| 1. |
- Emami, Azita, et al.
(författare)
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Making sense of illness : late in life migration as point of departure for elderly Iranian immigrants´explanatory models of illness
- 2005
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Ingår i: Journal of Immigrant Health. - : Springer Science and Business Media LLC. - 1096-4045 .- 1573-3629. ; 7:3, s. 153-164
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Tidskriftsartikel (refereegranskat)abstract
- This article is based on data gathered through 60 qualitative interviews conducted within the realm of three research projects that have used "culture-appropriate lenses" to study the postmigration situation of late-in-life Iranian immigrants to Sweden. The findings gathered through these studies were interpreted against the backdrop that culturally appropriate nursing theories provide. This meant that it was, at times, these elders' backgrounds as cultural "others" that were implicitly used to make sense of the various issues that were brought to the fore by these studies. The particular issue with which this article is concerned is the "unusualness" of these elders' explanatory models of illness. Inspired by the concept definition of situation in the symbolic interactionist perspective and by the feeling that this perspective might bring about a different interpretation of the original findings regarding their understandings of illness and disease, we set out to conduct a secondary analysis of these elders explanatory models of illness. The findings presented in this article will show how the elderly Iranian immigrants interviewed in these three studies utilize the process of "late in life migration" as a point of reference for their understandings of what has caused the illnesses from which they suffered. Hereby we will suggest that the "unusualness" of their explanatory models of illness might be best understood if we focus on what they shared as immigrants (i.e., the fact that the process of late-in-life migration has made their culture obsolete) as opposed to what they shared as Iranians (i.e., their culture of origin).
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| 2. |
- Ehrlich, Kethy, et al.
(författare)
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Family caregivers’ assessments of caring for a relative with dementia : A comparison of urban and rural areas
- 2015
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Ingår i: International Journal of Older People Nursing. - : Wiley. - 1748-3735 .- 1748-3743. ; 10:1, s. 27-37
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study aimed to describe and compare urban and rural family caregivers' reactions to caring for a relative with dementia and to examine the associations between caregiving and socio-demographic factors. Background: Most studies on family caregivers' experiences caring for older people with dementia have been conducted in urban areas, and little is known about the experiences of family caregivers living in rural areas. Design: A cross-sectional study design was used. Methods: A total of 102 caregivers (response rate 85%) from urban (n = 57) and rural (n = 46) areas completed the Caregiver Reaction Assessment (CRA) Scale and demographic information. Data were analysed using descriptive and inferential statistics and linear regression models. Results: Overall, family caregivers reported high satisfaction even if they also reported high impact on finances and daily living. Rural caregivers experienced a higher negative impact on finances but reported more support from family members than urban caregivers. Age, gender and relationship were significantly associated with four of the five CRA subscales. Educational level and geographical setting were not associated with any of the CRA subscales. Conclusions: The results of the study raise questions about the financial situation of older female caregivers and on the expectations of built-in family structures in urban and rural areas. Further studies focusing on the meaning and constitution of a family would help us to understand how these factors influence family caregiving both in rural and urban areas. Implications for practice: To provide person-centred care and to avoid stereotyped caregiving, a better picture of traditions in family caregiving can improve a more differentiated and appropriate professional caregiving pliable with the cultural context in which it is carried out.
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| 3. |
- Ehrlich, Kethy, et al.
(författare)
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The relationship between geographical and social space and approaches to care among rural and urban caregivers caring for a family member with Dementia : a qualitative study
- 2017
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 12:1, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge about family caregivers in rural areas remains sparse. No studies to date have addressed the sociocultural aspects in caregiving, thus neglecting potentially significant data. This study aimed to explore and better understand family caregivers’ experiences in rural and urban areas and the sociocultural spheres that these two areas represent. How do family caregivers approach their caregiving situation? A hermeneutical approach was chosen to uncover the underlying meanings of experiences. Open-ended in-depth interviews were conducted. The ontological and epistemological roots are based on hermeneutic philosophy, where a human being’s existence is viewed as socially constructed. The study followed a purposeful sampling. Semi-structured in-depth interviews were conducted with 12 rural and 11 urban family caregivers to persons with dementia. These were then analyzed in accordance with the hermeneutical process. The findings provide insight into the variations of family caregiver approaches to caregiving in rural and urban areas of Sweden. There seemed to be a prevalence of a more accepting and maintaining approach in the rural areas as compared to the urban areas, where caregiving was more often viewed as an obligation and something that limited one’s space. Differences in the construction of family identity seemed to influence the participants approach to family caregiving. Therefore, community-based caregiving for the elderly needs to become aware of how living within a family differs and how this affects their views on being a caregiver. Thus, support systems must be individually adjusted to each family’s lifestyles so that this is more in tune with their everyday lives.
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| 4. |
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| 5. |
- Emami, Azita, et al.
(författare)
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An ethnographic study of a day-care center for Iranian immigrant seniors
- 2000
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Ingår i: Western Journal of Nursing Research. - : Sage. ; 22:2, s. 169-188
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Tidskriftsartikel (refereegranskat)abstract
- Late in life immigrants are often at risk of psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolatio
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| 6. |
- Emami, Azita, et al.
(författare)
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Assessing stress using repeated saliva concentration of steroid hormones in dementia care dyads : results from a controlled pilot care music intervention
- 2023
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Ingår i: Upsala Journal of Medical Sciences. - : Upsala Medical Society. - 0300-9734 .- 2000-1967. ; 128:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stress-related biomarkers have the potential to provide objective measures of whether interventions directed at people with dementia (PWD) and their family caregivers (FCG) are successful. The use of such biomarkers has been limited by logistical barriers to sample collection.Objective: Explore saliva concentration of steroid hormones in dementia care dyads during a music intervention.Methods: Consecutive PWD attending a memory evaluation center and their FCG were allocated to either an intervention-with-music or a non-intervention control group. All were living at home. Stress biomarkers, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) samples were collected by the PWD and their FCG, in the morning and evening, 5 days a week, for 8 consecutive weeks. Biomarker concentrations of the intervention and the control groups were compared at week 8, in an intention-to-treat approach with adjustment for baseline value.Results: Twenty-four PWD in the intervention group and 10 in the control group, and their FCG were included in the analyses. The mean number of morning saliva collections was similar in the intervention and the control groups, ranging from 4.3 to 4.9 per participant weekly during the first 7 weeks, declining to 3.3 during week 8. Median log morning cortisol (pg/mL) among caregivers was lower in the intervention group than in the control group (8.09 vs. 8.57, P = 0.0133).Conclusion: This study demonstrates that music intervention was associated with lower morning saliva cortisol concentrations for FCGs.
