Caring for a spouse with cancer at home during the end-of-life period is emotionally demanding and can have lasting effects on bereaved partners. For some wives who assume the primary caregiving role, this experience becomes a source of meaning, personal growth, and relational reconstruction after loss. However, the longitudinal processes through which they derive positive meaning and rebuild their relationship over time remain unclear. This study builds on our previous research involving bereaved wives and husbands, who provided home-based end-of-life care for a partner with cancer between 6 months and 2 years after bereavement, and examines their positive interpretations of caregiving. In this follow-up study conducted approximately two years later, we re-interviewed the wives to explore how they interpreted their caregiving experiences. Through longitudinal comparison with the initial findings, we examined how caregiving meanings evolved. We used a qualitative longitudinal design and conducted second interviews (approximately four years after bereavement) with wives who participated in the initial study and provided renewed consent. The semi-structured interviews were transcribed verbatim and analyzed using sequential comparative analysis. Five themes were identified: "the enduring bond of the married couple," "the importance of family members who spent time together until the end," "the meaning attached to caring for the husband in the terminal phase," "confronting life without the husband," and "reflection on one's way of life." Over time, wives gradually reconfigured their relationships with their husbands, shifting from viewing caregiving as a "concluded past" to experiencing it as a "continuing relationship in the present." This transition represents a conceptual shift, illustrating a dynamic process in which earlier interpretations are revisited and integrated into an evolving life narrative. The meaning-making process surrounding care for a dying husband did not remain fixed after bereavement; it evolved as a dynamic, ongoing reinterpretation. The findings indicate that positive meaning-making after loss deepens over time and is accompanied by relational growth. Through end-of-life care support, visiting nurses can understand how wives "make meaning of their marital relationship" and provide opportunities for narrative exchanges that lead to post-bereavement meaning construction.
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This study aimed to develop and validate the "Awareness of Parental Responsibility (APR)" scale for first-time fathers with a wife who is pregnant with their first child. This study was conducted in three stages. Data were obtained from 92 fathers in the pilot study and 396 fathers in the main survey. We analyzed construct validity, reliability, and criterion-related validity using the collected data. The APR was ultimately confirmed through confirmatory factor analysis (CFA) to comprised 4 factors and 27 items:"Positive responses to children," "Imagining life with a child," "Sense of gender role division," and "Imagining the practice of childcare." Cronbach's alpha coefficient of the total scale was .87. The CFA results indicated a consistent fit between the model and data, with values of χ²/df ratio=2.42, Goodness-of-Fit Index (GFI)=0.870, Adjusted Goodness-of-Fit Index (AGFI)=0.845, Comparative Fit Index (CFI)=0.895, Root Mean Square Error of Approximation (RMSEA)=0.060. The composite reliability (CR) value for the entire scale was 0.774, with values ranging from factors 1 to 4 of 0.697, 0.810, 0.794, and 0.941, respectively. This was considered to be sufficiently reliable. Thus, APR is a valid and reliable tool for assessing readiness to become a father from the perspective of "A Parental," it can also be used to verify the effectiveness of preparatory education for becoming a parent. J. Med. Invest. 73 : 166-175, February, 2026.
To determine the incidence and type of wife abuse in relation to mental health status, a survey was undertaken in a community-based sample of wives. The incidence rate of physical abuse was 10.6%, psychological abuse 13.1%. Nearly all physically abused wives were psychologically abused. Wives at highest risk of abuse were those: 1) separated from their husbands in the previous year; 2) aged 18-44 years; 3) in relatively new relationships; 4) whose husbands were unemployed, in school or working part-time. Physically and psychologically abused wives had more somatic complaints, higher levels of anxiety and insomnia, greater social dysfunction and more symptoms of depression than non-abused wives. Alcohol dependency was associated with abuse; 16.3% of physically abused and 11.3% of psychologically abused wives were alcohol-dependent, compared to 2.4% of non-abused wives.
