WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 |

«Downloaded from on October 17, 2016 - Published by group.bmj.com PEER REVIEW HISTORY BMJ Open publishes all reviews ...»

-- [ Page 1 ] --

Downloaded from http://bmjopen.bmj.com/ on October 17, 2016 - Published by group.bmj.com

PEER REVIEW HISTORY

BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to

complete a checklist review form (http://bmjopen.bmj.com/site/about/resources/checklist.pdf) and

are provided with free text boxes to elaborate on their assessment. These free text comments are

reproduced below.

ARTICLE DETAILS

TITLE (PROVISIONAL) Self-reported physical and mental health of Australian carers: A cross-sectional study AUTHORS Hussain, Rafat; Wark, Stuart; Dillon, Gina; Ryan, Peta VERSION 1 - REVIEW REVIEWER Professor Sally Chan University of Newcastle, Australia REVIEW RETURNED 26-Mar-2016 GENERAL COMMENTS The aim of the study needs to be clarified. If this study aimed to establish a profile of self-reported health in rurally-based informal carers, the comparisons to Australian population norm have to be removed from the Results section. The authors may discuss this in the Discussion section but not present in Results.

There are well-established evidences that many informal carers of people with chronic health conditions have poor physical and mental health status. It is also known that younger caregivers experienced more stress than older caregivers because of various responsibilities in life. The study presented little new knowledge on the health status of informal caregivers.

The authors may want to compare their results with previous studies that were conducted in metropolitan areas so that the unique health problems of this target group may be identified.

REVIEWER Michele Peters University of Oxford, UK REVIEW RETURNED 02-May-2016 GENERAL COMMENTS This is a manuscript on the physical and mental health of Australian carers. This is an important topic for research, as it is important to assess outcomes in carers but also as this focuses on a population that is likely to be less researched. Overall the article

–  –  –

Reviewer One Comment 1: The aim of the study needs to be clarified. If this study aimed to establish a profile of selfreported health in rurally-based informal carers, the comparisons to Australian population norm have to be removed from the Results section. The authors may discuss this in the Discussion section but not present in Results.

Authors’ Response Part A: Clarity in Aim – Agree with comment.

Action: Manuscript text revised in response to the reviewer’s comments [see p. 5] Part B: Comparison with Australian norms - Both reviewers have commented on this issue. On review we agree with the reviewers’ comments.

Action:

1. Manuscript revised to remove discussion of Australian normative data for outcome variables from Results section. Comparison of findings from present study and Australian normative data has been moved to Discussion section and appropriately revised to link in better with discussion of other relevant issues.

2. Figure 2 has been revised to only reflect study data.

3. Figure 3 (original Figure 2) has been placed in supplementary materials section. We feel it provides useful comparative information but leave the final decision of its inclusion to the Editor.

Comment 2: There are well-established evidences that many informal carers of people with chronic health conditions have poor physical and mental health status. It is also known that younger caregivers experienced more stress than older caregivers because of various responsibilities in life.

The study presented little new knowledge on the health status of informal caregivers.

Authors’ Response Evidence from other studies

Action:

1. We have included more information on carer studies from Australia; see revised manuscript, p.4 (Introduction) and pp.15-17 (Discussion).

2. We undertook another exhaustive review of PubMed, Medline, ProQuest and other relevant Downloaded from http://bmjopen.bmj.com/ on October 17, 2016 - Published by group.bmj.com databases, and are unable to locate any Australian study that included an urban and rural comparison on carer health.

We disagree with the esteemed reviewer about generalizability of studies from urban areas of Australia to rural regions. If this was the case, there would not be such a gap which has been acknowledged by all national bodies including Seniors Australia, Carers Australia and the Commonwealth government itself.

All authors have considerable work experience of working in the Australian rural health sector and academia (combined over 50 years). Issues in carer health in rural areas have not been assessed in a systematic manner beyond some qualitative studies. There is no Rural Carer study that has used comprehensive and internationally validated outcome measures such as SF-36, CES-D and K-10 concurrently. The Australian Bureau of Statistics survey of Disability, Ageing & Carers Survey contains no validated outcome measures [only self-reported individual health issues in a somewhat inconsistent manner]. The ABS-managed Household Labour & Income Dynamics survey [HILDA] has a small rural sampling frame but no explicit focus on caregiving. Therefore, we feel the current statewide study provides information that is useful for understanding the health issues of rural carers.





