Background:There is a lack of studies of the size of burden associated with informal care giving
in psychosis.Aims:To evaluate the objective and subjective burden of informal care giving to patients
with psychoses, and to compare a diary and recall method for assessments of objective
burden.Method:Patients and their informal caregivers were recruited from nine Swedish psychiatric
outpatient centres. Subjective burden was assessed at inclusion using the CarerQoL and
COPE index scales. The objective burden (time and money spent) was assessed by the
caregivers daily using diaries over four weeks and by recall at the end of weeks 1 and
2.Results:One-hundred and seven patients (53% females; mean age 43 ± 11) and 118 informal
caregivers (67%; 58 ± 15 years) were recruited. Informal caregivers spent 22.5
hours/week and about 14% of their gross income on care-related activities. The time
spent was underestimated by two to 20 hours when assessed by recall than by daily diary
records. The most prominent aspects of the subjective burden were mental problems.Conclusion:Despite a substantial amount of time and money spent on care giving, the informal
caregivers perceived the mental aspects of burden as the most troublesome. The informal
caregiver burden is considerable and should be taken into account when evaluating
effects of health care provided to patients with psychoses.
Background Fibrinolysis plays an important role in destabilization of atherosclerotic plaques and is tightly regulated by specific inhibitors. Objective The fibrinolysis inhibitors plasminogen activator inhibitor type-1 (PAI-1) and thrombin-activatable fibrinolysis inhibitor (TAFI) were quantified and described in the morphological context of advanced carotid plaques American Heart Association VI-VIII to elucidate their role in plaque stability. Methods Immunohistochemistry in serial sections along the longitudinal axis of endarterectomies from patients with symptomatic carotid stenosis (n = 19) were studied using an antibody specific for free PAI-1 (I205), an antibody with high affinity for TAFI/TAFIa (CP17) and established antibodies for smooth muscle cells (α-actin), endothelial cells (von Willebrand factor [VWF]), macrophages (CD68) and platelets (CD42). Results PAI-1 and TAFI show a specific distribution in these advanced plaques with a maximum corresponding to the internal carotid artery (ICA). Free PAI-1 was mainly detected in macrophages and in intravascular thrombi, and TAFI in endothelial cells (ECs) but also macrophages. The one-way ANOVA analysis with Bonferroni's correction showed a significant increase of macrophages and ECs, TAFI and PAI-1 in areas with high neovascularization in endarterectomy sections corresponding to ICA. High Spearman factors for TAFI, PAI-1 and VWF indicate neovascularization as the main source of plasma proteins, transported by platelets into the atheroma (PAI-1) or expressed by ECs (TAFI). CD68 was highly associated with VWF, PAI-1 and especially TAFI, underlining the role of macrophages in fibrinolytic activity and inflammation. Conclusion The abundance of free PAI-1 and TAFI in the plaque may inhibit plasmin generation and thereby counteract plaque destabilization by fibrinolysis, cell migration and inflammation.
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