino acids (BCAA) and aromatic amino acids (AAA) increased as the animals continued to run; however, the plasma BCAA/AAA ratio was definitely depressed at exhaustion. This was also true with the brain BCAA/AAA ratio. A positive correlation was demonstrated between the plasma and brain BCAA/AAA ratios at r=0.5040 and P less than 0.05. These exercise-related changes suggest that physical exercise-induced central fatigue involves not only an increase in brain ammonia, but also a disturbance in brain amine metabolism accompanying plasma and brain BCAA/AAA ratio depression. Furthermore, the ammonia level and BCAA/AAA ratio in the brain correlated with those in the blood. It is reasonable to consider that the blood ammonia concentration and plasma BCAA/AAA ratio may serve as important indices of the clinical condition of exercise-induced central fatigue.
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PMID:Exercise-induced changes in branched chain amino acid/aromatic amino acid ratio in the rat brain and plasma. 343 93

Formaldehyde is but one of many chemicals capable of causing the tight building syndrome or environmentally induced illness (EI). The spectrum of symptoms it may induce includes attacks of headache, flushing, laryngitis, dizziness, nausea, extreme weakness, arthralgia, unwarranted depression, dysphonia, exhaustion, inability to think clearly, arrhythmia or muscle spasms. The nonspecificity of such symptoms can baffle physicians from many specialties. Presented herein is a simple office method for demonstrating that formaldehyde is among the etiologic agents triggering these symptoms. The very symptoms that patients complain of can be provoked within minutes, and subsequently abolished, with an intradermal injection of the appropriate strength of formaldehyde. This injection aids in convincing the patient of the cause of the symptoms so he can initiate measures to bring his disease under control.
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PMID:Diagnosing the tight building syndrome. 344 98

In 1978 Oswin documented a process of 'professional depression' affecting some nursing staff in long-stay hospitals. This study tested the hypothesis that 'professional depression' in long-stay nursing and 'emotional exhaustion' as a component of burnout describe a similar phenomenon. This hypothesis was supported. The results are consistent with Cherniss' characterization of burnout, which appears to show considerable similarities to the concept of depression. In this study professional depression demonstrated a substantial correlation with depressed mood. Personality demonstrated significant relationships with burnout variables, extrapunitive hostility correlating with hardening toward others, intropunitiveness with avoidance as a coping response. These findings, although confined to hospital nurses, support the usefulness of approaches stressing the interaction between the work environment and the individual.
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PMID:Burnout and professional depression: related concepts? 364 52

In patients with cerebral transient ischemic attacks or stroke myocardial infarction is the leading long-term cause of death. Despite the importance of coronary artery disease, patients with cerebrovascular insufficiency are seldom evaluated for the detection of ischemic heart disease and usually the cardiological evaluation is limited to the patients with angina or previous myocardial infarction. In order to identify asymptomatic coronary artery disease 74 consecutive patients with cerebral ischemia, and without symptoms or electrocardiographic signs of ischemic heart disease, underwent a maximal exercise treadmill test according to the Bruce protocol. An exercise Thallium myocardial scintigraphy was performed in patients with positive exercise test. A control group of 74 asymptomatic subjects underwent the same study protocol. The study population (Group I) included 57 men and 17 women; the age ranged from 22 to 72 years (mean age 54 years). An adequate exercise test was obtained in 67 patients. Exercise test was positive (ST-segment depression greater than or equal to 1.5 mm) in 19 cases (28%). The end points were exhaustion in 15 patients, ST-segment depression greater than 3 mm in 2 and systolic blood pressure greater than 240 mmHg in 2. The exercise Thallium myocardial scintigraphy was normal in 2 and abnormal in 17: reversible perfusion defects were detected in 12 cases and fixed defects in 5. In the control group (Group II), comparable for age and sex, exercise test was positive in 4 cases (5%; p less than 0.01 percentage of positive exercise tests in Group I vs Group II); the exercise myocardial scintigraphy was normal in 1 and abnormal in 3 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Early identification of ischemic cardiopathy in patients with cerebrovascular insufficiency.A prospective study with exertion test and perfusion myocardial scintigraphy]. 373 22

During interviews, married couples experiencing infertility reported emotional reactions such as sadness, depression, anger, confusion, desperation, hurt, embarrassment, and humiliation. Behavioral reactions to infertility included disorganization, distractability, exhaustion, moodiness and obsessive thoughts and behaviors. Participants also described multiple sources of stress and utilized a variety of coping strategies. Implications for social work clinical and research practitioners are discussed.
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PMID:Psychological impact of infertility: identifying issues and needs. 377 15


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