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Updated 2:15 PM December 9, 2008
 

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Scholarship & Creative Work
Attending to ailing spouse may increase caregiver longevity

Older people who spent at least 14 hours a week taking care of a disabled spouse lived longer than others, researchers found.

The study supports earlier research showing that in terms of health and longevity, it really is better to give than to receive.

"These findings suggest that caregivers may actually benefit from providing care under some circumstances," says researcher Stephanie Brown, lead author of the study report. "Previous studies have documented negative health effects of caregiving. But the current results show that it is time to disentangle the presumed stress of providing help from the stress of witnessing a loved one suffer."

Brown is an assistant professor of internal medicine at the Medical School and a faculty associate at the Institute for Social Research (ISR). She also is affiliated with the Ann Arbor Veterans Affairs Hospital.

The U-M Health and Retirement Study focused on 1,688 couples age 70 and older who all lived on their own.

At the start of the study in 1993, both members of each couple reported how much help they received from their spouse with a long list of everyday activities. These included eating, dressing and bathing, preparing meals, managing money and taking medications.

Over the course of the study, 909 people died — about 27 percent of the study population. Brown and colleagues found that the individuals who provided at least 14 hours of care a week to their spouses significantly were less likely to have died during the study period than those who provided no spousal care.

Results of the ISR Health and Retirement Study will appear in Psychological Science, a journal of the Association for Psychological Science.

Child vaccines cause financial burden to many physicians

The costs that health care providers are charged and reimbursed for childhood vaccines vary widely, and the high cost of some immunizations is leading to significant financial strain for some physicians, a pair of studies show.

The findings suggest that many physicians appear to be paying too much and receiving too little reimbursement, but they can use this new data to help improve both areas, the researchers say.

"Physicians need to be better business people, and negotiate better prices and payments," says lead author Dr. Gary Freed, chief of the Division of General Pediatrics and director of the Child Health Evaluation and Research (CHEAR) Unit at the U-M Health System C.S. Mott Children's Hospital. Freed is the immediate past chair of the U.S. Department of Health and Human Services National Vaccine Advisory Committee.

With vaccines for children enrolled in Medicaid funded by the public sector through the federal Vaccines for Children Program, prices are negotiated annually with vaccine manufacturers by the Centers for Disease Control and Prevention. But the data from the new studies support the belief that costs and reimbursements are widely variable in private practices.

The studies found that the price-per-dose of one brand of hepatitis B vaccine, for example, ranged from $4.26 to $13.06 at different medical practices. Reimbursements of the MMR (measles, mumps and rubella) vaccine ranged from $16.77 to $59.02. Many physicians in the survey expressed dissatisfaction with the price and reimbursement levels of vaccines.

The studies appear in the December issue of the journal Pediatrics.

In addition to Freed, authors of both papers were Sarah Clark and Anne Cowan of the CHEAR Unit. Sashi Gregory also was an author of the reimbursement study.

Religion, families comfort women caring for Alzheimer's patients

When caretaking for Alzheimer's disease patients, women are more likely than men to take advantage of some support services including transportation, but not seek in-home help.

Researchers at U-M and other universities looked at gender differences in how caregivers assisted Alzheimer's patients. They also looked at how religion affected the type of service considered for these patients.

"Given that women are traditionally accustomed to in-home tasks, they may perceive less difficulty in performing such tasks, and thus might be less inclined to seek and receive outside assistance," says Louis Burgio, who co-authored the study. He is the Harold R. Johnson Professor of Social Work and an adjunct research professor at the Institute of Gerontology.

Participants in the study answered questions about formal services, which included in-home aid such as receiving visits from a nurse or accepting meals delivered to their residences. Out-of-home services involved transportation, adult day care and support groups.

Women who are caregivers acknowledged that they rely on their families and friends for support, whereas men may have been hesitant to report this type of support.

The researchers believe women may not be comfortable with driving their spouses with dementia, which can prompt them to get transportation services.

A religious assessment tracked the number of times caregivers attended religious services or activities, and how frequently they prayed or meditated. Women who prayed and attended services more often were less likely than men to use in-home services.

The findings appear in the December issue of the Journal of Aging and Health.


New approach eliminates software deadlocks

Software deadlocks are the Catch-22s of the computer world. These common bugs can freeze the machine when different parts of a program end up in an endless cycle of waiting for one another as they access shared data.

Researchers developed a new way around this problem with a controller that can anticipate and prevent situations that might cause deadlock.

Their controller is called Gadara. It's a plug-in that operates using feedback techniques similar to those that give us cruise control in cars and thermostats in heating systems.

"This is a totally different approach to what people had done before for deadlock. Previously, engineers would try to identify potential deadlocks through testing or program analysis and then go back and rewrite the program. The bug fixes were manual, and not automatic. Gadara automates the process," says Stéphane Lafortune, a professor in the Department of Electrical Engineering and Computer Science and a Gadara developer.

Yin Wang, a doctoral student who works with Lafortune in the same department, will present a paper on Gadara Dec. 9 at the USENIX Symposium on Operating Systems Design and Implementation in San Diego.

Deadlock is becoming a more pressing concern as multicore chips grow in complexity and software performs an increasing number of tasks simultaneously. The bug shows up often in parallel programs that use shared data.

Gadara works by analyzing a program to find potential deadlocks, and then inserting control logic into the program. The control logic ensures that the program cannot deadlock.

The paper is titled "Gadara: Dynamic Deadlock Avoidance for Multithreaded Programs." Other co-developers of Gadara are Scott Mahlke, a professor in the Department of Electrical Engineering and Computer Science; Terence Kelly, who received his doctoral degree from U-M; and Manjunath Kudlur, a recent doctoral graduate.


Adventure counseling enhances effectiveness of individual therapy

Making a peanut butter and jelly sandwich or playing "rock, paper, scissors" may seem like ordinary activities. But for patients in counseling these fairly common actions can lead to better communication with their therapists.

"The shared experience between therapist and client has the potential to deepen the therapeutic relationship and to help establish engagement with treatment goals," says Gary Stauffer, an adjunct lecturer at the School of Social Work.

Stauffer collaborated with lead author D. Maurie Lung and Tony Alvarez in writing a book about adventure-based, individual counseling that allows clients to take action during the session.

Therapists often use games or activities as icebreakers or fillers to start their session or engage clients. These games include checkers, dominoes, coloring, drawing or even playing basketball.

But the authors offer a different approach. The activities serve as one of the main processes of counseling, whether it's in the clinical office, school office or a wilderness therapy setting. During the activity, the therapist discusses the issues that arise from the action with the intent of connecting this material to treatment goals and leading the desired change.

They suggest about 40 activities that can be incorporated into the session, including:

• PB&J sandwich: The client writes step-by-step directions for making the sandwich. The instructions must be followed exactly as they were written. The purpose is to help the client learn about communication and following directions

• Giant "rock, paper, scissors": The client and therapist put their backs to one another and turn around in an exaggerated position of rock, paper or scissors. The goal, which teaches relationship, is to match the other person

• Jousting: The client and therapist use 3-foot foam noodles to knock a piece of 1-inch foam off the back of the other person's hand. This activity focuses on making decisions and building relationship.

This approach to individual counseling sessions appears in the book "Power of One: Adventure and experiential activities within one-on-one counseling sessions."


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