Suchergebnisse

Family members are involved in every aspect of end-of-life decision making and care. The present article reviews family involvement in providing care during chronic and terminal illness, in discussions and plans for advance directives, in decision making during chronic illness, in executing advance directives and making critical decisions near the end of life, and the long-lasting effects of caregiving and difficult decisions on the family member during bereavement. Although legal standards and much of the research on end of life emphasize individual decision making and the value of autonomy, end-of-life care and decisions should be increasingly understood within a family context. There is also increasing need to study how issues of race, ethnicity, and culture affect end-of-life care and decisions within families.

Through each era, the southeastern United States was and continues to be an epicenter for industrial companies to establish factories and plants. Though this development attracts economic gain for the companies and surrounding areas, low-income and predominantly Black communities bear the brunt of the environmental consequences while frequently remaining stagnant economically. This qualitative, community-based participatory research study grew out of a larger study designed to recruit lay community advisors from communities labeled as hard to reach in research. We focus on Holt, Alabama, an unincorporated community in the southeastern United States region. The primary goal of this research inquiry is to thematically analyze community interviews stemming from a topic of research, practice, and policy interest to community members: the effects of industrial pollution on Holt citizens' daily lives. Content analysis of focus-group transcripts revealed four emergent themes, including: (1) how the pollution affects their water, soil, and air quality; (2) illness related to pollution; (3) community engagement and empowerment; and (4) suggestions regarding what government officials could do to address this area of need. Building upon the prior research regarding environmental justice, human flourishing, and the definition of nurturing environments, suggestions are made regarding the creation, implementation, and maintenance of project advisory councils focused on issues of environmental justice. Community advocacy and empowerment as well as community and scientific partnerships are imperative to alleviate problems associated with environmental justice.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence-based treatment. This study examined the efficacy of mindfulness-based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans. METHODS: Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90-minute group MBSR or present-centered group therapy (PCGT) for eight weeks. Follow-up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16. RESULTS: Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self-reported PTSD Checklist for DSM-IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single-blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women. CONCLUSION: Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self-reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS-IV scale.