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| 7. |
- Emami, Azita, et al.
(författare)
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Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions
- 2013
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: To develop a healthcare environment that is congruent with diversity among care providers and care recipients and to eliminate ethnic discrimination, it's important to map out and assess caregivers' awareness and acceptance of diversity. Because of a lack of standardized questionnaires in the Swedish context, this study designed and standardized a questionnaire: the Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD, for short).Method: The questionnaire was developed in four phases: a comprehensive literature review, face and content validity, construct validity by factor analysis, and a reliability test by internal consistency and stability assessments.Results: Results of different validity and reliability analyses suggest high face, content, and construct validity as well as good reliability in internal consistency (Cronbach's alpha: 0.68 to 0.8) and stability (test-retest: Spearman rank correlation coefficient: 0.60 to 0.76). The result of the factor analysis identified six dimensions in the questionnaire: 1) Attitude toward discrimination, 2) Interaction between staff, 3) Stereotypic attitude toward working with a person with a Swedish background, 4) Attitude toward working with a patient with a different background, 5) Attitude toward communication with persons with different backgrounds, 6) Attitude toward interaction between patients and staff.Conclusion: This study introduces a newly developed questionnaire with good reliability and validity values that can assess healthcare workers' awareness and acceptance of diversity in the healthcare environment and healthcare delivery.
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| 8. |
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| 9. |
- Emami, Azita, et al.
(författare)
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Developing a questionnaire for conducting cross-national studies : 'Self-reported health and needs among elderly Iranians and Swedes'
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 24:2, s. 372-9
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This paper describes the process of developing and validating a questionnaire to investigate self-reported health and care needs of elders in Iran and Sweden.BACKGROUND: Both developing and developed countries face dilemmas under the current condition of increasing mental and physical health morbidity globally. In order to fully assess and understand the extent of these dilemmas and the global and local factors that alleviate or worsen them, a comparison of the self-reported health and care needs in a developed and a developing country is required. To these ends, two research teams within a joint international project worked together to construct a questionnaire to measure self-reported health in elders in Sweden and Iran.METHODS: The questionnaire was developed according to a multiphase process, during which the researchers tested the validity and reliability of the questionnaire using various methods and modified it based on the test results. First, the concepts to be used were agreed upon and a literature review was conducted. Thereafter, face and content validity was measured in Iran, looking at the initial items that were developed. The questionnaire was then translated and back-translated. Finally, both teams conducted a test of content validity using target groups in Iran and Sweden, respectively.RESULTS: Validity was established by testing face and content validity with the use of expert groups. Reliability was also determined according to two different dimensions, stability and internal consistency. Both methods gave satisfactory results, indicating that the instrument was reliable.CONCLUSION: The questionnaire was thereby developed and titled, 'Self-reported health and health-care needs'. The results confirm validity and reliability of the final version of the questionnaire.
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| 10. |
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Emami, Azita, et al.
(författare)
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The Feasibility and Acceptability of In-Home Saliva Collection for Stress in Persons With Dementia and Their Family Caregivers
- 2022
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Ingår i: Biological Research for Nursing. - : SAGE Publications. - 1099-8004 .- 1552-4175. ; 24:3, s. 308-315
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although increasing attention is being paid to cortisol and the sulfated form of dehydroepiandrosterone (DHEA-S) as stress biomarkers, the feasibility of saliva collection of such biomarkers has yet to be investigated among dementia care dyads (persons with dementia [PWD] and family caregivers) living in a home setting. We explored the feasibility and acceptability of in-home saliva collection for cortisol and DHEA-S as stress biomarkers among dementia care dyads.Methods: Dementia care dyads were recruited from a memory evaluation center. After pre-evaluation and education sessions, participants collected their saliva 3 times a day, 5 days a week, for 8 consecutive weeks. We calculated frequency counts and percentages to assess enrollment rate, retention rate, the completion rate of saliva collection, and valid samples of cortisol and DHEA-S. Independent samples t-tests were performed to compare mean differences in the total number of collected samples and valid samples between PWD and family caregivers at each time point of saliva collection.Results: A total of 46 dyads were referred to this study; 32 dyads (69.6%) agreed to participate, and 26 started collecting saliva. Twenty-four dyads (75%) completed 8 weeks of saliva collection. There were no significant differences (p > 0.05) in the number of collected samples and valid samples between PWD and caregiver participants.Conclusion: This study supports the feasibility of in-home saliva collection for stress biomarker assay and the need for further investigation into self-administered collection of stress biomarkers with a particular focus on dementia care dyads living at home.
