Caregivers, like all working people, can encounter difficulties in the course of their professional activities. These difficulties, compounded by the particularities of caregiving practice, can lead to situations of isolation, overwork, exhaustion, disagreement and even ethical dilemmas in complex situations. Thadeo\'s free listening service offers support to caregivers who need it.

BACKGROUND: Recognizing patients with psychological problems can be difficult for general practitioners (GPs). Use of information collected in electronic medical records (EMR) could facilitate recognition.
OBJECTIVE: To assess relevant EMR parameters in the decade before patients present with psychological problems.
METHODS: Exploratory case-control study assessing EMR parameters of 58 228 patients recorded between 2013 and 2015 by 54 GPs. We compared EMR parameters recorded before 2014 of patients who presented with psychological problems in 2014 with those who did not.
RESULTS: In 2014, 2406 patients presented with psychological problems. Logistic regression analyses indicated that having registrations of the following statistically significant parameters increased the chances of presenting with psychological problems in 2014: prior administration of a depression severity questionnaire (odds ratio (OR): 3.3); fatigue/sleeping (OR: 1.6), neurological (OR: 1.5), rheumatic (OR: 1.5) and substance abuse problems (OR: 1.5); prescriptions of opioids (OR: 1.3), antimigraine preparations (OR: 1.5), antipsychotics (OR: 1.7), anxiolytics (OR: 1.4), hypnotics and sedatives (OR: 1.4), antidepressants (OR: 1.7), and antidementia drugs (OR: 2.1); treatment with minimal interventions (OR: 2.2) and physical exercise (OR: 3.3), referrals to psychology (OR: 1.5), psychiatry (OR: 1.6), and psychosocial care (OR: 2.1); double consultations (OR: 1.2), telephone consultations (OR: 1.1), and home visits (OR: 1.1).
CONCLUSIONS: This study demonstrates that possible indications of psychological problems can be identified in EMR. Many EMR parameters of patients presenting with psychological problems were different compared with patients who did not.

This preliminary study examines an initiative to further develop capacity in reflective practice among public health home visitors and their supervisors. A Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Expansion Grant to the Minnesota Department of Health funded the development of a tiered structure to support reflective practice within county public health agencies throughout the state. Study data revealed a general consensus among individuals at all levels of the county programs that state supports were adequate to implement reflective practice. Although there were no significant changes in home-visitor and supervisor scores on a standardized measure linked to reflective functioning and reflective practice, a majority of home visitors and supervisors perceived that their knowledge and skills in reflective practice had increased during the evaluation period. A standardized measure of employee burnout did not reveal significant changes in either \"depersonalization\" (indicating burnout) or \"personal accomplishment\" (a mitigating factor in burnout) subscales; however, home visitor \"emotional exhaustion\" subscale scores did increase over the evaluation period. In contrast to the subscale results, home visitors reported a sense of accomplishment in their reflective work and that they value \"releasing\" emotions in a safe environment during reflective supervision.

BACKGROUND: General practitioners (GPs) and patients can have different ideas about the causes of fatigue, which may hinder management of fatigue.
OBJECTIVE: To investigate the causal attributions of patients and their GPs for fatigue, their level of agreement, and the association between patients\' attributions, and fatigue characteristics and other illness perceptions.
METHODS: Baseline data, collected between 2004 and 2006, of a prospective cohort study among 642 adult patients presenting to Dutch primary care practices (n = 147) with a main symptom of fatigue, were used. Patient causal attributions and illness perceptions were measured using the revised illness perception questionnaire (fatigue version). GP causal attributions were measured with an open question included in the form that was completed at the end of the patient\'s visit. Fatigue severity was measured using the checklist individual strength.
RESULTS: Psychosocial causes were among the most often reported causal attributions by both patients and GPs. In 33% of 519 cases, the GP had no idea about the cause whereas the patient did. Overall, the agreement between the first reported causal attribution of patients and GPs was low. Qualitative differences in the labelling of causes were also found. Type of attribution (physical vs psychosocial/psychological) was associated with duration of fatigue (40 vs 25 months), and personal control (score 17.4 vs. 18.9).
CONCLUSIONS: Most patients and GPs had ideas about the causes of fatigue, but differences were found in the first reported causes and the labelling of causes. The findings may provide leads for optimizing communication about fatigue.