OBJECTIVES: Metastatic prostate cancer is a serious disease that affects both men and their intimate partners. We explored the perceptions of men who have been treated for metastatic prostate cancer and the views of their wives regarding the changes that were caused by prostate cancer and its treatment. STUDY DESIGN: We conducted retrospective focus group interviews with married men and separate focus groups with their wives. POPULATION: Twenty married men (11 white and 9 African American) with an average age of 69 years (range=60-82 years) and 7 of the wives (5 white and 2 African American) participated in our study. Thirteen of the men were treated with orchiectomy, and 7 received monthly hormone ablation therapy. OUTCOMES MEASURED: We compared the accounts of husbands and wives concerning the diagnosis and treatment of prostate cancer. RESULTS: The participants' accounts indicate little spousal communication about the implications of prostate cancer on their lives. In particular, couples appear to talk little about their emotions, worries, and fears. CONCLUSIONS: Although wives have a profound interest in their husbands' prostate cancer, actual communication about the disease, its treatment, and the feelings it evokes may be less than we believe. Noncommunication in marriages might indicate that these couples are at increased risk for poor adjustment to prostrate cancer.
We argue that the husband's involvement in family planning (FP) should encompass a larger role such as participation in the joint decision-making on FP and supporting their wives in contraceptive use, rather than just being FP clients. This study assessed husbands' involvement in decision-making of family size and contraceptive use and examined factors associated with such involvement in two districts of Uttar Pradesh, India among husbands of 1,258 currently married women of reproductive age. The study considered a set of demographic, socio-economic, attitudinal, and programmatic variables to explain the variation in the husbands' involvement in FP. We have applied latent class analysis to identify classes based on the attitude of husbands towards FP and contraceptive use. Nearly two-thirds (65%) of the husbands are involved in decision-making on family size and over half (56%) of the husbands are involved in supporting their wives' contraceptive use. Having a positive attitude toward FP and contraceptive use along with media exposure to FP were the most significant determinants for husbands' involvement in FP to decide family size (AOR = 4.18, 95% CI 2.96-5.88) and support wives' contraceptive use (AOR = 3.98, 95% CI 2.82-5.61) even after adjusting for the factors like parity, religion, and having a son. The FP program should consider strategies involving husbands with positive attitudes across social and religious groups to popularize FP.
Depressive symptoms can contribute to poor cardiovascular health (CVH) but prior research largely focused on individual-based studies. Yet, health behaviours and outcomes are interlinked within social relationships, particularly in spouses. This study examined how depressive symptoms in opposite-sex spouses may jointly and uniquely impact CVH over time. We analysed 4360 opposite-sex spousal dyads in the Health and Retirement Study-a prospective cohort of middle-aged and older adults (2004-2016). Depressive symptoms were measured at baseline (2004/2006) using the 8-item Center for Epidemiologic Studies-Depression scale. CVH scores (range: 0-100; higher scores=better CVH), based on body mass index, blood pressure, fasting glucose, total cholesterol and smoking were assessed across three follow-up waves (2006/2008-2014/2016; 8-year follow-up period). We used the Actor-Partner Interdependence Model and latent growth curve modelling to examine how both spouses' depressive symptoms were associated with subsequent CVH, adjusting for sociodemographics and prior cardiovascular disease. In wives, a one-unit increment in depressive symptoms at baseline was associated with lower CVH scores (β=-1.25; 95% CI -1.60 to -0.91) at Wave 2. Similar associations were observed in husbands (β=-1.19; 95% CI -1.58 to -0.81). Wives' depressive symptoms were also associated with lower husbands' CVH scores (β=-0.39; 95% CI -0.70 to -0.07), while husbands' depressive symptoms were associated with faster CVH decline in wives over time (β=-0.08; 95% CI -0.14 to -0.03). No other significant spousal effects were found. Depressive symptoms in both spouses may contribute to one's own and one's partner's CVH, with distinct gender-specific patterns. These results may inform targeted dyadic interventions to optimise CVH in middle-aged and older opposite-sex couples.