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| 15. |
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| 16. |
- Emami, Azita
(författare)
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'We are deaf, though we hear; we are dumb, though we talk; we are blind, though we see' : understanding Iranian late-in-life immigrants' perceptions and experiences of health, illness and culturally appropriate care
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite the fact that elderly immigrants constitute nearly nine percent of the total population over 65-years of age, they have remained conspicuous by their absence in reports that underlie national welfare- and health care decision making in Sweden. The aim of this thesis was to deepen the understanding of Iranian late-in-life immigrants' experiences and perceptions of health, illness and culturally appropriate care. In paper I the findings elucidate the participants' description and explanation of their situation by utilizing phenomenological hermeneutic method. The findings thereby get an insight of the participants' life situation, their experiences of immigration and its effect on their health and social well-being. In paper II by using ethnographic method the culturally appropriate intervention program for senior Iranians and the manner in which the participants considered attending the day care center to be beneficial for their experiences of health was studied. Knowledge gained from this study calls for including culturally appropriate programs in order to meet the clients' needs and concerns for maintaining and/or improving their health and well-being. In paper III by using interpretive phenomenological method participants' perceptions of health and illness are elucidated. Participants in this study consider health as feeling continuity and balance in their life. Social well-being and a well-functioning familial relationship are the core aspects for maintaining and/or promoting health. Knowledge gained from this study opens up a new horizon in considering health and illness from the clients' perspective. In paper IV by utilizing interpretive phenomenological method based on participants' reflections on health and illness a socio-cultural explanatory model of health is developed. This study indicates that the process of maintaining and/or promoting health and participants' interpretation and reflections on health is a dynamic process that is influenced by participants' process of life. The findings presented in this study challenge health providers to consider the socio-cultural meaning of health as a central aspect in influencing clients' possibilities and difficulties in maintaining and/or promoting health and well-being. Paper V, by qualitative secondary-analyzing, challenges the concept of culture as the central, influential aspect for constituting an explanatory model of illness. This study sheds light on the importance of life disruptions and the dynamic process of life changes such as immigration, which confront the cultural understanding of illness. Conclusively this research suggest that in order to give and advocate health and medical services to persons, health professionals need to acquire a broad empathic sensitivity in understanding a person and her/his life-world as the source of healing, recovery, and health promotion possibilities. A socio-cultural awareness of a person, which embraces understanding of her/his cultural, socio-economic, educational, spiritual and environmental circumstances gives access to a person's situated possibilities in health care.
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| 17. |
- Fonad, Edit, et al.
(författare)
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Falls and fall risk among nursing home residents
- 2008
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Ingår i: Journal of Clinical Nursing. - Oxford : Wiley. - 0962-1067 .- 1365-2702. ; 17:1, s. 126-134
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Tidskriftsartikel (refereegranskat)abstract
- Aim and objectives. The aim of this study was to identify risk factors for falls in older people living in nursing homes. Background. Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved. Method. The study was carried out over four years (2000-2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom-restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient-bound. The study covered 2343 reported incidents. Results. There was a significant correlation between falls and fractures (r = 0.365, p = 0.004), fall risk and use of wheelchairs (r = 0.406, p = 0.001, safety belts (r = 0.403, p = 0.001 and bed rails (r = 0.446, p = 0.000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0.352, p = 0.005). Associations were also found between fall risk and the use of anti-depressants (r = 0.412, p = 0.001). Conclusions. In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti-depressants and sleeping pills, especially benzodiazepines.
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| 18. |
- Fonad, Edit, et al.
(författare)
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Falls in somatic and dementia wards at Community Care Units
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - Oxford : Wiley. - 0283-9318 .- 1471-6712. ; 23:1, s. 2-10
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Tidskriftsartikel (refereegranskat)abstract
- Falls and fall injuries are common problems for patients at nursing homes in Sweden. Impaired cognitive function, a poor sense of orientation and a high intake of medicine, can lead to an increase in falls among older people. The objective of this study was to investigate the associations between falls and: fall risks, fractures, the use of physical restraints and the use of certain medications in somatic and dementia wards, respectively. The study design is ecological, and aggregated data regarding falls, fall risk assessments, fractures, the use of physical restraints and medication were collected between 2000 and 2003. The Pearson correlation analysis and regression analyses were used to investigate associations between fall risks, medication, fractures, wheelchair-bound situations, bed rails and falls. The total number of reported fall incidents was 2651; of these, 737 incidents were registered in dementia wards and 1914 in somatic wards. Dementia wards and somatic wards differed regarding falls and fractures, as it was only in dementia wards that falls were associated with fractures. There was also a significant correlation between falls and assessed risk of falling, the use of certain medication, and physical restraints such as wheelchairs and bed rails in dementia wards. Falls at somatic wards were associated with the use of sleeping pills with benzodiazepines. For dementia wards there were associations between falls and fractures, physical restraints and the use of certain medications. Fractures were associated with the use of neuroleptics, sleeping pills and sleeping pills with benzodiazepines. At somatic wards, falls correlated with the use of sleeping pills with benzodiazepines, and with the use of wheelchairs and bed rails.
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| 19. |
- Fonad, Edith, et al.
(författare)
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Moving to and living in a retirement home : focusing on older people´s sense of safety and security
- 2006
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Ingår i: Journal of Housing for the Elderly. - : Taylor & Francis. - 0276-3893 .- 1540-353X. ; 3:20, s. 45-60
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Tidskriftsartikel (refereegranskat)abstract
- Bad health combined witii deteriorating physical functions force many elderly people to move to a retirement home. The primary focus of this study was to investigate the resident's experience of safety and security. From a sample of 57 residents, 12 persons volunteered to participate in the interview. Data were analyzed with qualitative content analysis. The standard and design of the participant's previous home made mobility difficult and this affected their sense of security. This motivated them to move into an environment where they felt more secure. The environment at the retirement home was predominantly described as secure and safe. The finding shows that the participants felt that safety and security were more important than independence.
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| 20. |
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| 21. |
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| 22. |
- Holmgren, Jessica, et al.