Reviewer Two

Comment 1: This is a manuscript on the physical and mental health of Australian carers. This is an important topic for research, as it is important to assess outcomes in carers but also as this focuses on a population that is likely to be less researched. Overall the article is very clearly written and well presented.

Authors’ ResponseNo action item requested.

Comment 2: The main comment is that the results of factors associated with self-reported health is a little confusing as many individual factors are discussed, possibly also as it includes a discussion of the rural carer scores to normative carer scores (the latter may be better placed in the discussion).

Authors’ Response Agree with the comment.

Action:

1. Manuscript revised to remove discussion of Australian normative data for outcome variables from Results section. Comparison of findings from present study and Australian normative data has been moved to Discussion section and appropriately revised to link in better with discussion of other relevant issues.

2. Figure 2 has been revised to only reflect study data.

3. Figure 3 (original Figure 2) has been placed in supplementary materials section. We feel it provides useful comparative information but leave the final decision of its inclusion to the Editor.

Comment 3: It would be good to pull all these findings together in a regression analysis.

Authors’ Response Agree with the comment.

Action: We have undertaken regression analyses for all four outcome variables. The techniques have been discussed in the Methods section and the results are presented both in the Results section and in an additional table (see Table 3).

Comment 4: Additionally, the SF-36 scores are not presented for all carer related variables e.g. the Downloaded from http://bmjopen.bmj.com/ on October 17, 2016 - Published by group.bmj.com condition being cared for, relationship to the person being cared for etc. This would be an interesting addition the paper.

As work is not the significant factor for worse outcomes in younger carers, could it be that it is the relationship to the carer (e.g. caring for a parent is more stressful or burdensome than caring for a spouse, possibly related to living or not living in the same household). The authors could focus on the significant relationships only and present additional material in a supplement?

Authors’ Response Agree with the comment.

Action: We have provided results for additional variables in an expanded and enhanced Table 2. We have also simplified the notations for significant results for Table 2.

The difficulty in presenting additional material in a supplement is that segmentation of data analyses and representation is not clear cut and we would need to almost repeat a considerable component of Table 2 in the supplementary table. We feel that the revisions and inclusion of another table [table 3 for regression results] now adds more coherence to data presented in the revised table 2.

Comment 5: A minor comment is that there is no key provided for the superscript letters in Table 2.

Presumably these refer to the levels of significance?

Authors’ Response Action: Apologies for the typo in the original submission. This error has now been fixed in the revised manuscript.

Comment 6: Out of interest, is there any other SF-36 data from Australian carers? It would be of interest to know if outcomes are different between rural and urban carers.

Authors’ Response We agree with the comment. However the information is not available.

Action:

As mentioned above, despite an exhaustive re-checking of all relevant scientific databases as well as grey literature, we have been unable to locate any study that explicitly provides data on SF-36 across urban and rural carers in Australia.

Comment 7:Finally, it would be helpful if the authors could comment on potential self-selection bias in the limitations.

Authors’ Response Agree with the reviewer’s comment.

Action:

Section on Limitations revised. See p. 18 of the revised manuscript.

–  –  –

REVIEWER 1 (Sally Chan) Comments

1. Ethical issue - Did those with high scores in CES-D get referral or support?

Authors’ Response:

The survey was largely “online and anonymous” and therefore there was no way we could organise referrals. The Survey Information Sheet which had to be read and ticked prior to starting the online survey clearly indicated that if participants felt anxious or depressed either as a result of the survey or thinking through their caring-giving responsibilities, they should contact the toll-free Lifeline Telephone Support Service, and the relevant telephone number was provided. Lifeline counsellors do suggest contacting their preferred doctor or a psychologist if symptoms have been ongoing.

Text has been added to clarify this situation in the Methodology Section, under the sub-heading of

Study Design, setting and participants on page 6 (reproduced below for ease of locating it):

"The majority of the completed surveys (nearly 90%) were done online. As most of the survey responses were on-line and recruitment was undertaken through a variety of community-based strategies, an overall response rate could not be determined. Participation was both voluntary and anonymous. This also meant that there was no capacity to refer individuals potentially at risk for support, however, the information sheet outlining details of the study provided to all potential participants, preceded the beginning of the survey questionnaire, and included specific details to facilitate access to free counselling support if required through Lifeline Telephone Support Service, and the relevant toll-free telephone number was provided. Lifeline counsellors do suggest callers to contact their preferred doctor or a psychologist if symptoms have been ongoing. This strategy was approved by the Human Research Ethics Committee as a viable option to maintain anonymity of participants whilst also providing information on how to access counselling support for those experiencing distress associated with their caregiving role."

