Social support and subjective burden in caregivers of adults and older adults: A meta-analysis.

BACKGROUND: Despite the generally accepted belief that social support improves caregiver adjustment in general and subjective burden in particular, the literature shows mixed findings, and a recent review concluded that the predictive strength of caregiver social support in determining caregiver burden is less evident, due to the conceptual diversity of this determinant. OBJECTIVE: The purpose of this review is to analyse the relationship of perceived and received social support with subjective burden among informal caregivers of an adult or older adult. METHODS: A systematic search was carried out up to September 2017 in the following databases: MEDLINE (PubMed), CINAHL, EMBASE, PsycINFO), Scopus and ISI Proceedings, and a meta-analysis was performed with the results of the selected and included studies. RESULTS: Fifty-six studies were included in the meta-analysis, which provided 46 independent comparisons for perceived support and 16 for received support. Most of these studies were cross-sectional. There was a moderate, negative association of perceived social support on subjective burden (r = -0.36; CI 95% = -0.40, -0.32) and a very small, negative association of received support on subjective burden (r = -0.05; CI 95% = -0.095, -0.001). CONCLUSIONS: 1) perceived and received support are not redundant constructs, 2) the relationships between social support and subjective burden depend on whether the social support is measured as perceived or received, 3) the relationship of perceived social support with subjective burden has a bigger effect size than that of received social support, the relation between received support and subjective burden being clinically irrelevant, 4) perceived social support may be a good predictor of subjective burden. IMPLICATIONS OF KEY FINDINGS: Our findings broadly support interventions promoting social support in caregivers to prevent or alleviate subjective burden, and specifically, to intervene on the promotion of perceived social support more than on the promotion of received social support when preventing or alleviating burden.

Effectiveness of a Brief, Basic Evidence-Based Practice Course for Clinical Nurses.

BACKGROUND: Barriers to the implementation of evidence-based practice (EBP) by nursing professionals include a lack of knowledge, inadequate skills in searching for and appraising evidence, and consulting research articles. However, few studies have addressed the effectiveness of educational interventions to improve their competence. AIMS: To evaluate the effectiveness of a brief basic online and face-to-face educational intervention to promote EBP attitudes, knowledge and skills, and practice in clinical care nurses. METHODS: This study was quasi-experimental, pretest-posttest design with a comparison group. The sample included registered nurses enrolled in the free continuing education courses offered in 2013 by the Nursing Council of Jaén (Spain). The study included 109 participants (54 in the intervention group and 55 in the comparison group). The intervention was a brief, basic EBP course with online and face-to-face learning. The comparison group received an educational intervention with different content. The evidence-based practice questionnaire (EBPQ) was used to evaluate EBP attitude, knowledge and skills, and practice before the intervention, and at 21 and 60 days following the intervention. Two-way mixed analysis of variance was conducted. RESULTS: There was a significant difference between intervention and comparison groups in the knowledge and skills dimension. The difference between groups was not significant in the EBP practice dimension. Both groups had high scores in the attitude dimension that did not change after the intervention. LINKING EVIDENCE TO ACTION: A brief basic educational intervention on EBP with online and face-to-face learning can produce improvements in the knowledge and skills of clinical nurses.

Immediate effects of spinal manipulation on nitric oxide, substance P and pain perception.

Previous studies have analyzed the effects of spinal manipulation on pain sensitivity by using several sensory modalities, but to our knowledge, no studies have focused on serum biomarkers involved in the nociceptive pathway after spinal manipulation. Our objectives were to determine the immediate effect of cervical and dorsal manipulation over the production of nitric oxide and substance P, and establishing their relationship with changes in pressure pain thresholds in asymptomatic subjects. In this single-blind randomized controlled trial, 30 asymptomatic subjects (16 men) were randomly distributed into 3 groups (n = 10 per group): control, cervical and dorsal manipulation groups. Blood samples were extracted to obtain serum. ELISA assay for substance P and chemiluminescence analysis for nitric oxide determination were performed. Pressure pain thresholds were measured with a pressure algometer at the C5-C6 joint, the lateral epicondyle and the tibialis anterior muscle. Outcome measures were obtained before intervention, just after intervention and 2 h after intervention. Our results indicated an increase in substance P plasma level in the cervical manipulation group (70.55%) when compared with other groups (p < 0.05). This group also showed an elevation in the pressure pain threshold at C5-C6 (26.75%) and lateral epicondyle level (21.63%) immediately after the intervention (p < 0.05). No changes in nitric oxide production were observed. In conclusion, mechanical stimulus provided by cervical manipulation increases substance P levels and pressure pain threshold but does not change nitric oxide concentrations. Part of the hypoalgesic effect of spinal manipulation may be due to the action of substance P.