(författare)
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Being perceived as a ‘visitor’ in the nursing staff’s working arena : the involvement of relatives in daily caring activities in nursing homes in an urban community in Sweden
- 2013
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Ingår i: Scandinavian Journal of Caring Sciences. - Oxford : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 27:3, s. 677-685
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIt is both complex and difficult for relatives when a loved one moves into a nursing home and many relatives are not prepared for the realities these new situations entail. Little attention has been paid to scrutinising the involvement of relatives in patient care, particularly in relation to the structures and routines of nursing homes or to the staff's reasoning concerning their involvement.AimTo describe, from a gender perspective, how nursing staff's routines and reasoning act to condition the involvement of relatives in nursing homes.MethodsFocused ethnographic fieldwork was conducted in a medium-sized urban community in central Sweden in three different nursing homes.ResultsThe nursing staff assigns a certain code of conduct to all relatives they perceived as ‘visitors’ in their working arena. This code of conduct was related to the routines and subcultures existing among the nursing staff and stemmed from a division of labour; the underlying concept of ‘visitor’ predetermined the potential for relatives' involvement. This involvement is explicitly related to the general gendered characteristics that exist in the nursing staff's perception of the relatives.DiscussionThe study's limitations are primarily concerned with shortcomings associated with a research presence during the fieldwork. The discussion focuses on the dimensions of power structures observed in the nursing home routines and the staff's reasoning based on their gendered assumptions. We argue that it is important to develop mechanisms that provide opportunities for nursing staff in elderly care to reflect on these structures without downplaying the excellent care they provide. We stress the importance of further exploring these issues concerning relatives and their involvement in nursing homes to facilitate the transition from informal caregiver to ‘visitor’.
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| 23. |
- Holmgren, Jessica, et al.
(författare)
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Intersectional perspectives on family involvement in nursing home care : rethinking relatives' position as a betweenship
- 2014
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Ingår i: Nursing Inquiry. - : John Wiley & Sons. - 1320-7881 .- 1440-1800. ; 21:3, s. 227-237
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Tidskriftsartikel (refereegranskat)abstract
- This study seeks to understand, in the context of intersectional theory, the roles of family members in nursing home care. The unique social locus at which each person sits is the result of the intersection of gender, status, ethnicity and class; it is situational, shifting with the context of every encounter. A content analysis of 15 qualitative interviews with relatives of nursing home residents in Sweden was used to gain a perspective on the relationships between relatives and residents, relatives and the nursing home as an institution, and relatives and the nursing home staff. We sought to understand these relationships in terms of gendered notions of the family and the residents, which are handed down from generation to generation and thus condition who and how relatives should be involved in care, and the ways in which relationships change as care moves from home to nursing home. It requires knowledge and awareness that the nursing home culture is based on intersectional power structures in order for relatives to be involved in nursing home care in alternative and individual ways.
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| 24. |
- Holmgren, Jessica, et al.
(författare)
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Replicating the Family : The Biopolitics of Involvement Discourses Concerning Relatives in Nursing Home Institutions
- 2014
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Ingår i: Aporia. - : Brigham Young University. - 1918-1345. ; 6:4, s. 19-29
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the biopolitics of involvement discourses articulated by nursing staff concerning relatives in nursing home institutions, using a Foucault-inspired discourse analytical approach. Previous research has described how relatives have not been involved in nursing homes on their own terms. This is partly due to a lack of communication and knowledge, but it is also a consequence of an unclear organizational structure. Results from a discourse analysis of six focus group interviews with nursing staff show that the "involvement discourse" in nursing homes can be described as a "new" vs "old" family rhetoric. This rhetoric can be said to uphold, legitimize and provide different subject positions for both nursing staff and relatives concerning the conditions for involvement in nursing homes. As part of a "project of possibility" in elderly care, it may be possible to adopt a critical pedagogical approach among nursing staff in order to educate, strengthen and support them in reflecting on their professional norming and how it conditions the involvement of relatives.
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| 25. |
- Jirwe, Maria, et al.
(författare)
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Kulturell mångfald
- 2014. - 2
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Ingår i: Omvårdnadens grunder. - Lund : Studentlitteratur AB. - 9789144083537 ; , s. 341-360
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 26. |
- Kim, Hyejin, et al.
(författare)
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Characteristics and Correlates of Perceived Physical and Psychological Health Among Family Caregivers Living With Persons With Advanced Dementia
- 2024
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Ingår i: Western Journal of Nursing Research. - 0193-9459 .- 1552-8456. ; 46:2, s. 104-113
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Tidskriftsartikel (refereegranskat)abstract
- Background:Various factors drive a care setting shift from institutional to home settings for dementia care until the latest stage of the disease, suggesting the critical role of family caregivers living with persons with dementia.Objectives:This study explored the characteristics and correlates of self-reported overall physical and psychological (ie, depressive symptoms and stress) health among family caregivers living with persons with dementia in Sweden.Methods:This cross-sectional, descriptive study used baseline data from an existing music-based intervention study of persons with dementia and their family caregivers (N = 76). Multivariable linear regression analyses were performed.Results:On average, caregivers (n = 38; mean age: 74.8 years) were slightly younger than persons with dementia (n = 38; mean age: 78.6 years). Most caregivers were female (n = 24; 63.2%) and spouses or partners of persons with dementia (n = 37; 97.4%). Caregivers’ perceived relationship with their family members with dementia was the only factor associated with caregivers’ self-reported overall physical health (b = −0.655, p = .046). This suggests caregivers’ more frequent feeling of a good relationship with the persons with dementia was linked to better self-rated physical health among family caregivers living with persons with dementia.Conclusions:This study highlights the importance of family caregivers’ perceived relationship with persons with dementia in the context of caregivers’ self-reported physical health. Future research is needed to explore the perceived relationship from the perspectives of persons with dementia and the determinants of caregiving dyads’ (persons with dementia and family caregivers) perceived relationship with each other.
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| 27. |
- Kim, Hyejin, et al.
(författare)
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In-home online music-based intervention for stress, coping, and depression among family caregivers of persons with dementia : A pilot study
- 2022
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Ingår i: Geriatric Nursing. - : Elsevier BV. - 0197-4572 .- 1528-3984. ; 46, s. 137-143
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about how music affects family caregivers who provide care to persons with dementia at home. We examined the effects of an 8-week online music-based intervention on self-reported stress, coping, and depression among dementia family caregivers. Mann-Whitney U test and Wilcoxon signed-ranked tests were performed to examine between- and within-group differences between intervention (n = 24) and comparison (n = 11) groups from baseline to post-test. The coping subscale yielded a significant difference between the groups at post-test (U=76.50, Z=-1.978, p=0.048), indicating the intervention group had better coping than the comparison group at post-test. Significant within-group differences in overall stress (Z=-2.200, p=0.028) and coping subscale (Z=-1.997, p=0.046) in the comparison group at post-test suggest that overall stress and coping were maintained throughout the study in the intervention group, whereas the comparison group had higher overall stress and lower coping at post-test. Our in-home music-based intervention showed potential benefits for dementia family caregivers.