Self-rated health (SRH) is a widely used indicator of overall health and a robust predictor of morbidity and mortality. Although metabolic health and obesity are well-established determinants of SRH, most previous studies have examined these factors at the individual level. This study investigated how spousal metabolic phenotypes, defined by metabolic and weight status, are jointly associated with SRH among Korean adults. We analyzed nationally representative data from 1817 heterosexual couples. Participants were classified into four phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obesity (MUO). We applied actor-partner interdependence models (APIM) and couple-level analyses to assess associations with worse SRH, adjusting for sociodemographic factors, health behaviors, perceived stress, and comorbidities. Among husbands, the MUNW phenotype was significantly associated with worse SRH, with marginal partner effects were observed when wives were MUNW. Among wives, both MUNW and MUO were significant predictors of worse SRH, whereas partner effects were not significant. At the couple level, husbands had higher odds of worse SRH across all non-MHNW couple combinations, whereas wives had higher odds only in discordant couples in which the wife was non-MHNW and the husband was MHNW. Sensitivity analyses among older couples confirmed these findings. These findings highlight gender-specific actor and partner effects and suggest that couple-level metabolic profiles may shape SRH, underscoring the importance of considering spousal metabolic status in its assessment.
Background: Informal dementia caregiving constitutes a substantial yet underrecognized form of work that places significant demands on family caregivers. Mexican American families, who experience disproportionate dementia burden and structural barriers to care, often rely on intensive family-based caregiving. While prior research has examined cultural values, stigma, and resource barriers separately, less attention has been paid to how these factors interact within a work system to shape caregiver burden. Objective: We characterized informal dementia caregiving among Mexican American families as work performed within a sociotechnical system, and examined how work system components interact to shape caregiver outcomes using the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. Methods: We conducted semi-structured interviews with 15 Mexican American dementia caregivers in a U.S.-Mexico border community. Using constructivist grounded theory, we analyzed informal caregiving as work embedded within everyday contexts through the SEIPS 3.0 lens. Analysis examined interactions among person characteristics, caregiving tasks, organizational supports, tools and resources, and the broader cultural and linguistic environment. Findings: Caregiving labor was sustained by strong cultural commitment but its structure limited delegation and support access. Cultural beliefs framing care as a non-delegable family responsibility, stigma inhibiting disclosure, demanding physical and emotional labor, language barriers restricting organizational access, and uneven distribution of care within families collectively imposed burden on individual family members, most often daughters or wives. Caregivers actively sought information and resources, yet system-level barriers constrained utilization. These interacting conditions produced predictable outcomes: exhaustion, declining health, and burnout. Conclusions: Viewing dementia caregiving as work clarifies why relationally meaningful care becomes unsustainable without supportive systems. Caregiver burden emerges from interactions within the caregiving work system rather than isolated cultural or individual factors. This perspective highlights stigma reduction and language-concordant services as key intervention leverage points through system-level approaches that sustain family caregiving without relying on individual endurance.
The pervasiveness of wife-beating attitudes (WBA) acceptance is alarming and significantly influences intimate partner violence (IPV). Understanding correlates of this acceptance is important for designing targeted interventions and policies to reduce IPV. Using de-identified data from the Lao PDR Multiple Indicator Cluster Survey 2023, a secondary analysis of WBA and their correlates in currently married/partnered men and women aged 15-49 years was conducted, with separate analyses performed for each sex. The correlates analyzed were age, educational attainment, residence, household wealth, number of children, multiple wives/partners, media exposure, alcohol use in the past 30 days, and age difference between a woman and her husband/partner. Simple binary logistic regression models were used to select correlates at a p ≤ 0.20 for inclusion in the multivariable models to analyze associations with WBA acceptance; in the multivariable models, a p < 0.05 was deemed statistically significant. The prevalence of WBA acceptance was 13.51% in women and 11.02% in men. For both sexes, the most commonly accepted reason for wife beating was if the wife argues with her husband, and the least common was if she burns the food. In the multivariable models, exposure to media was statistically significantly associated with lower odds of WBA acceptance in both sexes. In men, alcohol use in the past 30 days was associated with increased odds of WBA acceptance, while in women, having a husband/partner 10 years or more older was associated with decreased odds of such acceptance. The prevalence of WBA acceptance in double digits is concerning in Laos, suggesting the need for targeted health education and promotion campaigns to raise awareness about adverse and harmful attitudes, with a focus on both sexes and women's rights. Strategies to increase media exposure and use of media as a vehicle for tackling such attitudes hold promise.