Downloaded from http://bmjopen.bmj.com/ on October 17, 2016 - Published by group.bmj.com

2. The duration of caregiving and care recipients' stage of illness would have an impact on carers' health status. The authors need to address this in the discussion and limitation.

Authors’ Response:

ACTION: The authors agree with this recommendation, and additional information have been added to the discussion and limitations sections.

Text amended and additional details added to the paper (see page 17, under Discussion – highlighted section in the manuscript, reproduced below for ease of

locating it):

"It is acknowledged that, as an initial study, not all key demographic data was able to be captured. In particular, it is recommended that future research specifically examine two additional factors, the length of time the individual had been providing care, and whether the care recipient was receiving palliative or end-of-life care, as it is acknowledged that these issues may have a further impact upon carers’ health."

(see page 19, under Limitations – highlighted section in the manuscript, reproduced below for ease of

locating it):

"As noted in the discussion, there were two factors that were not captured in the data, the length of time the individual had been providing care and the care recipients' stage of illness. It is acknowledged that these issues may have consequences for carers’ health, but it is not believed that the failure to gain these data invalidates the reported outcomes. Nonetheless, it is recommended that future research consider stratifying the results by these variables to measure if there is any impact."

3. Please add implications of this study to future research and practice.

Authors’ Response:

ACTION: The authors agree with this recommendation, and additional information have been added to the discussion and limitations sections.

Text amended and additional details added to the paper (see page 20, under Conclusion – highlighted section in the manuscript, reproduced below for ease of

locating it):

"The need for access to specifically targeted psychological interventions for individuals at risk is clear.

Recommendations for future research to build upon these findings include examination of the previously identified factors of length of time the individual had been providing care and the care recipients' stage of illness, as well as undertaking a comprehensive study that comparatively examines carers residing in a variety of rural settings against metropolitan-based peers in order to recognise difference and disparity in health status."



Pages:   || 2 |


Similar works:

«RURAL ELECTRIFICATION IN OREGON: 1930-1955 AN HONORS THESIS SUBMITTED TO THE DEPARTMENT OF HISTORY IN CANDIDACY FOR THE DEGREE OF BACHELOR OF ARTS IN HISTORY LINFIELD COLLEGE BY KATIE ARCHAMBAULT MCMINNVILLE, OREGON MAY 2010 “Electricity is a modern necessity of life and ought to be found in every village, every home and every farm in every part of the United States.” 1 President Franklin D. Roosevelt (1938). Thomas Edison invented the incandescent light bulb in 1879. Three years later he...»

«Connotations Vol. 15.1-3 (2005/2006) Shakespeare’s Country Opposition: Titus Andronicus in the Early Eighteenth Century ANDREAS K. E. MUELLER Since the play’s first performance in the early 1590s, Titus Andronicus has enjoyed a rather uneven performance history. William Shakespeare’s first revenge tragedy achieved some considerable popularity in the playwright’s lifetime, with regular performances until his death in 1616 and, as a further mark of the play’s popularity, the appearance...»

«Universidad de Los Andes Facultad de Ciencias Sociales Departamento de Ciencia Política Bogotá, Colombia ¿De niño combatiente a ciudadano? Los retos de la reintegración política de niños desvinculados del conflicto armado colombiano Elaborado por Irina Mago Tesis para optar al título de Magíster en Ciencia Política Directora: Angelika Rettberg Lectores: Carlo Nasi e Iván Orozco Mayo 2011 Agradecimientos Esta investigación fue posible gracias a la colaboración de muchas personas e...»

«2012.3.391 Bruce Thrasher Crystal Perez: This is Crystal Perez. Today is February 23rd 2012, and I am interviewing Kelly Thrasher and Kathy Bruce in Decatur, Georgia for the DeKalb History Center. Ms. Thrasher is the Public Relations Manager at the Waffle House Museum, and Ms. Bruce’s uncle was one of the founders of the Waffle House, and also, her father built the first Waffle House. How long have both of you been associated with the Waffle House Museum? Obviously, you’ve always been...»