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| 28. |
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| 29. |
- Marmstål Hammar, Lena, 1979-
(författare)
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Caregivers' Singing Facilitates Mutual Encounter : Implementation and Evaluation of Music Therapeutic Caregiving in Complex Dementia care Situations
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Persons with severe dementia suffer from major cognitive impairment, and are in need of considerable caring services. They commonly react with problematic behaviors, such as resistance and aggression in close care (e.g., morning care situations). Non-pharmacological treatments such as care interventions should be used to enhance mutuality in the encounter and minimize problematic behaviors. Music Therapeutic Caregiving (MTC) is one such intervention and involves the caregiver singing for or together with the persons with dementia during caregiving. MTC is proposed to decrease expressions of aggressive behaviors and thereby enhance communication between persons with dementia and their caregivers. In addition, it has been suggested that MTC can enhance the posture and sensory awareness of persons with dementia, as well as alter the characteristics of the emotions and moods of both the caregivers and the persons with dementia. This thesis was designed with the aim of demonstrating how interventions using MTC impacted the participants in this study, which included patients with severe dementia and their caregivers. Five studies were included in this thesis, each of which focused on specific aspects of morning care situations with or without the use of MTC. The first study (I) aimed to describe the experiences of professional caregivers while caring for persons with dementia. The second study (II) aimed to present professional caregivers´ impressions of the persons with dementia. The third study (III) aimed to describe how persons with dementia and their caregivers express verbal and non-verbal communication and make eye contact during the care activity ‘getting dressed’. The fourth study (IV) focused on a single case and was designed to describe the expressions of emotion and of resistiveness to care of two nursing home residents with severe dementia, during morning care situations without and with music therapeutic caregiving. The final study (V) aimed to describe expressions of emotions and resistiveness to care among two groups of persons with dementia. Study I revealed that during usual morning care situations (without the use of MTC), the caregivers often had problems reaching the persons with dementia and described a struggle when it was necessary to physically restrain some patients due to aggression and resistance. They found consolation when the persons with dementia showed them affection. In study II, the persons with dementia were described as not mentally present during usual morning care situations, and their resistance and aggression lead to difficulties in communicating and cooperating. Study III revealed that the caregivers communicated mainly with verbal instructions and body movements, and that they seldom invited the persons with dementia to participate in the communication. The responses of persons with dementia were at times active and compliant, and other times confused, disruptive, resistant and aggressive. During MTC, the caregivers described a feeling of well-being, as positive emotions seemed dominant for both the caregivers (study I) and the persons with dementia (study II). The caregivers sense of well-being led to a joyful and positive encounter with the persons with dementia (study I). In study II, caregivers found the persons with dementia better able to express themselves appropriately. Expressions of positive emotions were dominant amongst patients and they were mainly described as relaxed, self-confident, and pliable. Study III also showed that the persons with dementia commonly responded to caregivers’ communication in a composed manner, by being active, compliant and relaxed. Study III further revealed that the caregivers seemed more interested in communicating with the persons with dementia and solicited mutual engagement. In study IV, both residents increased positive expressed emotions, while the negative expressed emotions and resistance decreased. Study V also revealed that the positive emotions, such as pleasure and general alertness significantly increased during MTC, while resistant behaviors, such as pulling away, grabbing objects and adduction, were significantly reduced. From this thesis, it can be concluded that the use of MTC during morning care situations with persons with dementia can increase their positive expressed emotions, decrease their negative expressed emotions and resistance to care, and lead to a more positive interaction with their caregivers. It can also be concluded that MTC can enhance communication between persons with dementia and their caregivers during caring and thus increase the mutuality in the encounter, thereby facilitating an interpersonal relation during morning care situations. More research concerning MTC is needed and should be conducted using different data collection and analysis methods, as well as different care situations.
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| 30. |
- Marmstål Hammar, Lena, et al.
(författare)
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Communicating through caregiver singing during morning care situations in dementia care
- 2011
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 25:1, s. 160-168
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Tidskriftsartikel (refereegranskat)abstract
- It is well known that persons with dementia (PWD) have problems expressing and interpreting communication, making interaction with others difficult. Interaction between PWD and their caregivers is crucial, and several strategies have been investigated to facilitate communication during caregiving. Music therapeutic caregiving (MTC) - when caregivers sing for or together with PWD during caregiving activities - has been shown to enhance communication for PWD, evoking more vitality and positive emotions. The aim of this study was to describe how PWD and their caregivers express verbal and nonverbal communication and make eye contact during the care activity 'getting dressed', during morning care situations without and with MTC. Findings revealed that during the situations without MTC, the caregivers led the dressing procedure with verbal instructions and body movements and seldom invited the PWD to communicate or participate in getting dressed. Patterns in responses to caregivers' instructions included both active and compliant responses and reactions that were resistant and aggressive, confused, and disruptive. In contrast to the 'ordinary' morning care situation, during MTC, the caregivers seemed interested in communicating with the PWD and solicited their mutual engagement. Although verbal communication consisted of singing about things other than getting dressed, e.g. dancing, love, sailing, God, the PWD mostly responded to caregivers in a composed manner, by being active, compliant, and relaxed, though some were also resistant or incongruent. The authors conclude that MTC could be a way for PWD and their caregivers to successfully interact and co-operate during caring situations, as it seems to evoke enhanced communication for both partners in this context
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| 31. |
- Marmstål Hammar, Lena, 1979-, et al.