This study aimed to explore the experiences of social support among pregnant women of advanced maternal age. Qualitative descriptive design with a phenomenological orientation. Data were collected via face-to-face, semi-structured interviews with 21 pregnant women aged ≥ 35 years and analysed using Braun and Clarke's thematic analysis. Three themes and nine sub-themes emerged: (1) providers of support. Spouses were the primary supporters, while important others (friends/colleagues) provided substantial aid; however, support from extended family (parents/parents-in-law) and medical staff was perceived as limited. (2) Types of support. Emotional and instrumental support were deemed adequate, whereas information support was insufficient. (3) Support outcomes. Social support facilitated the development of positive health behaviours and helped alleviate negative emotions during pregnancy. This study highlights the critical role of social support in the care of Chinese women of advanced maternal age. Social support should be regarded as a key aspect of perinatal care, and providing greater and more effective support may benefit women in developing positive coping strategies. Additionally, nurses and midwives should offer more personalised support services during the perinatal period. No patient or public contribution.
Partner support is both an important protective and risk factor for women's mental health perinatally. Although there is likely a bidirectional relationship between support and mental health, a research gap exists in understanding changes in women's experience of partner support over pregnancy and early childhood, and whether this differs for women with Major Depressive Disorder (MDD). This study examines whether women diagnosed with MDD antenatally are at increased risk of deteriorating partner support over the perinatal period, after accounting for demographic effects, ongoing depressive symptoms, stressful life events, and attachment orientation. 731 women recruited into a longitudinal pregnancy cohort study, the Mercy Pregnancy Emotional Wellbeing Study, were included, of whom 124 were diagnosed with MDD first trimester using the Structured Clinical Interview for the DSM (SCID). Perceived partner support was measured with the Social Support Effectiveness Questionnaire (SSEQ) in third trimester, 6 and 12 months, and 4 years postpartum. Partner support changes over time were analysed with mixed effects modelling. There was an overall small but significant decline in partner support over time for all women. However, this decline was larger for women with MDD between 12 months and 4 years postpartum. Ongoing depressive symptoms, stressful life events, and insecure attachment orientation contributed to perceptions of lower partner support. The perinatal and early childhood period poses an increased risk for the partner relationship for all women, but this risk is increased for women with MDD. This knowledge could be translated into identifying vulnerable women and offering appropriate interventions.
