Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China.

This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.

En este estudio se analizan los efectos longitudinales a 21 años y los efectos pronósticos de la transición de los cuidadores familiares y la presencia de cuidado familiar en el estado clínico de las personas con esquizofrenia en un área rural de China. Utilizando datos de panel extraídos del Proyecto de salud mental de Chengdu (Chengdu Mental Health Project, CMHP), se investigaron 250 díadas de personas con esquizofrenia y sus cuidadores familiares en 1994 y 2015. Se utilizó la Escala de síndrome positivo y negativo (Positive and Negative Syndrome Scale, PANSS) y la Evaluación global del funcionamiento (Global Assessment of Functioning, GAF). También se utilizó el método de modelo lineal generalizado. Los resultados de este estudio demostraron que los síntomas más intensos en las personas con esquizofrenia fueron pronosticados principalmente por la edad avanzada y el estado de soltería en el momento basal. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la PANSS fue considerablemente más alto en el grupo de "transición al cuidado de los hermanos". Se descubrió que principalmente el estado civil, la duración más corta de la enfermedad y un mejor estado mental pronosticaron un grado más alto de funcionamiento psicosocial. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la GAF fue considerablemente más bajo en el grupo de "transición al cuidado de los padres". La presencia de cuidado familiar no fue un factor pronóstico importante de la intensidad de los síntomas ni del funcionamiento psicosocial en las personas con esquizofrenia. En resumen, en este estudio se muestran los efectos pronósticos a 21 años de la transición de los cuidadores familiares en el estado mental de las personas con esquizofrenia, pero no la presencia de cuidado familiar. Deben ofrecerse intervenciones psicosociales y orientación específica a los cuidadores familiares para mejorar su calidad de cuidado y mejorar el pronóstico de las personas con esquizofrenia durante los periodos prolongados de cuidado en el hogar.

Tai chi exercise for patients with heart disease: a systematic review of controlled clinical trials.

CONTEXT: To summarize and evaluate the available evidence from controlled clinical trials of tai chi (TC) exercise for patients with heart disease. SEARCH METHODS: Fourteen databases were searched up to November 2010 with the terms tai chi, taichi, tai ji, taiji, taijichuan, cardiac, heart, coronary, myocardial, and atrial fibrillation in the title, abstract, or key words. No language restrictions were imposed. The quality and validity of randomized clinical trials (RCTs) were evaluated using the Jadad Scale. The strength of the evidence for all included studies was evaluated using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS: Nine studies including 5 RCTs and 4 nonrandomized controlled clinical trials met the inclusion criteria. Three studies examined the effectiveness of TC exercise for patients with chronic heart failure (CHF), and 6 studies examined the effectiveness of TC exercise among patients with coronary heart disease (CHD). Overall, these studies demonstrated favorable effects of TC exercise for the patients with heart disease. CONCLUSIONS: The existing evidence suggests that TC exercise is a good option for heart patients with very limited exercise tolerance and can be an adjunct to rehabilitation programs for patients with CHD or CHF.

Attitudes to and practices regarding sex selection in China.

This paper explores the problem of China's 'missing' girls--estimated to run into many millions. It considers the impact of the underpinning Confucian value system in China that has produced a culture of son preference and which, together with China's compulsory family planning program and 'one child policy', has effectively established a 'one son policy'. Discussion of the various means by which the birth or survival of daughters have traditionally been prevented provides the context for identifying the contribution of new sex selection procedures to the maintenance of son preference in contemporary Chinese society. The paper concludes that China's son preference is not simply a personal problem for the millions of 'missing girls' who were destined to live a shorter life and for the surviving girls who continue to face considerable discrimination simply because they are of the 'wrong' sex; it heralds a social and demographic disaster of major proportions for which neither the government nor the people of China appear to have the will or the means to forestall.