(författare)
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Finding the key to communion – Caregivers’ experience of ‘music therapeutic caregiving’ in dementia care : A qualitative analysis
- 2011
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Ingår i: Dementia. - : SAGE Publications. - 1471-3012 .- 1741-2684. ; 10:1, s. 98-111
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Tidskriftsartikel (refereegranskat)abstract
- ‘Music therapeutic caregiving’ (MTC), when caregivers sing for or together with persons with dementia (PWDs) during caring situations, has been suggested as a way to reduce PWDs’ behavioral and psychological symptoms of dementia (BPSD). An intervention was designed to elucidate what influences MTC might have on PWDs and their caregivers. The aim was to describe professional caregiverś experiences of caring for PWDs during morning care situations without and with MTC. Group interviews were conducted, and a qualitative content analysis was performed. Two themes were revealed. The first (without MTC), Struggling for care in communion, encompassed four sub-themes: Hampered communication; Physical and mental struggle with aggression; Struggling with ethical demands; and The reward — consolation and love. The second theme (with MTC), Consolidating care in communion, encompassed two sub-themes: awakening cooperation, and feeling of well-being. The authors conclude that MTC could be used to help caregivers provide improved care.
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| 32. |
- Marmstål Hammar, Lena, 1979-, et al.
(författare)
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Reactions of Persons with Dementia to Caregivers Singing in Morning Care Situations
- 2010
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Ingår i: The Open Nursing journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; :4, s. 35-41
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Tidskriftsartikel (refereegranskat)abstract
- Music therapeutic caregiving', when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with'Music therapeutic caregiving'. Through a qualitative content analysis two themes emerged.'Being in a different reality' was based on'usual' morning care situations. The caregivers' experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,'Being present', was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that'Music therapeutic caregiving' might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving.
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| 33. |
- Marmstål Hammar, Lena, et al.
(författare)
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The impact of caregivers' singing on expressions of emotion and resistance during morning care situations in persons with dementia : an intervention in dementia care
- 2011
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 20:7-8, s. 969-978
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The aim was to describe expressions of emotions and resistiveness to care among persons with dementia (PWD), during morning care situations without and with music therapeutic caregiving (MTC). BACKGROUND: Effective caregiving is dependent on the interpersonal relationship between nurse and patient. PWD suffer from major cognitive impairment, making interaction with others problematic. Such patients often react with problematic behaviours such as resistance and anger towards the care activity and the caregiver. Earlier research suggests that MTC - when caregivers sing for or together with PWD during caregiving - can reduce resistance and evoke positive emotions in PWD. DESIGN: This was an intervention study whereby MTC was implemented during morning care situations while PWD were being cared for. METHOD: The study included ten, 66-92-year-old men and women with severe dementia living in a nursing home in Sweden. Video observations of eight weekly sessions, consisting of four recordings of usual morning care and four recordings of morning care with MTC, provided data. The resistiveness to care scale and the observed emotion rating scale were used for analysis. RESULTS: Pull away was the most common resistant behaviour under both conditions. The PWDs' expressions of resistant behaviour, such as pull away, grab object and adduction, were significantly reduced under the intervention situation. Positively expressed emotions, specifically pleasure and general alertness, significantly increased under the MTC intervention compared with the 'usual' morning care sessions. CONCLUSIONS: MTC can be an effective nursing intervention to provide PWD a more pleasant experience of morning care situations as it decreases resistant behaviour and increases positive emotions. RELEVANCE TO CLINICAL PRACTICE: MTC offers a potential non-pharmacologic treatment that can be used in caring for PWD.
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| 34. |
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| 35. |
- Mazaheri, Monir, et al.
(författare)
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Bearing witness to life narratives : Iranian immigrant experiences of taking care of a family member with dementia
- 2011
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Ingår i: Diversity in Health and Care. - 1759-1422 .- 1743-4904. ; 8:1, s. 19-28
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Tidskriftsartikel (refereegranskat)abstract
- Caring for a person with dementia is one of the most devastating and challenging experiences that caregivers have to face. Many studies indicate that the experience of care giving reflects cultural care values and beliefs. Even though dementia care giving is the most frequently studied type of care as reflected in the literature, few studies have focused on dementia caregivers from culturally and linguistically diverse backgrounds. The purpose of this study was to explore Iranian immigrant experiences of taking care of a family member with dementia.An interpretive phenomenological approach was employed to investigate the experiences of ten Iranian family caregivers, each caring for a family member with dementia and living in Sweden. Caregivers were recruited through purposeful sampling and took part in semi-structured interviews. All of the individuals who were contacted participated in the study. The participants included seven women and three men, ranging in age from 40 to 65 years, from different cities. They had all lived in Sweden for at least 20 years. Two caregivers were married to people with dementia, and eight were caring for parents with dementia. Data analysis was guided by Benner's interpretive phenomenology and revealed three key themes, namely caring as an experience of fulfillment, admitting the diagnosis of dementia, and the shock of not being recognized by their family members with dementia. Positive aspects of care giving should be recognized and supported in order to facilitate the maintaining of caregivers' involvement. The positive experiences of care giving could help to alleviate the problems that are experienced by the caregivers of people with dementia.
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| 36. |
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| 37. |
- Momeni, Pardis, et al.
(författare)
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Enabling nursing students to become culturally competent : a documentary analysis of curricula in all Swedish nursing programs
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:4, s. 499-506
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Tidskriftsartikel (refereegranskat)abstract
- Research has shown that majority of nurses feel that they lack relevant knowledge about immigrant's cultural backgrounds, and therefore, feel incompetent in providing these patients with good care. Last year alone, 4520 nursing students graduated from nursing schools throughout Sweden. Later on, they will meet and treat people from diverse cultural backgrounds and consequently, it is crucial that their educational training prepares them for their future work in a multiethnic society. The aim of this study was to investigate whether the nursing curricula in Sweden's nursing schools provide students with the necessary tools for becoming culturally competent. The present study was based on two main questions: (i) Do the present educational plans and courses provide nursing students with the opportunity to become culturally competent? (ii) How do the contents of the educational plans match the contents of the course plans? The study was conducted using a quantitative documentary analysis, where the authors analysed the curricula of 26 nursing schools in Sweden and then compared them to the theoretical frame of reference 'The Process of Cultural Competence in the Delivery of Healthcare Services', a model written by Campinha-Bacote. The results showed that 69% (18/26) had included the concept of culture in their educational plans, whereas 77% (20/26) had included this in their courses. In all, 15% (78) from a total of 504 curricula had included the concept of culture in some way or another. However, the analysis found that only three schools provided students with specific training on the topic. Conclusively, the results showed that nursing students were not prepared for their work in a multiethnic society and nursing education in Sweden has failed to implement existing research into the nursing curricula.
