Social science & medicine
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Social science & medicine · Mar 1995
Comparative StudyRelationship of caregiver reactions and depression to cancer patients' symptoms, functional states and depression--a longitudinal view.
This research examined, in a sample of N = 150 cancer patients and caregivers, the relationships among patient's physical functioning, depression and symptomatology, impact on caregivers' schedule and health, and caregiver depression, as well as the changes in these variables over time. A measure of caregivers' optimism was also included in the analyses. The disposition of caregiver optimism was a strong predictor of caregiver reactions to the burdens of caring, and seemed to play the role of a personality characteristic which was for the most part independent of patient variables. ⋯ Caregivers' reactions were clearly distinct, and were influenced differently by different patient variables. However, all three types of caregivers' reactions were influenced by caregivers' optimism. Oncologists, nurses and other health care professionals involved in the care of patients with cancer should consider this potentially important personal characteristic in the assessment of need for and the development of interventions designed to assist patients with cancer and their family caregivers.
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The results from two surveys in England of relatives and others who knew people in samples drawn from death certificates are reported. The main focus is on a sample of 3696 people dying in 1990 in 20 health authorities, with supporting analysis from an earlier national sample of 639 people dying in 1987. The argument that good care and, in particular, hospice care is effective in reducing the desire for euthanasia has been proposed as an argument against the legalization of voluntary euthanasia. ⋯ It is suggested that this may be due to hospice care being geared to helping patients express their fears and exercise choice. The wish for euthanasia may then be an assertion of personal control, rather than an act of surrender. Alternatively, people (and their relatives) who accept hospice care may be predisposed to consider the benefits of an earlier death.(ABSTRACT TRUNCATED AT 250 WORDS)
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Social science & medicine · Mar 1995
An organizational analysis of the World Health Organization: narrowing the gap between promise and performance.
The World Health Organization's (WHO's) nearly half century amelioration of suffering stands as a singular achievement in international cooperation. But after 45 years, the Organization has grown into a complex bureaucracy with an outdated organizational structure. A multidisciplinary framework, which emphasizes organizational theory, yields some insights into these problems. ⋯ For more complex social and economic issues, newer, often non-medical, approaches are needed. The internal and external rules, which shape the incentives of WHO staff and leaders, need to be realigned to close the gap between WHO's myths and its day to day work. In the short run it is possible for WHO to do more with its limited budget if it changes its organizational structure; in the long run a reorganized WHO will be able to garner more funding and attract wider international participation.