Our purpose was to examine the cognitive processes that influence involvement in physical activity among 100 adolescents, 55 boys and 45 girls, ranging in age from 12 to 18 years, with trivial, mild, or moderate forms of congenital cardiac disease. We hypothesized, first, that the severity of the congenital cardiac malformation itself has an indirect effect on self-efficacy regarding physical activity, and that the relationship between the two is mediated by the recommendations of the cardiologist and the attitude of the mother. Second, we argued that self-efficacy serves as a mediating variable between the recommendations of the cardiologist and the attitude of the mother, on the one hand, and involvement in physical activity, on the other. The results confirmed both hypotheses. In a population of adolescents with trivial to moderate congenital cardiac malformations, beliefs in self-efficacy, rather than severity of the disease, were the most influential factors in determining whether or not adolescents will engage in sports or other physical activities. We also demonstrated the importance of the role played by the recommendations of the cardiologist in determining both the attitudes of the mother and the belief in self-efficacy of the adolescents.

Background: Planning the home care of growing numbers of old, dependent people must include the caregivers' burden. Methods: A convenience sample of 129 caregivers of elderly patients with multiple diagnoses was interviewed about the caregiving context, burden, caregivers' tolerance of patients' troublesome behaviours and physical symptoms, mutuality and feelings of closeness between caregiver and patient. Continued maintenance of home care was assessed by a follow-up telephone call. Results: Caregivers were mainly spouses (67%) and female (73%), and the mean duration of care was 5.5 years. In five activities of daily living (ADL) 50-69% of the patients needed full help. Caregivers reported predominantly negative effects of caregiving on their physical and mental health, rest and sleep, leisure time and social life, problems with patients' symptoms and behaviours and little or no conversing (51%) or exchanging feelings with patients (71%). Predictive models: Contributors to variance were for burden (35%), impact of care on caregivers' mental health, social relations and leisure time, patients' gender, accumulation of patients' symptoms and behaviours; for caregivers' tolerance toward patients' symptoms and behaviours (17%) caregivers' physical health, patients' level of confusion, feelings of mutuality; for mutuality (22%) and for closeness (19%) caregivers' mental health, patients' accumulation of symptoms and behaviours. Within 23 months 19% of the patients had been institutionalized. Factors giving a higher likelihood of instrtutionalization were: being male, caregiver was not a partner, and less closeness between caregiver and patient. Conclusion: Caregiving of older persons has bio-psychosocial ramifications for caregivers. Closeness between caregiver and patient seems to be a key factor in determination of the long-term outcome.

Cancer patients' ability to control symptoms and to maintain reasonable quality of life is limited due to lack of knowledge, guidance, and instructions from health care providers, who usually refrain from transferring responsibility for the treatment to the patient. The present study describes a measured effect of a structured nursing intervention in which nurses were trained to apply the self-care model to 48 ambulatory cancer patients under chemo- or radiotherapy or both. The intervention included 10 structured home visits to each patient during 3 months, in which the nurse assessed symptoms and advised, guided, supported, and educated the patient in the relevant areas. The symptoms were quantitatively assessed using the Symptom Control Assessment (SCA) instrument, which was developed and validated specifically for this study. The SCA relates to 16 signs, symptoms, and complaints that encompass both the universal and the deviation-from-health needs, in addition to anxiety, body image, and sexuality. The instrument allows either the patient or the nurse to rate the severity of the complaint, the patient's independence in controlling it, the patient's perception of the familial and external help extended to him or her, and the knowledge of the symptom and its control possessed by the patient. Also, the SCA allows comparing the patient's ratings with the professional view of the visiting nurse. The SCA was proven to be a highly reliable and valid instrument. The results indicate that the intensity of the complaints decreased in the experimental group during the 3-month period while they increased in the matched control group, creating a considerable difference between the two groups on multivariate analysis of covariance (MANCOVA). On t-tests, significant improvement was found in 15 out of the 16 symptoms, including pain. The greatest reduction was found in the "psychosocial symptoms," namely anxiety, sociability, body image, and sexuality. Similarly, the patients' independence, knowledge, and perception of familial help increased in the experimental group and declined in the control group. Perhaps the most meaningful change was a significant increase in the ability of the experimental patients to assume responsibility for their own treatment as it is reflected by the increase of the independence ratings for all 16 symptoms. This is in sharp contrast to the decrease in 15 of the 16 symptoms among control patients. The results suggest that the self-care approach is effective also in improving the quality of life for unstable cancer patients by reduction of suffering and increase in controlling capabilities.

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