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| 38. |
- Momeni, Pardis, et al.
(författare)
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Factors of importance for self-reported mental health and depressive symptoms among ages 60-75 in urban Iran and Sweden.
- 2011
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 25:4, s. 696-705
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Depression is a common experience affecting 121 million people around the world. In high income countries, depression is one of the most common psychiatric conditions among the elderly. Studies show that immigrants are particularly at risk for mental ill health.AIM: This study investigates the self-reported mental health among two Iranian groups; one born and residing in Iran and one consisting of Iranian immigrants in Sweden, as well as native Swedes living in Sweden. The study also aims to explore and compare self-reported depressive symptoms among three groups.METHODS: This study is based on a cross-sectional design measuring self-reported health with a study specific questionnaire. The programme SPSS V.17.0 was used for all statistical analyses.FINDINGS: 1088 participants were approached (668 Iranians in Iran; 105 immigrated Iranians in Sweden; and 305 Swedes in Sweden). Factors effecting self-reported mental health was self-reported health, smoking, satisfaction with social life and also a sense of connection to ones cultural roots and traditions. Also demographic variables such as group belonging (Swedes vs. Iranians), sex and satisfaction with Income were shown to be important when performing the regression analysis. In the chi-square analysis the Iranian samples reported depressive symptoms to a larger extent than the Swedish group in all aspects of self-reported depressive symptoms. Self-reported depressive symptoms were reported to a greater extend in women compared to men. Our findings indicate that the Iranian populations living in both Tehran and Stockholm report depressive symptoms to an extent that merits concern. The findings indicate that Iranians living in Tehran and Iranians who have immigrated to Sweden require more attention regarding mental health care. Health care providers in both countries should be aware of the current state of mental health among Iranians in both Sweden and Iran.
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| 39. |
- Olt, Helen, et al.
(författare)
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Communication and equality in elderly care settings : Perceptions of first- and secondgeneration immigrant and native Swedish healthcare workers
- 2014
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Ingår i: Diversity and equality in health and care. - 2049-5471 .- 2049-548X. ; 11:2, s. 99-111
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Tidskriftsartikel (refereegranskat)abstract
- An ethnically diverse healthcare workforce is considered beneficial to meeting the needs of an ethnically diverse population. In the UK and the USA, lack of equality and difficulties in communication between co-workers and patients from different ethnic backgrounds is problematic. Little is known about the ethnically diverse healthcare workforce in elderly care settings in Sweden. This paper compares native Swedish and first- and secondgeneration immigrant healthcare workers' perceptions of diversity in relation to equality and communication in elderly care settings. The study used a cross-sectional design with a survey administered by self-completed questionnaire. The Assess Awareness and Acceptance of Diversity in Healthcare Organizations questionnaire was distributed to healthcare workers in elderly care settings in one municipality in Sweden. Responses from 643 healthcare workers were analysed. A factor analysis was performed on 26 items in the questionnaire. Reliability analysis on the subscales was conducted using Cronbach's alpha. Differences between native and first- and second-generation immigrants were analysed using ANOVA followed by post-hoc tests. The results showed that first-generation immigrant and native Swedish healthcare workers had different views on equality and communication in four of the five subscales, namely care of elderly patients from different backgrounds, equality in the workplace, communication with diverse co-workers, and treatment by family and significant others from a different ethnic background. Second-generation immigrants held similar views to native Swedish healthcare workers on two factors, namely equality in the workplace and communication between co-workers from different backgrounds. There were no differences between the groups with regard to their views on self-awareness in collaboration with co-workers. Differences in the experiences of first- and secondgeneration healthcare workers should be acknowledged, rather than assuming that they share similar experiences as immigrants. Managers need to promote equality and effective communication among an ethnically diverse workforce.
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| 40. |
- Safipour, Jalal, et al.
(författare)
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Feelings of social alienation : a comparison of immigrant and non-immigrant Swedish youth
- 2011
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Ingår i: International journal of sociology and social policy. - : Emerald Group Publishing Limited. - 0144-333X .- 1758-6720. ; 31:7/8, s. 456-468
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The objective of the study is to investigate the social alienation status of Swedish high school students with respect to gender and immigrant background.Design/methodology/approach – The sample was randomly selected from high school students aged 15‐19, and 446 students participated in the study. The Jessor and Jessor general alienation questionnaire was used to explore feelings of social alienation. Sequential multiple regression analyses were performed to examine the relationships between alienation, age, sex, and immigrant background.Findings – The results demonstrated a significant association between immigrant background and alienation. It was found that first‐generation immigrants felt more alienated than second‐generation immigrants and second‐generation immigrants felt more alienated than natives. Adolescents who were first‐generation immigrants had higher scores on the social isolation subscale than second generation immigrants and native Swedes. However, second generation immigrants had higher scores on the meaninglessness subscale than first‐generation immigrants and native Swedes. Age proved to have a significant quadratic component. The research found feeling of alienation significantly higher among youngest and oldest students but lower for those aged 17.Research limitations/implications – The study was limited by the number of participants with different cultural background in the immigrant samples. As such, it was unable to compare feeling of alienation between students with different cultural background.Originality/value – As the authors could not identify any studies that specifically address feelings of social alienation among adolescents in Sweden, thus this study is believed to be the first one in this context.
