BackgroundIndividualized, outreach and structured multicomponent interventions are a promising intervention approach to relieve the burden of informal caregivers of people with dementia. In this study, we adapted and evaluated a multicomponent intervention (Resources for Enhancing Alzheimer’s Caregiver Health II, REACH II), which was developed in the USA, to the German health-care system. Therefore the project is called the German adaptation of REACH II (in German: Deutsche Adaptation der REACH II, DE-REACH).MethodsThe effectiveness of DE-REACH was examined in a randomized, controlled trial on 92 informal caregivers of people with dementia. The intervention comprised 12 individual two-weekly sessions (9 at home with the informal caregiver and 3 via telephone) and combined five modules. The reduction of the burden of the informal caregivers was chosen as the primary outcome.ResultsThe results showed a great stabilizing effect of the intervention on caregiver burden (effect size d = 0.91), that is, comparing pre- and post-measurements the burden decreased very slightly in the intervention group whereas it increased very strongly in the control group. After a three-month follow-up period this effect decreased from a great to a moderate effect. There were also improvements as a result of the intervention in somatization, health-related psychological quality of life and the reaction of the informal caregivers in response to challenging behaviors of the relative with dementia. Moreover, the frequency of challenging behaviors of the affected person itself was reduced in favor of the intervention.ConclusionThe findings of this study provide further evidence for the impact of multicomponent support interventions for informal caregivers of people with dementia.Clinical trial registration NCT01690117. Registered September 17, 2012.
Surfactant associated protein-A (SP-A) is the most abundant pulmonary surfactant protein and belongs to the family of innate host defense proteins termed collectins. Besides pulmonary host defense, SP-A is also involved in the formation of pulmonary surfactant, as it is essential for the structure of tubular myelin. The human SP-A gene locus includes two functional genes, SFTPA1 and SFTPA2 which are expressed independently, and a pseudo gene. The largest amount of SP-A1 proteins assemble to larger molecular complexes, whereas SP-A2 forms mainly dimers and trimers. SP-A polymorphisms play a role in respiratory distress syndrome, allergic bronchopulmonary aspergillosis and idiopathic pulmonary fibrosis. The levels of SP-A are decreased in the lungs of patients with cystic fibrosis, respiratory distress syndrome and further chronic lung diseases. Future areas for clinical research include disease specific SP-A expression pattern and their functional consequences, the differential roles of SP-A1 and SP-A2 in human lung diseases, and therapeutical approaches to correct altered SP-A levels.
Surfactant protein D (SP-D) is an important component of the pulmonary host defense system. We hypothesized that bronchoalveolar lavage (BAL) SP-D levels are lower in children presenting with recurrent bronchitis, providing evidence for a role of SP-D in human respiratory diseases. SP-D levels in BAL were measured in 45 children, who suffered from recurrent bronchitis for an average of 2-3 yr. Clinical outcome was assessed 2 yr after BAL. For comparison, BAL fluids from 15 control children without respiratory symptoms were evaluated. Among the 45 children with recurrent bronchitis, 12 had no SP-D in their BAL at the time of investigation. These SP-D-deficient patients had more frequently pneumonias and their long-term outcome was worse than that of the children with detectable SP-D. No genetic cause could be identified for the SP-D deficiency. Among the children with recurrent bronchitis and SP-D clearly detectable in BAL, those with the diagnosis of allergic asthma had threefold elevated levels compared with controls. In accordance with animal and in vitro data, elevated SP-D concentrations in BAL may represent an up-regulation due to allergic airway inflammation. In contrast, SP-D deficiency due to consumption or failure to up-regulate SP-D may be linked to pulmonary morbidity in children.
Zusammenfassung. Hintergrund: Die aufgrund der Coronavirus-Pandemie veranlassten Maßnahmen haben weitreichende Folgen für den Alltag von Menschen mit Demenz und ihren pflegenden Angehörigen. Beide Gruppen gehören meist zur Risikogruppe und sollen sich entsprechend stark einschränken. Die Alltagssituation wird dadurch erschwert, dass Betreuungsleistungen und Entlastungsangebote pausieren. Zudem haben Menschen mit Demenz Schwierigkeiten, die Beschränkungen und Hygieneregeln zu verstehen und umzusetzen. Ziel: Die Studie will die aktuelle Lebenssituation aus Sicht der pflegenden Angehörigen und der Menschen mit Demenz beschreiben. Methode: Zu zwei Erhebungszeitpunkten im Frühjahr 2020 wurden Telefoninterviews mit 21 pflegenden Angehörigen und Menschen mit Demenz geführt und inhaltsanalytisch ausgewertet. Ergebnisse: Die Situation wird von den Befragten unterschiedlich erlebt. Besonders die soziale Isolation, der erhöhte Betreuungs- und Pflegeaufwand, die Ungewissheit der Situation und die Zunahme von psychischen Symptomen werden als belastend beschrieben. Bezüglich der Bewältigung der Situation werden die Unterstützung durch das soziale Umfeld, alternative Kommunikationsmöglichkeiten, Erfahrungen mit vergleichbaren Krisen, die Stabilität der Versorgung und der Umgang mit Informationen thematisiert. Schlussfolgerungen: Pflegende Angehörige und Menschen mit Demenz fühlen sich durch die Coronavirus-Pandemie belastet, verfügen häufig jedoch über Bewältigungsstrategien für die besondere Situation. Insbesondere informelle Hilfen sind dabei ein wichtiger Unterstützungsmechanismus.
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