Multiple myeloma (MM) is one of the most common blood cancers. Despite lengthening survival with modern therapy, it remains largely fatal. Understanding the influence of common modifiable risk factors on MM risk is necessary to inform prevention.We investigated the association between dietary exposures and MM in a population-based case-control study conducted in Victoria, and NSW, Australia (2010-2016). Incident cases of MM (n=746) were recruited primarily via cancer registries. Controls (n=706) were siblings or spouses of cases.We estimated odds ratios (OR) and 95% confidence intervals (95%CI) for associations between MM and dietary exposures, including dietary patterns, fish consumption, and a healthy lifestyle index, adjusting for confounders.Higher scores on a modified version of the Alternative Healthy Eating Index-2010 were associated with reduced risk of MM (mAHEI: OR=0.88, 95%CI=0.78-0.98). There was weaker evidence for reduced risk associated with higher healthful plant-based dietary index score (hPDI: OR=0.91, 95%CI=0.81-1.02). Increased MM risks were observed with higher scores on empirical dietary inflammatory pattern (EDIP: OR=1.20, 95%CI=1.07-1.35), empirical dietary indices for hyperinsulinaemia (EDIH: OR=1.15, 95%CI=1.02-1.31), and insulin resistance (EDIR: OR=1.21, 95%CI=1.08-1.37). There was no clear evidence of association with MM risk for fish consumption or a healthy lifestyle index.We observed an association between adherence to a healthy diet and lower MM risk. While adherence to dietary patterns with the potential to increase insulin levels, insulin resistance, or promote inflammation was associated with increased MM risk. Results of studies assessing dietary intervention for MM prevention could reveal whether dietary modification directly influences MM risk.
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X-linked dystonia-parkinsonism (XDP) is a progressive movement disorder that predominantly affects men from the Panay Islands in the Philippines. Although patient outcomes have been well described, the effect of XDP on caregivers has received far less attention. To evaluate caregiver strain, anxiety and depression among primary caregivers of patients with XDP and compare outcomes between caregivers of patients who had and had not undergone deep brain stimulation (DBS). We conducted a single-centre, cross-sectional study involving 52 dyads of patients with XDP and their caregivers interviewed via videocall. Socio-demographic and clinical information was collected, and caregiver strain and psychological symptoms were assessed using validated online questionnaires. Caregivers (mean age, 43.3 years; 96.2% female) provided an average of 13 h of care daily, most often as spouses. Nearly one-quarter were at risk for caregiver strain, and 21.2% experienced severe strain. Anxiety and depressive symptoms were reported by 53.9% and 40.4% of caregivers, respectively. Older caregiver age was associated with lower strain. Higher strain was associated with frequent unplanned hospitalisations, greater disease severity across multiple XDP domains by the Movement Disorder Society of the Philippines, patient anxiety and depression and the presence of a secondary caregiver. Caregivers of patients who underwent DBS treatment reported fewer depressive symptoms than those caring for patients who had not undergone DBS. Caring for individuals with XDP is associated with substantial physical and psychological burden. These findings point to the need for targeted psychosocial support, caregiver education and better coordination of caregiving roles to reduce strain and improve both caregiver well-being and patient care.
Caregivers of patients with chronic diseases are unpaid providers, whose contributions to healthcare and patient outcomes are well recognized. We sought to obtain the perspectives of those who have supported a kidney transplant recipient with a failing or failed graft. This qualitative study adopted an interpretive-descriptive methodology. Data collection entailed semistructured interviews that were analyzed thematically. Twenty-three caregivers (spouses = 11, parents = 10, and siblings = 2) reported that graft loss did not introduce new roles or responsibilities. However, the caregiver burden intensified because of the following: supporting recipients' wellbeing (emotional support and attention to social needs); adapting to the new reality of graft loss (dietary management, home dialysis support, logistical coordination for medical appointments, and treatments); navigation of care (information tracking and communication and advocacy); and managing multiple roles and responsibilities (increased household and parental load and balancing employment and caregiving). Care gaps included more focus on the graft instead of the person (clinical prioritization of the graft and lack of attention to mental health and emotional aspects of graft loss); communication shortcomings; and inclusion of caregivers in patient care (not recognizing the value of caregiver input and lack of role definition). Recognition of emotional labor and support; educational resources tailored to the graft loss phase; training and tools to fulfill the role of caregivers; peer support; and social work were the desired resources. Caregivers of kidney transplant recipients experience heightened burden with graft loss and reported feeling undervalued. We recommend strategies to better integrate, support, and educate these caregivers, as it may enhance both their well-being and the outcomes of recipients who experience graft loss.