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| 41. |
- Safipour, Jalal, et al.
(författare)
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Measuring social alienation in adolescence : Translation and validation of the Jessor and Jessor Social Alienation Scale
- 2010
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Ingår i: Scandinavian Journal of Psychology. - : John Wiley & Sons. - 0036-5564 .- 1467-9450. ; 51:6, s. 517-524
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Tidskriftsartikel (refereegranskat)abstract
- The objective of the study is to translate and examine the reliability and validity of the Jessor and Jessor Social Alienation Scale for use in a Swedish context. The study involved four phases of testing: (1) Translation and back-translation; (2) a pilot test to evaluate the translation; (3) reliability testing; and (4) a validity test. Main participants of this study were 446 students (Age = 15–19, SD = 1.01, Mean = 17). Results from the reliability test showed high internal consistency and stability. Face, content and construct validity were demonstrated using experts and confirmatory factor analysis. The results of testing the Swedish version of the alienation scale revealed an acceptable level of reliability and validity, and is appropriate for use in the Swedish context.
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| 42. |
- Safipour, Jalal, et al.
(författare)
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Migration status and self-reported health among high school students in Stockholm : A cross-sectional study
- 2012
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Ingår i: Vulnerable Children and Youth Studies. - : Taylor & Francis. - 1745-0128 .- 1745-0136. ; 7:2, s. 149-163
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Tidskriftsartikel (refereegranskat)abstract
- This article aims to determine the self-reported health status of Swedish high school students with respect to gender and immigrant background. The sample was randomly selected from high school students aged 15–19, and 446 students participated in this study. The Nottingham Health Profile (NHP) was used for capturing health status. The results showed that the most common problem was related to energy level (23%) and the least to physical mobility (1%). The proportion for other domains ranged from 2% to 14%. Self-reported health problems were more common among immigrants than native Swedes. Female students reported more problems on all aspects of health than males. Female gender and first-generation immigrants were found to be important factors associated with feelings of ill health among the target population. Gender disparity was more important among the students with an immigrant background.
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| 43. |
- Safipour, Jalal, et al.
(författare)
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The mediating role of alienation in self reported health among Swedish Adolescents
- 2011
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Ingår i: Vulnerable Groups & Inclusion. - : CoAction Publishing. - 2000-8023. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate the relationship between a sense of alienation and self reported health. A sample consisting of a total of 446 high school students aged 15-19 (Mean age=16.95, SD=1.01, Female=59%), with a participation rate of 91%. The Jessor and Jessor alienation scale and the Nottingham Health Profile for self reported health were used to gather data. To analyze the relationship between sense of alienation and self reported health, a path model was created and tested using structural equation modeling. The results suggest that sense of alienation is importantly related to the domain of self-reported health. The alienation variable mediates between mental health (energy level, sleep and emotional reaction) and physical health (pain pain and physical mobility).
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| 44. |
- Theorell, Töres, et al.
(författare)
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How Music Intervention Lowered Participants’ Morning Cortisol : Qualitative Case Stories
- 2024
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Ingår i: Case Reports in Clinical Medicine. - : Scientific Research Publishing. - 2325-7075 .- 2325-7083. ; 13:06, s. 193-206
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Tidskriftsartikel (refereegranskat)abstract
- Non-pharmacological interventions for improved home care of persons with dementia and their family caregiver are and will be increasingly important for society. A music intervention study was performed on persons with persons with dementia and family caregiver. The persons with dementia and family caregiver were instructed to choose a daily routine for joint listening to recorded music. They selected the music they were interested in from a menu. The intervention period lasted for two months. Both persons with dementia and family caregiver provided daily saliva samples for the assessment of stress-related steroid hormones. In previous reports we have reported that the morning cortisol levels decreased significantly among the family caregiver when the intervention group was compared to a control group. In the present study we report narratives from four dyads, two of whom with beneficial effects of the music intervention, one dyad with no clear beneficial effects and one dyad with mixed results. The narratives illustrate the strong cohesive effect that the joint music listening could have, leading to improved social functioning paralleled by decreased morning cortisol levels particularly in the family caregiver. The narratives also illustrate reasons for failed effects.
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| 45. |
- Theorell, Tores, et al.
(författare)
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The use of saliva steroids (cortisol and DHEA-s) as biomarkers of changing stress levels in people with dementia and their caregivers : A pilot study.
- 2021
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Ingår i: Science Progress. - : SAGE Publications. - 0036-8504 .- 2047-7163. ; 104:2
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Tidskriftsartikel (refereegranskat)abstract
- The rationale was to explore the efficacy/sensitivity of using morning and evening cortisol levels as biomarkers for stress reduction in persons with dementia (PWDs) and their family caregivers (FCGs) participating in a music intervention program. Thirty-two PWD and their FGC were recruited to an 8-week, home-based music intervention program. Daily home-based collection of saliva samples took place at bedtime and upon awakening. Cortisol was analyzed in the morning and evening saliva samples and DHEA-s in the morning samples. Trends over 40 workdays (15-40 observations per subject) were assessed using linear regression analysis. Twenty-three PWD (72% of invited, 16 men and 7 women, age 69-93) and 24 caregivers (75%, 8 men and 16 women, age 37-90) completed the intervention for at least 6 weeks and were included in the analysis. One-fourth of the PWD and FCG had decreasing evening cortisol, accompanied by decreasing morning cortisol levels. In one-fourth of the participants the ratio between cortisol and DHEA-S in the morning samples was improved, indicating improved balance between energy mobilization and regeneration. Several participants showed no significant endocrine change. There was a statistically significant (two-sided test) correlation within the PWD-caregiver dyads in evening cortisol trend and a statistically significant decrease (two-sided test) in the morning-evening cortisol slope for the FCG group. Reduction in stress, as measured by evening cortisol, was observed in a substantial number of the participants. Recording endocrine stress is helpful for the unbiased assessment of the intervention.
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