«UK Data Archive Study Number 5801 Concepts of Healthy Eating Food Research: Phases I and II, 19921996 Archiving USER GUIDE Concepts of Healthy Eating: The history of two ESRC-funded research projects on food in the 1990s Pat Caplan, Goldsmiths, University of London Paper presented at the BSA Food Studies Conference, British Library, July 14th-15th, 2008 as part of the special symposium ‘Preserving food (data): Food related research held at the UK Data Archive’ 1 Abstract In the 1990s, the...»

«CHAPTER 6 The Federal Reserve’s Role Actions Before, During, and After the 2008 Panic in the Historical Context of the Great Contraction Michael D. Bordo1 Introduction The financial crisis of 2007–2008 has been viewed as the worst since the Great Contraction of the 1930s. It is also widely believed that the policy lessons learned from the experience of the 1930s helped the US monetary authorities prevent another Great Depression. Indeed, Ben Bernanke, the chairman of the Federal Reserve...»

«Chapter 1 The History of Superannuation Having a secure income on retirement has always been a concern for workers. The labour movement for many years supported the concept of a universal age pension. Many of those who are retired now probably planned for their retirement in the belief that the age pension would always be there. During the post-World War II period, the Chifley Government adopted the concept of “social security” with the right to adequate security, particularly in old age,...»

«Rocznik Oddziału Polskiego Towarzystwa Historycznego w Skarżysku-Kamiennej Z dziejów regionu i miasta Rocznik 3/2012 Z dziejów regionu i miasta Rocznik 3/2012 1 2 Rocznik Oddziału Polskiego Towarzystwa Historycznego w Skarżysku-Kamiennej Z dziejów regionu i miasta Rocznik 3/2012 pod redakcją Krzysztofa Zemeły Skarżysko-Kamienna 2012 3 Recenzenci: prof. dr hab. Marek Przeniosło dr hab. prof. UJK Lidia Michalska-Bracha Rada Naukowa: prof. dr hab. Wojciech Iwańczak – przewodniczący...»

«1 0 wholesale mlb baseball jerseys 1 james white jersey material 2 custom hockey goalie jerseys 3 winnipeg jets jersey 1996 4 aaron rodgers community college jersey 5 cheap youth nba basketball jerseys 6 custom infant vikings jersey 7 dorsett jersey 8 miami heat jersey 2015 9 tom brady jersey near me 10 cheap baseball jersey 11 steelers super bowl jersey 12 create your own nfl jersey 13 winnipeg jets jersey vancouver 14 new york knicks swingman jersey 15 custom college football shirts youth 16...»

«24 Catholic Education / September 2010 Pastors’ Views of Parents and the Parental Role in Catholic Schools James M. Frabutt Anthony C. Holter Ronald J. Nuzzi University of Notre Dame, Indiana Heidi Rocha Cathedral Academy, Louisiana Laura Cassel University of Notre Dame, Indiana Over 300 years of official Church teachings and documents affirm the importance of the home-school relationship, yet relatively little research has systematically explored the need and value of parent involvement in...»

«DECEMBER 2013 Inside this issue. Charity Bake off Charity Bake Off PaLS Antrim held a Coffee Morning on Friday 22 November 2013 for the Page 1 victims of Typhoon Haiyan which recently hit the Philippines. Typhoon Haiyan (known in the Philippines as Typhoon Yolanda) is the deadliest Simon McGrattan’s 3 natural disaster in the country's history, killing at least 5,209 people, with Marathon Challenge many more still missing. Page 2 Letter of Thanks for BSO Page 3 Certificate of Thanks Page 4 HR...»

«PATTERNS OF INEQUALITY IN THE U.S. CLASS STRUCTURE By Eric J. Jenkins Advised by Professor Harold R. Kerbo SocS 461, 462 Senior Project Social Sciences Department College of Liberal Arts CALIFORNIA POLYTECHNIC STATE UNIVERSITY Winter, 2011 Table of Contents Research Proposal. 3 Annotated Bibliography. 4 Outline. 10 Text Introduction. 13 Background. 14 Social Mobility and Status Attainment. 16 Occupational Mobility. 17 Landmark Studies. 19 Income Distribution. 21 Historical Progression of Income...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.