People living with Alzheimer's disease (PLWD) often face unmet care needs, which may arise as caregivers and PLWD differ in their perceptions of PLWD's needs. To understand how these discrepancies vary by caregivers' perspective taking (i.e., their ability to understand PLWD's thoughts and feelings), we conducted a sequential mixed-methods study with 67 couples managing Alzheimer's disease. Both spouses completed semi-structured interviews to describe PLWD's needs and discussed how they communicated about needs. Caregivers' perspective taking was negatively associated with discrepancies in PLWD's needs. Thematic analysis of a subgroup parallel sample demonstrated that, when caregivers reported high perspective taking, couples described navigating PLWD's needs through open dialogue and caregivers adopted respectful communication practices. When caregivers reported low perspective taking, couples described misaligned expectations and communication efforts; caregivers initiated communication to identify PLWD needs and acknowledged employing insensitive language. Findings can inform interventions to improve the quality of dementia care and promote health.
Neurofibromatosis type 1 with plexiform neurofibromas (NF1-PN) is a chronic condition associated with significant morbidity. While patient outcomes have been characterized, the burden on caregivers of adult patients with NF1-PN has not been well described. This study evaluated caregiver burden and health-related quality of life (HRQoL) among primary caregivers of adults with NF1-PN. Primary caregivers of adult patients with NF1-PN in the United States participated in this cross-sectional survey study. Caregiver burden was measured using standardized tools including Zarit Burden Interview (ZBI), the Work Productivity and Activity Impairment Questionnaire for Caregivers (WPAI:CG), and EQ-5D-5L. One hundred caregivers completed the survey (mean age 49.0 years, 67.0% female). Caregivers were most frequently parents (25.0%) or spouses/partners (19.0%), and 41.0% had provided care for more than 10 years. Nearly all caregivers (93.0%) received additional caregiving support, with 69.0% receiving > 10 h per week of additional help. The mean ± standard deviation (SD) ZBI score was 36.6 ± 15.6, indicating comparable burden to caregivers of other severe chronic conditions. Most caregivers were not employed (37.0% homemakers, 24.0% retired). Among employed caregivers (18.0%), the mean ± SD overall work productivity loss was 47.5% ± 23.9, with 15.6% ± 27.7 work time missed and 41.7% ± 22.8 impairment while working. The mean ± SD activity impairment among all participants was 50.2% ± 20.5. Despite relatively preserved physical health (mean EQ-5D utility score 0.84 ± 0.18), 66.0% of caregivers reported anxiety or depression. Caregiving for adults with NF1-PN is associated with substantial burden, including reduced work productivity, restricted daily activities, pain, and psychological difficulties. Despite relatively preserved physical health among caregivers, psychological distress and activity limitations are common. These findings demonstrate that NF1-PN affects not only patients but also their caregivers, highlighting the need for caregiver-focused support alongside clinical management of patients.
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Stromal immunosuppressive pathways are key modulators of response to immune checkpoint inhibitors, but their tumor-intrinsic consequences remain incompletely defined. We conducted a clinical trial of bintrafusp alfa, a bifunctional PD-L1/TGF-β inhibitor, in small cell lung cancer. Among 34 evaluable patients, 18% had partial responses, 20% stable disease, and 62% progressive disease; 38% of progressors met criteria for hyperprogressive disease (HPD). HPD was also observed across other tumor types (n=450), in higher frequencies with bintrafusp than PD-(L)1 blockade alone. Blood and tumor profiling showed that HPD correlated with systemic immune suppression and elevated TGF-β signaling. Functional studies demonstrated that tumor-intrinsic TGF-β signaling restrains proliferation in a subset of SCLC; pathway blockade triggers hyperproliferation. External validation across cell lines and tumor samples confirmed a tumor-intrinsic TGF-β-high transcriptional state associated with inferior survival. Together, these findings identify a context-dependent, growth-constraining function of TGF-β and support tumor-intrinsic biomarker-guidance while targeting stromal immunosuppressive pathways.